Work comp doc: ‘Look at patients holistically’

Counseling, coaching help patients overcome ‘behavioral barriers’ to recovery

By Tony Gottschlich, Public Information Officer

The human body is more than a machine. And when it breaks down, simply repairing the parts won’t get it running again, especially when fear and poor coping skills are involved.

That was the message Friday from the chief medical officer for the Ohio Bureau of Workers’ Compensation (BWC) during a lecture entitled, “Integrating Behavioral Health into Injury Treatment,” at the Greater Columbus Convention Center.

“We need to look at patients more holistically and we need to have the tools to do that effectively,” said Terrence Welsh, MD, speaking at the fourth annual Ohio Workers’ Compensation Medical & Health Symposium. “If we don’t do that we are missing the boat, and we’re not going to accomplish what we set out to accomplish – getting our patients healthy again and back to work and life.”

Speaking to an audience of health care practitioners from across the state, Welsh said health care providers must incorporate a multifaceted approach to better understand and treat patients struggling to recover from injury. He said a “bio-psycho-social” model of care, “accepts that the mind and body influence each other.”

Welsh spoke of a tool BWC initiated last year called the Health and Behavioral Assessment and Intervention services rule, or HBAI. Under the rule, the agency will pay for counseling and coaching sessions that help injured workers overcome negative thinking, poor coping skills, lack of motivation and other behavioral barriers to recovery.

“These things actually work,” said Welsh, who is board-certified in physical medicine and rehabilitation, electrodiagnostic medicine and pain medicine. “There is evidence these services can improve outcomes.”

He cautioned the rule does not apply to mental illness and psychological disorders, but to naturally occurring emotional responses that many people experience following a serious injury.

In an interview before his lecture, Welsh said research shows behavioral barriers have three times or more the impact than pain alone in slowing an injured person’s recovery. That’s why it’s important to address barriers before they spiral into something more serious, such as depression and substance abuse.

Barriers that have the greatest impact on delayed recovery include:

  • Catastrophic Thinking: The tendency to ruminate about irrational worst-case outcomes. This can increase anxiety and prevent the injured worker from taking action, such as completing their rehabilitation treatment program.
  • Perceived Injustice: The injured worker’s belief that nothing will ever make up for what happened to them, and they didn’t do anything to deserve their situation.
  • Fear/Avoidance: The avoidance of movement and activity in an attempt to reduce pain. Studies show that this barrier generally results in both chronic pain and a disengagement from meaningful activities, which prolongs disability and may lead to depression.
  • Disability Beliefs: Injured workers’ expectations about recovery and their ability to manage returning to work. Studies show that an individual’s perceptions of the impact of their condition can have more influence on lost time, levels of impairment and activity levels than actual physical or medical indicators.

HBAI covers one health and behavioral assessment and up to six hours of intervention sessions per 12-month period. A number of licensed health professionals may provide the treatment, including physicians, chiropractors, psychologists, social workers and counselors.

For more information, click here.

BWC’s Medical & Health Symposium begins today

Attendance increases more than 350% in four years

By John Annarino, Chief Medical and Health Officer

Our 2019 Ohio Workers’ Compensation Medical & Health Symposium with its theme, Comprehensive Care for Injured Workers, begins today and runs through late Saturday afternoon.

We’re pleased that more than 800 health care practitioners, staff and legal professionals statewide will be attending our two-day event at the Greater Columbus Convention Center.

We’ve been planning our multi-disciplinary event for about a year. We can’t wait to connect with our attendees and exhibitors! This year’s symposium offers continuing-education opportunities with credits, taught by well-respected experts on leading health and medical issues that affect us all – at work and at home.

Our 2019 symposium brings medical and health specialists together with legal professionals to learn how we can better solve far-reaching issues such as managing pain and opioids, chemical dependency and how to recognize traumatic brain injury symptoms before it’s too late. Improving collaboration and trust with our health-care community is another vital issue, as is chiropractic medicine’s role in workers’ comp and occupational medicine.

How we got started

The journey to today’s successful symposium began four years ago. I challenged our Medical and Health division’s leadership to plan an event for health care providers focusing on pain. My vision for this educational event came after a quarterly pharmacy meeting and an in-depth discussion on pain medication. Most of the original planning team members worked on our 2019 Medical & Health Symposium.

Our goal for the symposium – then and now – is to address health care issues facing Ohio’s injured workers. For example, we know the overuse of opioid medication affects Ohio’s workers and their families. To learn more, listen to Chris Hart, an Ohio pharmacist, tell his story of chemical dependency and recovery on Friday followed by a question-and-answer session on Saturday.

In addition, Saturday’s provider clinical education sessions discuss medical marijuana with Mark Pew, who is better known as the Rx Professor; Reggie Fields of the Ohio State Medical Association and Robert Stutman, one of America’s highest-profile Drug Enforcement Agency special agents. Former judge Jodi Debbrecht-Switalski reviews the paradigm of liabilities for the medical profession with the drug epidemic.

How far we’ve come

Debi Kroninger, our chief of medical operations, leads the symposium’s planning team. I’ve learned our first symposium in 2015 had 177 providers registered, with continuing education opportunities for a limited number of professions.

Today, we offer continuing education for attorneys, chiropractors, nurses, occupational and physical therapists, rehabilitation counselors (CCM, CDMS and CRC*), physicians and psychologists. Experts nationwide are learning about our innovative approaches and programs in caring for Ohio’s workers. For example, we already have eight speakers who are asking to present at next year’s event.

For increased learning opportunities, the symposium offers two educational tracks – the provider staff forum (Friday) and provider clinical education (Friday and Saturday). We feature the session Becoming a World-Class Carrier – BWC Medical Initiatives that will Take Us There in both tracks. Freddie Johnson, chief of medical services and compliance, along with Dr. Terry Welsh, chief medical officer, and Debi lead the session.

In addition, take time to network with the symposium’s exhibitors that include health care companies, state agencies, boards, associations and others.

How to contact us

Registration is free. If you have questions, call the provider contact center at 1-800-644-6292, option 0-3-0, or email medsymposium@bwc.state.oh.us.

Together, join us in our journey of providing innovative and quality health care for Ohio’s injured workers, their families and communities. We look forward to seeing you today and/or Saturday at our 2019 Medical & Health Symposium!

*Certified case manager, certified disability management specialist, certified rehabilitation counselor

Coping with pain

‘Visualize your way out of it,’ psychologist tells work comp audience

By Tony Gottschlich, BWC Public Information Officer

There’s another way to deal with chronic pain that doesn’t involve medications or surgery, a psychologist told an audience Friday at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

It’s called Cognitive Behavioral Therapy, and it’s not as complicated as it sounds. In fact, the techniques are rather simple, said Michael Coupland, medical director for Integrated Medical Case Solutions in West Palm Beach, Florida.

Cognitive Behavioral Therapy (CBT) is a widely accepted form of psychotherapy that is based on the cognitive model: the way that individuals perceive a situation is more closely connected to their reaction than the situation itself.

Coupland explained that we can condition our brains to control pain or banish it from our consciousness. But it takes practice, a daily repetition of mantras, deep breathing techniques, meditation and other mindfulness methods for it to take root and stick.

Thanks to neuroplasticity, the brain can reorganize or rewire itself, both physically and functionally, throughout your life in response to your environment, behavior, thinking and emotions.

“Exercise your neurons, visualize your way out of this,” he said. “I tell my patients, ‘Whether you believe in this or not, just humor me and do this every day for eight weeks.’ These techniques help stand down the body’s stress-arousal system.”

Coupland admitted it’s tough for most patients to accept this approach. Mindfulness, a state of active, open awareness of the present moment, and meditation are about “letting go,” but the American educational system teaches us to “hold on” to everything we learn.

Coupland shared with the audience a book he authored in the style of Dr. Seuss that illustrates the simplicity and effectiveness of CBT. It’s titled, “Up Pain, Down Pain, Good Brain, Bad Brain,” and can be found for free here.

For more on Coupland and his work, visit www.icms.us or www.cope-with-pain.com.

‘Wired for addiction’

Addiction specialist addresses work comp health symposium

By Tony Gottschlich, BWC Public Information Officer

Many believe drug addicts are weak-willed people of diminished moral character who choose drugs, getting high and even criminal behavior over a proper, law-abiding life.

And they would be wrong, a longtime psychiatrist and addiction specialist said Friday morning at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

“Addiction is not about the drugs or the behavior, it’s all about the brain,” said Dr. Susan K. Blank, co-founder and chief medical officer for The Atlanta Healing Center, an outpatient treatment recovery program. “This is a genetically inherited brain disease.”

Blank, speaking to a capacity audience at the Greater Columbus Convention Center, spoke for an hour on the topic, “The Perfect Storm: Pathophysiology of Controlled Substance Misuse and Addiction.” Her presentation was the first continuing education session on the final day of the two-day symposium for health care professionals.

Blank explained there are three key forces behind addiction, and choice has little, if anything, to do with it. They include:

  • Genetics. Our brains are hardwired for addiction because of our genes. Some of us inherit malfunctioning “dopamine feedback loops.” When we experience pleasure, whether from food, drugs or sex, it’s because our brains are releasing the feel-good neurotransmitter dopamine. In addicts, that feedback mechanism doesn’t shut down and they just want more and more, regardless of the consequences. “It’s never enough,” Blank said. This is particularly hard to overcome if the addiction started in one’s youth. That’s because drug and alcohol abuse can damage the prefrontal cortex, our brain’s impulse-control center, which is still developing into our mid 20s.

Worried your children might be future addicts? Look for the thrill-seeking child who thrives on adrenaline, the child who’s the first to take a dare. These are behaviors that demonstrate he or she is seeking a dopamine release, Blank said.

  • Exposure. Growing up around addicts increases the likelihood of addiction.
  • Environment. There must be an environmental trigger or stressor – loss of a job or loved one, for instance – that keeps the addiction cycle going.

“You have to have all three legs of that stool for addiction to manifest itself in your life,” said Blank, who is also president of the Georgia Society of Addiction Medicine. Genes alone won’t doom you.

Addictions often start through prescription drugs, she said, and can’t stop without outside help. They lead to brain changes that can’t be undone. “Our rational brain is gone.”

Drug overdose is the leading cause of accidental death in the United States in recent years, fueled by powerful opioids, heroin especially. Ohio is the nation’s overdose death capital, with 3,050 OD deaths in 2015, or more than eight per day, according to state-by-state statistics compiled by the Henry J. Kaiser Family Foundation.

Blank noted that addictions aren’t limited to painkillers and street drugs, of course. People can be addicted to sugar, sex, tobacco and other dopamine triggers, too. It’s all about the dopamine. (Surprising fact to nonsmokers: “Nicotine is better than food, sex and morphine,” Blank said.)

Blank provided a number of sobering facts and statistics, including this one: “This is a chronic disease and there is no cure.”

But there is hope, she said. Addictions can be managed, and many addicts go on to live long, productive and healthy lives. Nationwide, opioid prescriptions are falling and there’s a growing awareness and understanding that addiction is a disease.

She concluded her remarks with a warning: “If you can’t escape addiction, choose yours carefully.”

The health symposium concluded Friday. It was held in conjunction with the 2017 Ohio Safety Congress & Expo, the Ohio Bureau of Workers’ Compensation’s annual safety, health and workers’ compensation conference.

Comprehensive care for injured workers, innovative employers highlight busy day 2 at #OSC17 and #BWCmhs, much more to come

Welcome back to the Columbus Convention Center, home of the Ohio Safety Congress & Expo and the Ohio Workers’ Compensation Medical & Health Symposium!

We have a lot in store before we bid farewell this afternoon but first, here’s a rundown of yesterday’s activities.

The second day of OSC17 was the first day of the Medical & Health Symposium. This is the second year of the symposium, which filled to capacity weeks ago. BWC sponsors this conference for health-care professionals who treat Ohio injured workers to hear from leading national and state experts. This year, our theme is “Comprehensive care for the injured worker.”

BWC Medical Director Dr. Stephen Woods welcomed participants and kicked off the event. The day featured several intriguing sessions on various topics related to the care of injured workers. One session covered how the aging workforce challenges the workers’ comp industry. Read a detailed blog on that topic here.

Over at OSC17, we got the day started with the Safety Innovation Awards. ICP Adhesives from the Akron area took first place, and Holloway, Henderson & Martin LLC of Pickerington snagged the People’s Choice Award.

All of the finalists were impressive!  Here’s the final list of award winners along with links to videos highlighting their innovations:

  • 1st place ($6,000 award): ICP Adhesives and Sealants, Norton (Video )
  • 2nd place ($4,000 award): C&K Industrial Services Inc., Cleveland (Video)
  • 3rd place ($3,000 award): Holloway, Henderson & Martin LLC, Pickerington (Video)
  • Honorable Mention ($1,500 award): Suburban Steel Supply Company, Gahanna (Video)
  • Honorable Mention ($1,500 award): Ames Arboreal Group, Columbus (Video)

And our very own Dr. Abe Tarawneh, superintendent of the BWC Division of Safety and Hygiene delivered a presentation on the role of safety leaders in building and executing strategic direction for occupational safety and health programs. Abe advised attendees that the mission of a safety leader is simple: elevate safety as a core value for the organization. If it is not a core value, make it one.

We’re not done yet! Our final day will feature more informative sessions at OSC and the symposium.

See OSC17 and symposium schedules here, in the event guide or on the mobile app. Follow @OhioBWC on Twitter and keep an eye on hashtags #OSC17 and
#BWCmhs for coverage.

Stay tuned for a wrap of the day as we bring the curtain down on another successful OSC17 and M&HS.

Register now: Free continuing education opportunities!

Dr. Brian Wilson, SE Regional Director, Provider Engagement

Among being involved in many initiatives here at BWC, I am honored to be assisting as a committee member on our 2016 Ohio Workers Compensation Medical and Health Symposium, March 10 -11. This year’s slate of speakers offers a wide array of topics from various experts in the field of pain management and neuromusculoskeletal care.

Free continuing education
As a fellow health-care professional, I am excited BWC is offering these sessions to my colleagues which will help inform them about the latest trends/treatments relative to practice and patient care, not to mention the fact that these sessions qualify for free continuing education credit for physicians, chiropractors, nurses and vocational rehabilitation providers. For your review, here is the symposium brochure.

Some of the topics I have a particular interest in are Concussion/Post-Concussion Syndrome, Knee Injuries, Multi-Disciplinary Approach to Pain Management, and Non-Opioid Treatment Options – just to name a few.  In today’s health-care paradigm, providers are collaborating more and more and utilizing a team approach toward patient care.  This proves most important when dealing with concussions and the myriad of approaches to manage those who suffer with this type of injury.

Also, the session dealing with knee injuries particularly resonates well here in Ohio since BWC unveiled its new pilot study, the Enhanced Care Program, in northeastern Ohio.  This program is designed to provide better coordinated care among our provider community for the injured worker. Finally, our intent is to give our attendees options in treatment of certain cases where they can utilize less opiate usage and more alternative methods with potentially the same outcome, just less invasive.

Case-by-case
We hope this symposium will help assist providers in addressing their patients’ needs by understanding various approaches from least invasive to most invasive measures while striving to provide the utmost evidence-based healthcare on a case-by-case basis.

Invitation
I hope you will consider joining us this year, so we can continue to build and expand this symposium in the future.

Attention medical & health professionals

WORLD NEWS (11)

 

 

 

 

 

DrStephenWoodsBy Dr. Stephen Woods, BWC Chief Medical Officer

One of the things I like most about this position is that it gives me an opportunity to see how different organizations and regions of the state approach pain management. It has been a challenge in getting all providers on board with appropriate prescribing methods across the state.

We plan to cover the statewide Opiate Action Team guideline changes at the Ohio Workers’ Compensation Medical & Health Symposium, so it will be a great place for providers to expand their knowledge base on opiates and learn that coming into compliance with all the regulatory changes and guidelines is easier than they might think.

BWC is putting on the two-day symposium to focus on current issues bubbling up for the industry.  The two tracks being offered this year are pain and neuromusculoskeletal management, because these two areas have a huge impact on managing care and treating injured workers.

email medhead

Free continuing education opportunities
Not only are we bringing leading world, national and state experts together to learn and network with us,  we are providing continuing education opportunities for Ohio’s health-care staff members free of charge.  This is an exceptional value for an outstanding learning opportunity. I encourage Ohio’s providers to take advantage of our symposium.

Traumatic Brain Injury (TBI)
TBI treatment and awareness continues to evolve over the years.  Recovery from a TBI may be a slow process.  We need to be careful about the continuum of care and consider possible complications that may arise in the future.

Because of the increased awareness of the impact of TBIs, this is an exciting area of medicine. After lectures on the topic, I always feel like I walk away with new insights. I’m sure that will be the case with our symposium. You don’t want to miss the experts we have coming in to speak.

Read brochure, register today
Check out the brochure and then go to the website to register. We are offering the symposium in conjunction with the 2016 Ohio Safety Congress and Expo at the Greater Columbus Convention Center in downtown Columbus. I look forward to talking with you at the symposium on March 10 – 11.