Aggressive Evaluation Leads to Cost Savings: Injured Workers Avoid Rehabilitation and Return to Work. Leonard N. Matheson, Ph.D. California Workers Compensation Enquirer. June 1987.
The study of cost effectiveness of health care procedures is difficult to achieve because the focus of health care is on providing the best possible care available. In the past, rehabilitation costs too often have been a secondary factor. However, it is occasionally possible to measure the cost effectiveness of a procedure that is under study for another purpose.
In this case, a study of the reliability of a procedure to measure lifting capacity yielded information about the cost effectiveness of a work evaluation procedure that can provide cost savings in selected cases. The procedure, called Job Match Analysis (JMA), is designed to compare the capability of an injured worker to the demands of a particular job. Detailed results of this study previously have been reported (Matheson, VEWAA Bulletin, Vol. 19, No. 3, 1986).Subjects for the original study included 162 ambulatory disabled adults referred for vocational evaluation. Seventy-nine (79%) percent of the subjects under study were male. The age of the sample ranged from 17 years to 68 years (mean = 35 years). All of the subjects were previously screened for presence of cardiovascular or pulmonary disease and were excluded from the sample if any indication was noted. Sixty-six (66%) percent of these subjects had diagnoses which involved injury to the lumbosacral spine and/or supporting tissue. Twenty-two (22%) percent of this subset had diagnoses which indicated impairment of the L4/L5 or L5/S1 intervertebral disc. Twenty-eight (28%) percent of the subjects with lumbosacral injuries of all types also had other impaired body parts. The most frequently encountered accompanying injury was to the knee. All subjects in the sample had been disabled from work for at least three months with a median time off work at the date of evaluation of twenty-seven months.
Eighty-eight (88%) percent of the subjects were evaluated as part of the vocational rehabilitation program provided under the Worker’s Compensation laws of the State of California. Each subject was believed by his or her primary care physician to be unable to return to usual and customary employment. In twenty-eight of the 162 evaluations a Job Match Analysis was conducted in response to a request to compare the subjects’ performance to specific job demands which were enumerated in job analyses. In fourteen of these cases, the evaluation resulted in a finding that the subject would be able to perform the work indicated. In six cases the finding indicated that the subject was able to perform his or her usual and customary work. All but one of these six subjects returned to usual and customary employment. In actuality, none of the six entered the vocational rehabilitation system. The subject who did not return to work (a young woman who was injured on a summer vacation job), chose to forego return to her previous employment and to continue her college career in an entirely unrelated field.
The practicality of the JMA procedure may be considered by measuring its cost effectiveness. The professional service fees totaled $8,400 for the 28 evaluations that were conducted. Six of these evaluations resulted in recommendations that the disabled worker return to his usual and customary employment although the worker had originally been considered to be unable to return. In these cases, the costs of additional rehabilitation were avoided.
In 1983, the year in which these cases were resolved, the average cost of a rehabilitation case in the Workers’ Compensation System in California was approximately $13,000 (CWCI, 1984). If only the case load savings due to the avoidance of rehabilitation charges are considered, a $69,600 savings is realized, comparing the cost of the evaluation with the average case cost for six cases in which rehabilitation was avoided entirely. This does not take into account the probable cost savings for those additional eight cases who were identified as able to perform the job for which the Job Match Analysis was conducted. Even though these entered the rehabilitation system, their case costs are presumed to be substantially lower because job placement appeared to be imminent.
An aggressive, job match evaluation can provide a safe and effective means of obtaining information that can be used to facilitate the injured worker’s return to employment. Even if the injured worker is unable to return to his usual and customary employment and enters the rehabilitation system, the results from such an evaluation provide a sound basis for focussed vocational exploration and rapid job assignment after injury.
Based on research results reported in Matheson LN: Evaluation of lifting and lowering capacity. Vocational Evaluation and Work Adjustment Bulletin, 19(3):107–111, Fall 1986.