Employer Services: An Inside Look

Merging Strengths and Acquiring Talent

The High Price of Physician-Dispensed Medication

GENEX’s Scholarship Program Keeps on Giving

Hernia Care Can Be Easy Lifting For Workers’ Comp

Whitepaper Series: The Essentials of Return to Work

Workers’ Compensation and Disability Management News

Spring 2014

Online: www.genexservices.com/contact-ustalkto us!

2 / PYRAMID / Spring 2014

A news magazine for GENEX clients

EditorMichele Ritchie

DesignMelissa Lapid

Correspondence440 East Swedesford Road

Suite 1000Wayne, PA 19087888.GO.GENEX

Emailmarketing@genexservices.com

Websitewww.genexservices.com

Material discussed herein is meant to provide information and should not be construed as legal or professional advice. Unless otherwise noted, the articles are written by independent authors, and the opinions expressed in them are not necessarily those of

GENEX Services, Inc.

All articles are reprinted with permission from the noted publication.

PYRAMID

F E A T U R E S

I N T H I S I S S U E

Contents

3 President’s Message

4 GENEX’s Case Manager Scholarship Program Keeps on Giving

5 The High Price of Physician-Dispensed Medication

6 GENEX Services of Canada

7 Hernia Care Can Be Easy Lifting For Workers’ Comp

9 GENEX’s Nurse Case Manager Scholarship Program Recognized

9 Legislative Update

15 Events Calendar

10GENEX: Merging Strengths and Acquiring Talent

12Employer Services: An Inside Look

Workers’ Compensation and Disability Management News / 3

Welcome to the Spring 2014 edition of the GENEX Pyramid publication. I know that many of you across the country have experienced a seemingly never-ending winter and any mention or sign of spring is welcome.

In our previous issue of Pyramid, we celebrated GENEX’s 35th year in business. We also recognized and heard from some of our long-tenured GENEX employees, who have been with the company since its earliest years. In this issue, we hear from a few GENEX colleagues who came to the company more recently by virtue of a merger or acquisition, and we experience it through their eyes. Our industry is seeing substantial merger and acquisition activity, and GENEX has benefitted from our own efforts in this area. While many measure the value of mergers and acquisitions from a strictly strategic or financial perspective, our view and experience have been that among the most valuable aspects of any transaction are the advantages gained through the extremely talented and dedicated people who have joined our company. We hope you find it interesting to hear their perspectives about mergers and acquisitions and, most specifically, their experience at GENEX.

In this edition, we also focus on the attention many of our clients are placing on using the combination of a case manager’s skills with those of the GENEX Ergonomic Specialists to promote and successfully accelerate an injured worker’s recovery and return to employment. Our ergonomically trained team members identify challenges in the work environment that may inhibit return to work, while recommending

PYRAMIDP R E S I D E N T ’ S M E S S A G E

Building on Our Strengths

modifications to solve these issues. Their work is resulting in outstanding case outcomes.

Another piece of news we are proud to bring to your attention is that the GENEX Nurse Case Manager Scholarship Program was recognized recently by Communitas and Ragan Communications for corporate social responsibility. The scholarship program is allowing a number of students across the country to pursue their education in the fields of nursing and case management, and we share the feedback from several of these individuals on their collegiate experiences.

Other interesting features include current trends in physician drug dispensing, a Q&A about our Canadian operations, legislative updates, and much more.

I hope you enjoy your spring and this issue of Pyramid.

Best regards,

Peter C. MadejaPresident and Chief Executive Officer

4 / PYRAMID / Spring 2014

L E T T E R S

In the Fall 2013 issue of Pyramid, we profiled the five schools chosen as the winners in our 2013 Case Manager Scholarship Award Program. The winning schools were chosen last May.

The program was created in 2012 to assist in the support of those institutions that develop and nurture those who are most significant to the success of GENEX – our case management employees. The program is also meant to strengthen the awareness of the case management profes-sion and to invest in a new generation of future graduates.

We are pleased to share some of the profound feedback we received from students in the nursing programs of the selected schools.

“By receiving this scholarship, it will make my goal much easier to obtain, and it has lessened the financial burden on my family,” wrote one of the recipients. “Your generosity is appreciated and accepted with extreme honor!”

“I am a single mother working full time to support my daughter and to set the right example for her,” one nursing student wrote. “While my path is mentally stimulating and emotionally rewarding, it can be stressful and challenging, especially as I try to budget money to pursue higher educa-tion. Please accept my sincerest thank you. Your generosity is impacting our lives more than you know!”

“Your decision to invest in the education of our

nursing students is inspiring.”

An executive vice president of one of the schools wrote, “Your company’s gift will impact 25 of our students by pro-viding much needed financial assistance. Your decision to invest in the education of our nursing students is inspiring.”

“As an older, displaced worker, I would not have been able to attend grad school if it was not for a grant. I am now a second-year student, holding a 3.87 GPA. When I graduate, I would like to be an agent of change and a voice for those in need. I am deeply grateful that your funding was available to help further my educational experience.”

We recently kicked off our third annual scholarship award program and expect to announce the winning schools in the next few months. For updates on this program and for other GENEX news, be sure to follow us on social media by click-ing the icons on our website at www.genexservices.com.

“Your generosity is

impacting our lives more

than you know!”

GENEX’s Case Manager Scholarship Program Keeps On Giving

Workers’ Compensation and Disability Management News / 5

T R E N D S

The High Price of Physician-Dispensed Medication

According to a recent study by the Workers’ Compensation Research Institute (WCRI), when an injured worker in Maryland needs the painkiller Vicodin, they can expect to pay about $0.37 per pill when they fill their pre-scription at the pharmacy. However, if they were to get it from their doctor through workers’ compensation, the price of that same pill climbs to $1.46 each. The same applies for Percocet. For the muscle relaxer, Soma, the cost is almost 700 percent more when the injured worker receives it from their doctor.

The difference in price is the result of doctors who buy prescription drugs that have been repackaged in ready-to-dispense containers. The repackager and the doctor work their fees in, and that is why the drug costs so much more.

Local governments and insurers are calling attention to the pricing dis-crepancies and are looking to discuss it. The government of Anne Arundel County, Maryland, found that it can save $100,000 a month by not paying the higher prices for medication. The “repackaging” practice has already been banned in six states.

There are two bills up for discussion that will zone in on physician costs. According to the Baltimore Sun, “The first would exempt employers from having to pay for doctor-dispensed medication 30 days after the initial visit. The bill would still allow doctors to provide initial doses of medication, but thereafter, patients would have to fill prescriptions at a pharmacy.”

“The second bill would exempt employers from being required to pay for narcotics dispensed by doc-tors, except under certain circumstances. That bill, backed by workers’ com-pensation insurers, is meant to combat the problem of prescription drug abuse and addiction by requiring doc-tors to receive authorization from an employer before dispensing narcotics, have the patient enter into a drug management plan, or take a drug test.” 1

1) Broadwater, Luke, “Doctors Overcharge on Workers’ Comp Medicine, Critics Say,” Baltimore Sun, December 13, 2013, http://bit.ly/1lhag3r

Average Price Paid to Physicians Much Higher than Pharmacies for Same Drug

Drugs most commonly dispensed by physicians in Maryland

Average Price Per Pill Paid For

Percent difference

Physician-dispensed drug

Pharmacy-dispensed drug

Tramadol HCL (Ultram®) $1.56 $0.60 +159%

Ibuprofen (Motrin®) $0.57 $0.25 +130%

Cyclobenzaprine HCL (Flexeril®) $1.79 $0.74 +143%

Meloxicam (Mobic®) $5.17 $2.11 +145%

Carisoprodol (Soma®) $3.36 $0.44 +667%

Naproxen (Naprosyn®) $1.84 $0.76 +141%

Hydrocodone with APAP (Vicodin®) $1.46 $0.37 +296%

Omeprazole (Prilosec®) $5.89 s/c —

Oxycodone with APAP (Percocet®) $3.29 $0.67 +393%

© 2013 WCRI

Did you know that since 1989, GENEX Services of Canada has been providing exceptional health management solutions to employers, disability insurers, third party administrators, and motor vehicle insurers, in both French and English?

We spoke to Chris L’Ecuyer, Branch Manager, about how U.S.-based employers with loca-tions in Canada can improve their companies’ performance, manage risk, and contain costs.

How does workers’ compensation differ in Canada?“In Canada, workers’ compensation is maintained by provincial government boards. Many U.S.-based employers with locations in Canada are under the assumption that they need to completely rely on these boards to manage their claims. This is unnecessary and costly. For every dollar paid to injured workers on claims, workers’ compensation can charge the employer at least two dollars. The same $2-$1 fee applies to medical assessments scheduled by the workers’ compensation boards, as well as to any treatment received by the injured worker. By using GENEX, employers can lower their costs and reduce their reliance on provincial governments to manage their compa-nies’ claims.”

Lost time is a big cost driver in workers’ compensation. Can GENEX help lower lost-time claims?“Yes, absolutely! Lost time is best reduced with GENEX’s First Report of Injury program, which features proactive claims management from day one. Our telephonic case management program provides immediate nurse triage to document the claim, coordinate assessments, recommend appropriate treatment, and provide solid return-to-work solutions. Questionable claims are promptly identified and challenged. Claims are effectively resolved, and employ-ers’ modified-duty programs are developed and enhanced. GENEX significantly increases early and safe return-to- work rates for employers in Canada.”

What services are offered to help manage workers’ compensation claims?“Our services include Telephonic and Field Case Man-agement across all of Canada, Independent Medical Examinations (IMEs), Physical Demands Analyses,

How GENEX Services of Canada can help U.S.-based employers with locations in Canada

Ergonomic Assessments, and Return-To-Work programs. We also offer Short- and Long-Term Disability and Physi-cian/Peer Review,” said L’Ecuyer.

“Our experience in the workers’ compensation arena ensures that employers will benefit from thorough docu-mentation of impairment and increased positive outcomes. GENEX’s Telephonic Early Intervention Program signifi-cantly reduces the impact of costs directly connected to medical disability, productivity, and lost time for employers.”

What about absences related to non-work-related illnesses/injuries? Does GENEX have any solutions? “We certainly do. GENEX Nurse Case Managers are experts in managing mental health claims, chronic pain, and multiple diagnoses, and can identify whether or not the absence is medically supported. They are particularly skilled in separat-ing medical from non-medical work-related issues and in assisting employers to resolve these challenging cases. They promptly identify barriers to return to work and make sure they are quickly resolved. GENEX works directly with the employees and the employers to reduce overall absence rates and lost-time claims due to non-work-related illnesses/injuries.”

If you have exposure in Canada and are having challenges surrounding the workers’ compensation legislation, privacy issues, or returning employees to an early and safe return to work, contact Chris L’Ecuyer at chris.lecuyer@genexservices.com or 1.800.465.1254, ext. 7409.

6 / PYRAMID / Spring 2014

Workers’ Compensation and Disability Management News / 7

Hernia Care Can Be Easy Lifting For Workers’ CompBy Ken Hagan, M.D., F.A.C.S., Director, National Hernia Network, Inc.

Hernias have been documented since the first medical literature was written. Until the advent of modern surgery, treatment was usually a truss or avoidance of physical activity. Prior to under-standing what hernias were and how to treat them, several myths arose. It was said that hernias only occurred in men, elderly people, or those in poor physical condition. Based on current claims data, this is certainly inaccurate, as hernias are diagnosed in men and women of all ages and all types of physical conditions.

A hernia, by definition, is “a protrusion of an organ or tissue through an opening.” The most common sites are inguinal (groin), umbilical (belly button), epigastric (mid-upper abdomen area), and incisional (through an old incision). They are often associated with symptoms of pain or a dull ache. In many cases, a bulge or lump in the area is also noticeable by the patient. While every hernia does not require repair, most will require operative intervention at some point due to discomfort.

From a workers’ comp point of view, hernia claims are relatively easy to process. Most of the claims are from on-the-job injuries, and the patient is able to relate a specific incident or activity (lifting, pushing, pulling) precipitating the pain and/or bulge. The vast majority of hernias are easily diagnosed on physical exam; although in rare cases, a repeat exam and/or x-ray study may be needed. Better than 90-95 percent of hernias will be diagnosed after a thorough patient history and a reliable physical exam. The diagnosis of a hernia is usually straightforward and simple to ascertain by a qualified general surgeon. Other workers’ comp injuries can require extensive workup, including expensive diag-nostic exams, in order to determine the diagnosis.

As with the diagnosis, current treatment of hernias is also fairly straightforward. Surgical intervention for symptomatic, work-related hernias is the only reasonable treatment option, as hernias do not “heal” themselves with rest or inactivity. There is no physical therapy, injection, or truss that can correct the underly-ing mechanical problem. Patients can sometimes function for a period of time without repair, but once they become symptom-atic, operative care is required. The type of repair (open versus laparoscopic) can and will be debated by surgeons. Regardless of which type is chosen, most surgeons would opt for a “tension-free” repair. The most common repair in the United States is still an open repair with mesh.

With improved technology and advances in anesthesia and pain control, hernia repairs are easily performed as a straight outpa-tient procedure. The patient is able to come in, have the repair, and go home the same day. This presents a tremendous cost

savings opportunity for the workers’ comp carrier. For the patient, outpatient surgery is typically more convenient and less stressful. The rare exception would be for patients who have an underlying medical condition that warrants inpatient care.

With tension-free herniorrhaphy (mostly mesh repairs), the time-frame for return to light-duty work status and Maximum Medical Improvement (MMI) has become somewhat standardized. The once widely held opinion that patients require six to eight weeks completely off work in order to convalesce from hernia repair is obsolete and currently not the usual course. Most patients can return to some work activity, with adequate restrictions, within a week of surgery. Full unrestricted activity will be determined at the discretion of the surgeon and patient. Barring any complica-tions, patients can return to full activity within several weeks of the hernia repair. In addition to a smooth post-operative course, educating the patient as early as possible about expected outcomes and usual post-op occurrences improves the return-to-work compliance. Many patients have incorrect information concerning the length of time it takes to recover from hernia repair and when they may safely resume usual work and other activities. Education about recovery is beneficial to the patient, beginning with their surgeon during the pre-operative appoint-ment. Long-term follow-up care is not required. If the patient has any post-operative difficulties, these can usually be addressed at a follow-up office visit.

Ultimately, this very common claim has some very easy and straightforward solutions. The following guidelines are the keys to effective workers’ comp hernia care:

1) Have the patient seen by a general surgeon as soon as possible after the injury so they can be diagnosed and treated quickly (many patients are taken out of work until seen by the surgeon)

2) Schedule the procedure in a timely fashion to avoid prolonged time off

3) The surgeon will provide the employer with all work restrictions so that the employer can offer the claimant light-duty work and transition to full, unrestricted activity (MMI) expeditiously

By following these guidelines, it is expected that the claimant will return to work in a timely fashion.

This article was written by one of GENEX’s CHOICE Network Providers.

CLINICAL PERSPECTIVE

CHOICE PROVIDER NETWORK

HTTP://INFO.GENEXSERVICES.COM/RETURNTOWORK

DOWNLOAD YOUR COPY TODAY!

Topics Include:

• Implementing a Fast Response System

• Ensuring Quality Care

Download GENEX’s free thought leadership series on the Essentials of Return to Work

This thought-provoking series addresses the challenges and

requirements of what is needed to respond to an injured worker,

minimize lost productivity, and accelerate return to work.

• Recognizing the Impact of the Personal Element

• Effective Planning for Return to Work

DID YOU KNOW that every year employers in the U.S. may unnecessarily spend some $500 million in workers’ compensation costs by utilizing Physical Therapy (PT) and Occupational Therapy (OT) networks primarily focused on discounting fees?

The majority of PT claims in today’s workers’ compensation marketplace are not effectively managed:

� Only 18% of workers’ compensation patients are receiving therapy through a truly integrated and managed physical medicine program

� Another 25% of claims are completely unmanaged claims

� As much as 57% of the claims are using networks that apply discounts only after treatment has occurred

Risky Business: Unmanaged Physical Therapy Claims

What can employers do to reduce their workers’ compensation costs?

Download Network Synergy Group’s white paper, “Risky Business: Unmanaged Physical Therapy Claims,” at www.network-synergy.com

8 / PYRAMID / Spring 2014

LEGISLATIVE UPDATE

Workers’ Compensation and Disability Management News / 9

HIPAAAs part of an ongoing effort to empower patients to be informed partners with their health care providers, the Department of Health and Human Services (HHS) has taken action to give patients or a person designated by the patient a means of direct access to the patient’s completed laboratory test reports. According to HHS, “The right to access personal health information is a cornerstone of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Information like lab results empowers patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans.”

The final rule is available for review at: http://www.federalregister.gov.

For summary detail go to HHS: http://www.hhs.gov/ocr/privacy/index.html

CaliforniaThe Office of Administrative Law (OAL) approved the Independent Medical Review (IMR) and Independent Bill Review (IBR) regulations. Both sets of regulations were filed with the Secretary of State on February 12, 2014, and are effective immediately. Prior to March 1, 2014, any version of the IMR Application form adopted by the Administrative Director under section 9792.10.2 may still be used.

To view the final regulations go to: http://www.dir.ca.gov/DWC/dwc_home_page.htm

Oklahoma

The newly formed Oklahoma Workers’ Compensation Commission (established in SB 1062) has begun to operate under the emergency rules effective February 1, 2014. The emergency rules are temporary and will have to be replaced by permanent rules to be developed over the next 12 to 18 months. The final rules will have to be approved by the Oklahoma Legislature in 2015.

To review full detail of the regulations go to: http://ok.gov/wcc/

GENEX’s Nurse Case Manager Scholarship Program RecognizedWe are proud to announce that our Nurse Case Manager Scholarship Program was recognized with a Communitas Award for Corporate Social Responsibility. GENEX also received an honorable mention from Ragan Communications/PR Daily for Best Education/Scholarship Program in their Corporate Social Responsibility Awards.

This program provides $100,000 annually in scholarship awards to schools nominated by our GENEX-employed alma mater. The scholarships are intended to recognize the GENEX graduates from these schools, strengthen awareness of the case management profession, and invest in a new generation of future graduates to fill a growing industry need.

"As the industry leader, employing 1,500 case managers, we are proud to receive recognition for supporting the schools that will educate and nurture the future generations of nursing graduates," said Peter Madeja, CEO of GENEX.

Communitas Awards recognizes exceptional businesses, organizations, and individuals that give of themselves and their resources and those that change the way they do business to benefit their communities. Awards are given to those entries exhibiting volunteerism, philanthropy, or ethical and sustainable business practices, as well as those looking to incorporate the spirit of communitas in their businesses.

Ragan Communications/PR Daily recognizes those organizations that go above and beyond their corporate goals to do public service and to communicate it to their customers and the public. People today are more engaged and informed, and social media and the internet have provided the vehicle for organizations to raise awareness and embrace opportunities for giving back.

Few announcements are as stressful for employees as news of a merger or acquisition. Fear and panic set in, and people wonder what will happen to their jobs and how the impending change will affect them. However, mergers can also open new opportunities for employees, such as jobs in different areas of the company, gaining new coworkers with diverse talents and skills, and benefitting from being part of an overall stronger business as a result of additional size, financial strength, and capabilities.

GENEX has a history rich in mergers and acquisitions, and with each acquired company throughout the years, one thing remains constant—the tremendous value of adding experienced and talented people as a result of these oppor-tunities. This, along with communicating the strategy and direction for each acquisition, creates a welcoming environ-ment for individuals who join us through these transactions.

We reached out to several of our employees who came to GENEX through a merger or acquisition and asked them to share with us some thoughts about their experiences.

The best of both worldsJo Lee MacLeod, Carolinas Manager, was the CEO of American Rehabilitation, Inc. (ARI) when they were acquired by GENEX. She had been with ARI for 23 years in various positions and was thankful for her company’s acquisition. “I am not sure we would have been able to sustain our business success throughout the recession,” she said. MacLeod noted that GENEX appears to have a more calculated acquisition plan, which allows for full integration of an acquired company before adding the next company. “My idea of success is to take the best of both companies to make an even better company.”

Diane Schneider, a vice president, had worked for Intra-corp for 30 years. During her tenure, she experienced the merger between INA and Connecticut General, which became known as CIGNA, as well as Intracorp’s merger into the CIGNA environment. Schneider believes that if you can leverage the strengths of both the acquiring company and the company being acquired, you will impress your market-place, retain employees, and maintain your customers. “The entire marketplace is watching to see if you will succeed or fail, especially our customers, who do not want any disrup-tion to their services,” said Schneider. “We deliver products

and services, and it was important to not push change too quickly.”

Communication and a well-paced transition of systems and structure is a necessity in any merger or acquisition. New employees are still mourning the loss of their previous employer and are nervous about moving to a new company.

“They are fearful of losing their jobs, a change in roles, new management, a change in culture, and a change in benefits,” said Schneider. “Weekly communication to walk through the logistics and paper work is critical, as is a genuine interest in learning about the strengths of the people and services in the company being acquired. It was great that GENEX senior leadership presented messages of acceptance, patience, and respect for two cultures merging into one.”

Mark Fabian, Regional Sales Manager for the Southeast Region, agrees. “People like to hear from the new man-agement staff, but they also want to hear from their own management, who are going to play a part in the future of the new company.”

Rhonda Craig, RN, CRRN, National Account Man-ager, echoed their sentiments. “The handbook provided by GENEX about mergers and acquisitions and the feel-ings associated with such transactions was excellent,” she said. Craig also feels that the merger worked out well after the transition period. “Many of the initial fears expressed by employees and clients were relieved within the first six months. Programs have been maintained and are resulting in excellent client outcomes,” she said.

Ellen Voodre, GENEX Medical Diagnostic Network National Manager, was employed by Independent Review Services (IRS) for more than six years before GENEX acquired her company. “IRS was a privately owned company with fewer than 20 employees that handled both indepen-dent medical examinations and diagnostic scheduling,” said Voodre. “Even though I was assured that my position was not in jeopardy and that I would have more potential for growth, I was still a little anxious about my future with GENEX.”

Voodre said that her initial introduction to GENEX included a visit with executive management and that reas-sured her of GENEX’s interest in her company. She related the beginnings of GENEX with her own company and, after the meeting, felt confident of a future with GENEX. “I felt very welcomed by those who mentored me during the

GENEX: Merging Strengths and Acquiring Talent By Michele Ritchie, Marketing Communications Manager, GENEX

10 / PYRAMID / Spring 2014

transition,” said Voodre. “Within six months of becoming a GENEX employee, I was the MDN National Manager, and I am thrilled with how everything worked out.”

Expanding products and servicesIn light of the uptick in merger and acquisi-tion activity in the workers’ compensation industry, one can question whether this is positive or negative. Fabian thinks that the industry is competitive and mature and that is what has precipitated acquisitions and mergers. “Vendors have had to do the same, even going to the next level of expanding their product offerings to maintain pres-ence in the industry and revenue growth overall,” said Fabian. He feels that mergers and acquisitions offer the customers more options across all product lines. He also likes the added value of working with new talent, because that leads to more creativity which results in a better end product and service.

MacLeod thinks that in today’s market, bigger might be better. “For the customer, it is more cost effective to partner with a com-pany that has the ability to offer all services to meet their needs,” she said. “Workers’ comp is continually changing, and we must have the resources to change with it to be successful.”

Craig agreed that companies are trying to better position themselves to provide more services and products to their clients. She also thinks that investment companies are recognizing the potential opportunities in the workers’ compensation industry.

Giving GENEX a tryWe asked the group their opinion on what could be done to make mergers and acquisitions smoother for employees. MacLeod said that listening and communicating are vital. “Change causes fear, and when people panic, they can some-times feel they do not have a choice,” she said. Providing adequate training to new employees is also important. “Give them the answers they need to feel good about the new com-pany—listen, communicate, and train.”

MacLeod didn’t feel that the acquisition of her company worked for all employees. She said that many employees didn’t give GENEX a chance and that they were afraid of a national company. MacLeod said the merger was good for her and that she is fortunate to report to a very understand-ing leader. She said her direct VP has been the important link and most likely the reason she has stayed with GENEX.

Schneider feels that managers and leaders play a criti-cal role to maintain staff and limit turnover through their actions to make new employees feel comfortable in the new company. “It is important to listen and learn from these new

employees rather than push change in practices too quickly,” she said. “I was saddened over the loss of Intracorp, but I decided to give GENEX a try. There was comfort in coming over with almost 900 people that I loved working with and had great respect for,” she said. While the first few months were challenging, Schneider said that hard work paid off and things again became familiar.

“There were a handful of people who took time to help me find the tools I needed to be successful in my new work environment. Those are the people who kept me here, and I credit them to this day with my tenure at GENEX. What I learned is that every employee who comes over with an acquisition has the choice to move or look for an alternative job. GENEX offered excellent communication, solid orga-nization, a well-paced transition of systems, and exceptional implementation with the success of keeping customers and employees,” Schneider said.

Schneider continued by saying that GENEX retaining a good portion of employees and all customers is testament to how well they handled communication and cultural differ-ences. “I am here today because of the work I do and the people I work with. I am thrilled with my decision to give GENEX a try!”

Working with new talent leads to more creativity, which results in a better end product and service.

Workers’ Compensation and Disability Management News / 11

Employer Services: An Inside Look

12 / PYRAMID / Spring 2014

GENEX’s Employer Services include:Ergonomics — provides consulting services that reduce

risk factors for preventive and case-specific situations. Ergo-nomic evaluators consider posture, productivity, health and safety, and cost benefit perspectives that will lead to improve-ments that enable employees to stay at work or return to work.

Physical Demands Analysis (PDA) — a biomechanical description of the essential functions of a job and the physi-cal demands required to perform them. A PDA is the basis of determining causation, medical treatment plans, return to work, and accommodation.

Customized Return-To-Work (RTW) Solutions — provides a predefined, step-by-step process in returning employees back to full-time jobs through transitional tasks.

We reached out to some of our case managers to learn just how these programs successfully prevent unnecessary proce-dures and keep employees on the job.

Teaching the teacherIt was getting close to the end of another weekday. Sister Barbara Miriam*, PhD, RN, a career counselor, and the Mother Superior of a religious order of nuns at a nursing college, was in her office, counseling students while she was trying to push through the pain in the bilateral upper extremities, neck, and head. She was determined to finish counseling the underprivileged students at the end of the semester.

Sister Miriam had received the same evaluation from the orthopedic hand surgeon for the last few years. He recom-mended bilateral carpal tunnel release, but Sister Miriam could not afford the time away from work or her students. She really did not want the surgery anyway but could not think of a way out of her predicament. The orthopedic hand surgeon recommended an ergonomic evaluation of the work station. The next day, she contacted the human resources department and requested an ergonomic assessment.

Enter Marci Levin, RN, BSN, BSW, CCM, a GENEX Ergonomic Team Lead, and senior-level Catastrophic and Disability Nurse Case Manager. Levin spent two hours with Sister Miriam, assessing her work habits, position, body mechanics, and equipment.

“When I first met with Sister Miriam, I was a little intimidated,” said Levin. “Here I was, evaluating a PhD-level nurse, who was also a Mother Superior, and I was going to have to tell her how to change the behaviors that were caus-ing her pain,” Levin chuckled.

After Levin completed her assessment, she saw many areas of body mechanics and behavior that needed to be changed. For starters, Levin adjusted the screen to the correct height and centered the work station so there was little torqueing of the cervical spine. When she asked Sister Miriam to look directly at the wording, it was then that Levin discovered the cause of Sister Miriam’s headaches. “She didn’t want to look old by wearing bifocals, so she just wore reading glasses instead,” said Levin. “She had to keep looking over the read-ing glasses, and this was giving her headaches. Once she got the correct glasses, the headaches went away.”

Levin discovered that Sister Miriam had everything at the wrong height, which caused her to keep moving her head up and down and from side to side, making her pain worse. She was also using the keyboard as an armrest.

“She wasn’t listening to her body’s signals; she wasn’t stopping at the pain. If a student came in to discuss a class schedule or roster, she would keep working through the pain,” said Levin.

Levin instructed Sister Miriam to keep a journal with the amount of time she spent on each task and when the discomfort began. Once she was able to alternate the tasks, the pain decreased.

Then Levin focused on the hands and upper extremi-ties. She brought the keyboard closer to the center, and they removed the arms of the chair to reduce stress on the sensi-tized nerves. She also asked that Sister Miriam shorten her nails so that the keying was on the pads of the finger and not the nail beds. Levin provided Sister Miriam with pictures of keying in a proper posture at a work station. These pictures were placed around the area where she worked as a reminder for her.

GENEX’s Employer Services provide preventive and return-to-work products that complement and enhance our managed care services. These services define the physical requirements of job tasks to identify hazards, mitigate preventable injuries, and facilitate return to work.

by MICHELE RITCHIE, Marketing Communications Manager, GENEX

Workers’ Compensation and Disability Management News / 13

Levin noted that Sister Miriam’s workspace was not her dedicated workspace. Other people used it, and the chair was constantly adjusted to different heights and not left in the proper position for her. Levin recommended that a specific chair be purchased for Sister Miriam, but she initially didn’t want to spend the money. Levin insisted, and she was glad she did when she went back to check on Sister Miriam at the three- and six-month intervals.

Levin said that Sister Miriam no longer had hand dis-comfort in the wrists, and she did not need surgery for carpal tunnel release. She was able to continue working and avoid surgery simply by adjusting her body mechanics and the tools in the work station. “Ergonomics is a very important

piece of the treatment plan to help an employee stay at his or her job and continue to be a productive member of society,” said Levin.

By now, Levin and Sister Miriam had developed a rapport. When Levin went back for her final evaluation, Sister Mir-iam asked her to speak to her students at the school’s career fair about opportunities as an occupational health nurse. She was so grateful for everything Levin had done in helping her stay productive in her job, and without pain. Levin gladly obliged, and she was asked back for several years after.

“She helped me as much as I helped her,” said Levin. “She is one of the reasons why I keep working in ergonom-ics along with my work as a catastrophic case manager. It’s amazing how making simple changes to a work station can make a huge difference in someone’s life!”

Making a difference, again and againNancy Kennedy, MS, CRC, CEAS, and a GENEX Ergo-nomic Specialist, said that she has had so many great results with her cases that she cannot count or identify one particu-larly outstanding one. “It seems every time I went into this one company’s administration center, I would have at least one person stop to tell me how well they were doing and that their symptoms were gone after the ergonomic changes were made,” she said. Kennedy noted that for other ergonomic evaluations she has done that included follow up, she could not think of one case that didn’t show improvement in dis-comfort and/or shorter release from “modified” duty.

“There was an interesting case involving a legally blind customer service representative, whose analysis resulted in

improved monitor position and a re-configuration of the keyboard tray. This brought the screen closer, and eliminated upper body twisting and low back discomfort,” said Ken-nedy. “But mostly, it is training employees on how to use and adjust their existing equipment properly.”

Kennedy said that she often receives referrals from new employers through positive word of mouth. She just received a request from a large law firm that will require a 22-person consultative ergonomics evaluation and follow-up services. She also received a new referral from an adjuster who had a positive response from her customer regarding an ergonomic evaluation that required some “out-of-the-box” thinking due to the physical layout of the facility and the corporate design-imaging concept. “Getting these word-of-mouth referrals is wonderful, because it is a true testament to the work we are doing and how people are able to stay in their jobs,” said Kennedy.

Analyzing the physical job demandsDan Warren* had just gotten off the phone with his CEO. Their company was acquiring another mine site, and he would need to set up workers’ compensation services. He knew exactly the person to call. GENEX Vocational Con-sultant Dennis McLuskie, MS, CRC, CEAS, was at the top of Warren’s list when it came to Physical Demands Analysis (PDA).

Warren had initially used McLuskie’s services at another mining company when an on-the-job injury required an evaluation of the physical job requirements. McLuskie went to the mine and conducted the first onsite PDAs for the company. Using the PDAs, the physician was then able to accurately evaluate the employees’ ability to safely return to work. McLuskie was asked to create onsite analyses for 38 jobs the company had. “Essentially, I created a job bank for the company to use when an employee becomes injured,” he said. “They can refer to this list for those employees off work, for work- and non-work-related injuries and illnesses, to assess the employees’ ability to safely perform the physical requirements of their specific job.”

“By having this as a resource, injured employees are able to stay on the job in a modified position and still be productive, which reduces disability costs for the employer. It’s a win for the employee and a win for the employer.”

Dennis McLuskie, MS, CRC, CEAS

Return-to-work program cuts workers’ compensation costs and lost wages

Dana Holding Corporation worked with GENEX to create their RTW program, and as a result, cut their temporary disability costs and lost wages by half. For employee Mike Adams, it meant that he was able to return to his work location and contribute within his restricted abilities, all while he recovered (and earned full wages) more quickly after a work-related injury. To read his case study, please visit http://info.genexservices.com/dana, and learn how GENEX can help you create your custom RTW solution.

CASE STUDY

14 / PYRAMID / Spring 2014

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“After using the list I created, the employer asked some of their medical providers their opinion of the new PDA forms the company was using,” said McLuskie. “They all agreed that the form and format was very helpful to them in completing their evaluations of individuals for a safe return to work.”

“We are able to bring people back to the position they had, returning them to a safe environment, because we know what their limitations are as a result of doing the physical demands analyses,” said McLuskie. “It’s very simple—you match the physical demands of the job to the physical abili-ties of the employee.” McLuskie said that this also allows the doctors and physical therapists to treat the injured worker based on the job they perform. “By having this as a resource, the employer is able to keep the employee on the job, where they can still be productive. This reduces disability costs for the employer. It’s a win for the employee and a win for the employer.”

Creating customized RTW solutionsOur RTW solutions provide a predefined, step-by-step process in returning employees back to full-time jobs through transitional tasks, dramatically reducing temporary dis-ability costs. Physical demands analysis and ergonomics are integrated into the process to create an RTW program that effectively reduces and manages injuries/illnesses from prevention to accommodation. The cornerstone of RTW is using these tools in conjunction with medical case manage-ment, creating a robust solution of services to manage a claim through the recovery process.

*Not the person’s real name

For more information on GENEX’s Ergonomics, Physical Demands Analysis, or customized Return-To-Work solutions, please contact your GENEX Account Representative, or call 1.888.GO.GENEX.

Workers’ Compensation and Disability Management News / 15

Workers’ Compensation and Disability Management News / 1

An Inside Look

at Medication

Safety

Page 12

Yoga as an

alternative to

pain meds

Page 8

Anesthesiologist

wins disability

benefits for

addiction

Page 7

Physician dispensed

medication by the

numbers Page 5

Veterans Affairs

overpays vets for

disabilities Page 6

Legislative update

on California

Senate Bill 863 Page 9

Workers’ Compensation and Disability Management News

Spring 2013

20

14EVENTS CALENDAR

GENEX will be attending these upcoming industry events. We look forward to seeing you!

Canadian Life and Health Insurance Association April 29, 2014 Quebec City, Quebec

Alabama Workers’ Compensation Organization May 1, 2014 Birmingham, AL

Washington Self-Insured Association (WSIA) May 14–16, 2014 Tacoma, WA

Minnesota Work Comp Symposium May 14, 2014 Minneapolis, MN

MSIA Spring Conference May 28, 2014 Grand Rapids, MI

Pennsylvania Bureau of Workers’ Compensation Annual Conference June 2–3, 2014 Hershey, PA

Tennessee Department of Labor Conference June 18–20, 2014 Nashville, TN

Florida Annual RIMS Conference July 29–August 2, 2014 Naples, FL

Alabama Self-Insurers Association August 10–12, 2014 Miramar Beach, FL

Workers’ Compensation Institute Conference August 17–20, 2014 Orlando, FL

Montana Governor’s WC Conference September 10–12, 2014 Big Sky, MT

RIMS Canada National Conference September 14, 2014 Winnipeg, Manitoba

Florida State PRIMA Conference October 13–16, 2014 Orlando, FL

SOLVING the cost/care equation for our customers

GENEX is the nation’s leading provider of integrated managed care services, focused on controlling health care costs and reducing disability expenses. Only GENEX offers the market experience, proven products, customized solutions, unique service integration, and technical expertise to solve your cost/care equation.

Workers’ Compensation & Disability ManagementMedical Cost Containment

Social Security Representation

To learn more about our products and services:• Visit us at genexservices.com • Call us at 888.GO.GENEX• Email us at marketing@genexservices.com

“Our continued affiliation with GENEX’s Managed Care Program has resulted in an average decrease of 12.5% in the amount of our workers’ compensation medical payments.”

Tracey Davanport, Argo Group Director,

National Managed Care