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May 12, 2020

Access to Care, Return to Work in a Pandemic

Summary:

Beyond the pandemic, claims teams will need to know how to prioritize medical care for injured workers.

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As businesses around the country prepare to reopen, there is a concerted effort made to prioritize the safety of the workforce. Employers are also preparing to face more leaves of absence than ever as they account for employee childcare needs, at-risk groups with pre-existing conditions and possible employee COVID-19 cases. So, how do we approach reopening the economy with these concerns in mind? Furthermore, how does the workers’ compensation industry provide access to care for injured workers throughout this crisis and in the future?

Three industry experts joined us for our special edition Out Front Ideas COVID-19 Briefing Webinar Series to discuss access to care and the return to work during the COVID-19 crisis: 

  • Bryon Bass – senior vice president, workforce absence, Sedgwick
  • Michele Hibbert-Iacobacci – senior vice president, regulatory compliance management, Mitchell International
  • Jennifer Ryon – chief revenue officer, Prime Health Services

Leave of Absence and COVID-19

Sweeping changes to leave of absence laws are rapidly occurring at both the federal and state levels, helping employers adjust to the needs of their workforce. They are also expanding our industry’s terminology of “return to work,” as it applies to how employers are adapting their efforts through the pandemic. 

The Families First Coronavirus Response Act (FFCRA) bill, introduced in mid-March, requires employers with 500 or fewer employees to provide their workforce with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. The bill requires up to 80 hours of paid sick leave at the employee’s regular rate of pay when an employee is in quarantine or experiencing COVID-19 symptoms and seeking a medical diagnosis. If an employee needs to take care of an individual subject to quarantine, or care for a child whose school or childcare provider is closed due to the pandemic, the employee is entitled to 80 hours of paid sick leave at two-thirds of the regular rate of pay. An additional 10 weeks of paid expanded family and medical leave at two-thirds the employee’s regular rate of pay must also be provided if an employee must care for a child whose school or childcare provider is closed due to reasons related to COVID-19. While the requirements only apply to businesses with fewer than 500 employees, the majority of businesses with more than 500 employees have instituted additional paid family leave or allowed their workforce to use their paid leave for COVID-19-related reasons. 

Many state and statutory paid leave policies have extended rights that are similar to the coverage offered by the FFCRA. Some of the nuances of these extensions include additional unemployment benefits for individuals who have been furloughed or laid off. Some states also allow for accrued paid sick leave for employees and are allowing employees to use these benefits for reasons related to COVID-19. Employers need to understand that some of these state and federal changes may run concurrently with offerings from self-insured plans. Some policies have offset provisions that allow benefits like short-term disability or workers’ compensation to be offset by benefits offered at a state or federal level. For example, if an employee is taking leave to care for a child whose school is closed due to COVID-19 reasons, they would benefit from the FFCRA, but not be able to take advantage of short-term disability. Self-insured benefits should be used as supplemental coverage, instead of being used in addition to federal and state benefits, so the employee is receiving 100% of standard pay in total.

See also: Pain Management, Wellbeing in Pandemic  

Business Reopening

As businesses consider their reopening plans, they should consider three components: preparation, deployment and sustainability of employees’ return to work. These components should be guided by principles that include the safety of the employees, visitors and general public, compliance from public health organizations and government agencies, collaboration across the organization and agility that enables a swift response to changes that may occur. Many questions require answers for each component of the plan, including:

Preparation 

  • Have you considered both community readiness and facility readiness? 
  • If employees return to the office, can you ensure social distancing? Is it being enforced within the community?
  • Have you adjusted the footprint in your office to allow for safe social distancing? Is it possible while still maintaining productivity?
  • Do you have testing capabilities? 
  • Will you require personal protective equipment (PPE) to be worn? Can employees buy their own, or will you supply items, like face masks, to your workforce? 
  • Have you allowed for flexibility in the workforce, especially for groups more vulnerable to the illness, and employees needing to care for children?

Deployment

  • Are employees adapting to the changes, or do you see a decline in productivity?
  • Have employees made use of flexibility policies? Is there an increased demand for leave?
  • Do employees feel safe with the return to work, or is there significant apprehension?
  • Are you adapting to the needs of your workforce?
  • Are you enforcing the use of PPE? Are employees encouraging others to maintain safe social distancing?
  • Is testing working, or are you seeing a rise in employee transmissions?

Sustainability

  • Have you been able to phase more employees back into the physical workspace?
  • Are employees more productive than they were when working from home?
  • Do employees still feel comfortable coming into a physical workspace?
  • Is the community prepared for a possible second wave of the virus? Has a vaccine been established?
  • Are you able to pivot back to a work-from-home model if necessary?

Access to Care

With hospitals not offering elective surgeries due to the pandemic, we may be considering how our injured workers are getting the care they need. It is also important to consider how we are handling these changes operationally between employers and claims teams. Are we considering which patients are more at risk? Can we use analytics to understand which patients should be recovering? Are there significant milestones tracked in a patient’s recovery? What are the expectations of your claims teams? Through this crisis, it is crucial to take a personalized approach to understand both the functionality of the team and the injured worker within a claim. 

Preferred provider organizations (PPO) work as a network for connecting workers’ compensation resources (hospitals, primary care specialists, occupational health, etc.). Some are providing their clients with a real-time listing of what providers are currently available, including operating hours and telehealth capabilities. While serving both the client (third-party administrator or carrier) and the provider, the challenge lies with how to provide better help to the client. TPAs and carriers are currently working with claims teams on their workflows to act as a liaison for communication between the payer, provider, employer and employee. This need for improved communication will increase as businesses around the country reopen and there is further demand to locate a provider.

Regulators are assisting in healthcare needs through efforts to push telehealth legislation. With patients fearing possible exposure from in-office visits, demand for telehealth is increasing. Harvard reported a 60% drop in in-person visits, with a 10% increase in telehealth visits. Due to increased demand, some physicians have rushed to offer telehealth capabilities without understanding regulations first. States are addressing issues related to telehealth, such as limitations on prescriptions that can be prescribed over the phone and the scope of care being provided. 

Provider Access 

There are concerns about on-hold elective procedures because there are restrictions on which providers are allowed to operate and which patients they can see. Dentistry, for example, can only see patients with infections or pain, which may result in more expensive procedures in the long term. However, patients are missing wellness visits that are crucial to the recovery process. For instance, serious procedures like biopsies, removal and replacement of orthopedic devices or hardware and cast replacements may result in further long-term damage to the patient. There may be an increase in the expansion of benefits in the instances where an injured worker needed care but could not receive it.

See also: Impact of COVID-19 on Workers’ Comp  

With elective surgeries being canceled or postponed, providers are adjusting through reschedules based on pain levels and how likely a patient may be to resort to an emergency room visit. With a decline in patients, some private practices are being acquired and consolidated by larger healthcare systems. Some satellite physicians are being reassigned to hospitals to help with pandemic needs. With healthcare staff adjusting to current needs, it is vital to assess how quickly they can be reassigned back to their original roles when we return to a state of normalcy, and the demand for elective procedures increases. 

Preparing Claims Teams

As we plan for the future beyond the pandemic, there is a need to address the impact on claims teams. They will need to know how to prioritize medical care for injured workers. Do they understand how social isolation has affected the injured worker? How has this crisis affected recovery and the injured worker’s level of functionality? Do you have tools at your disposal to suggest help for those affected more severely? Developing a communication plan for your claims teams and emphasizing data collection on current claims will create a more streamlined process while creating a better understanding of the patient population. 

To listen to the full Out Front Ideas with Kimberly and Mark webinar on this topic, click here. Stay tuned for more from the Out Front Ideas COVID-19 Briefing Webinar Series, every Tuesday in April and May. View the full list of coming topics here.

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About the Author

Mark Walls is the vice president, communications and strategic analysis, at Safety National. Mark is also the founder of the Work Comp Analysis Group on LinkedIn, which is the largest discussion community dedicated to workers’ compensation issues.

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About the Author

Kimberly George is a senior vice president, senior healthcare adviser at Sedgwick. She will explore and work to improve Sedgwick’s understanding of how healthcare reform affects its business models and product and service offerings.

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