Dr J's Jottings

British Columbia - 1st to commit to a Canadian SAW/RTW

A group in British Columbia has just decided to hold a Summit in November, 2008! People from several BC organizations held their own feasibility meeting this week to decide whether it makes sense to bring the 60 Summits Project idea there. The meeting was apparently a great success. There was strong multistakeholder support for the content of the ACOEM work disability prevention guideline and a wish to be associated with the 60 Summits Project. They agreed to aim at an initial summit in November of this year.

The first planning meeting is tentatively set for Feb 13th at which time the organizational structure will be established. Dr. Larry Myette, Director of Strategic Workplace Health for the Healthcare Benefit Trust that manages benefits for many of the healthcare employers in BC, convened the feasibility meeting and has agreed to serve as interim chair of the group. Among other attendees at the
feasibility session were WorkSafeBC and the Canadian Institute for the Relief of Pain & Disability.

If you wish to help plan the BC Summit or simply be invited to the actual event, contact Dr. Myette, who can be reached at: (250) 479-4089.

60 Summits Project Update

Yay! I just learned yesterday that Montana will hold three Summits in April 2008 in conjunction with The 60 Summits Project. The Governor's Labor Management Advisory Council on workers' compensation will be the lead sponsor, along with the State of Montana, the Montana State Fund, the Montana Building Contractors Association and the Sisters of Charity Leavenworth Health System and others. Three members of the Labor-Management Advisory Council are on the Summit Planning Committee! Montana has been looking for a new model to adopt in the return to work arena, and will be engaging the whole state in a conversation about implementing the new work disability prevention paradigm.

In 2007, we:
  -- held 5 Summits in 2 states, one in Northern California, and four in North Dakota, for a total to date of 7 Summits in 4 states.
  -- got 6 new Summit Planning groups formed and off the ground in Arizona, Ohio, Florida, Massachusetts, Michigan and Montana.
  -- benefited from association with our Charter North American sponsors, Prudential Financial and Webility Corporation, whose generous contributions made many of our 2007 activities and 2008 plans possible.
  -- developed materials, methods and other key infrastructure including our new-and-improved website: www.60summits.org

As of yesterday, we already have 7 Summits on the calendar for the first half of the year (MN-1, MT-3, OH-1, AZ-1, and FL-1). We're entering several new states in the next few months.

Now that we've built a solid foundation, I'd like to open the throttle in 2008. My goal is to be halfway to 60 -- to have activity underway in 30 states and provinces -- by the end of 2008.

In 2007, I travelled all over the continent and met a lot of very good people with a lot of talent and pent-up energy they want to put into improving these "systems". I represented the 60 Summits Project at meetings in Arizona, British Columbia, California, District of Columbia, Florida, Illinois, Idaho, Illinois, Maine, Massachusetts, Michigan, Minnesota, Montana, North Dakota, Ohio, Oregon, Rhode Island, Quebec, Texas, and Washington. Meanwhile, the 60 Summits Project staff built the "guts" of The 60 Summits Project as an on-going endeavor: developing materials and methods that would set appropriate expectations and create strong planning groups and successful Summit events and follow-on action groups.

We are building an organization that has to be comfortable with local variation and individual eccentricities due to the volunteer nature of most of our groups -- but we are centering ourselves around some unifying themes and values. Key among them are a Partner Attraction Plan (see www.60summits.org) and the Commitment to Partnership. Together they lay out our mutual commitments to how we are BEING with each other in addition to what what we are DOING together.

It's been a challenging roller-coast type ride, and this project has consumed the vast bulk of my professional time and most of my creative energies. And wow, do I ever find it exciting and fulfilling! When I enter a room for a feasibility session (the next one is Feb 7 in Madison, Wisconsin), I am CONFIDENT that I am with a remarkable group of people -- because who else would accept our invitation?

In our push to put "meat in the hamburger", we haven't paid as much attention to developing our sponsor relationships. Now that we've built a strong engine that's really ready to take us places, I'd like to put a lot more fuel into it. The 60 Summits Project derives its revenue from a combination of sponsor contributions and fees charged for services to local Summit planning groups. It's time to build up our sponsorship contributions by attracting organizations that are a good fit with us and forming on-going mutually fulfilling relationships with them, too.

Sponsor contributions to The 60 Summits Project make it possible for us to:
  -- build and maintain our infrastructure including our new website (www.60Summits.org)
  -- bring the possibility of The 60 Summits Project to new states
  -- form new groups and support them until they get organized and off the ground
  -- provide partial matching grants for local Summits
  -- support the action coalitions that are springing up after Summits occur
  -- and, in 2008, to hold our first national conference.

Summit Planning groups, once established, decide whether they want to be an official part of The 60 Summits Project and to have our support, in which case we then charge fees for our services. The local Summit planning groups in turn meet their expenses by charging registration fees to Summit attendees and garnering support from local sponsors.

I'd like to speed this whole thing up and be able to enter new states more often. I'd also like us to provide even BETTER support to the local groups -- especially the action coalitions that are springing up after the Summits -- so they can really become an ON-GOING and EFFECTIVE force for positive change in their states. As I said, our 2008 goal is to be halfway to 60 by year's end -- to have activity underway in 30 states.

You may wonder how you can help. Here are two ways:

  1. By passing along names and contact information for people who will want to participate in this project in specific states, either as a Summit planner, attendee, or as a local sponsor.

  2. By becoming a sponsor of our North American effort at some level. Join Prudential Financial and Webility Corporation as North American sponsors, or find another level at which to to contribute that suits your situation.

Ask yourself if your company:

  ---Likes to underwrite worthwhile activities, and would see supporting this inspiring grassroots effort as the right thing to do.

  ---Sees itself as a potential beneficiary of our initiative, and wants to assure the success of The 60 Summits Project by providing visible endorsement as well as financial support.

  ---Will benefit from being visibly associated in the marketplace with The 60 Summits Project's cutting edge thinking and an initiative that is being hailed as "brilliant and fresh . . . a new paradigm . . . a clear blueprint for positive change."

Sondra Seay from Florida has joined The 60 Summits Project as manager of sponsor relations. You can reach her at sondra.seay@60Summits.org.

North Dakota, here we come!

We're putting the final touches on preparations before North Dakota's four Stakeholder Summits on Preventing Needless Work Disability the week of September 10-14.  These Summits will have a different "feel" than the prior ones in larger states have had, largely because of the small size of the cities we will be in.   

(If you're curious about North Dakota, go to wikipedia like I did or to the official North Dakota website. The largest city we will visit is Fargo with a metro area of about 175,000 people.  The state capital is Bismarck whose metro area has about 100,000 people.  The Grand Forks area is about the same size.  The smallest we will visit is Dickinson, with about 20,000 people.)

Workforce Safety & Insurance, the state's workers' compensation insurance fund, is the sole sponsor of this series of Summits  -- and boy have they been a great partner to work with!   Their planning team has been preparing for this for months, intent on building better relationships, improving communications, and increasing collaboration among employers, physicians, and WSI in order to improve overall outcomes in workers' compensation cases.  In these final days, WSI has put their employer account reps and nurse case managers on the phone, inviting employers and doctors to the meetings.  Happily, attendance looks like it will be good. 

I suspect that the attendees at this Summit will be quite different than the attendees at the most recent Summit held in California in June.   In California, there were a lot of specialists in disability management or occupational medicine, or corporate staff or labor representatives or non-profit organizations with a special interest in disability and return to work.  Many had never met each other before.

In North Dakota, we will be close to the ground in a predominantly rural state.  Not many companies there with corporate disability management staffs.  The room is likely to be filled with small business owners/managers and local practitioners -- and they may already know each other.  There's a severe shortage of doctors in some specialties and some towns.  This will be a conversation with "the front line."   In fact, there will be a panel of local doctors and employers as part of each of the Summits, reacting to the recommendations made in the new ACOEM work disability prevention guideline, and talking about which ones they believe can be implemented successfully in their community. 

One of the things I love about this 60 Summits Project is the unique flavor and features -- and people -- in the workers' compensation and disability benefits system of each new state I visit.  Given the comparatively harsh , remote, and rural quality of life in North Dakota, I bet I'll be learning some new perspectives.   I'm also willing to bet I'll hear the same major themes in North Dakota that are everywhere. 

1.The lack of a team approach to preventing needless work disability during the stay-at-work and return-to-work process is harming the well-being of individuals, companies, and communities.   

2.People of good will in these two most critical stakeholder groups are inspired by the new model of working together portrayed in the Guideline as a good way to achieve better outcomes of the worrkers' compensation system for both injured workers and their employers.

Bringing the 60 Summits idea to Montreal, Quebec

The 60 Summits Project is entering Canada for the first time.  [The "60" in our name comes from the number of US states (50) plus Canadian provinces (10).] 

I'll be in Montreal the week of August 20, and among other planned activities have invited a small number of people to join me in exploring the feasibility of creating a stakeholder summit to propagate the new work disabiltiy prevention paradigm there -- in other words, to bring The 60 Summits Project to Quebec.   

The purpose of the meeting is to answer these questions:

1.  Is the time ripe in the province of Quebec to build a widely-shared positive vision of how the stay-at-work and return-to-process should function -- and then make that a reality? 

2.  Should we capitalize on the new paradigm embodied in The American College of Occupational & Environmental Medicine's work disability prevention guideline and use it as the framework for discussion at a Stakeholder Summit on Preventing Needless Work Disability by Helping People Stay Employed?

3.  Are there desirable future outcomes that such a Summit might make possible?

4.  Are there enough people of good will with gumption and commitment to "improving the system" available and willing to do the work to plan and produce a Summit for Quebec?

Stay tuned -- We'll wait to see who shows up, and how they react to the idea.  For me, this meeting is going to be especially fun because I enjoy listening to and speaking French -- even though my ability is at about the level of a nursery school age child.  It will be fascinating to appreciate how these issues look to Canadians and particularly the Quebecois.

I'm also going to be in Montreal to give a lecture on disability prevention and the use of disability duration guidelines that will be filmed as part of an on-line curriculum for physicians who are working in the area of insurance and legal medicine.  Three Canadian physicians will be part of the session.  Again, it will be fun to engage in dialogue with physicians in a different country (and thus a different environmental context) about a topic of shared interest.

6/12/07 Northern CA SAW/RTW Summit - Maybe there's space for you

There may still be a few seats available at the Northern California Summit on Promoting Stay at Work and Return to Work next week.  It's on June 21 at a Safeway Stores facility in Pleasanton.  If you're from California, understand the stay-at-work and return-to-work process, and are interested in being part of this potentially history-making event, go to the GREAT Northern CA Summit website, read up, and then register. (Registering does not guarantee you a seat since space is limited -- the enrollment is capped -- and the planning committee is balancing representation among various stakeholder groups.)

People of good will who have been waiting for an opportunity to pitch in to improve "life outcomes" for injured / ill employees in health-related employment situations -- and their employers -- whether in the disability benefits or workers' compensation arena -- should try to attend.  (If you're tempted to come in order to complain or blame others, do us all a favor and stay home!)  With every additional committed and well-informed person there, the odds get better that this Northern California event will be a milestone of a meeting!   

At the Summit, you'll sit side by side with a powerhouse list of other stakeholders and work together to figure out how to make the recommendations made in ACOEM's latest Guideline on Preventing Needless Work Disability by Helping People Stay Employed come to life in California! 

If you come, I'll see you there.  As founder and chair of the North American 60 Summits Project, I'm keynoting the session, along with Herb Schultz, the senior advisor on health policy for the Governor of California.

JHC

Happy News! Prudential sponsors the 60 Summits Project!

Yesterday it became official.  Prudential Financial is the first charter North American sponsor of The 60 Summits Project!  Their generous grant is going to make it possible for us to enter at least 5 additional states in the next few months. [We’re figuring out now which states are the best choices.  Any nominations?]  We will also be able to provide financial support in the form of partial matching grants to all the Summit planning groups now at work. 

In the last two weeks, The 60 Summits Project has been separately incorporated as a non-profit corporation in Massachusetts, and we have a new logo and website: www.60Summits.org.  It's still pretty basic.  More to come.

This rapidly-growing project is SUCH a great learning experience for us all.   For most of my life, I’ve been “ahead of the ball” but the pace of the 60 Summits Project keeps me scrambling.  Every step of the way, there’s something to improvise for the first time, an error to correct, an aha! and lesson for next time, and so on.  It’s very demanding, but truly exhilarating.  Happily, Prudential’s sponsorship also will allow us to further develop the central infrastructure we’ve realized is required to provide appropriate support services to existing and future Summit planning groups. 

To my knowledge, our grass-roots multi-stakeholder approach to creating positive change in disability benefits and workers’ compensation systems is unprecedented.  It is truly a joy to discover there are so many people of good will who are attracted to the 60 Summits Project because they are intent on making a positive difference.  I keep discovering that I’ve underestimated people.  In my previous life, I’ve sometimes been disappointed by people who initially looked promising.  The delicious thing about this project is that people whom I have never met or barely know keep showing up, taking on leadership roles, and then delighting me (and themselves and their fellow committee members) by demonstrating previously unseen skills, competencies -- and achievements! 

The Northern California Summit on Promoting Stay at Work and Return to Work is next week (June 21).  This ad hoc group composed of many stakeholders has put together a powerhouse of an agenda and guest list.  Check out their website at: http://www.saw-rtw-californiasummit.com.

Dr. J's Jitters / "First Class Comp"

I've got the pre-speech jitters -- again!  Am en route to Phoenix to serve as keynote speaker for the National Council of Self-Insurers conference.  I'll be talking about the new ACOEM* Guideline on Preventing Needless Work Disability by Helping People Stay Employed and Webility's 60 Summits Project. The NCSI audience will be mostly executives and managers who are responsible for their company's self-insured workers' compensation programs.  Since companies have to be pretty large to self-insure, they tend to hire people who are work comp experts.  Thus, this audience will be "system savvy."  I wonder if they're so savvy about the status quo that they won't be attracted to my story about a potentially brighter future.

Something's been missing in both workers' comp and disability benefits systems: a detailed vision of how the system ought to work -- what ought to happen from the employee's point of view as well as the employer's.  Mostly the participants in these systems talk about what is wrong or what we don't want to have happen.  Remember how shocked you were when people first told you about how the "comp system" works? --- the way that people's faces hardened and that cynical note in their voice?   Today, when you tell people you meet that you do a lot of work in the workers' comp or disability benefits system, do they say: "Gee, that's so cool; I wish I could do that!"?  Many people think of these systems as boring and beaucratic, or corrupt and adversarial, or sleazy or unattractive, right?

So, just for a shocker to get people thinking differently, I'm going to invite the NCSI audience to play with this idea:  "What would a first class workers' comp system look like?" By first class, I mean a system that is the equivalent of Nordstrom or LLBean for retail, the Four Seasons or the Ritz Carlton for hotels, or BMW or Mercedes Benz for cars.

Key point:  Nordstrom, the Ritz, and BMW believe that if they give people a wonderful product and fabulous service, they'll want to buy more and keep coming back.  In the game we'll be playing at NCIS ("First Class Comp"), the assertion is that if we give people fabulous service, they'll want to buy LESS because we'll meet their needs so completely and appropriately.  Injured/ill employees will stop "buying" unnecessary and inappropriate medical care, and both injured/ill employers and their employers will stop "buying" unnecessary time away from work.

Second key point:  This is NOT JUST about being polite to injured workers' and their supervisors -- though that's part of it.  And it is CERTAINLY NOT about catering to their every whim and demand.  We're talking about starting from the position that workers and their supervisors are each important  individuals who powerfully influence the outcome, and that we are being curious about how they see the situation, earning their trust, engaging them in the search for solutions, and really meeting their legitimate needs. 

When we're delivering "First Class Comp", we'll have shifted the focus to include more than simply watching what the worker does and how the employer responds and then deciding what that means for our workers' compensation or disability benefits claim.  We will now be planning ahead, anticipating people's needs and reactions, focusing on the whole situation created by the worker's injury or illness, envisioning the realistic best outcome given the circumstances, and then using best practices strategies and protocols to drive the situation towards that optimal resolution.   

The Guideline and The 60 Summits Project are designed to build a widely-shared positive vision of how the stay-at-work and return-to-work process could work.  Will that appeal to the NCSI audience?  Will the blueprint for improvement that the Guideline lays out make sense -- and lead them to take action? Will the grass-roots approach of the 60 Summits Project strike them as hopelessly naive, or as a good way to get action going in their own company, community and state?  Exactly how cynical and resigned are they?   

My goal is to leave the NCIS meeting having had at least 25 conversations with companies who are intrigued by The 60 Summits Project and say they want to get involved.  (Of course, I also hope some employers will be curious about how Webility's training and consulting services might assist them internally.) To date, the most enthusiastic Summit planners in Oregon, California, Arizona, and Ohio have been large employers.   Stay tuned . . .

(*ACOEM = American College of Occupational & Environmental Medicine, the professional society for occupational medicine physicians.)

Designated Guessers

Talked the other day with a doctor who works for a large workers' compensation carrier.  He's been asked to design and teach a course for physicians on how to set work restrictions and limitations.  He hesitated and stammered a bit and then confessed that he's realized that the emperor has no clothes in this area  -- that in fact no doctor (not one) REALLY knows how to do this accurately (in advance) because there is little or no evidence-based science on this topic, nor are there any studies supporting any of the specific estimates that the doctors make about work capacity.   In fact, the few studies there have been either refute or fail to address the predictive accuracy of the methods in common use.

So, the doctor from the insurance company and I laughed ruefully, and I found myself describing the doctors as "designated guessers."  Someone's simply gotta give advice to workers, to their employers, to benefits claims adjudicators and sometimes the courts about what an injured or ill person should avoid and what they can do safely.  I suppose it's actually better to have doctors doing the guessing than carpentry supervisors or benefits clerks.  At least the doctors have been trained in anatomy, physiology, and they have watched lots of people get sick and then heal and get better.   Orthopedists and occupational physicians (those who treat lots of work-related injuries) are more practiced at making these SWAGs (scientific wild-**sed guesses) than most other doctors are.  But they are still making guesses.  What's really weird is how quickly these guesses become the "revealed truth" written in stone.

Bluntly, doctors are being asked to predict the future, and to predict performance based on fragmentary knowledge of objective medical/physical factors only in an area where motivation, cultural and personal beliefs, individual tolerance for discomfort and fatigue, environmental and emotional suppport, skill/training/expertise, natural ability, and many other non-medical factors play a major role in what actually happens.  Realistically, the best way to tell if someone can do a job safely and comfortably is to let them try doing it, assuming they want to succeed.  Sadly, retrospective advice is not what is usually required, and not every worker wants to succeed at the tasks.   And, the fact that someone has been safe/comfortable "so far" is not a guarantee that they will continue to be so.

Studies have shown that doctors' advice tracks more closely with their own beliefs about the value of work, how to behave when ill, and the hazards of activity in general than with any factual information.  And, in the lone study of which I am aware that addressed the issue of the predictive ability of functional capacity evaluations (FCEs), they were found NOT useful in predicting people's actual ability to perform successfully at work. 

Things will get better if we start from the reality that the doctor is guessing.  How can we help the doctor make the best quality guess? 

Wouldn't you think that the best way to figure out what workers can do is to ask them?   But what about medical risks in the situation that the workers can't anticipate because they don't understand the process of wound healing or the side effects of their medications or overestimate their stamina or length of recuperation?  This is where we really do need medical expertise, but the problem is that almost all doctors have never been taught either a logical or a standard method for figuring these issues out (and there IS no generally-accepted method yet).  Also, as pointed out on page 11 of the new ACOEM Guideline on Preventing Needless Work Disabiltiy by Helping People Stay Employed, there is NO authoritative and comprehensive resource available that lists the medical risks for workers with particular diseases or in particular work environments or trades.  (The new book A Physicians Guide to Return to Work by Talmage and Melhorn from the AMA Press is the closest approximation available.)

Another reason why employers/payers don't want to ask the workers what they can do is that they don't trust the workers to be truthful.   This is where things REALLY get complicated.  Unfortunately, the doctors' ususal reaction to being put on the spot is .. . . . to ask the workers what they can do!  So what good did it do to put the doctor in the middle?

If we assume for the moment that ill-prepared doctors around the country (and world, for that matter) are being pressed into service as the "designated guessers", then it seems to me that it would make sense:

1. to train as many of them as possible how to think through these situations, and to develop some standard models to teach them.  I've been giving basic lectures on this topic to clinicians who laugh with relief when I acknowledge that we're all making guesses, then pay rapt attention and are grateful for the material -- they feel awful about having to make these decisions day in and day out without any conceptual or clinical model to rely on.  Remember, these are people who went into their chosen profession because they like feeling expert and masterful.

2.  for the other parties with personal knowledge about the situation to help the doctor as much as possible -- to contribute the data and background information they have, to point out aspects of the situation that are of concern or seem pertinent, etc. 

3.  to treat the doctor's advice as a tentative first cut, instead of the truth written in stone.  If the doctor's opinion seems off base to others with personal knowledge of the situation or experience in giving guidance in similar-seeming situations, then provide that data in a helpful manner to the doctor and ask for a re-thinking in light of the additional information.  Or, even better, have a conversation and work together in dialogue instead of sending formal missives back and forth to resolve the issue.

If we all start thinking of the stay-at-work and return-to-work process as a team sport with team members in different sectors of society, and if we have compassion for the doctors who are doing their best with an impossible task, and start collaborating on putting together a complete picture of the situation, the decisions that get made will at least be (a) based on richer data about the actual situation at hand and (b) more credible to all parties because they have all played a role in developing it.

Definition of "disability" in the ACOEM SAW/RTW Guideline

Two people have communicated "upset" to me recently about the negative way that disability is referred to in the new ACOEM Guideline on Preventing Needless Work Disability by Helping People Stay Employed.  When the second one spoke up, I got curious and checked the text of the Guideline.  Oh my gosh!  A critical definition was eliminated when the editor cut about 20 pages from our committee’s original white paper in order to make the final Guideline a more manageable length.  That omission has created understandable confusion.  And it turns out other key background information was also eliminated that helps clarify the context for the document.

On page 9 in the original white paper that was the source material for the Guideline, we defined “disability” this way:

"In this paper, we use the word 'disability' the same way that employers use it in their benefits programs and employment policies, and the same way that insurance laws, regulations, and policies do. We use 'disabled' to mean someone who is absent from work or not working at full productive capacity for reasons related to a medical condition. Please note that confusion is common regarding the word 'disability' since it is sometimes used to describe physical or functional impairments. For example, a person who has an impairment that affects one or more life functions is considered to have a disability under the Americans with Disabilities Act (ADA). However, people with ADA-qualifying impairments who are working at full productive capacity would NOT be considered 'disabled' according to our definition, because they are at work."

On page 10 in the original white paper, we also made it clear where the main focus of the Guideline was intended to be.  Here’s what we said:

"The focus of this paper is on the surprisingly large number of people who end up with prolonged or permanent withdrawal from work due to medical conditions that normally would cause only a few days of work absence. Many of those who end up receiving long-term disability benefits of one sort or another have conditions that began as common everyday problems like sprains and strains of the low back, neck, shoulder, knee and wrist, or depression and anxiety. As we will discuss below, prolonged work withdrawal (disability absence) by itself can produce unfortunate consequences, and this is one of our major concerns.
"On the other hand, many of the people who receive disability benefits have severe illnesses like a major cancer or schizophrenia or have suffered catastrophic injuries such as amputations, blinding, major burns, or spinal cord injuries, or have had major surgery. These people, too, are susceptible to the influences described in this paper, although the effects may be overshadowed by the obvious difficulties of coping with medical problems of this magnitude, and the need to learn skills and methods to deal with any resulting impairments. In these cases, a prolonged period of work absence is often unavoidable. The traditional rehabilitation approach delivered by an array of professionals was designed to meet the needs of these people. The question still arises: what amount of this work disability could be prevented?
"We contend that a considerable amount of the work disability due to common everyday conditions (and an unknown fraction of the disability that follows more serious conditions) is avoidable, as are its social and economic consequences. We believe that a lot of work disability can be prevented or reduced by finding new ways of handling important non medical factors that are fueling its growth."

So, I have added these important sections to the “Introduction to the Guideline.”   The revised version will appear on our website  (www.webility.md) in the next day or two. I will also make a point of clarifying the definition of disability whenever I talk about the Guideline in the future.

I'm grateful to the people who spoke up, especially because they spoke up passionately enough that I got curious.  I was sure that definition was in there, and couldn't figure out why they didn't "get it."  Their speaking up helped me correct a misunderstanding that has been hurtful to people who don’t need more problems -- and that might have weakened the Guideline’s effectiveness. 

My personal goal -- and imagine that I speak for the 20 other physicians who developed this Guideline with me -- is for this Guideline to help all people who experience illness, injury, age or any other kind of “differentness” -- particularly those for whom this represents a change -- to get the support they need so they can continue to have productive lives in society and the fullest practicable participation in life. 

ACOEM Cornerstone Summit Report

Dr. J’s First Jottings

Last Friday, a report arrived in the mail entitled “Shaping the Future of Occupational Medicine: Finding Opportunities for Collaboration”.  It summarizes the results of the American College of Occupational & Environmental Medicine’s Cornerstone Summit held in late January 2007.  The by-invitation-only meeting was the College’s first step towards building relationships with employers and payers.

The culmination of about five years of effort, the Summit began as a blinding flash in which I realized that ACOEM, the professional society for occupational physicians, had no “face” turned towards employers and payers, despite the fact that they write the checks for virtually all occupational medicine services.  ACOEM had traditionally focused on its own members, the public policy arena, and in particular the legislative and regulatory arena, especially federal agencies like OSHA and the DOT.  Things are changing:  today the ACOEM website has some portion of its pages designed for purchasers or users of occupational medicine services.

After leading a couple of preliminary smaller projects in this area, I chaired the committee that planned the Cornerstone Summit, and facilitated the daylong session.  The 7 employers who attended were not just large national organizations (Wal-Mart, Tyson Foods, Marriott International, the US Postal Service), but also regional (Reinhart Food Service, First Energy) and local (Duke University) employers.  The 8 payers present included some really big ones (Liberty Mutual, AIG, State Compensation Fund of California, Sedgwick CMS) but also some local ones (the Texas Association of School Boards, Unisource Administrators from Florida, Workforce Safety & Insurance (the North Dakota state workers’ compensation fund), the Food Industry Self-Insurance Fund of New Mexico.) Ten ACOEM members attended, representing the three funders of the project: the ACOEM Board of  Directors,  the ACOEM Private Practice section and ACOEM Work Fitness & Disability section.

Originally intended to be a wide-ranging discussion about the future of occupational medicine, the employers and payers in the room mostly wanted to focus on the new ACOEM work disability prevention guideline and how the three parties at the table might be able to work together more effectively in the stay-at-work and return-to-work process.  Four work groups, each with physician, employer and payer members, were formed and will continue to work together develop, refine, and try out new ideas that emerged during the Summit.   They are:  (a) forms and tools; (b) education; (c) processes and models; and (d) incentives and legislative mechanisms.

You can get a copy of the Cornerstone Summit report by calling ACOEM at 847-818-1800.