WC Stakeholders Look to Get Injured Workers Into Elective Procedures

Sarasota, FL (WorkersCompensation.com) – Many injured workers awaiting ‘elective’ surgeries have been on hold for weeks due to the coronavirus. With surgical centers shuttered in some areas and hospitals reserving their operations for only those with emergencies and COVID-19 cases, other patients have waited patiently on the sidelines.

That’s beginning to change, now that states are starting to lift their restrictions. What that means for injured workers awaiting surgical procedures is a big question. There are many considerations; such as whether particular facilities are able to accommodate these patients and to what extent, the geographical location and local infection rates, and how to prioritize which patients to treat first. Thought leaders say it could be a long and arduous transition.

In the meantime, the postponements of procedures is taking a toll on injured workers, both physically and, often, emotionally.

“It’s great that surgical centers are starting to open, that people have hope and there’s a light at the end of the tunnel,” said Andrea Buhl, SVP of Clinical Operations at Sedgwick. “But it’s definitely been a long journey for these workers.”

Elective Surgeries in the WC System

The exact definition of ‘elective’ surgery may vary by jurisdiction. Essentially, it includes procedures that, if not done immediately, do not pose a significant health risk to the patient.

Along with cataract surgeries and cosmetic procedures are many that affect injured workers. Chronic rotator cuff tears, posterior cruciate ligament injuries, degenerative meniscal tears are examples of the conditions treated with elective surgeries.

“Carpal tunnel surgery is a really prevalent one,” said Michele Hibbert-Iacobacci SVP of Regulatory Compliance Management at Mitchell International. Also “removal of orthopedic devices that can be infected, or having a cast replaced – they don’t last forever.”

Just how many injured workers are affected is not specifically known. But it is “definitely a significant amount,” Buhl said. “Just at Sedgwick over the past year for closed claims, about 5 percent had some sort of surgery.”

Impact of Delayed Treatment

While delaying elective procedures is not life threatening, it can result in more problems.

“While they may not be working, [injured workers] still have the potential for that injury becoming more severe just through activities of daily living,” Buhl said. “What they do on a regular basis - taking care of children, bringing groceries home, when you have an injury and do all those and are not getting the treatment you need it can definitely take a physical toll.”

The effect on an injured worker’s emotional health can also be very pronounced. In addition to the pain and dysfunction they may be experiencing are fears and anxieties about when an end may be in sight. Caregivers may unknowingly exacerbate these concerns

“If the provider who’s supposed to do surgery doesn’t communicate with the injured worker - or anybody - about it being postponed and keeping them in the communication loop,” Hibbert-Iacobacci said. “Cancelling is one thing, but not talking for two or three months causes a lot of angst.”

Additional delays in elective surgeries also add to the costs of caring for injured workers. Injured workers who had been scheduled for certain arthroscopic procedures in March or even April could have been back at work already. Instead, they remain on disability.

“It could really affect indemnity costs,” Hibbert-Iacobacci said. “There are probably in some cases going to be requirements to see the provider via teleconference or in person. So not only is there a delay in the timeline to when he’s needed surgery, we’re also going to pay for physician visits we wouldn’t have. Depending on how long it goes on, it could end up being a multiplier.”

Reopening Expectations

Providers expect to see an immense pent up demand for surgical and other elective procedures once these are again offered. A variety of organizations are offering guidance to facilities on how to open and prioritize the patients to be treated. Getting injured workers treated may be challenging.

“The injured worker is going to be in line with all the other non-injured workers to get healthcare,” Hibbert-Iacobacci said. “There’s really no blueprint … the triage needs to include a re-evaluation of the patients who have suffered very significant delays.”

Hibbert- Iacobacci points to the College of Surgeons and the Annals of Surgery as resources for how this triaging may be rolled out. For example, the Annals of Surgery suggests a way to prioritize patients.

“Those who suffer from acquired and persistent morbidity should be prioritized over others; those who have multiple problems other than, say, the ligament tear. [There] could be underlying problems,” she says. “They suggest delays for things like cosmetic surgery.”

The Ambulatory Surgery Center suggests those doing surgeries start “with patients who have lower co-morbidities and surgical risks,” and “with procedures that are lower risk with regard to airborne transmission and those with minimal risk of unintended hospital admissions.”

Medical authorities say patients can expect to see the following at facilities doing elective surgeries:

• Fully masked staff members, including those in the front office.
• Possible requests for patients to also wear masks.
• Family members encouraged to wait in their cars or at home until they get a phone call.
• Requests to answer a variety of more personal screening questions about their recent travel, symptoms and what they’ve been doing or who they’ve been with.
• Longer wait times.

While they await planned procedures, some injured workers are getting help to prevent reinjury and prepare. Sedgwick, for example, has a surgical nurse program dedicated to nurse case managers with a primary focus on surgical claims.

“Even though there is no surgery they’ve reached out with tips to make sure their nutritional intake is optimal. That’s important for wounds to heal properly,” Buhl said. “They’re providing a lot of information for nutrition and sleep hygiene, and providing recommendations for mental imagery and meditation to help people manage through their pain and anxiety.”

As states begin allowing elective surgeries, the nurses are reaching out to providers on behalf of injured workers. They are also suggesting ways the injured workers themselves can prepare.

An example is “preparing meals in advance, since they may not be able to cook food; ensuring their homes are safe and clearing throw rugs that might be a fall risk,” Buhl said. “They are providing a lot of education so they can have a better outcome and make sure they are making the most of their down time to prepare and recover quickly.”

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