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Is Your Functional Testing Program Measuring Up?: 

Is Your Functional Testing Program Measuring Up? Tom Tobin MBA, OTR Fit for Work ™ WellWorkforce.com

Pretty….does it have an engine ?: 

Pretty….does it have an engine ?

Employment Testing: 

Employment Testing System of ADA compliant employment tests and principles designed to prevent injuries, control injury related costs and combat fraudulent claims.

American’s with Disabilities Act (1990): 

American’s with Disabilities Act (1990) Title 1 – “Prohibits employment discrimination against qualified individuals with disabilities” EMPLOYER more likely to discriminate without objective testing

Types of Tests Available: 

Types of Tests Available Pre-offer Agility- physical agility only Post offer (Basic or Comprehensive)–Most leeway Fit for Duty-Existing Injured EMPLOYEE

Testing Customized to Look At:: 

Testing Customized to Look At: Job specific strength Baseline full body function “Significant” medical risks Common cumulative traumas Not Screen out based on arbitrary assessments Basic physicals

“Significant” Cumulative Traumas :: 

“Significant” Cumulative Traumas : Torn Rotator Cuff (Shoulder) Bad Backs (Neurological) Torn knee ligament Carpal Tunnel Operated Parts ETC !!!

ENTIRE MISSION OF TESTING IS:: 

ENTIRE MISSION OF TESTING IS: To prevent injuries To protect employer /employee To provide the best possible RTW conditions To maintain productivity

Slide9: 

MUST INCLUDE… Ergonomic Model Medical Model Functional Model

Employer Nightmares!: 

Employer Nightmares! Don’t know overall physical condition (baseline strength) No policies in place that allow testing post injury No consistency checks\ tests or action plan post injury No data to create accountability about the RTW decision Rising costs / decreased productivity

Another Problem:Worker’s Comp Assumes: 

Another Problem: Worker’s Comp Assumes Worker’s are perfect when hired Worker’s never grow old Whatever happens to the worker, is the employer’s fault

EPIDEMICS:: 

EPIDEMICS: Aging Obesity Arthritis Carpal tunnel

Post offer – Most leeway: 

Post offer – Most leeway Employer may investigate past records for crime, driving, and work related injuries (Background checks) May ask applicant if they can perform specific job tasks May interview and pick the most qualified applicant Will hire them contingent upon passing the post offer physical and drug test.

Post-offer : Medical Provider will or should…. : 

Post-offer : Medical Provider will or should…. Ask medical questions / Hx Ask “conditions” Perform medical and functional tests Expand scope of test and refer if needed Require safe performance of essential job functions Give capable / not capable recommendation

Post Offer Tests Must Be…: 

Post Offer Tests Must Be… Job related and consistent with business necessity Performed on all applicants for a specific job in the same geographic location. Employer gets to choose !! Consistent

REMEMBER…: 

REMEMBER… ADA ALLOWS employers to not hire employees who can’t perform job related and essential functions!

Standardized Protocols for Every Test Component: 

Standardized Protocols for Every Test Component ENTIRE PROCESS (Training Manual) Job Analysis Full Body Eval / Impairment ROM Quantifying “Syndromes” BP, HR, Aerobic Condition Lifting Strength in varied postures Job Specific Tests

Slide18: 

Highest Injury JOBS FIRST JOB ANALYSIS

Slide19: 

105 lb force 80 lbs =

Slide21: 

Confined Spaces

Slide23: 

ACTUAL TESTING

Slide24: 

Roll off Driver

Accurate Job FunctionsRoll-Off Driver: 

Accurate Job Functions Roll-Off Driver Climb up and down 18” step Lift 50 lb trash can from ground to 40” height and dump Repeat 5X (Under 80% MPHR) Lift 50 lb tarp from floor to 45” platform and then return Push 150 lb sled 5 feet and then pull back to starting position Dynamic lift from floor 75 lbs; to overhead 50 lbs. Skid / Turnbuckle

STRENGTH: 

STRENGTH Standard NIOSH boxes 4 Postures Must lift enough to attempt job related tests

Shoulder to Overhead: 

Shoulder to Overhead Instruct in proper body mechanics Avoid twist while lifting Give max safe limits

JOB SPECIFIC TESTS: 

JOB SPECIFIC TESTS Posture Repetition Force Aerobic Demand “ACTUAL” Testing

“Baseline” Full BodyMusculoskeletal Eval:: 

“Baseline” Full Body Musculoskeletal Eval: Posture Range of Motion (IMP measures) Joint Flexibility/ Wear and Tear Strength Palpation Investigation of Damaged Parts Medical evidence to support “not capable” for medical risk

Slide30: 

POSTURE

Slide33: 

Pre-existing Spine Impairment According to AMA Guides

Neck Impairment- AMA: 

Neck Impairment- AMA

Apportionment: 

Apportionment Any “individualized assessment” leading to quantified medical documentation of a pre-existing condition Based on WS data: “Renders decision ordering impairment and supplemental benefits reduced by 40%” Chief Appeals Judge, Case #950268, Texas

Measured Return to Pre-injury Status…..: 

Measured Return to Pre-injury Status….. STOPS BENEFITS !!! Is facilitated by knowing baseline strength and deficits Leads to faster RTW ALWAYS supersedes speculation or UNMEASURED OPINIONS (Porter v. Alumoweld)

Slide37: 

FLEXIBILITY

Carpal Tunnel…: 

Carpal Tunnel… 1/3 occur in first year of employment 15% occur in first 3 months $20,000 avg. per claim $50-300,000 with surgery 90 lost days with surgery CTD News 2004

Slide41: 

DON’T HIRE YOUR NEXT CLAIMANT!

Reasons to Withdraw Offer:: 

Reasons to Withdraw Offer: They can’t perform the functions of the job for which they are being hired! Lie on medical history Bad Attitude Can’t lift enough weight to qualify to attempt job functions Has permanent restrictions that limit ability to perform job tasks (and no qualified disability) Refuses to get medical clearance for a condition that poses a risk to test/ work

Medical Risk: 

Medical Risk Physician Consent to continue with testing process “Weed-Out”… some just disappear “Significant Medical Risk”… Not Capable

Medical Clearance…: 

Medical Clearance… Some conditions are simple Not been released from minor MVA Some are more serious Suspect torn rotator cuff If applicant willing to pay to see MD and gets clearance VERY motivated

Medical Clearance Continued…: 

Medical Clearance Continued… Many applicants disappear… Data limits liability… If time sensitive hiring Legal to make applicant re-apply when another position is available

Benefits to Employees: 

Benefits to Employees Less likely to suffer MSD’s More likely to RTW sooner Able to maintain full or partial wages and remain productive Creates accountable medical Rx Increases motivation and productivity Reduces turnover !!! (Less retraining, sharing work, etc)

Benefits to Employer: 

Benefits to Employer Promotes safe job performance Don’t pay for pre-existing conditions Only pay to rehab to baseline levels Test and treat in same network w/ same protocols (accountability) Don’t hire employees who aren’t strong enough or reclassify Don’t pay anything for doctor releases, hold harmless, and extra measures to clear a condition $30 saved for every $1 spent! Receive legally compliant policies and scientific data to control RTW

How Much Will A Claim Cost?: 

How Much Will A Claim Cost? Carpal Tunnel Low Back Strain Shoulder strain/surgery

Return on Investment Calculation:: 

Return on Investment Calculation: One Back Injury: Direct cost only……………$28k Net profit margin……………10% Additional sales/productivity needed to cover cost: $280,000

Return on Investment !!!: 

Return on Investment !!! Ask Yourself: How many people will I need to test before coming close to paying for 1 Back Injury?

If you use employment testing…: 

If you use employment testing… How many have failed? How has it impacted your incident rate?

Fit For Duty (Existing) : 

Fit For Duty (Existing) “The need for the exam may be triggered by some evidence of problems related to job performance, safety or… “to determine whether individuals in physically demanding jobs continue to be fit for duty.”

Fit for Duty--Existing Employee: 

Fit for Duty--Existing Employee Voluntary Singled out for performance problem Physically demanding (Public service) Other PD jobs: May do physical but not medical tests RTW OSHA defines physically demanding: 4 hrs at computer term. 25lbs. lifted below knee height 75 lbs lifted 1x 55 lbs lifted 10x

Purpose of Fit for Duty Tests: 

Purpose of Fit for Duty Tests Classifies according to risk with pre-determined wellness intervention protocols Identifies those who could benefit from a conditioning program. Stops MSD’s from progressing Allows employer to reclassify/accommodate Discovers disease processes

Fit for Duty—Post Injury: 

Fit for Duty—Post Injury “Under ADA, medical information or medical exams may be required when an employee suffers an injury on the job. Such an exam may be required when an employee wishes to return to work after an injury or illness, if it is job related and consistent with business necessity.”

POLICY“Fit for Duty” Post Injury: 

POLICY “Fit for Duty” Post Injury Effective date, EEs who suffer WR or NWR injury exceeding x lost days… …to determine extent of disability …to determine job capability …to determine reasonable accommodation

DATA IS POWER ..…No Matter How You Use IT !!: 

DATA IS POWER ..… No Matter How You Use IT !! BE ABLE TO TIP THE SCALES IN YOUR FAVOR … IF YOU NEED TO !!

FEARS / EXCUSES: 

FEARS / EXCUSES Cost Time to administer, supervise, stay on top Something else to do….especially something new Would rather pay higher out of pocket deductible Can we get them all done timely? Concerns over if it “works” Concerns over safety of testing My turnover is too high to afford it Complacent…Injuries are a part of doing business Reactive v. pro active is the way we always do it One stop shopping Will the test discriminate We may not be able to unintentionally discriminate as in the past….too old, big, etc We have a new TPA, have a new HR, have just implemented a safety program, etc

Functional Testing PAYS for ITSELF: Significant $avings: 

Functional Testing PAYS for ITSELF: Significant $avings Ability to test high risk new hires –Paid for by not hiring your next claimant / by matching strength to job. Ability to test existing EE’s — Paid for by reclassifying, accommodating, conditioning, medical retirement, detecting symptoms early, job match Ability to ALWAYS test injured EE’s — Paid for by immediate accountability re: symptoms, sincerity of effort, realistic goals (baseline) and ability to RTW in a measured capacity

Slide60: 

“You do not get injured workers well to get them back to work. You get them back to work to get them well.” -Richard Pimentel

Questions?: 

Questions?