Evaluation centers help close workers' comp cases
Evaluation centers help close workers’ comp cases
Hospital offers independent assessment of workers
The staff at some HealthSouth Corp. rehabilitation hospitals are providing their expertise to evaluate injured workers and their ability to return to work. The HealthSouth Evaluation Centers provide an independent assessment of injured workers to help resolve workers’ compensation, long-term disability, personal injury, and product liability claims.
The Birmingham, AL-based company is operating 17 evaluation centers in six states, with additional facilities to open in 1997.
"The centers are designed to serve the workers’ compensation system or any rehab system where questions need answering about case closure," says Devin Troyer, MD, of Health-South’s evaluation center at Health-South Columbia (SC) Rehabilitation Hospital.
The evaluation centers are staffed by a case manager, a technician, a therapist or exercise physiologist to do the computerized testing, and physicians who are board certified as independent medical examiners.
Most of the patients tested at the Columbia center are workers’ compensation patients who are referred for case closure to determine if they have met maximal medical improvement, says Jan Shaw, MS, clinical exercise physiologist who performs the tests on patients referred to the HealthSouth Columbia Evaluation Center.
The majority of referrals are from insurance adjusters or workers’ compensation case managers, Shaw says. Other referral sources include rehab specialists, employer risk managers, treating physicians, and defense attorneys.
"We aren’t biased one way or the other. Our system is set up to be very objective. Regardless of who refers the patient, we anticipate being able to generate the same outcome," Troyer says. Physicians and rehab specialists who refer often have been asked to rate a patient’s impairment or disability and want the kind of objective data the HealthSouth center offers before making the decision, Shaw says.
Questions the centers answer include:
• Has the patient reached maximum medical improvement?
• Does the patient have a permanent impairment or disability? Did the impairment partially or totally exist before the current claim?
• Can the patient return to work? If so, what restrictions apply?
• Will the patient respond positively to a rehabilitation program the case manager is considering?
• What treatment program should be considered to help the patient achieve maximum medical improvement?
When a referral comes to an evaluation center, the case manager compiles all medical records, interviews the patient, and puts together a complete report for the physician.
After performing a comprehensive examination, the physician instructs the technician which of the center’s testing protocols should be administered. Among the protocols are spinal range of motion, static lifting, dynamic lifting, hand grip testing, and strength pinch testing. A subjective pain rating by the patient is included in the testing.
All of the equipment used in the testing protocol is hooked to a computer that measures and reads the result, then generates a report.
The center’s physicians generate a final report using the medical records and the results of the physical examination and testing.
The HealthSouth computer system includes a database with information on normal range of motion for people of different ages and compares them with patients, Shaw says.
The computer has internal validity testing to determine if patients are giving full effort on any part of the test. For instance, patients are asked to squeeze the hand strength instrument three times during the testing. The computer programs can calculate if all three efforts are close to the same strength or if the patient is fudging on any of the efforts.
"A lot of times when we are seeing patient for closure, a patient has been coached that the worse they are, the better their compensation is going to be. We have built in a lot of validity checks that tell us if a patient’s effort is valid or if they are attempting to feign weakness," Troyer says.
Ensuring validity
The data produced by the HealthSouth Evaluation Centers’ assessment protocol meet statistical standards for "test-retest" and "inter-rater" reliability, Troyer says. This means that if the tests are performed by someone else or on another day, they will produce the same data, he explains.
The Columbia facility, which opened in April, performs about three evaluations a week, but Shaw adds that some HealthSouth centers that have been open longer see as many as eight patients a day.
The evaluation takes about three hours. The center has a complete report for the referral source in two to three business days.
The rehab center’s marketing department has arranged presentations for the workers’ compensation commission, insurance company case managers, defense attorneys, and other referral sources.
"People who refer patients for a functional capacity examination or an independent medical examination may find that the data generated at an evaluation center is as valuable if not more valuable. Our data includes the best of everything for those," he adds.
The center has not been open long enough to compile any statistics on case closure, Troyer says.
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