OARP Newsletter

President's Message
What Makes a Rehabilitation Case Difficult?

It is the second day of the war, raining, and I am sitting at home pondering the perplexing question about the kinds of clients that pose the most counseling difficulty. I am not engaging in such speculation just to avoid thinking about how excited, anxious and guilty  I feel about war in general, and this conflict in particular, but because the concept of case difficulty is an important, yet neglected aspect of the rehabilitation process.  Case difficulty is also a critical component in my effort to better understand and conceptualize decision making about cost services and the contractors who provide such assistance.     

Discerning readers may recall that the topic of using data to demonstrate the effectiveness of our profession was a subject of mine in a previous column.  Since then, I have used the opportunity presented by the necessity of a research paper in my graduate class covering research methods to write about how one could use data in making better service referral decisions. Little did I know that my decision to write about a real problem, namely who to chose to provide cost services, would lead me into philosophical morass of technical complexity and controversy. Actually, I must have had some idea because I initially tried to avoid any inclusion concerning case complexity in my paper.  Unfortunately, my wife Beth would not allow me to escape the importance of a case complexity rating in what I was proposing.  Consequently, I reluctantly returned to literature research and immediately determined the subject was fraught with construct and methodological peril. With my final grade hanging perilously in the balance, I took the offensive in the paper to decry how lame the idea was.  I ended with the recommendation that it would be relatively easy to for  rehabilitation professionals that I knew to easily list case difficulty elements and come to an agreement as to which elements best differentiate the easiest from the hardest.

This is where you come in.  Even though I did get an A, the instructor made a rather pointed reference about how difficult it would be to develop consensus about case complexity ratings.  He, of course, was thinking about it in terms of reliability and validity, concepts those of us that are more word-oriented sometimes have problems in understanding.   Well, I know that, even though most of us in the rehabilitation field are not research focused, we at least have the capacity and experience to determine which cases are harder, and why.

All kidding aside, what I would like to see happen is the development and review of case complexity factors and weightings by experienced rehabilitation professionals. The concept would then be used as an integral part of the contractor service profile tool  I have created.  The contractor service profile tool uses outcome data to assist those who are responsible for service authorizations in deciding who to chose to provide a particular service.   By itself, a case complexity rating system would have other applications, as well.

The rain has stopped and I can now hear a CNN commentator rapturously describing the devastating effects of some new type of ordinance. Maybe we also need some measure of war complexity.

Dan Irwin
OARP President
2002-2003

Treasurer's Report

Fedor Alvorado, OARP Treasurer, reported net assets of $5,303 as of the last Board meeting on April 15, 2003.  As always, feel free to contact any Board member to comment or recommend how you think OARP might best utilize this money to benefit members.

HIPAA
Health Insurance Portability & Accountability Act

by Michele Nielsen,
RN, BA, CRC, CLCP

On Monday April 14, 2003, new HIPAA rules went into effect to protect patients’ privacy.  While this is good, it has also caused vocational counselors difficulty obtaining important medical information such as work releases, physical capacities and the like.  Oregon’s Workers’ Compensation Division has both a HIPAA Coordinator, Twyla Knowles, and a web site, www.oregonwcd.com.  Twyla can be reached at (503) 947-7805 and is quite helpful.  The web site provides important links.

“Covered entities” under this federal rule are health care providers, Managed Care Organizations, hospitals, etc.  Federal Rule 45 CFR 164.512 (l) states

The HIPAA Privacy Rule does not apply to entities that are either workers’ compensation insurers, workers’ compensation administrative agencies, or employers, except to the extent they may otherwise be covered entities….The Privacy Rule recognizes the legitimate need of insurers and other entities involved in the workers’ compensation systems to have access to individuals’ health information as authorized by State or other law.  Due to the significant variability among such laws, the Privacy Rule permits disclosures of health information for workers’ compensation purposes in a number of different ways.

Disclosure may be made by a covered entity without individual patient authorization and with individual patient authorization.  You may access this federal rule via the WCD website (above) links (Laws & Rules).  If you encounter difficulty with a clinic (covered entity), try using this rule to teach the clinic that, indeed, such information may be released to us as long as we are complying with our administrative rules.

More information will be provided at the Spring Conference.  Plan to attend!

[Editor’s Note: Michele Nielsen has twice served as president of OARP. She has her own private practice.]

Officer & Board Member Elections

All OARP members should have received a ballot by US Mail.  Be sure to vote and return your ballots before May 9^th so that election results can be announced at the May 16^th Conference.

Candidates Are

President-elect: Sandy Johnson

Treasurer: Fedor Alvarado & Michele Nielsen

Secretary: Debbie Cross

Board Members At Large:

Fedor Alvarado
Adriane Gaffuri
Margaret Moore
Grace Smith
Kathy Wallace
Marlene Bastian
Linda Hill
Michele Nielsen
Scott Stipe
Tom Weiford
Cheri Ballantine
Jeanette Jones
Sandy Schramm
Kent Reigel
Gene Frank

Contact the OARP Office if you have not received a ballot!   office@oarg.org

Editors' Notes

The Program Committee is busy making all of the arrangements for the Spring Conference at the Greenwood Inn in Beaverton.  Dan Irwin will give some presidential remarks and past-president, Scott Stipe, will report on the IARP conference that took place earlier this month in Baltimore. The state’s economist will talk on his assessment of the Oregon economy and Preferred Worker Program speakers will give us the latest in worksite modifications in a manufacturing or production setting.  Twyla Knowles, the Oregon Workers’ Compensation Department’s HIPAA Coordinator will be available to answer questions and provide information about the Health Insurance Portability and Accountability Act.

After the yummy and hearty lunch provided by the Greenwood Inn, you will meet the new OARP Board.  Then we will hear speakers from Aetna and Standard Insurance speak about Long Term Disability.  After the break, Bridget Carney will speak about ethical consideration in case management (for 1.5 ceu credits in ethics).  The conference will end with vendor door prizes.  We hope you can join us for this exciting and informative program.

Thanks to the Program Committee members for all the work they are doing to put the Spring conference together.  We are all grateful to Margaret Moore, Sandy Johnson, Grace Smith, Cheri Ballantine, Linda Hill, Debbi Cross and Adriane Gaffuri for their hard work in contacting speakers, vendors, and making all the other arrangements

The Board of OARP continues to thank Linda Hill for her willingness to administer the OARP Injured Worker Fund.  Thanks to all of you who have contributed to the fund to keep it going over the years.

As always, please continue to provide feedback about OARP At Work or anything else related to OARP or the Rehab community to any Board member (names and phone numbers are listed on the front of this issue). The opinions expressed in any OARP At Work article are those of the author of the article only and do not necessarily represent the opinion of the OARP Board or any of its members.

Adriane Gaffuri

Injured Worker

The Oregon Association of Rehabilitation Professionals created the Oregon Injured Worker Fund in 1994.  The fund was created to provide assistance to injured workers with a variety of return-to-work/vocational needs not covered by their insurance carrier.

Due to several very generous donations we have been able to meet the demand.  Recently, the fund provided $200 to an individual starting a training plan.  The money was used to pay their electric bill and provide food until the first time loss payment.  In addition, $200 was provided to another individual starting a training plan, who needed money to pay for a R.V. site and gas to get to and from their training.

There have been several requests over the past two months and the fund balance has dropped significantly.  We are in need of donations at this time.

Anyone who wishes to make a contribution or who wants to request information about the fund can contact any board member or you can contact:

Oregon Injured Worker Fund

c/o Linda L. Hill
833 SW 11^th Avenue
Suite 507
Portland, OR.  97205

OARP would like to thank each of you who have contributed to the fund for your generous donation.

RAU Update

By Adriane M. Gaffuri, PhD, CRC, CCM Jerry says there’s not much new to report.  There have been no changes to the RAU personnel.

The Job Match Program continues to be in operation since this spring.  This program attempts to match preferred workers with employers interested in utilizing the Preferred Worker Program.  The web site for the Job Match is www.oregonwcd.org, then click on Job Match.  Employers can place job orders on the web site and workers can view the job orders and learn how to apply.  RAU is in the process of gathering statistics from employers and workers.  They are attempting to determine how well the program is working and if there are ways to increase its effectiveness in matching injured workers and employers. 

Jerry Rutherford also indicated that RAU personnel have been trying to think of other ways to encourage the use of the Preferred Worker Program incentives to re-employment.  He commented that the Preferred Worker Program lost its sales force with so few injured workers having the assistance of vocational counselors to advocate the use of the Preferred Worker Program incentives to employers on the injured workers’ behalf.  If anyone has suggestions, please contact Jerry.

Bob Williams and Bruce Friedrichsen will give a presentation on worksite modifications in industrial settings at the Spring OARP Conference on May 16 at the Greenwood Inn in Beaverton.  If there is anything specific you’d like them to address, contact Bob or Bruce to discuss this.

Long Term Disability Referral Tips

By Ed Hickok

I had the privilege of being part of a 4 person panel at the 2002 (12/5/02 through 12/8/02) IARP, Forensic Sections annual conference in Orlando Florida.  The panel addressed several issues important to Vocational Experts and Long Term Disability Insurance as they related to:

·         Litigated Cases where the use of Vocational Experts or lack of them, made a difference.

·         LTD Disability Referral Tips (What to expect in referrals from LTD carriers).

·         The Use of Vocational Experts in Litigation, LTD vs. Personal Injury Litigation

·         The Use of Vocational Experts in ERISA cases.

On the panel with me was Bill Harney, Manager of Vocational Services for Sun Life (discussing Litigated cases); Ralph Losey, Esq. (defense, discussing use of VEs in Litigation); Greg Swartwood (plaintiff, discussing use of VEs in ERISA cases and their preparation).

My job on the panel was to address the business end of things, “How to provide vocational services to LTD referral sources”.  Primarily I pointed out that clear communications of expectations and objectives are keys to effective working relations.  I tried to provide general guidelines and provide information regarding the LTD insurer’s expectations of vocational professionals handling, processing, and providing services to the LTD claimant.

We all want to think that the work we do is unique and that is true of LTD companies.  They DO NOT want to be confused with Workers’ Compensation carriers.  LTD insurance and insurers have their own language and expectations; private vocational professionals need to honor these differences (even if they seem confusing or irrelevant to the task at hand, vocational service).  In the 18 years that I worked in comp I didn’t see much difference.  It wasn’t until I started working at Standard seven years ago that I began to understand them.  Please avoid:

·         Referring to LTD claimant’s as “workers” or “injured workers” (They are as likely to have NOT been injured at work).

·         Please do not use workers’ compensation billing, coding or report formats.

·         An overly aggressive vocational rehabilitation stance.  LTD vocational services are generally voluntary on the part of the insurer and are governed by the contract signed by the employer (not by state statute as in WC).

Things to Remember

·         Unless the contract specifies “mandatory rehabilitation” participation on the part of the claimant is voluntary too.     

·         Written reports should be timely and consistent.  Thirty days from date of receipt is a good frame of reference.  If there is a problem, communicate it.

·         LTD insurers understand the value of vocational services and they provide extra contractual services selectively.  Under most circumstances they will provide authorized services only, and then evaluate the results (review the written report, talk to the claimant and vocational professional) to determine the next step within the LTD context.

·         Each file is unique.

·         Only provide the services that have been discussed and authorized.

·         Some insurers have written formats but many don’t.

·         Confirm the receipt of a file or documentation sent to you (in writing).

·         The insurer should get a copy of all correspondence directed to the claimant or other parties.

·         Make sure you have written permission from the insurer before releasing reports or correspondence to ANY third party.

Most Common Service Requests:

·         Claimant Interviews

·         Independent Vocational Evaluations

·         File Review and Opinion, Recommendations, Comments, etc.

·         Labor Market Surveys and Research

·         Vocational Plan Development  and Training Plan Monitoring

·         Work-site Modifications and/or Accommodation, Ergonomic assessment, etc.

·         Job Seeking Skills and Return to Work 

Finally:

What the LTD insurer is looking for from you as a vocational professional and expert in your field is your Professional Objectivity!  If your professional objective, observations, opinions, comments, and recommendations are asked

for, provide them.  As a professional vocational service provider and expert you are often the only member of the insurance team who has seen or met with the claimant.

Be sure to state clearly when medical information is given whether the claimant is reporting their symptoms, diagnosis, etc. (subjective) or if it comes from medical records that are part of the file (objective).  Let the LTD carrier know about any obstacles in getting your job done.  It is generally a good idea to communicate your findings with the insurer prior to writing your report.

I realize that by outlining all of this I have now set myself up as the LTD “Preacher” but that certainly was not my intent.  The opportunity to provide good vocational services to LTD claimants is certainly there for those vocational rehabilitation professionals that are willing to embrace quality service.

I remain impressed with the high quality of service we provide in our profession.  We work very hard at improving what we do and staying ahead of those that seek our service. We should all be proud of the work we do.

[Editor’s Note: Ed Hickok works for Standard Insurance Company and will serve as the OARP President for the term 2003-2004.]

Getting the Most from Your Community Colleges

Throughout Oregon, record numbers of students are turning to their local community college for certificates, degrees or courses to enhance their employability.  Those of you in the rehabilitation community already know that classes are filling more quickly and some needed coursework may be hard to come by.  As I write this article, Portland Community College, like its colleagues is wrestling with what it will take for us to offer quality educational programs in an economy that has reduced our funding by millions of dollars.  I want to offer up my suggestions for how you can be proactive in getting the most out of your local community college in the tough times ahead.

·         Most colleges publish their class schedule on their website before the paper version is available.  This can give you a head start in planning courses.

·         Know the registration schedule for your school and register as early as possible.  You would have thought that Sylvania’s anatomy and physiology courses were a rock concert.  They filled in a matter of minutes this term.

While our Professional Skills Program registers its own students for all of their classes, students in on-campus academic offerings may find online registration a fast and easy way to register. 

·         If it is appropriate for your client or if the class you want is full, consider a class offered in a different venue such as self-paced learning or distance learning. 

·         If you have a student registered in a course of study that you think may be eliminated, know that the program is obligated to give the student some time to complete the course of study or make alternative plans.  

Some classes generate a waiting list. Use the waiting lists generated by classes that are full.  Courses may have students registered who fail to show up or who drop in the first week or two.  Attending the first class and talking to the instructor may also work

·         for some courses and some instructors. 

·         If the courses are all full, you might talk with the department who offers this course and confirm whether they are/or are not considering opening additional sections.

·         For some majors, such as the medical professions, students are accepted in the Fall term as a cohort and continue through their studies together.  From a timing point of view this can be a problem for most of your clients, but it may work for a few and is a good way for them to plan their course of study more easily.

·         If a student doesn’t get the courses they need at the local community college, you might consider other community colleges in the area that are in commuting distance.  There may also be internet classes offered from any number of  sources that could also meet your student’s needs.

·         It is a given that prices will increase.  Not only tuition will rise, but also you will see additional fees charged.  Periodically check the website for your community college and be sure that there are no surprises lurking out there for your vocational plan.

Right now is the most uncertain time.  Colleges are winding up their budget year and going through the final stages of preparing their budget for 2003-2005.  By the time we get to the Summer term most of the big decisions that affect a school’s offerings will have been made.  I believe you will find that your community college is still a place where you can get quality education and training at a reasonable price.

Sandy Schramm
OARP Newsletter
Co-editor