In Part 1,
I highlighted three different approaches to measuring return-to-work outcomes:
1.
Standardized calculation based on standardized
claims payment data at specific milestone submitted by jurisdictions (AWCBC
approach),
2.
Retrospective survey of workers by central
researcher group using a stratified sample from each jurisdiction withing
strict time frames (Safework Australia),
3.
Retrospective interview approach normalized
for each participating jurisdiction (WCRI)
Each approach
provides insights for stakeholders and policy makers. Comparability and
consistency among participating jurisdictions are often primary
objectives.
Individual
jurisdictions have different objectives in measuring their RTW outcomes, each tuned
to the features, priorities, and demands of their jurisdiction.
With that
in mind, here are four examples of jurisdictional RTW outcome measures.
Texas: 2023
Return to Work
The Texas
Department of Insurance (TDI), Division of Workers’ Compensation, Workers’
Compensation Research and Evaluation Group (WCResearch) analyzed RTW outcomes
for claims between 2007 and 2020 in this report. The report focuses on initial
and sustained RTW (defined as a return to work and staying at work for three
calendar quarters (9 months) following injury).
I asked
WCResearch at TDI to expand on the study methodology:
The
return-to-work report uses data on tens of thousands of employees who received
Temporary Income Benefits (TIBs) after a work-related injury, examining wage
records from the Texas Workforce Commission to determine when these individuals
began earning wages again. The report assesses whether this return was
classified as initial, referring to the first time an employee returns to work
after the injury, or sustained, defined as maintaining employment for three
consecutive quarters. These findings are linked to demographic details such as
age, industry, employer size, and benefit type allowing for further statistical
analysis. The methodology also includes an analysis of average wages before and
after the injury, along with the average number of days employees spent away
from work.
The results
over the study period include the following:
92% of
employees were back at work within one year.
69% of
workers back at work within six months stayed at work and achieved pre-injury
earnings within two years.
Days away
from work averaged 43 (median 29).
For 2020
injuries, the initial RTW rate at six months post injury was 83%, a bit higher
than the average 80% for the 2007-2020 study period. The sustained RTW rate was
69%, higher than the average 63% for the study period.
The “sustained”
RTW outcome in this report is striking. The
three quarters (9 months) of earnings post RTW is a significant threshold and
the objective sources for this data provide a rigour not found in many studies
that rely on interview responses.
One
challenge with this study approach is the lag necessary for a year’s cohort of
claims to fully develop (close) to their ultimate duration. While that is
happening, changes to law, policy, practice, and economic conditions may impact
current RTW results.
Victoria
Australia: WorkSafe Victoria RTW
WorkSafe
Victoria has made return to work a “headline” Key Performance Indicator (KPI)
in their Corporate Plan 2023-2024 and Strategy 2021-2024. (https://www.worksafe.vic.gov.au/resources/corporate-plan). “At a headline level, we measure safe and
sustainable return to work outcomes for injured workers with physical and
mental injuries at 16 weeks, 26 weeks, 52 weeks and 104 weeks post claim
lodgment. A return to work is defined as one that has been sustained for a
three-week period.”
In
Victoria, the claims management function is delivered by third party “agents”
with WorkSafe Victoria oversight. Remuneration of agents includes a performance
adjustment for meeting targets set for RTW outcomes at 26 weeks. Claims
management software requires case managers code RTW status upon case closure and
provide for case notes or other documentation confirming RTW details.
The
following is my summary of WorkSafeVicotria’s methodology for the26 week (182
day):
1.
Calculation:
Number of injured workers
working at 182 days [divided by]
Population (paid claims in
reporting period with > 10 days weekly compensation paid (including employer
excess))
2.
RTW Status Assessment made 182 days post injury.
a.
Assessment of whether the worker has continued
to remain at work for three weeks (21 days) following the return to work.
b.
Based on recorded fielded responses in systems
(ACCtion, Fineos) and documentation of RTW (email, letter, Novus note, …).
3.
RTW Status Assessment and Validation at 21
days are subjected to random sample audit.
Note the
exclusion of the 10 days of weekly compensation) in this calculation. Shorter
duration absence in this range typically resolves with 100% RTW. Eliminating
these from the calculation denominator and the numerator will tend to lower the
overall RTW rate than if these cases were included.
WorkSafe
Victoria’s data relies on the integrity of the information encoded in claims
management systems about initial and continued employment at three weeks. Audits of data entries to confirm the integrity
of the coded information is a critical component of this measure.
A key feature
WorkSafe Victoria’s RTW outcome reporting is the separate tracking of physical
and mental injuries. Mental injury cases
tend to have longer recoveries. If a jurisdiction has a larger proportion of
mental injury claims, a combined RTW measure will result in a lower percentage
of RTW at 26 weeks.
For
physical injuries, the result at 26 weeks is 73.60%, but for mental injuries,
the return-to-work rate was 41.60%. This highlights a significant difference
between mental injury cases and other injury types.
WorkSafeBC:
Key Performance Indicator
WorkSafeBC
is the operating name for the Workers’ Compensation Board of British Columbia. Its
operational priorities include “Maximize overall recovery and post-injury
earnings for injured workers”. A key performance indicator (KPI) to track
progress against this priority objective is included in their Annual Report and
Service Plan.
The KPI, “Improve
return-to-work outcomes” carries the description: “The percentage of B.C.
workers who return to work within six months (26 weeks) of their work-related
injury.” The calculation method as stated in the 2024 Annual Report and 2025-2027
Service Plan (p. 34) is described as follows:
“This KPI
measures duration (by 26 weeks), whether the return to work is voluntary (the
worker does not object), and whether it is safe and durable, with no
subsequent inability to work for 30 days. To track the percentage, we
compare the number of claims meeting these criteria with the total number of
wage-loss claims open for more than 26 weeks.” [emphasis added].
Fielded
case management data are used to determine status on closure. The absence of a
claim re-opening indicating an inability to work infers durability. There is no explicit confirmation of sustained
RTW or return to full earnings.
The KPI
results reached a high of 81.3% in 2022 before falling to 78.5% in 2023 and
rising again to 79.7% in 2024. The target going forward is to achieve 81.0%
return to work by 26 weeks. (Note: AWCBC
records 85.00% (2022) and 83.62% (2023) under 25.5-Percentage of Wage-Loss
Claims off Wage-Loss Benefits at 180 days (%)
There is no
waiting period in British Columbia’s workers’ compensation system, so the
results capture many very short duration claims. These cases tend to have very high successful
RTW outcomes. Self-insurance is allowed
in BC but not self-administration, so the results include for these deposit-class
employers (governments, certain large employers) are also reflected in this
measure.
South Australia:
return-to-work milestones
When you
rebrand your workers’ compensation authority “ReturnToWorkSA”, the messaging is
clear. As you might expect, RTWSA has measures that reflect RTW status at
various milestones such as 4, 12, 26, 52, and 78 weeks.
The
data-rich report on ReturnToWorkSA Insurer Statistics FY2024 provides RTW
outcomes for the 26-week milestone, similar to others noted in this part. This time, there are three RTW status
outcomes noted: “Not at work”, “Partially at work”, and “Fully at work”. This reporting reflects a level of importance
on “stay at work” outcomes within the system.
The four-year
time series provided for this milestone reflects a trend toward fewer workers
not working and an increase in the number and proportion of workers fully RTW:
Not at work
5.7%,
Partially
at work 3.5%,
Fully at
work 90.9%.
This is a population-based study reporting on 12,121 cases in the 2024 result. According to RTWSA:
“The milestone is
measured from the workers first date of work incapacity, or injury date if the
worker does not have work incapacity. Improvement has been achieved with a
multifaceted program of work aimed at improving services to injured workers and
employers.”
Note the
subtlety of a worker suffering a work injury but not a work incapacity.
The accepted claim covers the medical costs, but the worker may continue working
on modified duties as part of a stay-at-work program, an approach actively
promoted by RTWSA.
Summary
Comment
Jurisdictional
approaches to measuring RTW outcomes are often specifically crafted to address
particular needs and priorities. Where
the national measures must find commonality among the jurisdictions, individual
jurisdictions can allow the unique data systems and to provide greater
depth. Each approach starts with a purpose,
and each design has its limitations. In
general, the results highlighted by the measure lag significantly behind changes
in policy or initiatives to improve outcomes.
Texas can
focus on sustainable RTW outcomes, WorkSafe Victoria can differentiate results
for mental and physical injury cases, and ReturnToWork South Australia can provide
data on partial RTW and include successful stay at work outcomes that might be
excluded from other designs.
Note the
different approaches in determining sustainability. In Part 1, we saw Safework Australia and WCRI
ask workers directly about their work status as the time of interview. Their retrospective
methodology builds in significant distance from initial RTW to assess
sustainability of the RTW. In Part 2, we
see WorkSafeBC uses a case criterion “with no subsequent inability to work
for 30 days” to exclude non-durable RTW outcomes from its measure, while
WorkSafeVictoria uses an audited 21 day record (or direct/indirect inquiry) to
assess whether the worker has continued to remain at work.
Again,
there is no one “right way” to measure RTW outcomes. Those jurisdictions willing to participate in
studies, establish well defined measures, and post transparent results allow leadership,
stakeholders, and policy makers assess performance and achieve better outcomes
for injured workers and their families.
In Part 3,
we will look at RTW outcome trajectories.
[This post
was prepared as a resource for DMCCT- Evaluating DM Programs & Assessing
RTW Processes, Pacific Coast University for Workplace Health Sciences]
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