As businesses around the country prepare to reopen, there is a concerted effort
made to prioritize the safety of the workforce through strategized planning.
Employers are also preparing to face more leaves of absence than ever before as
they account for employee childcare needs, at-risk groups with preexisting
conditions, and possible employee COVID-19 cases.
So, how do we approach reopening the economy with these concerns in mind?
Furthermore, how does the workers compensation industry provide access to care
for injured workers throughout this crisis and in the future?
Three industry experts joined us for our special edition Out Front Ideas
COVID-19 Briefing Webinar Series to discuss access to care and the return
to work during the COVID-19 crisis.
- Bryon Bass—senior vice president of Workforce Absence, Sedgwick
- Michele Hibbert-Iacobacci—senior vice president of Regulatory Compliance
Management, Mitchell International
- Jennifer Ryon—chief revenue officer, Prime Health Services, Inc.
Leave of Absence and COVID-19
Sweeping changes to leave of absence laws are rapidly occurring at both the
federal and state levels, helping employers adjust to the needs of their
workforce. They are also expanding our industry's terminology of
"return to work" as it applies to how employers are adapting their
efforts through the pandemic.
The Families First Coronavirus Response Act (FFCRA) bill, introduced in
mid-March 2020, requires employers with 500 or fewer employees to provide their
workforce with paid sick leave or expanded family and medical leave for
specified reasons related to COVID-19. It requires up to 80 hours of paid sick
leave at the employee's regular rate of pay when an employee is in
quarantine or experiencing COVID-19 symptoms and seeking a medical diagnosis.
If an employee needs to take care of an individual subject to quarantine or
care for a child whose school or childcare provider is closed due to the
pandemic, the employee is entitled to 80 hours of paid sick leave at two-thirds
of their regular rate of pay. An additional 10 weeks of paid expanded family
and medical leave at two-thirds the employee's regular rate of pay must
also be provided if an employee must care for a child whose school or childcare
provider is closed due to reasons related to COVID-19. While this only applies
to businesses with less than 500 employees, the majority of businesses with
more than 500 employees have instituted additional paid family leave or allowed
their workforce to use their paid leave for COVID-19-related reasons.
Many state and statutory paid leave policies have extended rights that are
similar to the coverage offered by the FFCRA. Some of the nuances of these
extensions include additional unemployment benefits for individuals that have
been furloughed or laid off. Some states also allow for accrued paid sick leave
for employees and are allowing employees to use these benefits for reasons
related to COVID-19. Employers need to understand that some of these state and
federal changes may run concurrently with offerings from self-insured plans.
Some policies have offset provisions that allow benefits like short-term
disability or workers compensation to be offset by benefits offered at a state
or federal level.
For example, if an employee is taking leave to care for a child whose school
is closed due to COVID-19 reasons, they would benefit from the FFCRA but not be
able to take advantage of short-term disability. Self-insured benefits should
be used as supplemental coverage instead of being used in addition to federal
and state benefits so that the employee is receiving 100 percent of their
standard pay in total.
Business Reopening
As businesses consider their reopening plans, they should consider three
components: preparation, deployment, and sustainability of employees'
return to work. These components should be guided by principles that include
the safety of the employees, visitors, and the general public; compliance from
public health organizations and government agencies; collaboration across the
organization; and agility that enables a swift response to changes that may
occur. Many questions require answers for each component of the plan, including
the following.
Preparation
- Have you considered both community readiness and facility readiness?
- If employees return to the office, can you ensure social distancing? Is
it being enforced within the community?
- Have you adjusted the footprint in your office to allow for safe social
distancing? Is it possible while still maintaining productivity?
- Do you have testing capabilities?
- Will you require personal protective equipment (PPE) to be worn? Can
employees buy their own, or will you supply items, like face masks, for your
workforce?
- Have you allowed for flexibility in the workforce, especially for groups
more vulnerable to the illness and employees needing to care for
children?
Deployment
- Are employees adapting to the changes, or do you see a decline in
productivity?
- Have employees made use of flexibility policies? Is there an increased
demand for leave?
- Do employees feel safe with the return to work, or is their significant
apprehension?
- Are you adapting to the needs of your workforce?
- Are you enforcing the use of PPE? Are employees encouraging others to
maintain safe social distancing?
- Is testing working, or are you seeing a rise in employee
transmissions?
Sustainability
- Have you been able to phase more employees back into the physical
workspace?
- Are employees more productive than they were when working from home?
- Do employees still feel comfortable coming into a physical
workspace?
- Is the community prepared for a possible second wave of the virus? Has a
vaccine been established?
- Are you able to pivot back to a work-from-home model if necessary?
Access to Care
With hospitals not offering elective surgeries due to the pandemic, we may
be considering how our injured workers are getting the care they need. It is
also important to consider how we are handling these changes operationally
between employers and claims teams. Are we considering which patients are more
at risk? Can we use analytics to understand which patients should be
recovering? Are there significant milestones tracked in a patient's
recovery? What are the expectations of your claims teams? Through this crisis,
it is crucial to take a personalized approach to understand both the
functionality of the team and the injured worker within a claim.
Preferred provider organizations work as a network for connecting workers
compensation resources (hospitals, primary care specialists, occupational
health, etc.). Some are providing their clients with a real-time listing of
what providers are currently available, including operating hours and
telehealth capabilities. While serving both the client (third-party
administrator or insurer) and the provider, the challenge lies presently with
how to provide better help to the client. They are currently working with
claims teams on their workflows to act as a liaison for communication among the
payer, provider, employer, and employee. This need for improved communication
will increase as businesses around the country reopen and there is further
demand to locate a provider.
Regulators are assisting in healthcare needs through efforts to push
telehealth legislation. With patients fearing possible exposure from in-office
visits, demand for telehealth is increasing. Harvard reported a 60 percent drop
in in-person visits with a 10 percent increase in telehealth visits. Due to
increased demand, some physicians have rushed to offer telehealth capabilities
without understanding regulations first. States are addressing issues related
to telehealth, such as limitations on prescriptions that can be prescribed over
the phone and the scope of care being provided.
Provider Access
There are concerns about on-hold elective procedures since there are
restrictions on which providers are allowed to operate and which patients they
can see. Dentistry, for example, can only see patients with infections or pain,
which may result in more expensive procedures in the long term. However,
patients are missing wellness visits that are crucial to the recovery
process.
For instance, serious procedures—like biopsies, removal and replacement of
orthopedic devices or hardware, and cast replacements—may result in further
long-term damage to the patient. There may be an increase in the expansion of
benefits in the instances where an injured worker needed care for their
recovery but could not receive it.
With elective surgeries being canceled or postponed, providers are adjusting
through reschedules based on pain levels and how likely a patient may be to
resort to an emergency room visit. With a decline in patients, some private
practices are being acquired and consolidated by larger healthcare systems.
Some satellite physicians are being reassigned to hospitals to help with
pandemic needs. With healthcare staff adjusting to current needs, it is vital
to assess how quickly they can be reassigned back to their original roles when
we return to a state of normalcy and the demand for elective procedures
increases.
Preparing Claims Teams
As we plan for the future beyond the pandemic, there is a need to address
the impact on claims teams. They will need to know how to prioritize medical
care for injured workers. Do they understand how social isolation has impacted
the injured worker? How has this crisis affected recovery and the injured
worker's level of functionality? Do you have tools at your disposal to
suggest help for those impacted more severely? Developing a communication plan
for your claims teams and emphasizing data collection on current claims will
create a more streamlined process while creating a better understanding of the
patient population.
Listen to the full Out Front Ideas with Kimberly and
Mark webinar on this topic. Stay tuned for more from the Out Front
Ideas COVID-19 Briefing Webinar Series, and view the full list of upcoming topics.
Mark Walls is vice
president of communications and strategic analysis for Safety
National. See his full bio.
Kimberly George is senior
vice president of corporate development, mergers and acquisitions, and health
care for Sedgwick.