Return to Work in Ohio Workers’ Compensation

May is Open Enrollment month for Ohio Managed Care Organizations (MCOs), the privatized solution to Ohio managed care. During Open Enrollment, MCOs are trying to define the competitive advantage between each other. Like in any workers’ compensation managed care program, Return to Work (RTW) is a valuable quality indicator, however, Ohio makes a unique effort to redefine quality RTW.

In Ohio, RTW is measured by DoDM or Degree of Disability Management, a disability management strategy for returning injured workers to work. The DoDM model was built where the length of a disability of each injured worker is positioned on a 100 point scale. -100 is the worst case scenario, 0 in Ohio means Loosely Managed (LM) and +100 is Well Managed (WM) which is the benchmark.

For example, for an Injured Worker (IW) with a given ICD9 code and manual classification, an MCO may actually have returned the IW to work in 4 days. If the optimal, WM benchmark for that ICD9 code and manual classification is 3 days and the statewide average LM benchmark is 7 days, the MCO would have a 75.00% along the continuum from the fixed statewide average (7 days) to the optimal (3 days) for an IW with that combination of designated ICD9 code and manual classification.

The MCO’s DoDM score for a given quarter shall not be based solely on its performance on any one IW’s RTW. The MCO’s score for a given quarter shall be based on its total RTW performance during the reporting period for all claims where the principal ICD9 is one of the 266 designated ICD9 codes being measured for which an actual or released to RTW date, whichever is earlier, was reported.

The BWC has also developed Ohio Specific Disability Duration Outcomes or OSDD is the standard by which optimal RTW dates are established. OSDD data is based on Ohio only workers’ compensation data from January 2000 to December 2003, regarding missed work days based on ICD9 codes. How efficient can 3 years of state specific data be when there is a nationally recognized guideline system already established that is reviewed each year adding the previous year’s data from all 50 states? This system is called ODG.

VOHP uses ODG or Official Disability Guidelines to determine our RTW outcomes which is currently 87%. Since ODG is the national standard and includes a much larger sample of injuries, the guess work is taken out of measuring our RTW outcome. The data does all the work for us.

DoDM and OSDD seem to muddle the big picture with in depth formulas and bureaucratic jargon…does it really have to be this complicated. No it doesn’t. ODG uses evidence based standards to simplify this crucial piece of the workers’ compensation puzzle. It’s all about results and your bottom line. All everyone really wants is their workers working and their premiums minimal. VOHP can help get you there efficiently.