WORKERS COMPENSATION REPORT -- FY2004

**I. Background**

In 1997 the Veterans Health Administration undertook a fundamental
realignment of its health and safety systems and programs as part of its
restructuring in the Vision for Change. VHA recognized that the
centralized approach, common throughout the Department, had led to
improved performance. A major element of that reform was the
establishment of a performance measures system, top management
commitment, and the construction of infrastructure support systems.
These included the development of an injury management system, the
Automated Safety Incident Surveillance and Tracking System (ASISTS), and
a well funded Center for Engineering and occupational Safety and Health.
From 1997 until 2001, the lost time claims rate (LTCR) was used as the
core health and safety measure. In addition, each VISN established local
programs targeted to specific needs as a second measure. The summary
data were provided from the Workers Compensation Management Information
System (WC-MIS), but use of the LTCR was discontinued because of
concerns with the denominator.

In 1999, VHA assembled a technical advisory group (TAG) to improve case
management, a group subsequently used to support a joint effort with the
Office of the Inspector General (report). In 2002, VHA established a
formal national program with a designated Workers' Compensation Program
Manager. VHA reviewed all data accessible through WC-MIS (CEOSH data
report); met with Workers' Compensation staff from the Office of the
Designated Occupational Safety and Health Official (DASHO), the
appropriate VA staff office, to outline joint and separate
responsibilities; and, in March 2003, assembled a TAG to develop a
strategic plan. The TAG included lead VISN Workers Compensation
managers, representatives from the DASHO Office, and other members from
VHA's community of practice. In August, 2003, the Human Resources
Committee (HRC) of the National Leadership Board (NLB) approved the
strategic plan and authorized implementation.

**II. Strategic Plan and current status**

The VHA strategic plan for Workers' Compensation is based on five
elements. Although individual elements have evolved since the initial
approval, the strategic plan retains the core domains outlined in this
document. The current status is captured on a dashboard summary (Figure
1).

1.  Education: An annual course was put on for workers compensation
    specialists by the DASHO until 1999. No systematic coordinated
    effort since then has educated and trained new staff. The TAG
    recommended the following actions

    a.  Introductory lectures /streaming audio: Turnover at the facility
        level forces the system to rely on relatively untrained staff.
        To support just-in-time training, a series of educational
        lectures, with questions and answers, was held and is being
        mounted on the intranet/web as streaming audio resources.

    b.  Workers Compensation Guidebook: A collection of frequently used
        tools (laws, regulations, forms) has been assembled, is under
        review by an advisory group, and will be published in late 2004
        (FY2005).

    c.  Workers' Compensation training: An introductory course for
        Workers' Compensation specialists has been held; a follow-up
        course is planned for January 2005.

2.  Data systems/peer competition

    a.  Data from WC-MIS are disseminated into the field on a quarterly
        basis to present comparisons, by VISN, of rankings and
        performance.

    b.  Website access: Screens for a website have been defined. The
        website itself is under design. Date TBA.

3.  Local support

    a.  The Workers' Compensation Program Manager conducted audit visits
        in five VISNs as of the end of FY2004.

    b.  On-site training and support was provided to 10 facilities on
        separate field trips. Training occurred at three national
        conferences.

    c.  Over 50% of the work day for the VHA National Program Manager is
        spent in local support for workers compensation claims
        management, with some support for safety and occupational health
        clinicians.

    d.  A case-management module has been development for ASISTS

> e\. It is anticipated that the Workers' Compensation Program Manager
> will conduct audit visits in one VISN each quarter of FY 2005.

4.  Performance monitors: Performance monitors and measures

    a.  For FY2004, VHA implemented a Workers' Compensation performance
        monitor based on the submission timeliness for CA1/2 claims with
        a 19.6% improvement, well beyond the 3% as defined in the SHARE
        goals. SHARE is a White House initiative (Safety, Health, and
        Return to Employment program).

5.  Improved data accuracy: Review of WC-MIS and ASISTS data suggest
    that miscoding of data is common, as is inadequate completion of the
    form 2162 "first report of injury" by supervisors. Three
    enhancements are planned:

    a.  A drop-down menu at the 2162 guides supervisors to consider six
        domains as they complete the report to explore and document
        reasons for the event.

    b.  A computerized CA-7 is planned to increase timeliness of
        submission of employee claims for compensation.

    c.  A change in ASISTS nomenclature, in tandem with one episode of
        the broadcast lecture series, addressed the issue of coding
        inaccuracies.

    d.  A restructured menu aims to help supervisors complete the
        correct body part.

    e.  An auditing activity is planned to evaluate performance.

    f.  A web site is under design to avoid the quarterly mail out of
        data.

    g.  A procedure to improve the accuracy of COP days was identified
        for dissemination

6.  HAIG survey: discussions in the TAG identified the need to
    understand the current performance of the VHA Workers' Compensation
    system. The Health Analysis and Information Group (HAIG) has
    developed a draft instrument (attachment A) to examine staff
    distribution, assignments, and collateral duty status; their
    educational needs and habits; and how those affect system
    performance. That instrument is being piloted.

III\. Results - Data

Figure 3 presents the overall VHA workers compensation chargeback sum,
with a cost-of-living adjustment, since 1992. Readers should be aware
that the chargeback year (July-June) differs from the fiscal year.
Figure 3 presents the chargeback compensation costs by VISN since 1997,
year of the safety reorganization. Despite a general increase in Federal
costs, VHA compensation costs have remained relatively constant.

Figure 4 depicts the changes in compensation costs per VISN since 1997.
The data suggest that some VISNs have consistently improved, some have
worsened progressively, and some fluctuate. Some worsening may reflect
DOL practices, some may reflect local employment, retirement, and
downsizing aspects of employment, and some are specific to Workers'
Compensation management. Local audits are needed to understand why and
to support local staff in improvement strategies. Figure 5 presents the
lost time claims rate since 1997. There has been no substantial movement
in VHA.

Figure 6 presents timeliness data, the current workers compensation
performance monitor for all three administrations. Implementation of
EDI, electronic filing of claims led to a improvement as did the
implementation of a Network Director Performance monitor in the last
fiscal year. Submission of CA1 claims within two weeks of filing has
risen from 64 to 77% (FY03 to FY04, Figure 7: Performance monitor), with
four VISNs filing over 90% of claims within two weeks. Only two VISNs (9
and 22) are still performing at below acceptable levels. Figure 8
presents the timeliness in filing CA7s, rank ordered by change in
performance from FY2003 to FY2004 (1^st^ three quarters). Though not
part of the Presidential SHARE initiative, this is recognized as a
marker of employee-focused attention, ensuring that money is paid
promptly. It represents an additional element of the planned workers
compensation performance index. Again, some facilities are improving
(left side of graph) and others are worsening performance (right side of
graph).

Review of further data, by VISN, suggests specific priorities for site
visits and interventions.

IV\. Quality improvement programs

1.  Field visits have identified practices associated with better
    performance. These have been incorporated into an auditing tool

2.  Different models of VISN-based coordinators (DOL District
    clustering, mentoring, direct supervision) are underway to be
    evaluated

3.  The auditing tool was piloted and refined after visits in 5 VISNS.
    The most recent version is included as attachment B

4.  A workers compensation performance index will be piloted during
    upcoming the HAIG survey.

V. Workers Compensation and Safety: Closing the loop

VHA has established an injury management system, the Automated Safety
Incident Surveillance and Tracking System, to foster the various
participants in lifetime injury management into a single community of
practice. Data from that system (Figure 2) suggest that the most common
injuries result from slips, trips, and falls; materials handling; being
struck by/against objects; assaults; cumulative trauma; and blood borne
pathogens exposures.

VHA has developed programs for five of these six. VHA has mandated the
use of accident review boards to understand determinants of injury and
is currently conducting three aggregated root cause analyses to
understand the failure of specific programs.

VI\. Next Steps

1.  Completion of the HAIG survey will allow the examination of
    staffing, education, and performance.

2.  Procedures to improve accuracy of lost time claims rate and COP days
    are under way to implement the presidential SHARE objectives as
    Network Director Performance Monitors in FY2006 in conjunction with
    the implementation of DFAS across VA.

3.  Educational programs are underway, including planning for the basic
    curriculum twice in FY2005

4.  Website construction. Date TBA.

5.  Use of the audit tool will support the construction of an external
    peer-review program, built along the lines of the EPRP for clinical
    practice guidelines, for the development of a performance index.

6.  A case-management module has been developed for ASISTS. Awaiting
    funding approval.

7.  Approval and planning of potential private sector pilot projects

    a.  Insurance DOL PN/PR review

    b.  Assignment of a clinical case manager to high-risk cases to
        extend beyond DOL assignment

    c.  Emergency up-staffing for workers compensation specialist
        turnover

    d.  Interagency user training (3-day beginner course)

**FIGURE 1: VHA PLAN AS APPROVED BY NLB HR COMMITTEE August 2003 and
CURRENT STATUS - DASHBOARD**

+---+----------------+--------------------+-------------------+--------+
|   | **Plan         | **Initial Plan**   | **Current status  |        |
|   | Element**      |                    | AND ANTICIPATED   |        |
|   |                |                    | COMPLETION**      |        |
+---+----------------+--------------------+-------------------+--------+
| * | **Public       | -   **COP/FTEE**   | -   **CA1/2       | **G    |
| * | Feedback       |                    |     timeliness    | REEN** |
| 1 | System**       | -   **CA1/2        |     reported out  |        |
| . |                |     timeliness**   |     regularly**   |        |
| * |                |                    |                   |        |
| * |                | -   **COP cost     | -   **LTCR        |        |
|   |                |     data**         |     reported out  |        |
|   |                |                    |     regularly**   |        |
|   |                | -   **New          |                   |        |
|   |                |     cases/FTEE**   | -   **FTEE        |        |
|   |                |                    |     accessed**    |        |
|   |                | -   **PN Cohort    |                   |        |
|   |                |     movement**     | -   **Website     |        |
|   |                |                    |     creation in   |        |
|   |                | -   **Scheduled    |     progress:     |        |
|   |                |     award          |     completion    |        |
|   |                |     tracking**     |     date:         |        |
|   |                |                    |     2/15/05**     |        |
+---+----------------+--------------------+-------------------+--------+
| * | **Educational  | -   **Introductory | -   **Delivered,  | **G    |
| * | tools**        |     lectures       |     desk-top      | REEN** |
| 2 |                |     /streaming     |     mounting      |        |
| . |                |     audio**        |     underway**    |        |
| * |                |                    |                   |        |
| * |                | -   **Workers      | -   **Printing    |        |
|   |                |     Compensation   |     scheduled for |        |
|   |                |     Guidebook**    |     FY 2005.**    |        |
|   |                |                    |                   |        |
|   |                | -   **Website      | -   **1^st^       |        |
|   |                |     access**       |     abbreviated   |        |
|   |                |                    |     course        |        |
|   |                | -   **Workers      |     1/2004; next  |        |
|   |                |     compensation   |     round         |        |
|   |                |     training**     |     scheduled for |        |
|   |                |                    |     January       |        |
|   |                |                    |     2005**        |        |
+---+----------------+--------------------+-------------------+--------+
|   | **Continuing   | -   **Skills       | -   **DASHO       | **G    |
|   | education**    |     catalogue for  |     documents     | REEN** |
|   |                |     facility       |     modified**    |        |
|   |                |     managers**     |                   |        |
|   |                |                    | -   **Under       |        |
|   |                | -   **Skills and   |     Construction  |        |
|   |                |     toolkit for    |     FY 2005.**    |        |
|   |                |     VISN           |                   |        |
|   |                |     coordinators** |                   |        |
+---+----------------+--------------------+-------------------+--------+
| * | **Local        | -   **Creation of  | -   **Audit tool  | **G    |
| * | support        |     audit tool**   |     created,      | REEN** |
| 3 | through        |                    |     used, and     |        |
| . | training and   | -   **Creation of  |     modified**    |        |
| * | auditing**     |     quality        |                   |        |
| * |                |     improvement    | -   **EPRP        |        |
|   |                |     programs for   |     program for   |        |
|   |                |     specific       |     back pain     |        |
|   |                |     syndromes**    |     12/04**       |        |
|   |                |                    |                   |        |
|   |                | -   **ASISTS       | -   **EPRP -      |        |
|   |                |                    |     mental health |        |
|   |                |    case-management |     6/05**        |        |
|   |                |     module**       |                   |        |
+---+----------------+--------------------+-------------------+--------+
|   | **Creation of  | -   **Occupational | -   **OHRS design | **YE   |
|   | performance    |     Health         |     completed, on | LLOW** |
|   | index**        |     Record-keeping |     hold**        |        |
|   |                |     system**       |                   |        |
|   |                |                    | -   **ASISTS      |        |
|   |                | -   **ASISTS       |     funding under |        |
|   |                |                    |     review**      |        |
|   |                |    modifications** |                   |        |
|   |                |                    | -   **No WC-MIS   |        |
|   |                | -   **WC-MIS       |     input**       |        |
|   |                |     access**       |                   |        |
|   |                |                    | -   **HAIG Survey |        |
|   |                |                    |     under design  |        |
|   |                |                    |     on time**     |        |
+---+----------------+--------------------+-------------------+--------+
|   | **Auditing and | -   **Use of       | -   **Audits of 5 | **YE   |
|   | local          |     auditing tool  |     VISNs         | LLOW** |
|   | training**     |     and reports**  |     completed.**  |        |
|   |                |                    |                   |        |
|   |                |                    | -   **Two VISN    |        |
|   |                |                    |     Audit per     |        |
|   |                |                    |     Quarter       |        |
|   |                |                    |     planned for   |        |
|   |                |                    |     FY2005.**     |        |
+---+----------------+--------------------+-------------------+--------+
| * | **Performance  | -   **FY04: CA1/2  | -   **FY04        | **.G   |
| * | monitors**     |     timeliness**   |     Timeliness    | REEN** |
| 4 |                |                    |     EILEEN?**     |        |
| . |                | -   **FY05:        |                   |        |
| * |                |     Performance    | -   **LTCR and    |        |
| * |                |     index**        |     COP as PI**   |        |
+---+----------------+--------------------+-------------------+--------+
| * | **Data         | -   **COP day      | -   **Under       | **YE   |
| * | accuracy       |     model          |     Construction  | LLOW** |
| 5 | improvement**  |     identification |     for FY        |        |
| . |                |     and            |     2006.**       |        |
| * |                |                    |                   |        |
| * |                |    dissemination** | -   **ASISTS      |        |
|   |                |                    |     modifications |        |
|   |                | -   **Coding       |     planned +     |        |
|   |                |     accuracy**     |     training      |        |
|   |                |                    |     under         |        |
|   |                | -   **System costs |     development** |        |
|   |                |     estimation**   |                   |        |
|   |                |                    | -   **Under way   |        |
|   |                |                    |     3/1/05**      |        |
+---+----------------+--------------------+-------------------+--------+

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? Check source sheet to confirm if figures are FY or CBY?

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