Opinion | How a Doctor’s Note Improves Return-to-Work Results

By: | August 12, 2019

Nina Luckman is a business journalist based in New Orleans, focusing primarily on the workers' compensation industry. Her credentials include a B.A. and M.A. from Tulane University, both in the study of English Literature. Over the last several years, Nina has served as Editor of Louisiana Comp Blog, a news site she started in 2014 under the auspices of a group self-insurance fund. Louisiana Comp Blog won the WorkersCompensation.com Best Blogs award in 2016, 2017, and 2018. She can be reached at [email protected]

The claims advocacy model, which emphasizes the injured worker’s experience and treatment of the whole person, echoes a new push in group health for freely accessible doctor’s notes.

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The “OpenNotes” movement could provide a new window for workers’ comp to help injured workers navigate a system that is often confusing and bogged down by administrative detail.

The OpenNotes movement is spearheaded by OpenNotes.org, which describes itself as “the international movement that’s making health care more transparent. It urges doctors, nurses, therapists, and others to invite patients to read the notes they write to describe a visit.”

The notes are accessed through a secure web-portal for privacy.

The OpenNotes site features a page dedicated to research about the project, including a May 2019 paper published in JMIR Publications, which examines patient attitudes seven years after the project began.

Among the 136,815 patients who received invitations to read their notes, 21.68% responded. Of those, 72.62% rated note reading as very important for helping take care of their health, 69.85% reported feeling in control of their care, and 65.82% said it helped them remember the plan of care.

Even more striking was the benefit to marginalized and minority groups. The authors explained that “less educated, nonwhite, older, and Hispanic patients, and individuals who usually did not speak English at home, were those most likely to report major benefits from note reading.”

Since return-to-work is the end goal of most claims, this research underscores the effect feeling in control can have on that end goal.

Combined with the impressive level of patient satisfaction discussed above, the availability of OpenNotes to injured workers would seem to be a relatively low-cost method of helping them feel more in control of their treatment and minimizing the risk of nonadherence and litigation.

Transparency could conceivably extend to adjuster files and tame the adversarial nature of a 100-year-old system of benefits that continually faces criticism for its treatment delays and perceived apathy.

The Society of Human Resource Management notes in “The Myth of the Bad Employee” that while occasions of fraudulent claims make “memorable anecdotes,” the more significant problem is “not malingering but delayed recovery.”

Reading doctor’s notes and/or adjuster files has the potential to help injured workers understand why an independent medical exam is being ordered, or why opioid medications are being tapered, which makes them an active participant in their own care rather than just another claimant.

Research on “message framing” in the return-to-work process echoes the importance of the “why” in injured worker recovery.

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A paper published in 2017 by the National Center for Biotechnology Information revealed that when presented with wage and pain information that was positively framed, “injured workers showed higher scores in expectation and confidence for return to work, whereas the Ambivalent Group that had both negative messages showed lower scores.”

Since return-to-work is the end goal of most claims, this research underscores the effect feeling in control can have on that end goal.

While OpenNotes and the effort for more transparency in health care wouldn’t be a quick fix, it would increase accountability on all sides. That’s better than the alternative. &

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The R&I Editorial Team can be reached at [email protected]