Tiger Woods Returned to Work After Back Surgery, Can You?

Medical experts offer their take on Tiger Woods' recovery from spinal surgery, and what it might take for workers' comp patients to score similar wins.
By: | May 2, 2019

Tiger Woods reigned supreme on April 14th at Augusta National, winning his first Masters title since 2005 and marking an incredible comeback for the internationally renowned athlete.

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The road to victory was hardly a well-traveled one though. Woods has sustained several injuries that could have been career-ending, and his lumbar fusion surgery in 2017 raised questions about his ability to continue in the sport.

The progression of Woods’ surgeries is extensive. The PGA website lists his injury history in full, noting his first back surgery in 2014 to remedy a pinched nerve, a micro-discectomy in 2015, another back surgery in 2015 to “relieve discomfort,” and finally the 2017 lumbar fusion at L5/S1.

The procedure, relatively common in the workers’ compensation arena, has varying levels of success, particularly when viewed through the lens of return to work.

This begs the question, if Woods’ operation was a tally in the win column, does that translate to the average person who suffers a work injury?

The AMA Guides to the Evaluation of Work Ability and Return to Work urge physicians to consider the patient’s work ability before recommending surgery, explaining that, “while physicians are well-trained in diagnosis and treatment, most have received little or no training in how to evaluate their patients’ work ability.”

“It comes down to patient selection. You set the expectation of return to work, you give encouragement, and with that encouragement they can often return to work at full capacity.” — Dr. Ramin Raiszadeh, MD, a surgeon with the Spine Institute of San Diego

The AMA suggests framing the issues with the use of three terms: risk, capacity and tolerance.

Risk refers to the chance of harm to the patient, co-workers or to the general public if the patient engages in specific work activities.

Capacity refers to concepts such as strength, flexibility and endurance.

Tolerance is the ability to tolerate sustained work or activity at a given level and involves psychophysiologic assessment.

For Douglas Lurie, an orthopaedic surgeon with Orthopaedic Associates of New Orleans, tolerance is the most important of the three terms in Woods’ case. “The driving factor here is the third of the AMA factors, the tolerance issue,” he said.

“In other words, how much discomfort are you willing to endure for the benefits of returning to work. Tiger has the ability to recondition towards maximum capacity. The resources for most patients are not unlimited like they are for him.”

Lurie places the odds of a similar success story after a lumbar fusion surgery for workers’ compensation patients at below 50 percent.

A study published in the January 2015 issue of Spine bears this out, but also sheds light on potential reasons behind the disparity.

Researchers compared the functional outcomes for lumbar spinal fusion under New Zealand’s universal no fault compensation system, together with workers’ compensation and non-workers’ compensation cohorts from other countries.

Researchers noted markedly inferior outcomes for the workers’ compensation cohort, possibly attributable to an “adversarial environment, delayed resolution of claims and care, and increased compensation associated with prolonged disability.”

This suggests that the claims advocacy movement, with its focus on moving away from an adversarial model, is a better path toward positive outcomes for workers’ comp spinal fusion patients and others.

Help Workers Stay Motivated

As evidenced by Woods’ quick succession of surgeries and his celebrity status, he likely had minimal delays in treatment and faced little adversity from a legal perspective, meaning that unlike most workers’ comp patients, he could dedicate his time to the psychophysiologic requirements of developing tolerance.

Ramin Raiszadeh, MD, a surgeon with the Spine Institute of San Diego and an avid golf fan, spoke in more optimistic terms about Woods’ success compared to the average person.

“It comes down to patient selection,” he said.

“You set the expectation of return to work, you give encouragement, and with that encouragement they can often return to work at full capacity. In Tiger Woods’ case, he has definite motivation to return to work so that’s obviously very helpful for recovery.”

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Raiszadeh added on the tolerance issue that it’s impossible to know ahead of time how the patient will respond, so surgeons need to look at the indications carefully.

“Pain tolerance is different for everyone,” he said.

“So I can’t accurately predict how much pain a person is going to be in after surgery.”

That unpredictability, along with the treatment delays typical in workers’ comp, can lead to disappointment on the other side of the knife, but the motivation of a champion can tip those odds. &

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]

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]