On Site MSD Intervention Author: Dr. Andrew P. Hatch, DC, MBA, PhDc Introduction: The purpose of this article is to increase awareness to the seriousness of the socioeconomic costs associated with musculoskeletal disorders (MSD s). With MSD s costing industrialized nations billions of dollars each year in productivity losses, absenteeism and burdening inefficient health care systems, there is a tremendous need for cost containment and cost avoidance solutions related to MSD. This article sheds light on two interrelated concepts; Workplace Wellness Programs (WPWPs) and Musculoskeletal Disorders (MSDs) and how within this relationship exists an opportunity for a business strategy to be applied to the existing WPWP market sector. The article will define the history, focus and business strategy behind WPWP s. It will include a discussion on the concept of MSD s, what they are and what the direct and indirect costs are to corporations and governments. The research revealed that MSD s are a primary cost driver for self-insured companies in the United States and for European socialized medicine countries are not being addressed efficiently with current medical systems and practices. The literature review revealed that WPWP s generally did not offer solutions for the workplace MSD epidemic. A case study of one such solution is presented that formed the basis for this article that revealed a theory as to why and how an on-site approach of detection, early intervention, education and prevention of MSD s is a viable business strategy for any organization and should be an integral part of any private or public employee health initiative. Workplace wellness Programs (WPWP s) A report stated that there was much more at stake concerning WPWP s due to ever higher health care costs putting financial pressure on corporations.(1). Ryan suggested that the WPWP had to be aligned with the priorities and objectives of the company as well as having capitalized on the organization s values. (1) The use of workplace wellness programs has been on the rise in the United States according to the International Foundation of Employee Benefit Plans.(2) The study showed that companies focused their workplace wellness initiatives and resources on health fairs, health screenings and flu shots. The survey, Wellness Programs and Value Based Health Care, showed 60% of employers have had workplace wellness programs since 2008 with an additional 24% since 2010. The National Business Group on Health estimated that the demand for WPWP s would increase by 18 percent over the next five years. (3). According to Archer (3) insurance premiums in the U.S. increased 114 percent between 2000 and 2010. During the same period workers premiums increased 147 percent. (4). The literature demonstrated that the increased need for cost containment
created business opportunities. The evidence of positive outcomes justified investing in programs, staff and facilities. (5). DeJoy (6) suggested that workplace health promotion should be a part of a core business strategy and operations management. DeJoy said that WPWP s were an effective single strategy that aimed to maximize employee health and productivity. Goetzel (7) stated that in today s business environment, the competitive edge went to the organization that made the best use of their human resources. Leurent, et al. (8) commented on statements from the 2008 World Economic Forum, that WPWP s had been successful at improving workers health and productivity, increased employee loyalty and decreased health care costs. It has become an accepted fact within the NHS trust system that socially responsible organizations that embraced workplace wellness were profitable. A healthier, fit and happier workforce made economic sense. (9). An American researcher (10) tested the hypothesis that a company s stock market performance could be influenced by comprehensive and well implemented WPWP s aimed at reducing health and safety risks. By studying a wide range of companies recognized for having award winning health and safety programs, he concluded that such companies had a competitive advantage in the marketplace which resulted in greater value for their investors than companies that did not have such programs. Fabius s (2013) study concluded that these companies overall demonstrated 20% more revenue per employee, 16% higher market value and 57% higher shareholder returns. A study by RAND (11), a non-profit research organization, put the ROI into a proper perspective for these programs. Dr. Soeren Mattke, head researcher for RAND stated, The PepsiCo program provides a substantial return for the investment made in helping employees manage chronic illnesses such as diabetes and heart disease But the lifestyle management component of the program while delivering benefits did not provide more savings than it cost to offer. According to this study 87% of health care cost savings came from Chronic Disease management which accounted for only a 13% participation rate by employees in the program. Quite ironically, 87% of employees participated in Life Style programs which accounted for only 13% of health care cost savings. The vast majority of WPWP s and services offered today focus on life style rather than disease management, therefore, there is no mystery as to why the lexicon of such providers are now avoiding the term ROI (return on investment) and switching to VOI (value on investment) after reading the RAND study. There is a chronic disease global epidemic that cost billions of dollars to treat each year in lost productivity, absenteeism and presenteeism. This epidemic is known as musculoskeletal disorders or MSD, mainly low back and neck pain but also includes several other painful conditions of the muscles and bones. MSD s are among the chronic disease category but have largely been ignored by WPWP s The National Institute for Occupational Safety and Health (NIOSH) identified the following MSD s such as low back pain, neck pain, tendonitis, hand-arm vibration and carpal tunnel syndrome. (12). According to the Mayo Clinic, there were a number of factors that contributed to MSD, primarily lower back pain and neck pain, including lifting forces such as heavy objects,
chronic poor posture or slouching in front of computer terminals that lead to muscle fatigue and soft tissue damage, and chronic emotional stress that lead to chronic muscle tension which is a known cause of back pain. (13). MSD accounted for a major part of the health care costs related to work place illness or injury. (12). The National Occupational Research Agenda for Musculoskeletal Disorders (12) estimated the cost of work related MSD to range between $13 and $54 billion per year. A report from Johns Hopkins University written in The Journal of Pain stated the total cost in treating and lost productivity of chronic pain primarily caused by MSD in the U.S. was as high as $635 billion per year. According to this report, that was more than the annual cost of cancer, heart disease and diabetes combined. The cost of lost productivity to companies in the U.S. due to pain was estimated to range from $299 to $335 billion. (14). Case Study: The United States is struggling to find solutions for its health care crises by cutting costs on health care spending. Ironically, companies are spending billions of dollars on WPWP s that focus on life style choices more than chronic disease management that the research clearly demonstrates is not a cost effective approach. While doing so, our nation is not looking at the indirect costs which amount to over five times the direct medical costs. The U.S. is all but ignoring the MSD epidemic as evidenced by the fact that less than 1% of companies offer on-site MSD solutions such as physiotherapy and chiropractic service even though MSD is always one of the top three health care cost drivers in any company. The United States could learn a lot from the Europeans. The Europeans have identified MSD as the primary cause of missed days work and associated lost productivity, long, short and permanent work disability. In Europe, the primary focus concerning MSD s is the lost productivity, absenteeism and presenteeism that results in a decrease in global economic competitiveness. A nation is only as strong as the health of its citizens. The European Union commissioned a research project known as EI or early intervention for MSD s. They established MSD EI centers in hospitals and clinics that resulted in millions of potentially lost productive work days returning to the economy. Inspired by the EI programs in Europe, an on-site MSD clinic was established in a consulting firm in Portugal to study if an on-site MSD EI program would yield greater results than referring employees to the external clinics. The U.S. headquarters of the consulting firm asked that the direct medical costs be converted into U.S. dollar values in order to make a cost savings comparison that could be applied to the U.S. market. The purpose of the study was to make a health care cost and absenteeism comparison between the use of on-site and off-site clinics for the early diagnoses, intervention and treatment of MSD s. The study consisted of an evaluation of seven years of patient electronic health records data and associated medically related absenteeism in a consulting firm in Lisbon Portugal. The MSD service provider processed 20 381 visits from June 2007 to June 2014 using a mixed discipline approach of chiropractors and physiotherapists. This data from 660 patients was converted into U.S. Dollar equivalents based on average wages and the cost of similar or same interventions if performed in the U.S. market.
Results: Over the 7 year period 5,400 medical procedures(including surgical interventions, rehab, MRI, CT etc.) and 21,250 working days of medical related absenteeism & lost productivity were avoided. This amounted to a total savings of over $9 million U.S. of which $5.8 million was in medical cost savings. There were some limitations to the study, for example, exact medical cost data for offsite diagnostics and medical procedures avoided were not available and were estimated. Actual fees for service in the U.S. market differ drastically by region and provider and estimates were based on the medical cost blue book values. Regardless, the use of highly conservative cost values still revealed that the socioeconomic implications of the on-site approach are tremendously beneficial in both the private and public sectors across the spectrum of stakeholders. U.S. employers, especially the self-insured companies have fiduciary duty and should investigate and implement an on-site MSD focused intervention solution when looking for real cost savings strategies. The focus on disease management, especially MSD has an immediate impact on a company s bottom line where as the focus on life style management may take years to show some if any ROI. There are very few providers offering on-site intervention for companies. Most providers offer preventive strategies for the manufacturing sectors using physiotherapists or personal trainers. Very little help exists for the office workers who actually suffer more than the employees from manufacturing due to chronic poor posture and long hours of sitting in front of their computers. These forgotten souls are the heart of most companies operations and their MSD issues are the primary health care cost drivers for these organizations. It is time for new thinking beyond best practice for it is not working effectively and move to next practice where greater economic results can be achieved almost immediately. References 1. Planning worksite health promotion programs: models, methods, and design implications. Ryan, M, Ls, Chapman and MJ, Rink. ISSN: 0890-1171, s.l. : American Journal of Health Promotion and Allen Press, Jul-Aug 2008, American Journal Of Health Promotion: AJHP [Am J Health Promot], Vols. Vol. 22 (6),, pp. pp. suppl 1-12, iii following p. 452. 2. Health Is Wealth: THE RISE OF WORKPLACE WELLNESS. Archer, Shirley. 5, May 2012, IDEA Fitness Journal, Vol. 9, p. 37. 3. Keiser. Employer Health Bennefits: 2012 Annual Survey. Menlo Park, Cal. : The Keiser Family Foundation, 2012. 4. From Theory to Practice: a determinants approach to workplace halth promotion in small business. Eakin, JM, Cava, M. and Smith, TF. 2, 2001, Health Promotion Practice, pp. 172-181. 5. Organizational health promotion: broadening the horizon of workplace health promotion. DeJoy, DM and MG, Wilson. May-June 2003, American Journal of Health Promotion, Vol. 17 (5), pp. 337-41.
6. Promising practices in employer health and productivity management efforts: Findings from benchmarking study.. Goetzel, R.Z. 49(2), 2007, Journal of Occupational and Environmental Medicine, pp. 111-130. 8. Wellness in the Workplace: A Multi-Stakeholder Health-Promoting Initiative of the World Economic Forum. Leurent, Helena, et al. 6, July/August 2008, American Journal of Health Promotion, Vol. 22, p. 379. 9. Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice. Blake, Holly and Lloyd, Scott. 6, s.l. : Radcliffe Publishing Ltd, 2008, Quality in Primary Care, Vol. 16, pp. 449-455(7). 10. The link between workforce health and safety and the health of the bottom line: tracking market performance of companies that nurture a "culture of health". Fabius, Ray. Sep, September 2013, J Occup Environ Med., Vol. 55(9), pp. 993-1000. Other Authors: Thayer RD, Konicki DL, Yarborough CM, Peterson KW, Isaac F, Loeppke RR, Eisenberg BS, Dreger M.. 11. RAND. RAND. [Online] 2014. [Cited: Februay 8, 2014.] http://www.rand.org/pubs/research_briefs/rb9744.html. 12. NORA. National Occupational Research Agenda for Musculoskeletal Disorders. Centers for Disease Control and Prevention. [Online] January 2011. [Cited: December 24, 2013.] http://www.cdc.gov/niosh/docs/2001-117/pdfs/2001-117.pdf. 13. Mayo Clinic. Back Pain at Work:Preventing Pain and Injury. Mayo Clinic. [Online] May 16, 2013. [Cited: February 11, 2014.] http://www.mayoclinic.org/back-pain/art-20044526. 14. American Pain Society. Chronic pain costs U.S. up to $635 billion, study shows. Science Daily. [Online] September 11, 2012. [Cited: December 24, 2012.] http://www.sciencedaily.com/releases/2012/09/120911091100.htm.