Articles

Management of Musculoskeletal Injuries

NATIONAL COUNCIL OF SELF-INSURERS

Since 2003, Costco Wholesale has been utilizing an innovative and effective program to reduce the frequency and cost of work-related musculoskeletal injuries. Like many employers across the USA, strain/sprain injuries are Costco’s #1 injury. Musculoskeletal injuries are often caused by repetitive lifting, pushing and pulling activities and these injuries often result in the need for physical therapy (“PT”). For Costco in California, 28% of claims require PT and 17% of claim dollars are spent on PT. In Washington State, 42% of claims require PT and 30% of claim dollars are spent on PT.

Costco uses PreCare as their vendor partner to provide onsite injury prevention, PT and return to work (“RTW”) services at select warehouses across the United States. The goals of the overall PreCare program are:

• To reduce costs associated with work-related injuries by preventing them from occurring and facilitating efficient recovery for employees who are injured.
• In collaboration, create & implement solutions for ergonomic problems that increase risk of musculoskeletal injuries.
• To partner with case managers, claims examiners, treating physicians and warehouse management to facilitate an efficient return to work.

PreCare hires, trains and manages physical therapists and athletic trainers (‘clinicians”) who provide services onsite for Costco. Each clinician is assigned to a set number of warehouses and visits each warehouse on a regular basis to provide services. The clinicians interface with employees, supervisors, management, physicians, case managers and claims examiners to facilitate injury prevention and efficient return to work.

The primary focus for PreCare and Costco is prevention; prevention is the only way to avoid injuries with their associated costs to the injured worker and Costco.    Prevention goals include:

• Assess and reduce risks for strain/sprain BEFORE an incident happens.
• Reduce unnecessary work to increase productivity and reduce employee fatigue.
• Provide education and early intervention for employees experiencing discomfort or excessive fatigue.

PreCare provides a wide variety of prevention services for Costco. Clinicians provide Early Intervention Screenings, one-on-one Job Coaching, Work-n-Stretch/Conditioning Classes, Wellness Programs, Manager & employee training classes, new employee orientation, Safety team participation, Ergonomic Assessments & Recommendations and Project Consultation. All services are provided “in the trenches” with employees so the reality of the day-to-day work load and pace are incorporated into the program.

For the injuries that do occur and require PT, PreCare clinicians provide treatment onsite at the warehouse. Costco provides a small, private space for the treatment. Treatments are one hour and include the work environment. Rather than simulating the work in a clinic, the patients actually perform appropriate work tasks as part of the rehabilitation process. This allows the injured employee to be educated while being conditioned back to full capacity work. Employees perceive the onsite treatment to be an added benefit to working with Costco. The program is enthusiastically embraced by both employees and management.

Return to Work Job Coaching is for an employee who has an open claim, is not receiving physical therapy with PreCare, is on transitional work, and is not moving efficiently toward full duty. Costco refers employees to RTW Job Coaching if the claim is musculoskeletal and open after 30 days. Clinicians assess the referred employee’s current work capabilities compared to the physical demands of the job. The clinician then works with the employee on body mechanics, work technique, coaching, conditioning, demonstration and practice to get the employee safely released to full duty. Written communication is sent to the physician, claims examiner and case manager. This is extremely helpful in bridging the gap between the off-site vendor partners and the worksite and also reduces the employee’s chance for re- injury.

Costco’s results have demonstrated that the PreCare program has been effective in both reducing cost and in employee satisfaction. In the states where PreCare is implemented (CA, WA, OR, NY, NJ), PT treatment duration, frequency and cost is less than in those states where PreCare has not yet been implemented. In regards to prevention results, the states where PreCare is implemented have a 32% less indemnity rate than those states where PreCare has not yet been implemented.

Costco’s success in reduction of strain/sprain injuries and cost can be attributed to their philosophy that it is right to invest in employees’ overall health, safety and well-being.

Katrina Zitnik, Director of Workers’ Compensation, Costco Wholesale
Sara Craig, Founder of PreCare

Article Published in the National Council of Self-Insurers November 2009 Newsletter