The Concentra Approach to Work Injury Care in Construction

Construction is a dangerous business, so having a way to manage work injuries is essential. In many ways, good injury care is a lot like construction project planning; both share an interest in achieving solid outcomes based on a well-thought out plan. You enlist professionals with particular expertise and instill consistent management of work processes to achieve quality control and expedient results, all at the lowest possible cost. So do we. This is Concentra® work injury care for construction in a nutshell.

Concentra’s Approach to Injury Care

In professional fields where customers have many choices, expertise and experience are important – those qualities help grow a business. In the United States, there are more than 700,000 construction companies, and being recognized as an industry leader often is achieved through demonstrated expertise and experience.1 That’s true in occupational health and work-related injury care, too. Concentra is the largest occupational health provider – both in scope and years in service. We operate nationally (in 44 states) and have been in business for 40 years. We currently provide injury care for 1 in every 5 cases of work-related injuries in the United States.

Experience has taught us that good injury care is much more dynamic than checking a few boxes on a form, sending your injured employee home for rest and relaxation and waiting a few weeks to revisit recovery progress.

Concentra’s injury care approach is unique for three reasons:

1. While many providers will claim to focus on excellent clinical outcomes, we regularly measure clinical outcomes, such as case duration and days away from work and hold ourselves accountable to avoid unnecessary disability.
2. We efficiently manage the stay-at-work/return-to-work process to minimize case duration and costs.
3. We use objective criteria to limit referrals to specialists (including physical therapists) to those cases where recovery will be expedited by specialty care.

Providing Injury Care. Measuring Clinical Outcomes

At Concentra, medical education is not a “one-and-done” for our clinicians. Our clinical leaders are industry experts who stay current on the latest research and most effective treatments. Some are involved in research work themselves to advance industry knowledge of effective injury care. In addition, Concentra has several medical expert panels (MEPs) that continually review regulations and update guidance documents our clinicians use as a resource. Through these documents, MEPs communicate medical decisions in a way that allows our medical teams flexibility in adapting injury care to the unique needs of each individual and case.

When you send an injured construction employee to us, you get our “early treatment” approach, which recognizes that injured tissues can worsen and become more difficult and costly to heal if treatment does not begin soon after the injury.  In addition to treating the physical injury, Concentra clinicians also address psychosocial barriers that can delay healing – such as an injured employee’s anger or fear concerning the injury, the workplace, or the employer. Our clinicians teach injured employees a positive “capabilities mindset” to replace the “disability mindset” that can set in after an injury and delay recovery unnecessarily.

Concentra treatment plans focus on recovery of function with progress determined by objective measures agreed upon at the start. We communicate and collaborate with the employer, the injured employee, and the insurer, as needed, to align goals and expectations. These elements are standard in work injury care at Concentra because they contribute to excellent outcomes and lower costs, while generating higher employer and employee satisfaction.

Managing Stay-at-work/Return-to-work Efficiently

We know that you value your employees and want them to receive quality injury care. We also know that employers struggle with high workers’ compensation costs and lost productive time when injuries occur. Concentra clinicians can provide quality care, while reducing workers’ compensation case duration and associated costs. Work-related injury care is a core Concentra service, so efficient case management and knowledge of workers’ compensation regulations in every state are our bread and butter. We work hard to make the process more efficient. Employers we serve want that and so do we. Here is an example: 

Concentra Outlier Case Management Program

It is not uncommon in the workers’ compensation system for a small number of cases to represent a majority of total costs. As an example, research into claims involving lower back pain revealed that 10 percent of cases accounted for 86 percent of total expenditures.2 These costly “outlier” cases get stuck in the system for a variety of reasons. Essentially, the injured employee’s functional recovery does not progress, despite the best clinical efforts. Life stagnates for the employee, and your costs escalate. 

In 2017, Concentra implemented an Outlier Case Management Program. Using data analytics, we identified several triggers that lead to delayed recovery. Cases found to have those triggers are placed in an intense review and management cycle so that center- and director-level clinicians can look at the arc of the case and take appropriate action to bring it to the best possible conclusion. Our efforts are paying off in significant reductions in case duration.

Concentra Workers’ Compensation Clinicians

In addition to process improvement initiatives like the Outlier Case Management Program, we guide our clinicians in developing proficiency in five critical aspects as efficient workers’ compensation professionals:

1. Determining injury causation and OSHA recordability with their expertise in workplace job functions, mechanisms of injury, and knowing the right questions to ask
2. Documenting a thorough injury history, which is essential to quality care throughout the case
3. Timing return visits to achieve optimal case performance. Evidence shows that long intervals between visits (common in some other practices) unnecessarily prolong case duration.
4. Managing the stay-at-work/return-to-work process in a positive way so the injured employee avoids lapsing into a lethargy, marked by disinterest in following the treatment plan
5. Issuing work restrictions only when the employee’s ability to perform essential job functions is affected. This approach helps you keep OSHA recordable cases to an absolute minimum. 

Limiting Specialty Referrals in Injury Care

Concentra continually monitors specialty care referrals (including physical therapy). We use objective criteria to limit referrals to only those cases where treatment by specialists will expedite recovery.

Physical therapy is used to treat work-related musculoskeletal disorders (WMSDs). These are injuries or illnesses to muscles, tendons, and joints, and inflammation of tissues caused or aggravated by work. Examples are back or neck strain, damaged rotator cuff in the shoulder, and repetitive stress injuries like carpal tunnel syndrome.

Construction is plagued by a higher incidence of WMSDs than most other industries – and this is nothing new. The National Institute for Occupational Safety and Health (NIOSH) documented this injury care challenge in construction as long ago as 2006 and cited a long string of research studies overflowing with documentation.

“Incidence rates for construction workers’ back and upper- and lower-extremities WMSDs exceed the national all-industries average. Construction workers’ rates of injuries and illnesses due to bodily reaction and overexertion consistently exceeded those in all private industries. Within the construction industry, the Special Trades Contractors, which is the largest sector in the industry, usually reports higher rates of overexertion and repetitive motion injuries than does General Building Contractors or Heavy Construction Contractors,” NIOSH concluded.³

Today, nearly two-thirds of all construction employees are in the specialty trades (64 percent or 4.8 million as of August 2019). The remaining 36 percent are employees in building construction (residential and non-residential, each 11 percent) and infrastructure projects (highways, bridges, and tunnels, at 14 percent).⁴

Statistics on WMSD injuries in the specialty trades make sense, given the injury risks often presented by their essential job functions.

Specialty trade employees in plumbing and heating, ventilation, and air conditioning (HVAC) face similar challenges. They both often work in confined spaces and in sustained awkward positions, with an ever-present risk of slips, trips, and falls, alternating between high altitudes and depths.

Bricklayers, another specialty trade, have the highest rate of back injuries with lost work days among construction specialty trades. This is partially due to the weight of the materials they need to move and manipulate manually – lifting, twisting, and stressing their musculoskeletal system.⁵

Falls are also a major problem in construction. “Roofers and painters had the highest rates of nonfatal falls to a lower level in 2016, according to the Bureau of Labor Statistics report in July 2018. The rate for roofers was 86.9 cases per 10,000 full-time workers. The rate for painters was 75.0 cases per 10,000 full-time workers. Their rates far exceeded the rate for all workers combined of 5.1 cases per 10,000 full-time workers.”⁶

“First-line supervisors of construction trades and extraction workers needed the most time away from work to recover when injured in falls to a lower level. They were away from work a median of 90 days. Construction laborers fell at a higher rate than their supervisors but took fewer days away from work, a median of 30 days. For all workers who suffered nonfatal workplace injuries from falls to a lower level in 2016, the median number of days away from work was 19.”⁶

Job functions are not the only factor that present work injury challenges in construction. OSHA also cites⁷:

• New construction techniques, materials, and tools
• Greater construction workforce diversity – maybe different languages
• Aging workforce and a rising sedentary lifestyle among all ages

When physical therapy is needed, it’s good to remember that historically Concentra’s number of physical therapy visits per case, as well as our referrals to surgery, are lower than the industry overall.

Partner with Concentra for Injury Care

Concentra is proud to serve a large number of construction companies. In addition to work injury care, our clinicians have extensive expertise in injury prevention. Employers, construction associations, and construction employees themselves have made great strides and recognize the importance of safety and health in strong business performance.

Let’s partner to tackle the next level of challenges to keep construction strong as it builds America’s homes, business facilities, and infrastructure.

Connect with Concentra for injury care to serve you in three ways:

1. Excellent clinical outcomes
2. Workers compensation case management
3. Optimized specialist and physical therapy referrals

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Resources

1. “These are the 10 biggest construction companies in America,” Zippia, 2016. Accessed September 28, 2019 /
2. Hashemi L, Webster BS, Clancy EA, Volinn E. Length of disability and cost of workers’ compensation low back pain claims. Journal of Occupational and Environmental Medicine. 1997; 39(10): 937-45. 
3. NIOSH publication. Accessed September 28, 2019.
4. NKBA Economic Indicators 9/9/2019, Accessed September 28, 2019.
5. Interventions to Reduce Back Injury in Masonry – Tip Sheet, Center for Construction Research and Training Electronic Library of Construction Occupational Safety and Health. Accessed September 28, 2019.l
6. The Economics Daily: Roofers and painters had the highest rates of nonfatal falls to a lower level in 2016, Bureau of Labor Statistics, July 31, 2018. 
7. Recommended Practice for Safety and Health Programs in Construction, Occupational Safety and Health Administration (OSHA), October 2016.