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Next Steps in Workers' Compensation for Treating Brain Injury

Next Steps in Workers' Compensation for Treating Brain Injury

Part I

The ultimate goal for the person with a traumatic brain injury (TBI) who participates in a comprehensive postacute rehabilitation program is to return to a productive life after discharge. Many times that involves returning to work. If the person sustained a brain injury in the workplace, he/she enters into the worker’s compensation continuum of care treatment system and is entitled to certain benefits that aim to reduce medical and living costs.

However, the public health care options available do not offer much in the way of treatment for TBI or stroke patients, as those options provide people with a considerably smaller chance at returning to higher productivity.

A collaborative report from the California Traumatic Brain Injury Advisory Board states, “For those significantly or profoundly impacted by this injury, reintegration into the community is overwhelming due, in part, to limited services and insurance coverage for critical medical and social rehabilitation. Moreover, persons with TBI often need help with community reintegration multiple times and at different junctures, because of the complexity of their injury and changes in their medical condition, living arrangement, or caregiving situation. (2010)” 1

Centre for Neuro Skills (CNS) has a legacy of success in the worker’s compensation industry and has helped thousands of people to return to productive lives. Since our inception in 1980, we’ve focused on community integration through an individualized, goal-oriented approach to therapy.

Postacute TBI rehabilitation that incorporates various therapeutic disciplines, including occupational therapy and vocational rehabilitation, can simulate real-world work environments, assisting people in re-learning skills for independent living. Through neurobehavioral therapy and behavior analysis in postacute care, clinicians can individualize the treatment needs of each person – increasing their participation in rehabilitation and community activities. This enables them to practice skills needed for independent living and provides them with a greater chance of a productive life post rehabilitation.

Can the benefits of postacute rehabilitation continue long-term?

A 2016 research study, led by Grace Griesbach, Ph.D., National Director of Clinical Research for CNS, investigated whether benefits of postacute rehabilitation for TBI are sustained after discharge from a full time comprehensive postacute rehabilitation program.

In the project, moderately to severely injured people with TBI who participated in a full-time comprehensive postacute rehabilitation program were interviewed one year after discharge. “In the analysis of employed and unemployed subjects, it was revealed that 43.75% had an occupation of equal position to that before an injury. Those that were working also showed positive levels for social participation, cognitive function, and social satisfaction,” the paper states. Additional analysis revealed that as many as 66% returned to some form of paid employment.

These findings support the durable outcome and beneficial effects of postacute TBI rehabilitation long-term, it noted, “concluding that individuals with a good rehabilitation outcome are more likely to regain their former occupation and quality of life.” 2

Do these findings also conclude that access to health insurance is vital for TBI recovery? I’ll address that topic in part two of this blog, Next Steps in Worker’s Compensation for Treating Brain Injury, which explores cost savings, reporting, data collection, and public health care options that are currently available.

Part II

The focus in health care today is often on the high cost of care and ensuring access to care through legislative reform.  Change in recent years has focused largely on preventative care and care for common medical conditions.  However, health care after catastrophic injury, such as brain injury, is vastly more complicated.

Few individuals receive the full measure of treatment after brain injury that we now know will bring them to their ultimate recovery and functional status possible – due to uninformed financial restrictions to accessing care.  We have learned that early treatment is better than late treatment, in part, because we can prevent the development of unnecessary complications.  Expert treatment avoids inappropriate medications and surgeries while promoting and optimizing the neurological recovery of function.

“Patient-centered care” must be combined with the notion that “the dollars follow the patient” to enable this maximized recovery and return to the most meaningful and productive, as well as, the least expensive and least restrictive life after brain injury.  Catastrophic brain injury presents unique challenges in comparison to other health conditions. A brain injury can affect multiple organ systems quite randomly, and it is often said that no two patients are the same.  The tremendous variability requires medical treatment that is both comprehensive and expensive.  Furthermore, the cost of treatment has not and will not be reduced to a pill or a surgery.  So, treatment of brain injury requires a regiment of physicians, allied health professionals, case managers, attorneys, and family members, in addition to combination therapies that may also include surgeries and medications. Simply put, there is no medical condition today that is as complicated as brain injury.

Further, care pathways and endpoints of treatment are evident in most medical conditions. Appendicitis, as an example, is a medical condition that can almost always be treated the same way – but this is less the case for brain injury. Each patient recovers differently depending upon a host of variables that include the injury itself, the person’s educational, vocational and social history, the person’s pre-injury medical status, the person’s genetic factors, other system involvement, the timing of emergency treatment, the etiology of the injury, the expertise of the treatment given, the duration of treatment provided. Factors that affect access to treatment are also variables and may include access to insurance, socioeconomic status, patient and family education, and awareness of advocacy by treaters of appropriate treatment options.

What are the cost savings of a full-time comprehensive postacute rehabilitation program?

When treatment duration is determined by patient progress alone, rather than interference by financial restrictions, the data shows us that many patients seem to reach maximized recovery after injury when exposed to intensive and expert medical rehabilitation.  These patients’ outcomes are stable or improving at extended follow-up 5 to 7 years post-injury. Additionally, the financial benefit to an insurance company or society is tremendous – at an average of $1.5 million per person lifetime. Incredibly, some patients’ recoveries have resulted in more than $7 million in lifetime savings. When the expense of these treatments is contrasted to the financial savings alone, the return on investment is truly immense.

Is access to health insurance vital for TBI recovery?

Health insurance is not yet routinely providing all the treatment one would reasonably prescribe in the first year after injury. This is not to say recovery doesn’t extend beyond this point in time; rather it says that this is the most rapid and easily modifiable recovery period. The solution is found in collaborating with the teams of professionals who work to determine how benefits are applied and medical researchers who are on the hunt for the most productive and efficient treatment.  It is doubtful that recovery from brain injury will ever be reduced to a pill or a surgery.  Recovery will remain dependent upon intensive, expensive and well-executed therapies combined with thoughtful use of appropriate medications and surgeries.