10/23/2018

Check it once, check it twice

– SHOW ME THE MONEY!

Presented By:
Megan Coville, MS, OTR/L, ARM, CSPHP
Senior Risk Management Consultant

Objectives

• Identify required elements of the Safe Patient Handling Act

• Describe how the insurance incentive is applied to standard

premiums (starting point for worker compensation insurance
policies)

• List next steps to understanding worker compensation policies

and how to identify facility loss drivers (accident causes) to
reduce worker compensation costs

Who is Required?
Public Health Law § 2997-h
1. “Health care facility” shall mean general hospitals, residential health
care facilities, diagnostic and treatment centers, and clinics licensed
pursuant to article twenty-eight of this chapter, facilities which provide
health care services and are licensed or operated pursuant to article
eight of the education law, article nineteen-G of the executive law or
the correction law, and hospitals and schools defined in section 1.03 of
the mental hygiene law.
§ 1.03 Definitions, NY MENT HYG § 1.03
11. “School” means the in-patient service of a developmental center
or other residential facility for individuals with developmental
disabilities under the jurisdiction of the office for people with
developmental disabilities or a facility for the residential care,
treatment, training, or education of individuals with developmental
disabilities which has been issued an operating certificate by the
commissioner of developmental disabilities.

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NYS Safe Patient Handling Act –

What is Needed
✓ Safe Patient Handling committee
✓ Implement Safe Patient Handling program
✓ Conduct a Hazard Assessment
✓ Identify criteria for equipment use
✓ Provide training & education
✓ Establish process for injury investigation & plan of corrections
✓ Conduct annual performance evaluation
✓ Consider SPH when developing new construction or
remodeling
✓ Create a process for good faith employee refusals

Committee Requirements
• Purpose of Committee: Develop, evaluate and revise facility
SPH program as an ongoing process with an ultimate goal of
changing the safety culture of the facility.

• Can be newly established or rolled into already established

committee*

• No meeting time requirements (i.e. weekly, monthly, quarterly,

etc.), meetings should be periodically and make most sense for
your facility

• The committee must include people with expertise or

experience relevant to SPH.

Committee Representatives

• ½ the committee must be frontline non-managerial employees

providing direct care

• At least 1 non-managerial nurse & 1 direct care worker present

• Leadership of committee should be co-chaired by management &

non managerial nurse/direct care worker.

• Where there are employee representatives, at least one shall be

appointed on behalf of nurses and at least one shall be appointed on
behalf of direct care workers.

• Where a resident council is established, and where feasible, at least

one member of the committee shall be a representative from the
resident council.

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Committee Representatives

• Other positions could include:

Risk Management, Safety, Clinical, Nursing, Program
Directors/Managers, DSPs, Union Representation,
Patient/Resident/Individual representation,
Maintenance, Purchasing, Senior or Executive
Management, etc.

• Executive Management support & engagement is

necessary for success

Written Policy, Procedures &

Implementation Plan
• Policy = a clear statement of commitment & support for SPH

• Procedures = steps outlining agency process for assessments,

equipment needs, training, program evaluation, employee
contribution, communication & refusals

• Plan = steps outlining how the facility will put procedures in

place

Implementation may be phased in… while phasing out of

manual transferring and movement

Ultimate goal is to:

Remove or reduce human strength from
transfers, movement and repositioning tasks
• To increase the quality of care
• To perform a safe & comfortable lift, movement and/or
transfer using mechanical or strength reducing devices
• To create a safe working environment by reducing the
frequency of manual lifting, transfers & repositioning.
• To reduce & prevent work related injuries to direct care
workers
• To reduce lost time related to injury and/or fatigue in staff

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NIOSH Guideline - Up To 35lbs?

“…Clearly, the majority of patient handling

situations are far less than ideal, thus NIOSH
cannot designate 35 lbs., nor any other weight, as
a protective “exposure limit” for patient
handling. Instead, NIOSH shares in the consensus
among patient handling professionals that the
goal of safe patient handling programs should be
to eliminate all manual lifting whenever
possible.”

Assessment Requirements
• Patient/Resident/Individual Assessments
• Initial/admission, status change, periodical reassessment
• Address contraindications of devices

• Hazard Assessment
• Assessment of current patient/resident/individual abilities
• Evaluate equipment and environmental needs
• Identify potential problems with equipment (e.g. lifts vs. beds)
• Accessibility, storage & maintenance of equipment
• Trends in injuries & near misses for employees and
Pt./Res/Ind.

Training Requirements
SPH Training Must be Initial and Annually for all Direct Care &
Supervisory staff!
Training should include, at minimum:
• Policy & procedures
• Education on patient-handling related injuries (causes &
prevention)
• Reporting procedures for reporting injuries, near misses and
unsafe work conditions
• SPH equipment demonstrations & hands-on participation
training for staff involved in direct care activities
• Skills check or competency testing is highly recommended

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Training – NOT IN BEST PRACTICE

• Lacks tools to evaluate training effectiveness

• Fails to include both lecture and hands on
• Built on body mechanics and/or focuses on human
strength
• Does not reference written policy
• Fails to include education on anatomy of injuries
• Fails to include causes of injuries and preventative steps

Right to Refuse / Good Faith Refusal

• Develop a process by which employees may refuse to perform

and be involved in patient handling or movement that the
employee reasonably believes in good faith will expose a
individual or employee to an unacceptable risk of injury.

Within a well-planned program, this situation should generally

not occur

Injury Investigations

1) Gather the Facts

2) Analyze the Facts
3) Correct the Issue

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Injury Investigations

Gather The Factors

1) Who? (was injured/involved)
2) Where? (location)
3) When? (time frame)
4) What happened? (Injury)
5) How did it happen? (actions causing injury)

6) Why did this happen?

7) How will we prevent this accident from occurring again?

Injury Investigations

What is supposed to happen?

• (policies/procedures, plans of protection/care plans,
safeguards, transfer & mobility plans, etc.)

What usually happens?

• (norms)

What happened that day? What was different about that day?
• (event/close call)

Why weren’t we prepared for this situation?

Focus on prevention, not blame or punishment

Evaluate system vulnerabilities first, then performance:

-Ineffective Communication -Environment Barriers
-Lack of Accountability -Inadequate Training
-Lack of Supervision/Management -Fatigue/Schedules
-Equipment Barriers/Failures -Cultural Norms

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Should eliminate or reduce the effects of the root cause

What can we do to prevent this event from occurring again??

✓ Identify why the situation occurred

✓ Address factors leading up to situation
✓ Set up plans to address similar situations if they do happen again: (who to
contact, what to do, how to support without getting hurt)
✓ Communication is key!

➢ Always follow up to ensure corrective actions were implemented and are

working!

Annual Performance of SPH

Program
• To what extent has the SPH program reduced risk of injury to
individuals and employees

• Track, trend and monitor injury data

• Review equipment needs, replacement needs and use protocols

• Adjust program as patient/resident/individual needs change

• Construction/remodeling architectural planning

SPH Data Analysis

Employee Injury Data Patient/Resident/Individual
• Frequency vs. severity Incident Data
• Report vs. medical vs. lost • Falls
time claims • Combativeness during transfers
• OSHA Logs • Pressure Sores
• Age of employee / tenure of • Physical function/activity levels
employee
• Root causes / activities
causing injury Other Data
• Type of injuries • Worker fatigue
• Shift / time of day • Job satisfaction
• Programs or locations or Unit • Pt/Res./Ind. Satisfaction
• Indirect impacts from injuries • Worker turnover

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Constructing a Workers Compensation Premium

The Starting Point:

Manual Premium x Experience Modification Factor

= Standard Premium

• Where it all starts for an underwriter.

• Where the price of premium starts for the insured

Constructing a Workers Compensation Premium

Classification Codes & Rates

Specific to exposure (the type of work you do)

The “Rate” is defined by NY State
Rate reflects the degree of risk.

LOST COST
CLASS CODE
RATE
8829 Nursing Home–All Employees $3.77
8833 Hospital–Professional Employees $1.46
8865 Alcohol or Drug Rehabilitation Facility-All Employees-& Clerical $3.49
9040 Hospital–All Other Employees $5.04

Constructing a Workers Compensation Premium

Manual Premium

Class Rate x Payroll* / 100

EXPOSURE/ MANUAL
CLASS RATE
PAYROLL PREMIUM
8829 $3.77 $8,000 $30,160
8833 $1.46 $8,000 $11,680
8865 $3.49 $8,000 $27,920
9040 $5.04 $8,000 $40,320

*Payroll Example = $800,000 in each class code

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Constructing a Workers Compensation Premium

Experience Modification Factor (EMF)

ACTUAL LOSSES
EXPECTED LOSSES

2014 2015 2016 2017 2018

• Uses the oldest 3 years of the last 4 years experience

• One BAD loss year stays with you for 3 years
• <1 = Better than Average; >1 = Worse than Average
• Developed by State Workers’ Compensation Board or NCCI

Constructing a Workers Compensation Premium

Manual Premium X EMF = Standard Premium

EXPOSURE/ MANUAL
CLASS RATE
PAYROLL PREMIUM
8833 $1.46 $8,000 $11,680
9040 $5.04 $8,000 $40,320
$52,000

SPH
Manual Standard ANNUAL
EMF Credit
Premium Premium PREMIUM
2.5%
Excellent $52,000 0.75 $39,000 ($975) $38,025
Average $52,000 1.00 $52,000 ($1,300) $50,700
Poor $52,000 1.25 $65,000 ($1,625) $63,375

How the SPH Credit Effects Premiums

Manual SPH Credit ANNUAL

EMF SP
Premium 2.5% PREMIUM
Excellent $52,000 0.75 $39,000 ($975) $38,025
Average $52,000 1.00 $52,000 ($1,300) $50,700
Poor $52,000 1.25 $65,000 ($1,625) $63,375

Difference between EMF

1.25 vs. 1.00 is $13,000 > Credit

Preventing worker compensation claims to

reduce EMF provides a more savings than the
SPH insurance incentive credit.

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Types of Insurance Programs

• Guaranteed Cost Low Risk Assumption

• Sliding Scale
• Retention
• Retrospective Rating
• Deductible
• Self Insurance
• Captives
High Risk Assumption

Control The Risks By:

• Reporting injuries immediately
• Investigating for root causes immediately
• Implementing corrective actions and follow up
• Reviewing claims periodically
• Returning workers to the job ASAP
• Know your industry-specific exposures –review data for your
specific trends

• Patient Handling • Material Handling

• Behavioral/Aggressive interactions • Ergonomics
• Slip Trips Falls • Cut by/Struck by Objects

Next Steps
• Review your SPH program to ensure you have all
elements required

• Review your organization worker compensation program

– determine if and how the SPH credits may apply

• Find out your Experience Modification Factor (EMF) – is

it above or below 1.00?

• Contact Broker/Agent/Carrier to determine what they

need to obtain the credit?

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What to Expect?
Your carrier may request:

• A signed affidavit

• Review of a compliancy checklist

• Copies of policy, procedures & trainings

• Copies of SPH committee meeting minutes

• Onsite compliancy visit

• May request to attend committee meetings

Check the Box vs. Culture Change

• Set clear expectations and measurable goals
• Communicating specific responsibilities
• Education and Buy In
• Creating accountability
• Institute consequences
• Address deficiencies promptly
• Changing the thought process
• Share the experiences

References

• NYS Zero Lift Task Force SPH Best Practice Guide. Available at:
http://www.pef.org/wp-content/uploads/2015/12/NYS-Zero-Lift-Task-Force.pdf
• NYS DOH SPH Report to the Commissioner of Health. Available at:
https://www.health.ny.gov/statistics/safe_patient_handling/
• NYS SPH Legislation. Available at: http://www.zeroliftforny.org/nys-legislation/
• NY Workers’ Compensation and Employers Liability Manual… Approval of SPH Act
Filling (January 2017). Retrieved from: http://www.nycirb.org/bulletins/rc2429.pdf
• Safe Patient Handling & Mobility: “Limited Guidance” – Not “NIOSH Policy:” Caution
regarding the 35 lb. Limit. Retrieved from:
https://www.cdc.gov/niosh/topics/safepatient/default.html

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