Access to Care and Return to Work during a Pandemic

Leave of Absence and COVID-19

Sweeping changes to leave of absence laws are rapidly occurring at both the federal and state levels, helping employers adjust to the needs of their workforce. They are also expanding our industry's terminology of "return to work" as it applies to how employers are adapting their efforts through the pandemic.

The Families First Coronavirus Response Act (FFCRA) bill, introduced in mid-March 2020, requires employers with 500 or fewer employees to provide their workforce with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. It requires up to 80 hours of paid sick leave at the employee's regular rate of pay when an employee is in quarantine or experiencing COVID-19 symptoms and seeking a medical diagnosis. If an employee needs to take care of an individual subject to quarantine or care for a child whose school or childcare provider is closed due to the pandemic, the employee is entitled to 80 hours of paid sick leave at two-thirds of their regular rate of pay. An additional 10 weeks of paid expanded family and medical leave at two-thirds the employee's regular rate of pay must also be provided if an employee must care for a child whose school or childcare provider is closed due to reasons related to COVID-19. While this only applies to businesses with less than 500 employees, the majority of businesses with more than 500 employees have instituted additional paid family leave or allowed their workforce to use their paid leave for COVID-19-related reasons.

Many state and statutory paid leave policies have extended rights that are similar to the coverage offered by the FFCRA. Some of the nuances of these extensions include additional unemployment benefits for individuals that have been furloughed or laid off. Some states also allow for accrued paid sick leave for employees and are allowing employees to use these benefits for reasons related to COVID-19. Employers need to understand that some of these state and federal changes may run concurrently with offerings from self-insured plans. Some policies have offset provisions that allow benefits like short-term disability or workers compensation to be offset by benefits offered at a state or federal level.

For example, if an employee is taking leave to care for a child whose school is closed due to COVID-19 reasons, they would benefit from the FFCRA but not be able to take advantage of short-term disability. Self-insured benefits should be used as supplemental coverage instead of being used in addition to federal and state benefits so that the employee is receiving 100 percent of their standard pay in total.

Business Reopening

As businesses consider their reopening plans, they should consider three components: preparation, deployment, and sustainability of employees' return to work. These components should be guided by principles that include the safety of the employees, visitors, and the general public; compliance from public health organizations and government agencies; collaboration across the organization; and agility that enables a swift response to changes that may occur. Many questions require answers for each component of the plan, including the following.

Preparation

• Have you considered both community readiness and facility readiness?
• If employees return to the office, can you ensure social distancing? Is it being enforced within the community?
• Have you adjusted the footprint in your office to allow for safe social distancing? Is it possible while still maintaining productivity?
• Do you have testing capabilities?
• Will you require personal protective equipment (PPE) to be worn? Can employees buy their own, or will you supply items, like face masks, for your workforce?
• Have you allowed for flexibility in the workforce, especially for groups more vulnerable to the illness and employees needing to care for children?

Deployment

• Are employees adapting to the changes, or do you see a decline in productivity?
• Have employees made use of flexibility policies? Is there an increased demand for leave?
• Do employees feel safe with the return to work, or is their significant apprehension?
• Are you adapting to the needs of your workforce?
• Are you enforcing the use of PPE? Are employees encouraging others to maintain safe social distancing?
• Is testing working, or are you seeing a rise in employee transmissions?

Sustainability

• Have you been able to phase more employees back into the physical workspace?
• Are employees more productive than they were when working from home?
• Do employees still feel comfortable coming into a physical workspace?
• Is the community prepared for a possible second wave of the virus? Has a vaccine been established?
• Are you able to pivot back to a work-from-home model if necessary?

Access to Care

With hospitals not offering elective surgeries due to the pandemic, we may be considering how our injured workers are getting the care they need. It is also important to consider how we are handling these changes operationally between employers and claims teams. Are we considering which patients are more at risk? Can we use analytics to understand which patients should be recovering? Are there significant milestones tracked in a patient's recovery? What are the expectations of your claims teams? Through this crisis, it is crucial to take a personalized approach to understand both the functionality of the team and the injured worker within a claim.

Preferred provider organizations work as a network for connecting workers compensation resources (hospitals, primary care specialists, occupational health, etc.). Some are providing their clients with a real-time listing of what providers are currently available, including operating hours and telehealth capabilities. While serving both the client (third-party administrator or insurer) and the provider, the challenge lies presently with how to provide better help to the client. They are currently working with claims teams on their workflows to act as a liaison for communication among the payer, provider, employer, and employee. This need for improved communication will increase as businesses around the country reopen and there is further demand to locate a provider.

Regulators are assisting in healthcare needs through efforts to push telehealth legislation. With patients fearing possible exposure from in-office visits, demand for telehealth is increasing. Harvard reported a 60 percent drop in in-person visits with a 10 percent increase in telehealth visits. Due to increased demand, some physicians have rushed to offer telehealth capabilities without understanding regulations first. States are addressing issues related to telehealth, such as limitations on prescriptions that can be prescribed over the phone and the scope of care being provided.

Provider Access

There are concerns about on-hold elective procedures since there are restrictions on which providers are allowed to operate and which patients they can see. Dentistry, for example, can only see patients with infections or pain, which may result in more expensive procedures in the long term. However, patients are missing wellness visits that are crucial to the recovery process.

For instance, serious procedures—like biopsies, removal and replacement of orthopedic devices or hardware, and cast replacements—may result in further long-term damage to the patient. There may be an increase in the expansion of benefits in the instances where an injured worker needed care for their recovery but could not receive it.

With elective surgeries being canceled or postponed, providers are adjusting through reschedules based on pain levels and how likely a patient may be to resort to an emergency room visit. With a decline in patients, some private practices are being acquired and consolidated by larger healthcare systems. Some satellite physicians are being reassigned to hospitals to help with pandemic needs. With healthcare staff adjusting to current needs, it is vital to assess how quickly they can be reassigned back to their original roles when we return to a state of normalcy and the demand for elective procedures increases.

Preparing Claims Teams

As we plan for the future beyond the pandemic, there is a need to address the impact on claims teams. They will need to know how to prioritize medical care for injured workers. Do they understand how social isolation has impacted the injured worker? How has this crisis affected recovery and the injured worker's level of functionality? Do you have tools at your disposal to suggest help for those impacted more severely? Developing a communication plan for your claims teams and emphasizing data collection on current claims will create a more streamlined process while creating a better understanding of the patient population.