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Work Solutions Insight February 2016 Newsletter
Work Solutions Insight February 2016 Newsletter
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Research Update
I mportance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs.
Fritz JM,  Kim J,  Dorius JJ Eval Clin Pract. 2015 Sep 29.

A retrospective study was conducted by the authors to examine outcomes across the numerous ways in which patients enter in to and receive medical care for lower back pain. The study concluded that the entry point into care does have an association with the care path and future health care costs.The authors suggest that a strategic entry point into medical care could prove beneficial to the low back pain patient by improving overall outcomes and reducing costs.
Of the 747 patients included in this study, when physical therapy was the entry point, fewer radiographs were necessary (50% of the overall average), fewer emergency room visits were conducted (50% of the overall average), and no surgeries were performed. 1-year treatment costs averaged $904 whereas the overall average cost per patient was $1.194. However, physical therapists as the first provider accounted for only 6.4% (49) of the patients in this study. Chiropractors accounted for 27.7% of the patients (207) with 1 year treatment costs averaging $878.
DSI comments: Even though physical therapy shows evidence of substantial cost savings and decreased diagnostic, emergent and invasive procedures being necessary for patients with low back pain, this study suggests that physical therapy as an entry point continues to be grossly underutilized. Concurrently, increased utilization of therapists as the entry point for care at the workplace supports improved outcomes and reduced costs associated with low back pain. It could be of significant value to repeat this type of study with industrial workers entering into medical care for low back pain at the workplace through therapists and other on-site medical practitioners.
Reference : J Eval Clin Pract. 2015 Sep 29. doi: 10.1111/jep.12464. [Epub ahead of print]
Physical Therapist as Work Injury Prevention and Management Specialist
  In many physical therapy practice settings, discharge planning occurs as the initial evaluation is being done. With inpatients recovering from surgery or illness, focus is given to planning for equipment and support that will be needed. Additionally, discharge destination needs to determine whether the home is an appropriate destination or if short-term rehab may be required. In the outpatient setting, discharge goals include return to full play for an athlete, resuming functional activities, and returning to work. 
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Legal Update
Justice Department Reaches Settlements with Four Cities Across the Country to Remove Disability-Related Questions from Job Applications and Ensure Web Accessibility

The Justice Department announced today that it has reached settlement agreements with the cities of DeKalb, Illinois; Vero Beach, Florida; Fallon, Nevada; and Isle of Palms, South Carolina.  The agreements resolve investigations of each city under Title I of the Americans with Disabilities Act (ADA).  The investigations found that each city’s online employment application asked questions about disabilities in violation of the ADA.  The ADA does not permit employers to inquire as to whether an applicant is an individual with a disability or as to the nature of such disability before making a conditional offer of employment.  Under Section 503 of the Rehabilitation Act of 1973, however, federal contractors subject to affirmative action requirements may invite an applicant voluntarily to self-identify as an individual with a disability, consistent with certain requirements. 

The investigations also found that each city’s online employment opportunities website or job applications were not fully accessible to people with disabilities, such as those who are blind or have low vision, are deaf or hard of hearing, or have physical disabilities affecting manual dexterity (such as limited ability to use a mouse).  In recent months, the department reached similar settlement agreements with the city of Hubbard, Oregon, and Florida Stat e University. 

“Congress intended for people with disabilities to be able to compete for jobs on a level playing field,” said Acting Assistant Attorney General Vanita Gupta of the Civil Rights Division.  “Including disability-based questions on a job application is illegal and creates barriers for people with disabilities.  These agreements ensure that people with disabilities will have an equal chance to compete for public sector jobs.  We commend each city for its cooperation and efforts to ensure accessibility and fairness in the job application process.”   

Under the settlement agreements, each city agrees to ensure that its hiring policies and procedures do not discriminate against any applicant on the basis of disability, including by: 
  • not conducting a medical examination or making a disability-related inquiry of a job applicant before a conditional offer of employment is made;
  • not requiring a medical examination or making inquiries of an employee as to whether such employee is an individual with a disability or as to the nature or severity of the disability, unless such examination or inquiry is shown to be job-related and consistent with business necessity;
  • maintaining the medical or disability-related information of applicants and employees in separate, confidential medical files;
  • training employees who make hiring or personnel decisions on the requirements of the ADA, designating an individual to address ADA compliance matters, and reporting on compliance; and
  • ensuring that its online employment opportunities website and job applications conform with the Web Content Accessibility Guidelines 2.0, which are industry guidelines for making web content accessible.
DSI Comments:  Case law continues to emphasize that the inappropriate use of medical/disability information pre-offer offer of employment, post-offer of employment or at any time during employment is against the law. Medical examinations must be job related and consistent with business necessity. DSI Work Solutions Job Function Matching® system strives to clearly meet the requirements of Title I of the ADA while at the same time positively supporting employers and workers with successful employment experiences. Contact us at: to receive more information.
Those interested in finding out more about the ADA may call the Justice Department’s toll-free ADA information line at 800-514-0301 (TDD 800-514-0383) or visit . 
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