Continuum of Care
Effective date: July 1, 2014
Application: All claims.
Policy subject: Health care services – general
To establish the guiding principles of the Continuum of Care Model.
Continuum of Care Model means a framework for the efficient and coordinated planning and provision of health care and return-to-work plans appropriate to each stage of a worker’s injury and recovery.
Medical aid, also referred to as health care, means “the provision of medical and surgical aid, of hospital and professional nursing services, of chiropractic and other treatment and of prosthetics or apparatus” (Section 2(1)(v) of The Workers’ Compensation Act, 2013 (the “Act”)).
- Under Section 19(1) of the Act, the Workers’ Compensation Board (WCB) has a duty to:
- Arrange provision of any health care or treatment that may be needed because of a work injury.
- Arrange to provide rehabilitation to injured workers.
- Consult and cooperate with injured workers in the development of rehabilitation plans intended to return them to positions of independence in suitable productive employment.
- Workers have a legislated responsibility to take all reasonable action to lessen earnings loss resulting from an injury and to co-operate with the WCB in a rehabilitation plan to return the worker to a position of independence in suitable productive employment (Section 51).
- The WCB may request a worker to undergo a medical examination by one or more healthcare providers (Section 58).
- Section 53 of the Act states “an employer shall co-operate with the board and the worker to achieve the early and safe return of an injured worker to their employment.”
- Saskatchewan human rights legislation requires that all employers make every reasonable effort, short of undue hardship, to accommodate injured workers, and allow them to return to work as soon as medically safe. The Saskatchewan Employment Act also provides job protection to certain employees who are absent from work due to a work injury.
- Health care providers examining or treating injured workers are expected to furnish any reports the WCB may require, including recovery and return to work progress reports (Sections 55 and 56).
- The WCB has established the Health Care Advisory Committee (HCAC) to evaluate and make recommendations to the WCB regarding the provision of health care for injured workers. The HCAC includes:
- A chairperson appointed by the WCB.
- Up to two members representing employer organizations.
- Up to two members representing labour organizations.
- And one member from each of the following health care provider areas chosen from their respective health care provider organization:
- Occupational therapist.
- Other licensed health care providers may be invited at the discretion of the WCB.
- The Early Intervention Program (EIP) model was implemented by the WCB in 1996. The program intended to ensure an injured worker’s optimal recovery and resumption of normal activities, including work, in the most appropriate, timely and safe manner. The program was renamed Continuum of Care to better reflect the progressive levels of assessment and treatment available to injured workers.
- The WCB has adopted an integrated partnership model of recovery and return to work with open communication between all partners – the employer, health care providers, the injured worker, union representative (by the injured worker’s request) and WCB – and an awareness of the role each plays in achieving the most appropriate, timely and safe return to work.
- The WCB supports the functional rehabilitation model that recognizes the importance of returning the injured worker to functional activities relevant to their life, including return to work, during the recovery period. The functional rehabilitation model encourages health care providers and workers to recognize that successful long-term recovery is associated with return to function, even in the presence of increasing subjective symptoms where there are no objective signs of harm.
- There are three levels of assessment and treatment in the Continuum of Care model – Level I (primary), Level II (secondary), and Level III (tertiary). The levels graduate towards increased program complexity, scope and resources, depending on the needs of the injured worker. The goal is to ensure that injured workers receive the right care at the right time.
Level I Assessment and Treatment (Primary)
- Level I assessment and treatment begins with the initial diagnosis and medical management by the primary health care provider.
- Injured workers choose their primary health care provider and may also choose to see other providers, with whom the WCB has a relationship agreement, consecutively or concurrently. A referral from a licensed health care provider is required if the other provider is not licensed (for example, an exercise therapist or massage therapist). POL 18/2016 and PRO 18/2016, Health Care Services, establish the guidelines for the provision of health care services to injured workers.
- Where requested by the primary health care provider, the WCB will arrange diagnostic tests, specialist appointments or surgeries, as needed. Where a waiting list exists, the WCB may arrange expedited appointments to ensure timely access to treatment. In-province services will be used unless unavailable within a reasonable period of time.
- Return to work should be integrated into the treatment plan as soon as possible, preferably with the injured worker’s first visit to the primary health care provider. POL 08/96, Return-to-Work Plans, applies.
- The primary health care provider will assess the worker’s condition and will provide the worker with a list of functional restrictions resulting from the work injury. This list is to be shared with the employer and updated as the worker’s condition changes.
- A physician, chiropractor, physical therapist, occupational therapist, psychologist or nurse practitioner may arrange and monitor the injured worker’s return to work, with the cooperation of the primary health care provider. Where this occurs, progress reports will be provided to the primary health care provider.
- Where a work injury results in restrictions that impair a worker’s ability to perform their pre-injury duties, whether or not the employer has a return to work (RTW) program, the WCB will assist the worker and employer with a RTW plan that will enable a return to suitable productive employment.
Level II (Secondary) and Level III (Tertiary) – Advanced Assessment
- At any time during treatment, the primary health care provider or WCB may request advanced assessment when:
- There is no active treatment plan.
- The worker is not working and has no confirmed RTW date.
- Significant risk factors for chronic disability have been identified (see Appendix A).
- The expected recovery date has passed (see Appendix B), or
- The worker continues to work in employment but has not returned to full duties and/or full hours of work after the work injury as expected.
- Assessment teams accredited by the WCB bring together a number of health disciplines to perform advanced assessment of a worker’s medical, physical, functional and psychosocial condition.
- The WCB will select the appropriate assessment team based on the length of time the worker has been away from regular job duties or the presence of psychosocial and pain management issues. Additional specialists may be added to the assessment teams at the discretion of the WCB, or other assessments requested (e.g., psychological or psychiatric), as required.
- The assessment team will confirm a diagnosis and recommend a plan of treatment to assist the health care provider(s). The required reports and recommendation and fees payable for assessment teams are set out in PRO 51/2017, Health Care Services – Assessment Teams, and the Secondary and Tertiary Assessment Manual (http://www.wcbsask.com/care-providers/).
Level II (Secondary) and Level III (Tertiary) – Advanced Treatment
- When the primary health care provider approves the assessment team’s treatment recommendations, they may make a direct referral to a WCB approved treatment centre or ask the WCB to make the referral.
- To prevent an actual or potential conflict of interest the WCB will avoid requesting assessment or treatment from a centre that has a financial relationship with the injured worker’s employer. Where the primary care provider is being offered a choice of treatment centres, any such relationship will be disclosed to the primary health care provider and the injured worker to ensure the opportunity for an informed decision.
- Once referred to the treatment centre, the primary care provider will continue to see the injured worker and monitor progress throughout the treatment. Other Level I therapies will stop and the recommended treatment will be provided by the Level II or Level III treatment centre.
- The treatment centre will provide all recommended components of treatment to ensure cohesive health care and re-employment management. When a component of the treatment is not available in the centre, the WCB will locate an alternate provider for assistance.
- Workers expected to make a full recovery from the injury and regain the ability to perform the pre-injury job will be referred to Level II treatment. Programs may include: biomechanical treatment, regional conditioning, global conditioning, work simulation, work hardening, psychosocial counselling, ergonomic consultation, education related to the injury and a monitored return to work.
- Workers expected to make a full recovery from the injury but needing more extensive therapy, as well as those with permanent functional restrictions, will be directed to Level III programming. In addition to the physical conditioning at Level II, Level III treatment involves chronic pain management, lifestyle adjustment and stress management. Suitable duties and tasks will be arranged with the employer while the worker attends the program.
- The worker will be expected to attend Level II or Level III programs up to five days per week. Where the worksite may be used to make functional progressions, less treatment time may be indicated.
- Accreditation, practice standards of care and a schedule of fees payable to Level II and Level III clinics are outlined under PRO 51/2016, Health Care Services – Secondary and Tertiary Treatment.