1. Innovation and Change: The 4 Keys
To Solving America’s Workers’
Compensation Crisis
Written by George K. Lewis Jr., PhD
Chief Executive Officer and President, ZetrOZ, Inc.
Manufactured by:

2. The workers’ compensation system in
America has become so ineffective and
plagued with questionable practices that
some experts have deemed it “broken.”
The medical community, insurers, employers,
and patients alike complain of feeling trapped
in a system where costly, catastrophic cases
dominate, becoming unmitigated “train
wrecks,” which often could have been more
simply resolved.
This sad reality has stakeholders scratching
their heads in confusion. How did a system
that was originally intended to protect the
health and safety of American workers become
so intractable, and how can we solve what has
become a multi-billion-dollar workers’ comp
crisis?
A panel of experts with deep experience in
workplace injury, health care, insurance,
and pain management tackled the question
in a comprehensive discussion of the state
of workers’ compensation today. The panel
members agreed upon directions that, if
adopted, could improve treatment and
healing for injured workers while also keeping
long-term costs in check for employers and
insurers.
All agreed, however, that addressing
the worker’s compensation crisis will
require innovative approaches, a deeper
understanding of diagnosis and worker
lifestyle, and a willingness to challenge public
policy.
The panel discussion was moderated by
Michael Shor, MPH, Managing Director at Best
Doctors Occupational Health Institute, and
included: Dr. Ralph Ortiz, who is on the Board
of Directors and a Founding member of the
New York State Pain Society and Founder and
Director of Medical Pain Consultants; Robert
Woods, Senior Vice President of Energi, Inc,
a company that provides risk management
and insurance programs; David Cohen,
Executive Vice President at Standard Oil of
Connecticut, Inc; and Dr. Gerard Malanga, a
Rutgers University Clinical Professor of Physical
Medicine and Rehabilitation and Medical
Director of Horizon Casualty Services, Inc., a
subsidiary of Horizon Healthcare Services, Inc.
The resulting insights, summarized in this
paper, can be translated into solutions that
have the potential to bring the workers’
compensation system back on track, reducing
costs and helping patients return to work
safely and more quickly. In nothing short of
a total paradigm shift, stakeholders in the
system must embrace four essential changes
to return America’s workers’ comp system to
what it was intended to be -- a system that
helps injured workers return to work safely.
The panel’s recommendations are as follows.
Innovation and Change: The 4 Keys
To Solving America’s Workers’
Compensation Crisis

3. 1
Eliminate unproven therapies in favor
of accurate diagnosis followed by
evidence-based treatment.
It’s my opinion that the classic model is not successful due to outdated modes of thinking. The
current model of treatment consists of using lots of non-steroidal anti-inflammatories (which
are meager in efficacy to begin with), referral to physical therapy that is often perfunctory,
with a reliance on passive physical therapy (instead of active physical therapy). For persistent
complaints, patients are often provided repeated cortisone injections, which are well known
to inhibit tissue healing, rather than trying to regenerate tissue. When these treatments fail,
patients then often undergo surgery, with various surgical procedures that have become
embedded in classic traditional orthopedic treatment, such as partial meniscectomies
(removal of a piece of cartilage in your knee that cushions and stabilizes the joint), and spinal
fusion procedures. The current medical literature has demonstrated that in many patients,
partial meniscectomy is no better than physical therapy or even sham meniscal surgery. And
yet 700,000 partial meniscectomies are performed every year.
-- Dr. Gerard Malanga
Proper diagnosis is closely linked to proper
treatment, and providers need to focus
more heavily on accurate diagnosis to deliver
appropriate care. Yet some 30 percent of
patients are misdiagnosed: in the worst cases,
what could have been an injury that might
heal within weeks with proper treatment
can, if improperly diagnosed and treated,
snowball into a life-altering, permanent injury
that prevents that worker from ever going
back to work. Too often, providers choose a
conservative intervention in the beginning of
a workers’ compensation case, usually due to
its low cost. But when applied in the wrong
circumstances, conservative treatment can
cost more in the long run, as later, more costly
treatment is required.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis
30%of patients are
misdiagnosed

4. 2When we’re dealing with a work-related injury we’re dealing with a very specific population –
they make a living pushing, pulling & lifting. In our research, it’s a high school education or
less. They’re very ill equipped to really understand how to access the medical system, never
mind judge what is good care from bad care, so that places a huge burden on what [the
insurance company and company] do, in terms of trying to help that injured worker through
that process.
-- Michael Shor
Identify at-risk workers early, and invest
in wellness as well as sickness.
At the same time, preventing patients from
spiraling downward at the onset of injury is
crucial. Panelist Robert Woods, Jr., Senior Vice
President, Claims Energi, Inc. has discussed
his company’s demonstrable success with
use of nurse case managers (NCMs) for those
entering the workers’ comp system. Energi
assigns NCMs to every patient, providing
services from filing the claim, helping to
guide treatment and care, and accompanying
patients to doctor visits.
Energi retained Risk Navigation Group, LLC
(Risk Navigation) to conduct an analysis
of medical management outcomes in two
samples of claims. Risk Navigation examined
incurred losses to determine if there was a
distinction in the disability duration outcomes
between two programs, one using NCMs
for all claims and the other using NCMs in
less than 40 percent of claims. Use of NCMs
demonstrated a materially and financially
advantageous effect on both overall medical
management and, more particularly, a
diminution of disability duration in similar
claims. Specifically, “days of disability” were
reduced from 316.9 to 85.65 when NCMs were
activated from “day one.” According to Woods,
“Though some companies consider it an extra
cost, nurse case managers have been known to
help close workers’ compensation cases at 70
percent of what they would normally cost.”
Another example of a company investing in
wellness is Horizon Casualty’s innovative Pain
Management Medical Home. Anecdotally
speaking, patients with an unhealthy lifestyle
(e.g. smokers, overweight/obese, etc.)
combined with the psycho-social aspects of
negative relationships at work or at home
tend to be more likely to have a negative post-
injury experience. Strategic new initiatives
such as the Pain Management Medical Home
approach put people on the best therapeutic
course early in their care by implementing a
care team approach. The care team consists of
a diverse set of healthcare providers, including
a Physical Medicine and Rehabilitation
physician, a functional rehabilitation provider,
and a psychologist. This holistic approach to

5. the patient’s care applies a biopsychosocial
model to health care. Early studies show that
patients treated under the Horizon Casualty
Services Pain Management Medical Home
program, using evidence based medical
guidelines, had significantly improved medical
outcomes. In addition, there was a statistically
significant 50% reduction in medical and wage
replacement costs. Variables contributing to
lower costs were: fewer steroid injections,
fewer physical therapy treatments and no
patients discharged on opioid narcotics.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis

6. 3What is evidence-based medicine? It’s the publications and the journals, but it’s also the his-
tory and knowledge of the physician with the different techniques, and the history and goals
and desires of the patient. That’s evidence-based medicine.
--Dr. Ralph Ortiz
Embrace innovative
treatment solutions.
The panelists agreed that the physician
“quiver” is short on “arrows” when it comes
to treating musculo-skeletal pain, the most
common form of workplace injury. Today,
treatments offered may be limited to what’s
reimbursable rather than what might work
best for the patient. According to Dr. Ralph
Ortiz, “Pills, passive physical therapy and
injections only mask the pain – there are
newer therapies available, showing real patient
improvement - let’s get rid of the red tape, be
the innovators and try them.”
Dr. Ortiz is mainly speaking of innovative,
new treatments currently available, but
not yet considered part of the generally
accepted standard treatment protocol (and
thus unlikely to be covered) by the insurance
industry. However, more progressive workers’
compensation insurers such as Energi are
thinking more flexibly. Such companies are
allowing patients in some individual cases to
have access to new and innovative treatment
options where the treatment appears to most
likely be successful given the patient’s medical
circumstances because they view each injured
worker as an individual, and not just another
claimant.
Some of the novel therapies that may be
useful in some circumstances that were
discussed by the Panel include four distinct
therapeutics that enhance the human body’s
natural healing processes. Although well-
supported and researched in the medical
community, they are today largely “not
covered” by insurance carriers:

7. Prolotherapy
Widely considered the progenitor of each of the following
treatments, it is also called proliferation therapy or
regenerative injection therapy, a treatment of tissue with the
injection of an irritant solution into a joint space, weakened
ligament, or tendon insertion to relieve pain.
Platelet-Rich Plasma (PRP) Injections
An in-office procedure that uses the body’s own healing
mechanisms by injecting the patient at the site of injury with a
sample of their own blood enriched for platelets as a means to
promote the healing of injured soft tissues.
Sustained Acoustic Medicine (sam®)
A portable, wearable FDA cleared medical device that delivers
long duration, low-intensity therapeutic ultrasonic energy
to relieve pain and muscle spasms, and to increase local
circulation that will accelerate the natural healing processes.
Stem Cell Therapy
An in-office procedure using the unique capability of stem
cells to differentiate and proliferate into distinct cell types
throughout the body; the harvesting of stem cells from bone
marrow for reinjecting into the injury site aids the natural
repair process for damaged or degenerated tissues and joints.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis

8. The Affordable Care Act had one key
change that, intentionally or not, had major
ramifications for the workers’ compensation
industry. Historically, group health and
workers’ compensation were billed as “fee
for service,” meaning health care providers
were reimbursed based on the services
provided for a patient (including diagnostics,
procedures, office visits, etc.) But post-ACA,
workers’ compensation remains fee for service
while group health is evolving toward more
focus on capitation, in which doctors are
reimbursed a lump sum per patient based
on their diagnosis and thus must manage the
patient’s healthcare within a fixed budget. The
result: for patients with chronic degenerative
conditions – a bad knee, a bad shoulder, a bad
back -- it’s more efficient and more financially
sound for insurance and medical professionals
if patients can be classified under workers’
compensation because the patient’s cost of
care is not capped.
While the primary goal of all stakeholders
should be to ensure quality patient care,
the financial motivations (where can a
provider make the most money) and budget
considerations (how can a payer save the most
4When group health squeezes the financial balloon, it’s workers comp that makes up
the difference.
--Michael Shor
Advocate for a paradigm shift that alleviates
the implications of current public policy.
money) are real. Says panel participant and
employer, David Cohen, “What all involved
must keep in mind is, getting a patient back to
good health – and work - faster, will always be
the ultimate money saver.”
Reversing this trend requires the collaborative
efforts of key stakeholders: workers’
compensation insurance carriers, workers’
compensation preferred provider medical
networks, employers, and providers. Through
productive and transparent collaboration,
evidence-based medical care strategies can
be established to support diagnostic and
therapeutic products and services that deliver
high-quality health outcomes. This represents
a shift in the workers’ compensation industry
from current practice to focus on referring
claimants to medical providers that work in
collaboration with likeminded providers within
metrics based programs that consistently
achieve improved medical outcomes at
lower cost. Ultimately, this trend may result
in a shift from “fee-for-service” to “pay for
performance,” in which financial rewards
are only realized upon production of quality
health outcomes.

9. Where does the industry go from here?
According to the most recent findings from
the NCCI (National Council on Compensation
Insurance), although claim frequency has
generally declined over the last two decades,
the severity of claims has continued to
increase. And although recent increases
in the average medical costs have been
more modest than before, the underlying
drivers of medical costs “are still present and
remain a concern,” the NCCI says.
Beating back those “underlying drivers of
medical costs” is in large part the answer
to realizing lasting, meaningful reduction in
workers’ compensation claims, according
to Dr. George K. Lewis, whose progressive
medical device company, ZetrOZ, sponsored
the panel.
“Insurers, healthcare professionals,
employers and medical innovators have
to put aside dollars and differences and
be open to exploring a combination of
therapies - from the tried and true to the
new and innovative - that better prevent and
treat workplace injury,” Lewis said.
What’s more, the industry must move
beyond the comfort zone of treating
patients according to old patterns, Lewis and
other panelists agreed. All players should
take a fresh and unbiased look at evidence-
based medicine and adopt a more open
attitude to promising new therapies. Taken
together, these recommendations have the
potential to unlock a bright new future for
all who are involved in America’s workers’
compensation system.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis

10. About ZetrOZ, Inc.
ZetrOZ develops wearable bio-regenerative devices for the delivery of sustained
acoustic medicine, a new treatment form. sam® is an FDA cleared device
which provides ultrasonic waves that penetrate 5 cm into the tissue, increasing
circulation, oxygen and nutrient delivery, and the removal of waste products, such
as lactic acid, from the site of a musculoskeletal injury accelerating the natural
healing cascade.
Built on a proprietary miniaturized platform designed for the treatment of acute
and chronic musculoskeletal conditions, ZetrOZ devices are clinically proven to
enhance tissue recovery, accelerate the body’s natural healing processes, and
relieve pain. Since the company’s founding in 2009, ZetrOZ has successfully
applied this innovative technology to the development of two products now
available on the market: sam®, an FDA approved device, and UltrOZ™ Elite for the
maintenance and rehabilitation of equine athletes. For more information, visit
www.zetroz.com.