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There may be a safety net for hospitals
Health information professionals are on overload these days. Not only do they have to learn a new outpatient reimbursement system and comply with requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), but now they have to deal with a potentially costly ergonomics law too.
The Occupational Safety and Health Administration (OSHA) rule — covering such problems as carpal tunnel syndrome, tendinitis and back injuries — will no doubt raise medical transcription costs, says Stella Olson, CMT, CEO of STAT Enterprises in St. Louis. STAT Enterprises provides services in consulting, training, health care documentation, and marketing. "It’s going to increase costs more than OSHA has estimated. It’s going to be extremely expensive overall."
The ergonomics rule, published in the Nov. 14 Federal Register, has so alarmed industries almost across the board that many have filed or joined lawsuits to have the law thrown out, including provider organizations such as the American Hospital Association (AHA) in Chicago. They charge that OSHA rushed to get the legislation passed before the Clinton administration left office, and in the year-long push, created a rule that is too broad, overly vague, and scientifically unsound.
"You cannot do something this big this fast and still do it right," says Mike Baroody, senior vice president for policy, communications, and public affairs for the National Association of Manufacturers in Washington, DC. "If OSHA were serious about a sensible rule making, it simply could not have finalized the ergonomics regulation in less than a year."
In addition, the rule reaches beyond the workplace to make employers liable for injuries aggravated, but not caused by, work; it overrides existing workers’ compensation laws and creates a most-favored injury’ status for ergonomics; and its finalization now ignores the will of a bipartisan majority in both houses of Congress, which voted to block implementation of the rule, he says.
"We are concerned that OSHA’s ergonomic standard lacks a sound scientific basis and would cost hospitals and health systems millions of dollars without proof that it will ensure the prevention of repetitive stress injuries," wrote the AHA in a letter to Sen. Michael B. Enzi (R-WY) last summer. The American Society for Healthcare Human Resources Administration (ASHHRA) in Chicago also signed the letter. "In fact, the scientific community is unable to come to a consensus about what causes repetitive stress injuries and what are its proven remedies."
OSHA estimates that the proposed rule will cost about $4.2 billion per year. The Employment Policy Foundation in Washington, however, estimates the regulation will cost $125.6 billion per year to business. The foundation says this figures come from examining 2,000 pages of data that "OSHA inserted into the record so late that it was impossible for interested parties to officially comment."
"The higher costs can be attributed to the new empirical data submitted by OSHA that found that the average job fix per affected employee to be more than $2,000 — over three times higher than OSHA’s original estimate," the foundation writes.
What it means for health care
Only a few industries are exempt from this rule, including maritime, agriculture, railroads and construction. The rule would especially devastate small businesses. Hospitals should acknowledge the benefit they may receive from small businesses’ efforts to fight the legislation, Olson says.
The rule shouldn’t be as much of a problem for hospitals if they don’t have any injuries in their workplace, says Jonathan Eisen, spokesman for the National Coalition on Ergonomics (NCE), Washington, DC. The NCE is another organization that is actively fighting the ergonomics legislation. "You do have to provide information [to your employees]. But as soon as you as get an injury, the rule becomes much more problematic, and you are looking at a great deal of expense in trying to comply."
According to the legislation, if someone gets a musculoskeletal disorder, an employer has to determine whether that injury is work-related, Eisen explains. "The definition of work-related’ in the regulation is caused or contributed to the injury.’ That is pretty broad." The employer is going to have to assume that work caused or contributed to the injury, he says.
Then, the employer will have to check whether the employee in his or her job violates what OSHA calls "action triggers" in the regulation. "One of the action triggers is the use an input device such as a keyboard or mouse in a steady manner more than four hours total in a workday, Eisen says.
Most full-time medical transcriptionists will be in violation of that action trigger. "Companies will then have to enact the entire ergonomics regulation," he explains. "That means they will have to put in place management leadership, employee participation, MSD management, job hazard analysis, hazard reduction and control, and training."
The real expense in the program is the hazard reduction and control, Eisen says. "According to the agency, engineering controls are preferred. That means you have to find engineering ways to reduce the hazard, which is typing for four hours." Hospitals, therefore, may have to buy new keyboards, chairs, or other equipment. "If you continue to have injuries, you will have to continue to make these improvements."
"Every chair, every station — everything the transcriptionist uses — is going to have to be ergonomically correct," Olson says. "That means that the stations are going to have to be a specific level for every individual who sits there."
This could be especially difficult for a hospital facility that may have two or three shifts, she adds. "If you have a short person who works at that station at one time of the day and a tall person at another time, there has to be adjustments made for the second individual." Ergonomically correct equipment is expensive. One chair could cost up to $1,000 or more, she says.
The rule became effective in January. Most of the compliance dates in the regulation are Oct. 15, 2001, Eisen says. "You have to have your entire program in place by that day."
One ray of hope, though, is a provision in the rule that allows providers to "grandfather" existing ergonomics programs. Grandfathered programs will be exempt from "numerous requirements," and employers will not be required to revamp their programs, the AHA says. The association has been encouraging its members to grandfather their programs before the Jan. 16 deadline. OSHA, however, is said to be considering a request made by the Organization Resources Counselors in Washington, DC, to extend the deadline to March 17.
In the long run, Eisen thinks the chances are good that the challenges to the regulation will result in it being thrown out. Having a new president who seems to care about entrepreneurship and small businesses may help, Olson says.
The lawsuit, which consolidated the various petitions from the different groups, went directly to the U.S. Court of Appeals in the District of Columbia. "We are probably not looking at an answer before early 2002," Eisen says.