Functional Employment Testing Orientation to Work STEPS testing

Functional Employment Testing Orientation to Work. STEPS® testing performed at Select Medical Facilities Select Medical Outpatient Division Family of Brands § Keeping America on the Job!

Introduction § Select Medical Corporation is the nation’s largest outpatient rehabilitation provider with 900+ outpatient facilities nationally. § Select Medical Corporation is the largest single provider of post offer of employment testing with 15 years of testing experience. 2014 WORKSTRATEGIES®

Select Medical History § Select Medical is a leading provider of specialized health care in both inpatient and outpatient settings § Founded in 1996 and based in Mechanicsburg, PA § Listed on the New York Stock Exchange as SEM § 29, 571 employees nationwide § Four Operating Divisions § § Long-Term Acute Care (LTAC) Hospitals Medical Rehabilitation Hospitals Contract Therapy Outpatient Division 2014 WORKSTRATEGIES®

Outpatient Division AK ME WA MT VT ND NH MN OR SD ID NY WI MI PA WY IA NE NV UT CO IN WV KY KS NC TN OK AZ DC VA MO AR MS NM SC AL GA LA TX 2014 WORKSTRATEGIES® NJ MD OH IL CA MA CT FL DE RI

Work. Strategies Program Work. Strategies is the work injury prevention and rehabilitation management product line for Select Outpatient Division. Goals: § Assists employers and carriers in reducing work related injuries, claims and costs. § A comprehensive continuum of services: § Injury Prevention / Safety § Early Intervention / Physical Rehabilitation § Return to Work Programs 2014 WORKSTRATEGIES®

Work. Strategies® Continuum of Services Hiring Post-Offer Employment Testing Safety Injury Prevention Ergonomics Symptom Intervention 2014 WORKSTRATEGIES® Injury Recovery Acute Physical Work & Hardening/ Occupational Conditioning Therapy Functional Customized Capacity Return-to. Evaluation Work (FCE) Closure Utilization Management System (UMS) Outcome & Data Analysis

http: //www. bls. gov/news. release/archives/osh 2_11262013. pdf This is a quote from the BLS News release from Nov 2013 § Length of service. Among private industry workers, injuries and illnesses to workers with fewer than 3 months of service and 3 to 11 months of service accounted for 30 percent of all cases. The number of injury and illness cases for workers with fewer than 3 months of service increased 8 percent—notably in manufacturing with a 9 percent increase. Workers with 3 to 11 months of service had a 5 percent increase in the number of cases—notably in retail trade with an 18 percent increase. § To mean this says, the number of injuries and illnesses in newly hired workers is increasing and the solution is POETesting 2014 WORKSTRATEGIES® 8

About Work. STEPS Functional Employment testing system developed in 1986 Network of more-than 1, 000 independently-owned and operated, licensed providers in 48 states, with expanded footprint in Canada, Australia and New Zealand All providers must undergo formal WS training, follow standardized protocols, and recertify annually Work. STEPS tests for 3, 000 employers in 48 states Work. STEPS employs 25 full-time employees C-Corporation headquartered in Austin, TX 2014 WORKSTRATEGIES®

Work. STEPS Natl. Footprint 2014 WORKSTRATEGIES®

Work. STEPS Mission Statement Work. STEPS was founded to meet a critical employer need—to create a medically-safe, legally-compliant, scientific and objective means of matching a worker’s functional capabilities with the essential functions of his or her job Program is scalable, standardized, reproducible, outcome-validated, with predictive and proven return on investment 2014 WORKSTRATEGIES®

Work. STEPS Suite of Services § Functional Employment Testing § Agility § Pre Employment Post Offer § Post Employment Testing § Upper Quadrant/Carpal Tunnel § FCEs § Job Analysis § Proprietary, Automated PAVE Validation Software § Corporate Scheduling § Account Management 2014 WORKSTRATEGIES®

Steps for Implementation § Identify positions that will be subject to testing § Establish policies outlining the employment process and the “post-offer contingencies” § Education for personnel involved in implementation § Job analysis to identify physical demands and create accurate criteria § Validation Process 2014 WORKSTRATEGIES®

Job Analysis § § § § Administer an ergonomic assessment of the position (sitting, standing, kneeling, etc. ) Measure the weights of materials that are lifted, pushed, pulled or carried Document and measure material-handling heights and ranges-of-motion Document frequency and repetition of lifts Observe and document environmental conditions (flat/uneven surfaces, indoors/outdoors, confined spaces, environmental temperatures, required safety equipment, etc) Document cognitive demands Document knowledge skills required Document any other factors impacting the performance of the job 2014 WORKSTRATEGIES®

2014 WORKSTRATEGIES®

2014 WORKSTRATEGIES®

2014 WORKSTRATEGIES®

Work. STEPS Pre-Employment Post Offer Test Process 2014 WORKSTRATEGIES®

Medical History Interview Post-Offer – Comprehensive Medical History: § Conducted as an interview § Questions are asked multiple ways to solicit honesty § Candidate signs and initials disclosure that “falsification of information can result in the employer withdrawing the offer of employment” § Candidate is asked if they consider themselves to be disabled or need an accommodation to perform the test § Ensures candidate is safe to participate in the test § Identifies areas that may need additional medical screening and specific baseline measures based on their specific medical history 2014 WORKSTRATEGIES®

Medical History Interview § If certain medical conditions (or recent injuries/surgeries) are present, the test candidate may be required to provide clearance from his/her medical doctor, at his/her own expense § If blood pressure and/or heart rate exceeds safe norms, candidate will be required to provide physician clearance before they can proceed with the test as his/her own expense § Includes Information on whether or not the candidate is currently seeing a physician, chiro, or physical therapist for any reason 2014 WORKSTRATEGIES®

Baseline Testing (post-offer) § Cardiovascular Measures – HR/BP; Step Test § Musculoskeletal Assessment § 40 Baseline Measures § Shoulders, elbows, wrists, back, ankles, knees, hips, etc. § Creptius and ligament stability checked § Lumbar & cervical spine checked § Flexion, extension, side bending & twisting § Visual inspection for signs of surgical procedures § Deep tendon reflexes of the biceps, triceps, patellar tendon & archilles tendon performed to further check for spinal cord problems 2014 WORKSTRATEGIES®

Baseline Testing (post-offer) § Shoulder range of motion checked & measured as well as movement in the internal and external rational planes § Rotator cuff is checked § Quantifies any pre-existing deficits § Identified issues that may result in a medical risk recommendation § Can include additional customized measures at the employers request 2014 WORKSTRATEGIES®

Dynamic Lifting § Standardized, baseline testing component § Every post-offer comprehensive test will follow same basic structure § Four lifts are conducted in four different postures: § Floor to knuckle § 12 inch off the floor to knuckle height § Knuckle to shoulder and shoulder § Shoulder to overhead 2014 WORKSTRATEGIES®

Dynamic Lifting § Candidate is given education in recommended lifting techniques, and this is documented in the test record. § Also contains 2 qualifying criteria Qualifies candidate to attempt job specs. Qualifies candidate to safely work in the position. 2014 WORKSTRATEGIES®

Job Specific Tasks § Candidate must perform all tasks safely and with good control to meet criteria. § Typically consists of a 4 -6 tasks that simulate heaviest essential functions or essential functions associated with endurance. § Protocols will be presented to employer for approval prior to implementation. § Tasks may be expanded for an individual if there is cause, as long as they remain “job related and consistent with business necessity”. 2014 WORKSTRATEGIES®

2014 WORKSTRATEGIES®

Recommendations(Post-Offer) § Capable § met all physical criteria, no medical concerns § Not Capable due to physical demands § Lacks essential strength – no medical § Not Capable – Impairment § Physical demands not met, but there was a contributing medical condition/impairment § Not Capable due to Medical Risk § Physical demands were met, but clinician identifies ‘direct threat’ 2014 WORKSTRATEGIES®

Reporting Process: Immediate 2014 WORKSTRATEGIES®

Post-Employment: aka “Fit for Duty” Testing “Under ADA, medical information or medical exams may be required when an employee suffers an injury on the job. Such an exam may be required when an employee wishes to return to work after an injury or illness, if it is job related and consistent with business necessity. ” TAM VI-13 2014 WORKSTRATEGIES®

Fit for Duty Testing EEOC Enforcement Guidance: Disability Related Inquiries and Medical Examinations of Employees under the ADA Allows employer to test § when an employer “has a reasonable belief, based on objective evidence, that an employee’s ability to perform essential job functions will be impaired by a medical condition” § When an employer can reasonably attribute performance problems to a known medical condition 2014 WORKSTRATEGIES®

Post Injury Test Compares baseline to current status Defines exact deficit caused by injury Utilizes latest technology to determine depth of symptoms compared to diagnosis Has proven consistency measures (Peer review published) to prove or disprove symptom exaggeration Creates accountability, accurate goals and transitional return to work 2014 WORKSTRATEGIES®

Work. STEPS® These tests allow employers to manage the function of employees from new hire through retirement. Use of functional tests by employer results in safer, more productive workforces with fewer injuries, reduced turnover and significant reductions in workers compensation costs. 2014 WORKSTRATEGIES®

Value, Impact, ROI 2014 WORKSTRATEGIES®

Value and Impact Work. STEPS’ testing services help employers: § mitigates the incidence and cost of worker injury, § provides employers with baseline data to use in apportionment & remediation of claims § incidence and costs are reduced almost immediately 2014 WORKSTRATEGIES®

Value and Impact – Independent Outcomes § § § § § Reductions in absences Reductions in incidence of injuries Reductions in the frequency of claims filed Reductions in the severity of claims Reductions in group health costs Expedited safe, early return to work Reductions in turnover Increased Productivity Employee who are successful at performing the essentional functions of their jobs work safer! 2014 WORKSTRATEGIES®

Other reporting advantages § Worksteps can provide monthly or quarterly reports outlining all tests completed for all locations, job titles, capable / not capable result and not capable reasons to employer. § Employer can utilize this information to track program compliance, results, ROI, and some employers utilize the not capable reasons in their safety programs. 2014 WORKSTRATEGIES®

Questions? Select Medical Outpatient Division Family of Brands Keeping America on the Job!