February 27, 2015

 

David Williams has posted Health Wonk Review: Happy 10th anniversary edition at Health Business Blog. There's a great crop of articles - plus, kudos to David, he is celebrating his 10-year blogging anniversary. If you're interested in the business of health, his blog should be on your short list. He covers everything from medical devices and pharma to health care services and breaking business stories. Check it out!

"Out Front Ideas with Kimberly and Mark" - Two of our respected colleagues, Kimberly George and Mark Walls, just announced a new initiative that we think is worth sharing. They'll be teaming up to host a complimentary webinar series and interactive forum called "Out Front Ideas with Kimberly and Mark." The series - sponsored by Sedgwick and Safety National - will be dedicated to covering important workers' compensation-related topics that are not receiving enough attention in the industry. You can follow along and register for selected events here: Out Front Ideas.

Time to Act on Diversity - Roberto Ceniceros, Risk & Insurance: "I have heard at least one CEO for a major third-party administrator discuss the potential advantages of meeting an increasingly diverse U.S. workforce with claims managers who can navigate cultural variations. And the title of "chief diversity officer" has been around for a few years at some major insurers.
Recognition has spread that the insurance industry and workers' comp service providers need to respond to our country's changing demographics, but where are the strategies for moving forward?"

King V Burwell and the Supremes' view of "standing" - Joe Paduda, Managed Care Matters - "The suit, funded by the Koch-backed Competitive Enterprise Institute, is ostensibly being brought by four plaintiffs who, in theory, have to prove they were harmed in order to have "standing". In a nutshell, "standing" means that if you aren't harmed by an action, then you can't complain about it. I may not like the speed limit in Hawaii, but since I never go there I have no standing to sue."

Record Snow-Related Worker Deaths And Injuries Prompt Immediate Calls For Employer Precautions - WorkersCompensation.com: "Two workers died this past week in Canton and two more were hospitalized in Avon and Burlington in separate incidents from falls while clearing snow from roofs. Two weeks prior to these tragedies, 60-year-old Cesar Moya, a Whole Foods employee, was hit and killed by a snow plow that was clearing the Medford supermarket parking lot."

Workplace mental health stigma persists - Matt Dunning, Business Insurance: "More than 24% of employers polled in July and August of 2014 said they believe workplace stigma surrounding diagnosed psychological or psychiatric disorders has increased, compared with just 7% of employers polled in 2012, according to findings released last week from the San Diego-based DMEC's "2014 Behavioral Risk Survey."
Additionally, between 20% and 25% of employers polled said they perceived a rise in workplace stigma in 2014 surrounding the treatment of mental and behavioral health conditions -- including consultations with mental health professionals, use of mental health-related prescriptions and utilization of employee assistance programs -- compared with just 3% in 2012."

Bad Faith Followup - Dave DePaolo, DePaolo's World: "Nevertheless, I was still surprised that every single response, regardless of perceived orientation, was that exclusive remedy should NOT protect the payor, and that if egregious behavior was committed then liability for bad faith claims administration should be applied."

Manufacturers Looking at a Big Shortfall of New Workers - Industry Week: "The manufacturing industry is looking at shortfall of more than 2 million workers over the next decade, according to new reports from Deloitte and The Manufacturing Institute.
The shortage is led by the expected retirement of nearly 3 million Baby Boomers and fewer young people who see the industry as a career destination. A study survey showed while nine in 10 Americans believe manufacturing is essential to the U.S. economy, only one in three parents would encourage their kids to pursue a career in the industry."

Study Provides Reasons for Increasing Hospital Costs in Workers' Comp - "A new study from Mass.-based Workers Compensation Research Institute (WCRI), updates a recently published 33-state study with an extra year of data and the early impact analysis of major regulatory changes in North Carolina.
The study, Hospital Outpatient Cost Index for Workers' Compensation, 4th Edition, compares hospital outpatient costs across states, identifies key cost drivers, and measures the impact of reforms."

Quick Takes

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February 26, 2015

 

The WCRI Annual Issues and Research Conference gets underway a week from today in Boston. The conference and Lynch Ryan are each in their 31st year, but, truth to tell, the first WCRI conference could have been held in a telephone booth (not The Tardis).

We wrote about this conference a couple of weeks ago, so no need to cover old ground. However, it is worthwhile to mention how valuable the conference has become. It's a serious event attended by serious professionals. Sorry- not much partying. Las Vegas it aint. And this year its style is even more cramped what with more than eight feet of snow hanging around. But the walkway around the Charles is cleared, so you can bring your running shoes. I, on the other hand, coffee in hand, will be happy to wave goodbye to you as you head out the hotel door for that morning run. The older I get the more I subscribe to Winston Churhill's view of exercise: he said he got enough of it carrying the coffins of his athletic friends.

Unfortunately, we just learned that the WCRI has "reluctantly" decided to cancel its Opt Out session, because "at least one of the presenters felt that the time allotted for the session was too short for the objectives to be well-met." This is truly unfortunate given the momentum the Opt Out movement is gaining nationally. You would have thought the presenters could have raised this issue a lot earlier. Nonetheless, I'm sure there will be much opt out discussion among attendees outside of the sessions. WCRI is offering to refund registration money for those who choose to "opt out" of Boston due to the cancellation. Regardless, I hope to see you in Boston.

Inside Baseball In California

When looking for something a bit out of the ordinary, California workers' comp never disappoints. Work Comp Central's Greg Jones reports this morning that:

A Southern California applicants' law firm claims in court filings that Knox Ricksen "hacked" the computer network of a vendor it uses to sign up new clients to gain access to an estimated 2,000 confidential and privileged documents.

In the suit, the plainiffs' law firm, Reyes & Barsoum, says it has a vendor, HQ Sign-up Services Inc., whose job it is to "sign up" customers for the firm. The suit alleges that the defense law firm Knox Ricksen hacked HQ Sign-up, gaining access to claimant information which HQ Sign-up would forward to lawyers at Reyes & Barsoum. This would give Knox Ricksenan unfair and illegal advantage in the legal proceedings. People, I did not title this Inside Baseball for nothing!

This little dust-up shines a light on the dog-eat-dog adjuducative business that is California workers' comp. It's not pretty and it never has been. I wonder what opt out legislation would do for California?

Patient Records In New Jersey

Now we balance the cesspool into which California's workers' comp courtroom wars sometimes descend with workers' comp law as it should be practiced. John Geaney, a man for whom I have great respect, is an executive committee member and shareholder with New Jersey's Capehart Scatchard. John began publishing a client newsletter in 2001. A few years ago it morphed into a blog, which Lexis Nexus awards as one the nation's Top 25 workers' comp blogs. John's blog should be required reading for all workers' comp professionals in New Jersey. For that matter, it's instructive wherever you are.

Today's blog post concerns the right of injured workers to have access to their medical files. In my experience, there are some claims adjusters that resist this. However, doing so can worsen the situation and alienate the injured worker. Transparency is good for everyone. This blog post is well worth reading.

Who's Managing What Care

In his Quick Tips blog post of today, Barry Thompson takes no prisoners as he derides what has become of "Managed Care," which Barry has renamed "Manipulated Cost." His is a tale told in anger, and he asks, "Where's the outrage?" Good question. In the early 1990s, I gave a presentation at NCCI's Annual Issues Conference and titled the presentation Managed Care: Who Manages, Who Cares? 'Twas ever thus. It seems that the question is still begging for an answer.

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February 23, 2015

 

In the mid-1980s, workers' compensation underwent a management revolution. Until then, employers bought insurance policies, and when injuries occurred passed the baton to their carriers. Then they went back to making widgets trusting that the carriers would take care of everything.

That didn't work out so well, and costs took a rocket ride to the moon. Across America, employers looked for help. Why would injured workers remain out of work long after it was medically necessary for them to do so. The answer, as we all know, was found in the mirror. Employers, themselves, were the key to getting injured workers back into the bosom of the workplace, but they'd never been taught how to do that. Didn't know it was their job.

Thus was the workers' comp management consulting industry born. My company, Lynch Ryan, was first out of the gate. We were the Pathfinders, and Peter Rousmaniere was Employee Number 3 in what was to become a 55 person firm. Peter - Groton School, Harvard BA, Harvard MBA - wanted to join us because he was looking for a challenge. I wanted Peter to join us because he was really smart, and his brain worked like nobody's I'd ever met. Peter thought "outside the box" before there was an outside the box.

Peter still thinks like nobody else, and today Work Comp Central has published his Seismic Shifts: An Essential Guide for Practitioners and CEOs in Workers' Comp, subtitled, How Technology and Demographics Will Impact Workers' Comp From Today Through 2022. This self-funded, year-long venture looks out into the future and envisions another revolution, one that we ignore at our peril.

In Seismic Shifts, Rousmaniere catalogues the nearly unnoticed, but drumbeatingly steady, changes in workers' compensation since the early 1990s. He shows that since 1991 lost time injuries have declined by 60% and projects that by 2022 there will be a further decline of at least another 35%. He is perplexed about how the insurance industry has missed this decline in injuries and claims, what he calls 'the elephant in the room," and suggests that it has done so because for more than a decade it has been obsessively fixated on medical costs, an observation with which I agree. Rousmaniere contends that the insurance industry does not understand how this has happened or why.

His thesis is that this sea change, this seismic shift, is the result of employer improvements in safety engineering, information technology, telematics, robotic design, predictive modelling analytics and the continuous yearning for enhanced productivity. And most important, this natural gravitational movement will continue inexorably. Further, he believes that the workers' compensation insurance industry has not considered where all of this will lead, how it can be part of and optimize this transformational movement and what kind of workforce it will need to take advantage of this new paradigm.

In Rousmaniere's view, workers' compensation practitioners, as well as occupants of the C-Suite, would be well-advised to understand what's happening and embrace, rather than resist, these evolutionary developments. In his mind, the embracers will succeed and control the future; the resisters will be swept away. It's as simple as that. He describes, as example, the profound employer movement toward total absence management, rather than merely occupational absence. The move toward total absence management is gathering steam at larger employers, and workers' comp insurers don't know what to do about that. Neither do they have a plan for coping with the "opt out" phenomenon. First Texas, then Oklahoma, and just last Friday legislators in Tennessee filed opt-out legislation built on the Oklahoma model. This is becoming a trend.

But the workers' compensation industry has never distinguished itself in the race to the future. It will be interesting, indeed, to see if Rousmaniere's clarion call is even acknowledged by today's potentates. To help it along Work Comp Central is hosting a 4-part webinar series during which Peter will lay out his thesis and try to persuade others in the workers' comp community to join him in his effort to drag the industry kicking and screaming into the future. Check with Work Comp Central for dates of the Webinars.

Seismic Shifts is an important work, one deserving of your attention and consideration.

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February 13, 2015

 

Peggy Salvatore hosts an excellent Valentine's Edition of Health Wonk Review at Health System Ed Blog. Peggy describes it as being "For Health Policy Lovers Everywhere." Controversies over the Affordable Care Act, more familiarly known as Obamacare, continue to be a key theme in entries, but there are many other topics: the Anthem data breach, pharmaceuticals and medical ethics to name a few. This digest is a great biweekly way to keep up on key issues in the health policy arena.

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February 12, 2015

 

As Bostonians try to dig out from the most snow ever recorded in a 30-day period in Boston, we look forward to the WCRI's upcoming Annual Conference at the Westin Copley Place Hotel on Thursday and Friday, March 5th and 6th.

More about the snow a little later, but first the conference.

This year, the conference theme's title is Resilience or Renovation. However, we won't get the resilience and renovation until Friday, Day Two. Day One is devoted to updates on all things medical, starting with Dr. Richard Victor, the Institute's Executive Director, discussing the impact of the ACA on case shifting, which promises to be interesting, indeed. From there we move on to physician dispensing and the perverse effects of low fee schedules.

When the boat docks at Resilience and Renovation on Day Two, we begin with a session titled Resilience: Lessons From Two Decades of Reforms. The panel will discuss reforms in Texas, Pennsylvania, Oregon and Florida. While I am sure this discussion will be stimulating, as well as engaging, I find it curious that conference planners skipped over the greatest reform in the history of workers compensation. It happened in 1992 right where conference attendees will be sitting - the Commonwealth of Massachusetts.

"Renovation" is a good way to describe a couple of late morning sessions on Day Two, one on Opt Out and the other on challenges to the constitutionality of workers comp. You might think that a bit wonky, but I think attendees will find it thought provoking. It's interesting that the Opt Out session will focus on the Texas perspective, not the Oklahoman. You may recall that the Texas Opt Out provision has what I consider to be flaws of the first order. Those flaws were corrected when Oklahoma adopted its version of Opt out.

All in all, the conference is an excellent opportunity for workers comp professionals to stay in front of the research curve and to connect with some of the leading lights in the field. I hope to see you there.

Now, the weather. Here's a Fenway Park snow sellout. Seats full of snow fans.

Speaking for all Bostonians, I think we've had enough. Really. Monday night, during our third major snowstorm within a week and a half, Boston Mayor Marty Walsh announced there would be no public transportation the following day. None. A gazillion people ride what we affectionately refer to as "The T" to get to work every day in and around Boston. Not Tuesday. Shortly after that, standing in front of the TV cameras, Governor 5-weeks-in-office Charley Baker said the 100-year-old MBTA's performance is "not acceptable." I guess the bloom is off his rose. We have entered the "find a scapegoat" phase. Yesterday, the first head rolled - Dr. Beverly Scott, the T's General Manager. She won't be the only one.

The rest of us will be fine, but, my God, I'm looking at more than five feet of snow outside my door, and it's not a drift! And Boston has nothing on Worcester, just 35 miles to the west where nearly 100 inches, that's more than eight feet, have already fallen at about the halfway point of the snow season. Mother Nature has now gifted Worcester with more snow than any other city in America. Take that, Fargo! You,too, Buffalo! When this stuff melts (please, God, make it melt) we'll probably have a new lake to rival Michigan in Central Massachusetts. Oh, and our friendly local meteorologists, never happier than when they're forecasting impending doom, now predict that beginning tonight we'll descend into the coldest weather of the year. High temps will be in the single digits. Human digits will freeze and fall off. And Saturday night through Sunday there's a foot more of the fluffy white stuff headed our way just in time for Valentine's Day. The Lord just keeps showering us with his tender mercies.

But here's the good news: Spring training is right around the corner. Pitchers and catchers report in three days. By the time the WCRI Conference rolls around Fenway South will be in full bloom. And here in Boston the sun will be shining, the snow will be gone, temperatures will be balmy and the T will be running on time.

And pigs will be seen flying in formation outside the windows of the Westin Copley Place Hotel.

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February 11, 2015

 

NPR featured the first in a series of reports on one of the most dangerous jobs in America, one that they say has more debilitating back injuries than the construction industry or law enforcement. In Hospitals Fail To Protect Nursing Staff From Becoming Patients, Daniel Zwerdling investigates the high rate of back injuries that plague the nursing profession, largely the result of poor patient lifting practices, which are greatly exacerbated by the obesity epidemic.

The impact of obesity cannot be overstated - nurses are required to lift or support morbidly obese patients as many as 15 to 20 times a day. NPR puts this in context, citing NIOSH manager James Collins: "... before studying back injuries among nursing employees, he focused on auto factory workers. His subjects were "93 percent men, heavily tattooed, macho workforce, Harley-Davidson rider type guys," he says. "And they were prohibited from lifting over 35 pounds through the course of their work."

Yet nursing employees in a typical hospital lift far heavier patients a dozen or more times every day. Tom Lynch discusses safe lifting limits in a prior post:

"... according to NIOSH the most a nurse or aide in the 90th percentile of strength should lift at any one time is 46 pounds. But a typical 8-hour workday in this field involves lifting about 1.8 tons. Twelve percent of registered nurses who quit the field report that they do so because of back pain due to patient handling."

A Case in Point
Zwerdling talks to a number of nurses who discuss their injuries and how they happened. He focuses on the experiences of nurses at Kaiser Permanante in Walnut Creek, which he notes is no worse and perhaps better than many healthcare facilities. Although the hospital had dedicated lifting equipment and teams, there were not enough machines and not enough teams to staff them when needed. When patients need help, the need is often urgent and immediate.

Nurses who worked at Kaiser Permanante asked for a state investigation into lifting practices shortly after California's 2012 Hospital Patient and Health Care Worker Injury Protection Act went into effect. In January 2014, a state Administrative Law Judge issued an order that declared that Kaiser had failed to have "specific procedures in place to ensure that sufficient staff was available to perform patient handling tasks safely."

While this report is one that frames the issue in terms of nursing injuries, it's also a safety issue for patients.

The American Nurses Association tracks legislation related to safe patient handling and mobility (SPHM). They note that:

"...eleven states have enacted "safe patient handling" laws or promulgated rules / regulations: California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii.
Of those, ten states require a comprehensive program in health care facilities (California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Rhode Island, Texas and Washington), in which there is established policy, guidelines for securing appropriate equipment and training, collection of data, and evaluation."

Exacerbating Factors
In our prior post cited above, Tom talks about some additional factors contributing to the problem - the aging work force and nursing shortages.

"The average age of a registered nurse is now nearly 47. For Home Health Aides (HHA), it's 46; for Certified Nursing Assistants (CNA), 39. Wages for the aides and assistants average between $11 and $12. Forty percent have been on food stamps and many get their own healthcare through Medicaid. (See: HHS Direct Care Workforce) The BLS (Bureau of Labor Statistics) estimates that the demand for HHAs between 2010 and 2020 will grow by 69%; CNAs, 40%. Collectively, we are confronted with a critical shortage of healthcare talent. According to the U.S. Department of Health & Human Services, "Direct care work is difficult, the wages are low and fringe benefits are often limited."
It's the same with registered nurses where, oftentimes, the shortage is self-inflicted. A study of 21 hospitals in the Twin Cities found that when registered nursing positions were decreased by 9%, work-related illnesses and injuries among nurses increased by 65% (Trinkoff, et al., 2005)."

Related Resources:
SPHM Interprofessional National Standards and Implementation Guide

OSHA: Safe Patient Handling

NIOSH Safe Patient Handling

Retrofitting hospitals for obese patients

Prior Workers Comp Insider posts highlight other dangers involved in nursing:

Working the Graveyard Shift

Exposure to workplace violence from patients and peers

Chemical exposure risks

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January 29, 2015

 

Jason Shafrin, our favorite Healthcare Economist, is hosting Health Wonk Review: Super Bowl Edition, the best of the recent postings from blogging health policy wonks. Jason cuts right to the chase in a compact, digest version of posts that will keep you up to date on issues related to healthcare costs, policies, IT developments and safety. Oh, and kindness - which should be a de facto component of healthcare, no?

Speaking of football ... we hate to be the Debbie Downer of the sport's big weekend, but a new study on concussions was just released to coincide with the Super Bowl - it sheds more light on the seriousness of concussions In youth football, demonstrating that NFL players who began playing before age 12 are more susceptible to cognitive difficulties. "The difficulty faced by the former players, who reported an average of nearly 400 concussions each during their lifetimes, is separate from the problem of chronic traumatic encephalopathy, which can only be diagnosed after death."

Is the focus on concussions having an impact on football? Justin Rodriguez of the Times Herald-Record reports on how the concussion crisis is a big blow to football.


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