July 2010 Archives

July 28, 2010

 

Check out the Rocky Mountain High Edition of Cavalcade of Risk. Louise of Colorado Health Insurance Insider produces a great compendium of recent "best of the web" risk posts on a variety of topics ranging from the ubiquitous health care debates to investing and long term insurance. It's a great way to get a sampling of several blogs. Plus, Louise and Jay's blog always offers a refreshing street-level view of issues related to health care. They offer a wise take on the big issues but also offer good advice on everyday health issues: If you ever get a rock stuck in your nose...".

A good man wronged - Joe Paduda has been fighting the good fight for Sandy Blunt, former North Dakota state work comp fund CEO. Blunt had a recent setback when the Supreme Court affirmed his felony conviction, but more recently we learn that the prosecutor is under investigation for prosecutorial misconduct in the case. One of the charges against her is allegedly withholding exculpatory evidence from Blunt's attorney. (If you aren't familiar with the Blunt case, see Peter Rousmaniere's article Blunting Political Vindictiveness or plug "Blunt" into Joe's search feature and catch up.) We had the good fortune to meet Blunt at an industry symposium prior to all these events - he was on fire with his commitment to overhaul the ND agency, to inspire employees and employers alike, and to ensure the best possible care for injured workers. Innovative, energetic, creative - by all accounts, he was making a significant positive impact. Then came a series of surprising charges resulting in his ouster. As we've noted before, most of these charges were minor, trumped up administrative issues, such as spending a few hundred dollars on lunches and gift certificates to motivate staff - practices that were not uncommon in other state departments. Other more serious charges were dismissed or shown to be erroneous - and now we have potential prosecutorial misconduct being investigated.

ADA at 20 years - It's been 20 years since the Americans with Disabilities Act was signed into law, a groundbreaking initiative which afforded unprecedented public access and workplace protections to the disabled. All those parking spots, wheelchair ramps, wider doorways, and sloped curbs? They didn't exist a few decades ago. For a commemorative featuring recent news stories, commentary and employer resources, see HR Web Cafe: The ADA at 20 Years.

Calling Uncle Sam - Is the workers comp system broken for occupational diseases such as the ones that are likely to result from the BP oil spill cleanup? Peter Rousmaniere thinks so - the feds have had to bail the system out in two prior catastrophes within the past decade. He makes the case for federalizing occupational disease in his column at Risk and Insurance.

Walking the walk when it comes to obesity - Employees at Total Medical Solutions are taking their role as health care providers to heart and taking a leadership stance when it comes to doing something about obesity. In the last three months, 25 employees have shed a total of more than 400 pounds, and achieved good local press for their accomplishments. We were reminded of seeing this story when we read Roberto Cenicero's post on the biggest loser, corporate edition, which talks about a competitive challenge several of Minnesota's largest corporations have embarked on. His post also links to a recent study from Integrated Benefits Institute on "health and productivity management" practices at 450 U.S. companies.

Quick lesson in how to save $550,000 - Discouraging employees from filing a workers compensation claim for an on-the-job injury is a no-no. Just ask Rawley's of California how they fared in a recent criminal investigation, which revealed that some managers were routinely telling injured employees to use their own insurance rather than report injuries to the state.

In the "what else is new" department... - Mark Hoffmann of Business Insurance reports on news from the most recent RIMS Benchmark Survey: The soft market is still going strong. "The survey, based on information provided by risk managers, found that workers compensation experienced the greatest decline in the second quarter, at 3.8%, while property and D&O dropped by 3.5%."

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July 26, 2010

 

David Warren died last week in a suburb of Melbourne, Australia. He was 85. You may never have heard of this aeronautical researcher, but his work has impacted anyone who travels by air. David Warren is credited with the invention of the black box. (A splendid obituary by Douglas Martin in the New York Times can be found here.)

In 1934, when Warren was just 8 years old, his father died in a plane crash. His last gift to his son was a ham radio set. After earning a PhD in chemistry from the Imperial College in London, Warren went to work for the Australian defense department, where he investigated a spate of civilian air crashes.

Thinking like a good risk manager, he recognized the need for better data at the time of the crash. He volunteered to work on developing a flight recorder system. His bosses were not impressed. One went so far as to say: "If I find you talking to anyone, including me, about this matter, I will have to sack you."

His peers went on to note that if his idea had any merit, the Americans would have already made it (!). Preserving pilot conversations would yield "more expletives than explanations." (The pilots, naturally, did not like the idea of a permanent record of their chatter.) It was only a visit by a high ranking British aviation official in 1958 that triggered a positive response. Warren was flown to England to show off his little black box (which, for the record, was and remains red or orange). The rest, as they say, is history - a history that has significantly enhanced our ability to understand exactly why a given plane went down.

Obscurity and Fame
We live in an age of instant (unmerited) celebrity: you can become rich and famous for doing absolutely nothing (did someone say Snooki???). The quiet Australian David Warren accomplished a great deal in his long life and managed to stay in the background. He was able to transform the painful loss of his father into safer skies for everyone. It will not surprise you that he never profited from his work. Even if his government had offered him all the profits from his invention, he says he would have refused. He quipped that if he were to profit from his good idea, he might also get billed for the ones that amounted to nothing.

The latest generation of black boxes are self-ejecting, encased in steel and insulated against fire. They provide more than 200 measurements and dump data 128 times a second. These technical wonders have their origins in the mind of young child tinkering with a radio set and dreaming of a father who never came home. We should all be grateful for the exemplary life of this humble man.


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July 22, 2010

 

dog-days.jpg

Like much of the country, we've had a sizzling summer here in the northeast, and we are just entering the dog days of summer. In Ancient Rome, the Dog Days extended from July 24 through August 24 and were popularly believed to be an evil time "when the seas boiled, wine turned sour, dogs grew mad, and all creatures became languid, causing to man burning fevers, hysterics, and phrensies."

That sounds like a pretty accurate description of the climate as we head on into election season. If you thought all the excitement over health care reform had died down and you could slack off for your summer reading, think again. Things are still pretty heated and we expect much in the way of sea boiling, wine souring, madness, phrensies and hysteria right through the November election. To help you make sense of things, our esteemed contributors offer up an assortment of hot issues related to healthcare - from costs and reform to technology and ethics.

In A Reply to the Cato Insitute Report, Part 1 Maggie Mahar of Health Beat takes on Michael Tannner's 52-page thesis Bad Medicine, which asserts that the Patient Protection and Affordable Care Act is both unaffordable and unfair. Bad Medicine is meant to serve as a playbook for those who hope to kill reform, a theme that Tanner says will serve as the "centerpiece of Republican campaigns this fall."

In his post Controlling health care costs: Who's responsible?, Joe Paduda of Managed Care Matters wonders why those who believe health reform is socialism don't have faith in the free market's ability to control costs and deliver quality.

Uwe Reinhardt of Health Affairs Blog contemplates the difference between widgets and health care as he examines the issue of whether more insurers will better control health care costs.

In Standardizing Payments for Childbirth, Louise of Colorado Health Insurance Insider offers a quick and dirty summary of her idea to lower the c-section rate, which would be one piece of the 'costs' puzzle that is overwhelming our healthcare system.

David Williams of Health Business Blog expresses doubt about the sincerity of Republican objections to sending extra money to the states for Medicaid, but just in case, he offers a suggestion for how the deficit hawks can satisfy their concerns about Medicaid spending.

We have a pair of posts from the bloggers at Health Access WeBlog. First, Anthony Wright notes that the rate hikes by Anthem Blue Cross of California that helped jump-start health reform have had a second, third, and fourth act. He thinks that their recent rate filing demonstrates that public scrutiny matters. Next, Beth Capell reminds us that reform isn't just about expanding coverage - it's also about saying adios to the junkiest of junk health insurance.

A final rule for the "Meaningful Use" Regulation for Electronic Health Records has recently been issued, and two of our regular contributors shed light on the topic. Rich Elmore at Healthcare Technology News delivers a compendium of resources and analysis related to the final rules for Health Information Technology - Meaningful Use and Standards/Certification. David Harlow of HealthBlawg explains how this rule, along with the EHR certification rule and the HIPAA rule amendments (also recently released) will govern the future development of health IT in this country, and discusses details and implications of the meaningful use rule.

In his posting The Medicare 'doc fix': How to make political lemonade, Austin Frakt of The Incidental Economist, says that the Sustainable Growth Rate system was flawed from the start and should have been fixed years ago, but now we have an opportunity to make necessary systemic changes.

Jaan Sidorov of Disease Management Care Blog says that although the risk may appear to be low, Congress should consider the risk of a physician boycott of Medicare. He suggests that good business practice -- Enterprise Risk Management (ERM) -- requires it.

In Whose costs? Our costs, The Notwithstanding Blog suggests that patient convenience as a benefit of medical care delivery is largely ignored, and he makes the case for why it is a factor that should be weighed in any honest evaluation of competing reform proposals.

Peggy Salvatore of Healthcare Talent Transformation advocates for E-learning as the most cost effective and best way to educate healthcare workers on the use of IT in her post Technology for Healthcare Education: Build it and They Will Come, and Keep Coming!

Jared Rhoads of the The Lucidicus Project has been tweeting about the highlights and lowlights of the healthcare chapter of Mitt Romney's book, "No Apology: The Case For American Greatness." He's compiled his tweets in his blog post: Twead #3: Mitt Romney. (Here's a Twitterspeak Guide for all you non-tweeters)

Media Matters
In Everybody outta the pool!, Henry Stern of InsureBlog reports on a new high risk health pool and suggests that an agenda-driven press has mangled the message.

At Healthcare Economist, Jason Shafrin observes that when Congress enacted the Medicare and Social Security programs, the media coverage was intense. He notes, however, that Medicaid's beginnings were more humble.

Ethics and marketing
Roy Poses of Health Care Renewal posts that the Avandia spin cycle continues even after the FDA safety hearings, noting that the case offers a good lesson in the need for skepticism about data and claims proffered to support commercial health care products. He finds it particularly disappointing that formerly prestigious medical societies and disease activity groups are increasingly funded by industry, and increasingly act like industry marketers.

Tinker Ready looks at the ethics of advertising, questioning whether hospitals should be promoting drugs used in clinical trials as "treatment" in her post MGH: Research as Marketing? at Nature Network Boston. We usually see Tinker at Boston Health News but this post appears the forum/blog/calendar/jobs site for local scientists.

Extended reading
In a series of posts (#1; #2; #3; #4; and #5), Brad Wright takes a closer look at health reform by elaborating on quotes drawn from Brown University political science professor Jim Morone's Health Affairs article Presidents and Health Reform: From Franklin D. Roosevelt to Barack Obama."

Over a series of posts at The Apothecary, Avik Roy discusses a Medicaid study from the University of Virginia which suggests that Medicaid patients fare worse than the uninsured (and far worse than those with private insurance) when undergoing a broad range of surgical procedures. Roy also points to posts by Incidental Economist Austin Frank, who has a different take on the studies.

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July 19, 2010

 

The following guest post was submitted by Gary Anderberg, Phd, the Practice Leader For Outcomes and Analytics at Broadspire.

I was participating in a recent meeting of health, wellness, workers' compensation and disability professionals. One of the issues on the table was information that the regs defining "Cadillac" plans may loop the cost of wellness programs, disease management and other health related productivity benefits into the total cost of the employer's health plan for purposes of assessing penalties. If this intelligence is correct and if such provisions become effective, most large employer plans, so defined, will be subject to potentially expensive penalties, thus strongly incenting employers to relegate employee health care to the soon to be created exchanges.

This question stirred up a wide ranging discussion of how to frame the value of health and productivity programs for employers. For the last several years, most of the players in this space have been using the "investment" and "ROI" model, telling employers that they will reap rewards for astute investments in employee health and productivity. As a practical matter, returns on investment have been problematic to quantify. There is broad, intuitive agreement that a healthier workforce is a good thing, but what does it drive to the bottom line?

I suggested a different model -- risk management. If trained, knowledgeable, productive employees are indeed a corporate asset -- like trucks, buildings, airplanes, equipment, and so forth -- then the health and well being of those employees presents a major risk exposure for the corporation in very immediate terms. We know that as the overall well being of a workforce declines, not only do absences of all types go up, but so do opportunity costs and the costs of poor performance and decision making. As absence rates and disability claims climb, more positions are filled by new employees with less experience and training than the absent workers. Mistakes get made, customers do not get the service they expect, and product quality suffers.

I suggested that, properly viewed, health plans, chronic disease programs and all types of effective wellness programs are really risk management tools in much the same way that fleet maintenance is a risk management tool. We assume that companies will maintain their eighteen wheelers and provide safety courses for their drivers, but the health and well being of the person behind the wheel is equally critical to the company's risk exposure when a truck is on the road.

Every time a company hires a new employee, it takes on a new risk. For every employee on the payroll, from the CEO on down, there is a definite risk cost of employment which is based in large part on that person's health and well being. So, are health, wellness and productivity programs investments with uncertain returns or are they critical risk management tools which allow the employer an important measure of control over the performance of a key asset -- employees? It seems to me that these tools are vital to controlling employment costs and critical parameters of product and service delivery, especially in a world of very lean staffing and just in time management.

To my mind this is not just a question of which metaphor to use. Managing risk is real and the consequences of poor risk management are often dramatic and even tragic. I wonder how many companies would consider handing over the maintenance of their critical manufacturing and distribution equipment to a government program just to save a few bucks. But how many employers may be tempted to do the same thing if the soon to be created healthcare exchanges offer a short term dollar saving?

The words we use to frame decisions can carry massive consequences. If you think about the health and well being of your employees as a risk exposure to be effectively managed to minimize replacement costs and the expense of suboptimal performance and errors, what might you do differently? Think about it.

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July 14, 2010

 

Jaan Sidorov dishes up a summer smorgasbord of risk at the 109th Cavalcade of Risk Picnic edition over at Disease Care Management Blog.

Speaking of risk, yesterday Business Insurance twittered: Among the accomplishments of the legendary George Steinbrenner: making George Constanza learn about risk management. Risk management isn't a topic that surfaces in TV sitcoms too often, so we thank them for the reminder - check out a You Tube clip of Seinfeld's classic segment on risk management.

As long as we're having a bit of fun with risk management, let's up the ante a bit by throwing in some actuaries and accountants. A newly discovered blog that we are happy to recommend - Actuary Info - features many interesting and deliciously nerdy posts. For today's purposes, we call your attention to these two:

Actuarial Risk Management Humor: During the pause of a Risk Management conference, a professional risk manager, an accountant and an actuary were in the gents room standing at the urinals ...

Actuarial Risk Management Puzzle Joke: Three actuaries and three accountants are traveling by train to visit a 'Risk Management Conference'. At the station, the three accountants each buy tickets and watch as the three actuaries buy only a single ticket...

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July 13, 2010

 

From Michigan, we learn the tragic news of the silo-related deaths of two teens on a farm. Victor Perez, 18, was a recent high school graduate who had worked on the farm for about 4 years. His co-worker Francisco Mendez Martinez, 17, had been on the job for about a month.

News reports are thin and shrouded in mystery. One refers to the fatalities as a "mishap" (talk about understatement) and quotes a local farmworker as saying that the teens "weren't doing something particularly dangerous and they knew how to do it." (Apparently wrong on both counts). Other stories portray this as "just a tragic accident" with authorities quoted as saying they might never be sure what happened because there were no witnesses.

We should really expect better reporting from media whose beat includes farm country. And if the news reports are correct, there is at least one other local farm worker who needs to be alerted to silo dangers and the quoted sheriff needs to take an EMT refresher course.

A cursory Google search on silo deaths will show that there's nothing particularly mysterious about this "mishap" - unsupervised teen workers + confined space + silos + molasses storage - all should trigger red lights. The danger posed to teens of confined spaces in agriculture should be well known. Instead of breathless reporting about mysterious tragedies (see also "freak accidents"), media could do a huge service to local communities if they did a little research and used such horrific events as a springboard to educate people about a) safety for a high-risk group, teen workers and b) farm worker accident prevention.

The hazards associated with silos are well-recognized. One cited in this link might have been a description of the recent that killed the teens:

The typical scenario involves a worker entering an oxygen-deficient or toxic atmosphere and collapsing. Co-workers notice the collapsed worker and enter the same atmosphere and attempt a rescue; however, if they do not use proper precautions (respirators, ventilator fans, etc.), they also collapse.

Additional resources
Confined Space Hazards a Threat to Farmers
Dangerous Gases and Fires Can Make Silos Death Traps
Silo Gas Dangers
Silo Gas Dangers - from Farm Safety
Preventing Deaths of Farm Workers in Manure Pits
Confined Space Hazards
OSHA: Confined Space
Parental Alert: 2010's Five Worst Teen Jobs

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July 12, 2010

 

Today we examine one of the great conundrums in workers comp claims: the old injury that may or may not be defined as a new injury.

In 2006 David Poulton worked for Martec Industries in Rochester, New York, as a laborer. Poulton had a bad back, having already filed workers comp claims in 1998 and 2000. When he visited his treating physician in June 2006, he had the same old complaint: his back hurt, as it had virtually every day since his first injury in 1998. He told his doctor that he re-injured his back at work the prior day while lifting materials. At this appointment, a discouraged Poulton told his doctor he wanted to quit working.

In consideration of Poulton's long-established problem, apparently compounded by the prior day's incident, the doctor disabled him from work. He cited "old injuries and his continued decline." He characterized the situation as involving "episodic increases in pain" that had troubled Poulton for several years. The doctor, in fact, had been encouraging Poulton to stop working prior to this particular visit.

An independent medical exam determined that Poulton suffered from degenerative disc disease and that his disability was caused primarily by preexisting problems.

So is this a new injury, as reported by Poulton, or simply the recurrence of an old one?

Who Pays?
An administrative law judge found in Poulton's favor, determining that the lifting incident at Martec aggravated the pre-existing condition. However, this ruling was reversed by the appelate division of the NY supreme court, which found no evidence of a new injury and remanded the case for further consideration.

Poulton may yet succeed in re-establishing his workers comp claim, but it will draw upon the resources of the carrier for his prior employer, not the carrier for Martec. As is usually the case in workers comp, the narrative is driven by the evidence. In this case, the history of pain and suffering is so unrelenting and consistent, the "new injury" theory goes up in smoke. With his working days apparently at an end, Poulton probably does not care who pays for his troubles. He has suffered for a long time.The remaining question, of course, is who pays and how much.

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July 6, 2010

 

Happy post holiday weekend. This is a big vacation week, but if you are one of the many who is on the job today, here's a serving of a few news items that caught our attention.

Complex Care - here at Lynch Ryan, we focus on helping injured workers to recover and get back to normal life activities, including work, as soon as possible. But the reality is that some workers have serious injuries that require long-term recovery or permanent care. The Work Comp Complex Care Blog focuses on issues related to injured workers who require ongoing care. A few notable recent posts on things that can have a positive impact on outcome over the long term: Success Story: Simple Change Makes A Big Difference For Injured Worker and Standing Improves Mobility and Wellness in Patients Confined to Wheelchair.

West Virginia - We've been seeing a spate of stories about state workers comp programs moving from BrickStreet to private carriers. BrickStreet has been the sole provider of such insurance for government agencies, but that changed as of today, July 1. BrickStreet says this is to be expected, the same thing happened when competition went into effect for private sector clients two years ago.

Vermont is cracking down - Vermont employers who don't carry workers comp beware: your business may be shuttered. Previously, when an employer was found to be without workers comp coverage, there was a five-day grace period to obtain coverage before business closure, along with a fine of $150 a day. The Vermont legislature recently increased penalties for noncompliance - employers found without workers comp coverage must now be closed immediately and fines have been increased to $250 per day. In addition, as of September, the Labor Department will add four limited service positions to step up enforcement.

OSHA challenge - CalOSHA is convening a panel on how to better protect workers in the adult film industry. OSHA's existing state blood-borne pathogens regulations already cover condom use in productions filmed in the state, but many in the industry oppose mandatory condom use. It's a serious issue -- Los Angeles health officials have linked eight of as many as 22 possible HIV infections identified between 2004 and 2008 as tied to the industry.

Economic indicators - Roberto Ceniceros offers a roundup of recent economic news. In another post, he cites a recent news report noting that five Ohio pension funds and the state's Bureau of Workers' Compensation owned 30 million shares of BP stock, and wonders whether other state comp funds might be similarly affected.

Catastrophic risk scenarios - Jared Wade of Risk Management Monitor tells us about 7 potential disasters worse than the BP spill.

Obesity - At Booster Shots, the LA Times health blog, Tami Dennis notes that the obesity rate now tops 25% in two-thirds of the states, with Colorado being the only state coming in under 20%. The data is from a recent report F as in Fat: How obesity threatens America's future (pdf), which was issued by the Trust for America's Health and the Robert Wood Johnson Foundation.

DC court says no to PTSD - the D.C. Court of Appeals denied benefits to a former Pepco employer who sought benefits for a work-related case of post-traumatic stress disorder. Benjamin Ramey claimed that he suffered fear and embarrassment that resulted in PTSD after being tested for being drunk on the job. After the drug testing, Ramey was placed on suspension and enrolled in a rehabilitation program, but fired when he was ejected from treatment due to continued drinking.

Note to fraudsters - If you are out on workers' comp disability benefits, you may want to think twice about accepting a part in a Hollywood film.

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July 1, 2010

 

Joe Cassano is not apologizing to anyone. The former AIG executive who helped bring the world economy tumbling down says he did nothing wrong. His underwriting standards never changed: he never saw any risk in underwriting those collateralized debt obligations (CDOs). And if AIG leadership had had the cojones to keep him on board after the proverbial waste matter hit the fan, he would have cut the tax payers a better deal. He would have stuck it to the financial institutions that AIG was so anxious to insure. You want tough - Joe will show you tough!

Joe has avoided an indictment (he walks), and now he testifies (he talks). In his own not-so-humble opinion, he is blameless in the collapse of the worlds's largest insurer. When the final story is written about AIG, it will confirm what we have suspected all along: Cassano is not too bright. Tough, yes. Greedy, yes. Arrogant, for sure. A leader of men (and women, only because he has to), not so much. Self-aware and reflective: you gotta be kidding.

In Search of Leadership
When the great men and women of the revolution founded this country, they wanted freedom from tyranny. I imagine they also envisioned generation after generation of principled leaders to further their original goals. It's highly unlikely that Joe Cassano is what they had in mind.

As we approach the nation's birthday this weekend, let's (somewhat arbitrarily) shift our focus to a real leader: Joshua Lawrence Chamberlain, the prodigiously gifted general whose improvisation on Little Round Top turned the tide in the civil war. The Washington Post is running a series on leadership; here is their (video) take on Chamberlain's actions at Gettysburg.

The Insider extends to all our readers the wish for a fine holiday break. Amid the fireworks and family outings, pause for a moment in gratitude to those who brought us to this moment. In times of great need, great leaders have often emerged. Who knows, perhaps the same will eventually be said of these challenging times.

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July 1, 2010

 

A fresh new Cavalcade of Risk is awaiting your perusal at Wenchy's place - check it out!

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