March 2011 Archives

March 31, 2011

 

Jason Shafrin of Healthcare Economics is hosting the "Opening Day" version of the Health Wonk Review. Jason can be forgiven for his rather bizarre notion of the Milwaukee Brewers winning the World Series, as his line up of health-related articles is first rate.

Go Sox!

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March 30, 2011

 

A few years ago, an important NIOSH study on nursing home lifting equipment demonstrated that the benefits outweigh the costs. In addition to recapping the equipment investment in less than three years, NIOSH found a 61% reduction in resident-handling workers' compensation injury rates; a 66% drop in lost workday rates; and a 38% decline in restricted workdays. Plus, the rate of post-intervention assaults during resident transfers dropped by 72%. That's pretty impressive.

Now we have further evidence based on the recently-released study by NCCI: Safe Lifting Programs at Long-Term Care Facilities and Their Impact on Workers Compensation Costs (PDF). The study was a collaborative effort with the University of Maryland School of Medicine. It was limited to facilities that have had safe lift programs in place for more than three years. Originally, researches intended to compare the experience of facilities with and without such programs, but during the course of the research, the rate of adoption of safe lifting devices was so great that close to 95% of facilities had them and about 80% of those used them regularly.

NCCI summarizes the study results:

"After controlling for ownership structure and differences in workers compensation systems across states, the statistical analysis performed as part of this study shows that an increased emphasis on safe lift programs at long-term care facilities is associated with fewer workplace injuries and lower workers compensation costs. More precisely, higher values of the safe lift index are associated with lower values for both frequency and total costs. The safe lift index captures information on the policies, training, preferences, and barriers surrounding the use of powered mechanical lifts. The institution's commitment to effectively implementing a safe lift program appears to be the key to success."

One of the interesting aspects of the study is the safe lift index, referenced above, which was developed by researchers to aggregate answers from the survey questions into a single number. Researchers looked at several variables pertaining to policies and procedures. These included the training of certified nursing assistants in proper use of mechanized lifts, preferences of the Director of Nursing for powered mechanical lift use, potential barriers to the use of powered mechanical lifts, and enforcement of the lift policies. The report discusses these factors in greater detail, and demonstrate that there are many variables beyond just the equipment that affect overall program efficacy.

Many states have safe patient handling laws

In recent years, a number of states have enacted legislation mandating safe patient lifting - and that no doubt has contributed to the rapid adoption rate noted by NCCI researchers. According to the American Nursing Association, a strong advocate for such legislation, 9 states have implemented safe patient handling laws. These include Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In addition, they are tracking states with pending legislation in 2001, currently 6 states: California, Illinois, Maine, Massachusetts, Missouri and Vermont. You can also track this legislation via a map and you can access additional resources and information at ANA's excellent Safe Patient Handling website.

Prior posts on safe lifting
Texas enacts safe lifting guidelines for a hazardous industry
Washington passes "Safe Patient Handling" legislation
NIOSH study on nursing home lifting equipment: benefits outweigh costs
Safe Lifting and Movement of Nursing Home Residents

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March 24, 2011

 

Ready for a bi-weekly grab-bag of risk-related reading? Jacob A. Irwin hosts Cavalcade of Risk # 127 - Riskiest Jobs Edition at My Personal Finance Journey.

Agents & Experience Mods - What role do insurance agents play in keeping a client's workers' comp losses as low as possible? In PropertyCasualty360, Kevin Ring of the Institute of WorkCompProfessionals offers Six Ways to Keep a Client's Experience Mod Under Control.

Federalization - Over the years, talk about the impending federalization of workers comp has surfaced time and again. In recent years, with healthcare reform and a move to increased federal oversight of financial industries, talk of workers comp federalization has increased. Joe Paduda classifies this as a "never gonna happen" thing, and he makes his case in a four-part argument: part 1, part 2, part 3, and part 4.

More charges filed in Upper Big Branch case - Ken Ward of Coal Tattoo reports that criminal charges were filed against a former Massey Energy employee who faked his certification to perform safety exams. Ward reports that "...he is the second person to be charged as part of what is said to be a broad federal criminal investigation of the explosion and safety practices at the Massey operation." You can find more of Ken's reporting in the archives of the Upper Big Branch Disaster.

Healthcare - Liz Borkowski of The Pump Handle looks at The Affordable Health Care Act's first year and sees some disappointments but also great progress. Her post highlights a provisions that have already kicked in. And in another healthcare report, a new survey by Gallup reveals that there is a wide discrepancy in health coverage across U.S. metro areas. Nine of the ten most uninsured metro areas surveyed were in Texas and California; 8 out of the metro areas with the lowest percentage of uninsureds were in the northeast.

Just for fun - Your enjoyment and amusement at the following site will be in direct proportion to your age: Obsolete Skills is a wiki database of things we used to know that are no longer very useful to us. Some of these skills are everyday matters like dialing a rotary phone or adjusting rabbit ears, but the list is also a compendium of disappeared jobs, such as taking shorthand, asbestos installation, blacksmiths, bookbinding, and more. It's a fun site to browse and because it's a wiki, you can also contribute.

Quick Takes

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March 22, 2011

 

We are now a week and a half into the Japanese disaster, which encompassed a terrible trio of catastrophic events: an earthquake, a tsunami, and a near-nuclear meltdown that looked to be vying for a top spot in the record books. The death toll tops 9,000, with another 13,000 still missing. And today at the Fukushima Nuclear Plant, although a large scale meltdown looks to have been narrowly averted, the extent of the radiation leaks and the related damage are still yet to be fully assessed.

The heroes of the past week, those credited with keeping events at the nuclear plant from spiraling irretrievably out of control, are being hailed as "the Fukushima 50." In actual numbers, they are more like 200 courageous souls, taking turns in 50-person shifts while the world watched from outside the 20 kilometer evacuation zone.

When the full extent of the crisis at the Fukushima plant became apparent in the wee hours of March 15, TEPCO wanted to remove all staff. Prime Minister Kan summoned TEPCO President Masataka Shimizu to his Office and told him that leaving was was not an option. "This is not a matter of TEPCO going under; it's about what will become of Japan," he said.

ABC news sheds a bit more light on the team who struggled to restore order to the crippled plant. The crews are though to be hands-on workers, technicians, rather than managers.

"The crews are not necessarily made up of strong young men. Emergency nuclear scenarios suggest asking older retirees to volunteer, not because they're more expendable, or even because they're more skilled, but because even if they're exposed to massive amounts of radiation, history has shown they would die of old age before they die of radiation induced cancers, which can take decades to develop."

And what's the extent of the health risks they are facing? The Power company reports that at least 25 workers and 5 members of Japan's Self Defense Force had were exposed to unsafe levels of radiation. There are other injuries and two workers remain missing. As for "the fifty," ABC says that not all experts believe that the radiation levels the workers are exposed to will be fatal.

"While radiation-induced cancers are a serious worry for those exposed to high doses of radiation, they usually take at least a few years to set in.

"You may see an incidence of cancer 30 years down the road. Cataracts can set in in 30 to 40 years," said Jenkins. "Leukemia showed up within a few years in the atomic bomb survivors, but solid cancers did not appear until 10 years and continue [to show up] to this day," said Hall."

Wikipedia's page on the Fukushima 50 offers more detail about the radiation exposure these workers faced in comparison to that of other nuclear workers.

"The international limit for radiation exposure for nuclear workers is 20 millisievert (20 mSv) per year, averaged over five years, with a limit of 50 mSv in any one year, however for workers performing emergency services EPA guidance on dose limits is 100 mSv when "protecting valuable property" and 250 mSv when the activity is "life saving or protection of large populations."

Prior to the accident, the maximum permissible dose for Japanese nuclear workers was 100 mSv in any one year, but on 15 March 2011, the Japanese Health and Labor Ministry enforced the permitted 250 mSv limit, in light of the situation at the Fukushima Nuclear Power Plant."


For additional perspective on the numbers, see this excellent radiation dose chart.


Revisiting Chernobyl
As we approach the 25 year anniversary of the world's worst nuclear disaster, the inevtiable comparisons have been made. But Japan's a markedly different scenario than the one faced by the workers at Chernobyl, where 29 firefighters, rescuers and nuclear plant workers died in the two months following the nuclear disaster. At least 19 other workers have died since 1987, and others have reportedly died from leukemia and other illnesses. You can read the gruesome story of deceased Fireman Vasily Ignatenko, as told by his wife Lyudmilla Ignatenko.


Subsequent clean-up teams were called The Liquidators of Chernobyl. These were folks tasked with the cleanup. Of this cleanup. Wikipedia says:
Between 1986 and 1992, it is thought between 600,000 and one million people participated in works around Chernobyl and their health was endangered due to radiation. Because of the dissolution of the USSR in the 1990s, evaluations about liquidators' health are difficult, since they come from various countries (mostly Ukraine, Belarus and Russia, but also other former Soviet republics). Furthermore, the government of Russia has never been keen on giving the true figures for the disaster, or even on making serious estimates. However, according to a study by Belarusian physicians, rate of cancers among this population is about four times greater than the rest of the population. (Wikipedia notes that "All the figures quoted by various agencies are controversial.")

Insurance issues related to Japan's disaster
According to the Insurance Information Institute, Japan's earthquake could cost $15 billion to $35 billion, one of the costliest ever. This would be a tough enough kick in the shins for the insurance industry, but III notes that, "... four of the five costliest earthquakes and tsunamis in the past 30 years have occurred within the past 13 months."

See more from III at their excellent resource page on the Japan earthquake and Pacific Tsunamis

Here are some other insurance-related articles that shed light on one or another aspect of this mammoth event.

We aren't up our international compensation law, but our Googling turned up this overview of Workers Accident Compensation in Japan.

Joanne Wojcik tackled the nuclear topic in Business Insurance in her article Coverage restrictions expected to limit nuclear claims (subscription required). We offer this excerpt:

Under Japan's 1961 Law on Compensation for Nuclear Damage, which was amended in 2010, power plant operators' liability for accidents such as those after the earthquake and tsunami is limited to 120 billion yen (about $1.5 billion), with the Japanese government assuming responsibility for any third-party damage or bodily injury claims beyond that amount.

To meet the requirements of the law, Japanese nuclear power plant operators buy property and liability insurance from the Japan Atomic Energy Insurance Pool. JAEIP provides nuclear property, nuclear liability, general liability and terrorism coverage to nuclear power plant operators. However, JAEIP does not sell the utilities coverage for earthquake damage, tsunami damage or business interruption, leaving the Japanese government responsible for those costs.

If a nuclear incident similar to that occurring in Japan were to happen in the United States, the U.S. Price-Anderson Act limits liability for nuclear power plant operators to $12.6 billion.

At Risk Management Monitor, Emily Holbrooke looks at the issue of business interruption and its effects on global corporations. Many think the real story is one of good engineering saving thousands of lives - Jared Wade discusses this in his posting about how Japan's bulding codes prevented casualties.

Also in Business Insurance, Judy Greenwwald looks at the complicated claims process ahead:

Corporate policyholders that do business with companies in Japan face a complicated process when they attempt to tap their contingent business interruption coverage because of the intertwining nature of the disasters that have struck the nation, observers say.

"This is going to be one of the most complicated catastrophes that I've seen," said William Okelson, Chicago-based director of property claims for Lockton Cos. L.L.C. There are "so many variables," including the original quake, the tsunami, resulting fires, nuclear power plant dangers and the government rationing of electricity.

At LexisNexis, Julius Young examines a "what if " scenario: What If? Workers' Comp and Earthquakes. Jon Gelman puts the events in some historical context relative to other large-scale disasters and nuclear events: A Nuclear Workers' Compensation Disaster.

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March 21, 2011

 

In a move stunning for its contrariness, Vermont is moving toward a single payer health care system. In the course of the debate, the inevitable issue of whether to include workers comp has come up. At this point, a committee will make recommendations on whether to "integrate or align" workers comp with the state's radical reconfiguration of the health care system. (Further details are available at WorkCompCentral - subscription required.)

The Vermont approach would completely separate indemnity from medical benefits. Employers would continue to pay for the indemnity portion, but are unlikely to have any input into treatment plans. The Insider has pointed out - ad nauseum, some might say - that the relatively miniscule comp system is quite different from the behemoth health delivery system. In the interests of saving the Vermont committee a little time, here are a few of the conundrums confronting anyone trying to merge the two systems:

: Comp is paid solely by employers. Injured workers pay nothing (no co-pays, not deductibles, ever).
: Consumers pay quite a bit for conventional health coverage: a portion of premiums along with co-pays and deductibles for treatment and for medications
: Comp has very narrowly defined eligibility requirements, while conventional health has virtually none
: The goal of comp is to provide medical treatment for injured workers and, if possible, return them to work; if return to work is not possible, comp pays lost wage benefits and injury-related medical bills virtually forever.
: The goal of the conventional health system is to take care of people, regardless of the employment implications
: Comp provides indemnity, temporary or permanent, for those unable to work. No such wage replacements exist in the conventional health system
: Perhaps most important, medical services under comp have an occupational focus, with the explicit goal of returning people to their jobs. In the conventional health system, any occupational focus would be subordinate to the goals of the consumer.

Should Vermont achieve its ambitious goal of universal coverage, the presumption is that everyone would have a primary care physician, who would serve as gatekeeper for all medical services. (Let's set aside, for a moment, where the Green Mountain state will be able to find these primary care doctors.) In a unified system, injured workers would go to their primary care physicians for work-related injuries. These primary care docs may or may not focus on returning their patients to work. Many people hate their jobs and might welcome a few weeks or months of indemnity-supported leave. The primary care physician might be quite sympathetic to their cause.

This brings us to the great divide between conventional health care and workers comp: conventional health care may or may not embrace the need for return to work. Indeed, if the work is hazardous - as much work is - the doctor may want to discourage his patient from returning to it. The doctor's goal is to "do no harm" - so why send someone back into harm's way? If the patient suffers from lower back problems and has a job involving material handling, what is the right thing for the doctor to do?

Who Pays?
In the current system, workers comp pays doctors for eligible medical services. Whether or not they like the comp fee schedules, doctors are acutely aware that comp is paying for the services of a particular individual. Often, treatment is provided by occupational specialists, who bring a unique "return-to-work" focus to the treatment plan. These occ docs are often in communication with employers seeking to return injured workers to productive employment. The occ docs specify the restrictions so that employers can design appropriate modified duty jobs. The employers have a sense of urgency, as they are losing the productivity of the individual who is out of work - and of course, they are paying all of the costs associated with the injury.

Under the proposed Vermont system, all bills will be paid the same way. Comp disappears from the doctor's view. Employers may have little input into the choice of doctors or specific treatment plans. The role of occupational doctors is unclear, to say the least. Given that primary care physicians generally lack an occupational focus, return to work may become secondary to the comfort and personal inclinations of the patient. As a result, there is a risk of substantial increases in indemnity costs.

When contemplating change on the scale of Vermont's single payer system, it is tempting to brush aside the implications for something as small as the workers comp system. That would be a big mistake. The system might be small, but the costs to the state's employers are already substantial and have the potential for going much higher. The comp system plays an unique and long-established role in protecting both workers and employers. As they take steps to transform healthcare in Vermont, lawmakers need to remember that workers comp itself is worthy of their protection.

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March 17, 2011

 

Health Wonk Review - What do baseball and healthcare have in common? Find out - Glenn Laffel of Pizaazz hosts a fresh helping of the best of the health policy blogosphere: Health Wonk Review: Spring Training Edition

Does an anti-immigrant climate affect workers comp costs? - At Comp Time, Roberto Ceniceros discusses a recent news story in which Tom Hensley, president of Fieldale Farms Corp, testifies before the Georgia General Assembly about the detrimental impact that anti-immigration measures are having on his business. The impact included higher turnover and higher workers comp costs. Roberto is interested in hearing if anybody else has witnessed a similar trend of Latinos fleeing a state because of anti-immigrant sentiment and then claims trending upward - drop him anot if you have something to add.

Can you hear me now? Musicians and other workers who are exposed to loud music in their workplace are typically given short shrift in the occupational safety and health literature. Recent studies at nightclubs show that all employees (waiters, bartenders, DJs, etc,) were exposed to noise levels above internationally recommended limits and were at a higher risk of early hearing loss and tinnitus. The NIOSH Science Blog discusses music-induced hearing loss.

Giffords covered by work comp - Stephanie Innes of the Arizona Daily Star reports that federal workers' comp is footing the recovery bill for Gabrielle Giffords and two of her employees who were shot in January. Because they were working, it's an on-the-job injury. The federal law has no cap on medical payments, which is fortunate since the story reports that, "The Brain Injury Association of America says inpatient rehabilitation costs can range from $600 to $8,000 a day depending on services, and outpatient rehabilitation can cost $600 to $1,000 a day."

Shrinking employer appetite for RTW? - Joe Paduda looks at how the economy may impact workers comp in 2012. Is higher severity in the offing? Joe talks about why that might be the case.

What makes a good claims organization? - At PropertyCasualty360, Carl Van, president and CEO of the International Insurance Institute, Inc., has posted the first in a three-part series on The Five Standards of Great Claims Organizations. See how your organization or your vendor stacks up.

Complex care - the folks at TMS continue to demonstrate that in complex care cases, the devil is in the details - and those details may be impeding an injured worker's recovery and costing you money. See Pressure mapping: The underwear case for another example of how a small problem can become a big one.

Cool tool - Calculate your injury and illness incidence rates for your organization and compare them with national, state-specific, or industry-specific averages: Incidence rate calculator and comparison tool

Jobs of yesteryear - Ptak Science Books features a series of photos of Pennsylvania Coal Boys on the job in 1895 excerpted from an issue of Scientific American.

Japan - HR Web Cafe has posted various resources, including options for donations. The interactive before and after satellite images are very dramatic, giving some sense of scope.

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March 14, 2011

 

If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse.

In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

  • Health care workers are more likely to be attacked at work than prison guards or police officers.
  • Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
  • General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
  • Physical assault is almost exclusively perpetrated by patients.
  • 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
  • 72% of nurses don't feel safe from assault in their workplace.
  • Up to 95% of nurses reported having been bullied at work.
  • Up to 75% of nurses reported having been subjected to sexual harassment at work.
Last fall, the issue of safety for nurses and allied health professional was brought to the forefront after the deaths of two California healthcare workers in separate incidents. In October, psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County's correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.

While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. Last year, the Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC recently spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients' homes.

The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence brought into the workplace. And it's unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.

Some are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place. In a posting on KevinMD.com, respected physician Kevin Pho suggests that the rising tide of violence against healthcare workers might be emblematic of a dysfunctional health system, where healthcare is viewed as a commodity, and the caregiver-patient relationship is deteriorating. He says:

"Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they've waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse."

In HealthLeaders Media, John Commins discusses an innovative approach undertaken by the University of Wisconsin Hospital and Clinics - a program to codify risk of hospital violence.

Recently, the Emergency Nurses Association issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.

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March 11, 2011

 

Our thoughts and prayers are with the people in Asia who are suffering through a disaster of unprecedented scale. The digital age allows us to watch the apocalyptic images: entire neighborhoods being swept to sea; burning houses borne upon the dark tide of water and debris; hundreds of vehicles swept along as if they were rudderless boats; the boats themselves powerless against the sheer force of the waters. We engineer our buildings, our infrastructure, our vehicles, our very lives on the assumption that the odds are always with us, that destructive forces of this magnitude are very unlikely to rise up from the depths of the ocean. And yet, on occasion, arise they do.

It will take months to sort out the damages. Indeed, the damage has not even run its brutal and indifferent course. But we cannot allow this horrific moment to pass without at least a glance at the implications for the subject of this blog, the insurance industry. Insurance is all about risk and risk transfer. Individuals and most businesses are too small to absorb the risk of loss that surrounds us. We purchase insurance as a hedge against disaster: loss of life, property, assets, physical ability, etc. The law of large numbers works in favor of the insurer: sell enough policies, expand your markets far and wide, and the risk of loss is spread out over an immense area. A catastrophe in one place is absorbed by the absence of losses elsewhere.

In the scale of what is happening in Japan, there is no elsewhere. No actuarial calculation can take into account the implications of losses on this scale. And even if the actuaries could come up with a number, the cost of the insurance would preclude anyone from buying it.

Here's one relatively minor insurance issue emerging from the rubble in Japan: the quake hit at 2:30 in the afternoon. Many of the people being swept away by the surging waters were working. Their deaths will be compensable under whatever form of workers comp exists in Japan.

Our modern lifestyles do not recognize risk and disruption on this scale. We somehow think ourselves immune from disaster. It brings to mind a poem by Percy Bysshe Shelley about another powerful and confident civilization that could not foresee an end to its dominion:

Ozymandias

I met a traveler from an antique land
Who said: Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,
Half sunk, a shattered visage lies, whose frown,
And wrinkled lip, and sneer of cold command,
Tell that its sculptor well those passions read
Which yet survive, stamped on these lifeless things,
The hand that mocked them, and the heart that fed;
And on the pedestal these words appear:
"My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!"
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.

A century of horrific wars and occasional natural disasters have taught us that our arrogance and presumed mastery of the world are illusions. The lesson is clear: Ozymandias and his ilk (Muammar Gaddafi comes to mind) rule with arrogance and contempt. By contrast, our actions must be as full of generosity and compassion as possible. The risks that lurk in our lives may be beyond calculation, but what truly matters is our ability to embrace the time given to us and help those whose lives have been devastated by chance.

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March 11, 2011

 

We have to wonder if TV has really jumped the shark when we heard the premise of an upcoming sitcom today.

Now you've probably all been feeling slighted: there have been cop shows, doctor shows, teacher shows, even mortician shows - why the heck don't claims adjusters and insurance agents ever get any love?

Relax, your prayers are answered: Morgan Fairchild to Star in Comedy Pilot Presentation 'Workers Comp'. The show is being produced in Florida.

That scintillating topic of workers getting injured on the job, there's a hilarious premise: Fraud hijinks! Injury pratfalls! Wacky claims! Processing snafus! Can't wait to see it!

I guess this is as good a time as any to announce our new Hollywood division: "Lynch Ryan: Workers Comp Consultant to the Stars. "

(Thanks for the tip go to Helen King Knight)

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March 9, 2011

 

Jay and Louis Norris have posted the 126th edition of Cavalcade of Risk at Colorado Life Insurance Insider - and it's a good one. We post blog news roundups regularly - and we are always delighted when our friends from Colorado host - they do a great job summarizing, presenting and commenting on submissions. Check it out!

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March 8, 2011

 

Later this month, we will mark the 100 year anniversary of New York's horrific Triangle Shirtwaist Fire, an event that claimed the lives of 146 garment workers - young girls and women - who had been locked in the sweatshop to prevent theft. Most died in stairwells, jumping down the single elevator shaft, or by hurtling themselves from 9th story windows in desperate attempts to escape the fire. PBS recently ran a special on this disaster. (If you missed it, you can watch online: Triangle Fire). My colleague Jon Coppelman has also written about the fire in his post The Original "No Exit".

This fire was a watershed event that galvanized the nation. It occurred in an era where there were no regulations or labor protections. Workers often worked 12 hour shifts, 7 days a week. There were no child labor laws or safety mandates. Ironically, the day before the Triangle Fire, New York courts had struck down the state's first compulsory workers compensation law as unconstitutional.

This tragedy, along with some of the horrific mine disasters that resulted in wholesale loss of life, were catalysts which led to the enactment of various worker protections - including statutory workers' compensation.

Meanwhile, today in Wisconsin ...
We think this bit of history is an important backdrop to what's going on in Wisconsin today.

Wisconsin has the distinction of being the first state in the union to have enacted a workers' compensation law that survived legal challenge in May of 1911. In fact, the state of Wisconsin has a long, storied and sometimes bloody history of being on the front lines for worker rights. Workers and labor unions were in the forefront of the fight for the 8-hour day and the 40-hour work week. In 1932, Wisconsin was the first state to enact unemployment compensation.

To any who know this history, it comes as no surprise that, once again, Wisconsin is on the front lines in the battle for labor's future.

It's the budget, stupid - or is it?
The ostensible issue, according to Governor Walker, is that the state of Wisconsin is broke and a large part of the problem lies with overly generous benefit packages of public workers - teachers, prison guards and the like - which are said to be crippling the state. He called on unions to do their part and to make a sacrifice for the greater good.

All that might be well and good. The unions have indicated their willingness to take a financial haircut. But the part of Governor Walker's Budget Repair Bill that is going over somewhat less well is a call for the elimination of collective bargaining -- and therein lies the rub.

With a Republican majority in Wisconsin's House and Senate, the bill was all but a given until the Democratic senate contingent fled the state to prevent a vote. Since that time, there have been massive protests over three weeks and the so-called Fab 14 remain holed up in un-named Illinois' hotels. And there has been no shortage of drama in this story: an embarrassing and revelatory 20-minute prank call to Governor Walker from an impersonator of corporate financier David Koch; and a sheriff's refusal to play the role of "palace guard", among other things.

Part of national union busting agenda?
Critics of Walker's Budget Repair Bill say that the issue is not about budget balancing or overly generous benefits, but an ideological push to eliminate or curtail public unions - in a phrase, union busting. Opponents say that this is a corporate-funded campaign to eliminate public unions in Wisconsin and other states, and to privatize many institutions that are currently staffed by public workers. No less a staunch Republican than former Congressman and now host of MSNBC's "Morning Joe" program, Joe Scarborough, has publicly called Governor Walker's actions, "Un-American."

In Wisconsin, suspicions are high because Koch enterprises funded a large part of Walkers gubernatorial campaign. The fact that the budget bill contains a provision authorizing Walker to conduct no-bid sales of some state properties also heightens suspicion. Many are troubled by his plans for privatization of some public services. In his prior role as Milwaukee County Executive, Walker also used budget emergency as a justification for privatizing security guards, a move that proved less than successful.

Other states have also embarked on this path: Ohio may be making more headway in curtailing unions. In Indiana, Democratic legislators have followed Wisconsin's lead and left the state to postpone a vote. In Rhode Island, nearly 2000 teachers have been dismissed. Other states may be contemplating similar measures, although some may be a bit shy of action given the shifting public sentiment, which favors retention of collective bargaining and has given Walker a black eye - to a point where voters say they would not elect him again if they had a do-over. (see Wisconsin Public Research, Rasmussen, USA Today/Gallup, Public Policy Polling and various other polls. )

It's uncertain what will happen in the next chapters, but we will be watching. It is clear this is another watershed point in labor history, a public policy fork in the road, perhaps the beginning of the end of the movement that was propelled into mainstream America by that terrible fire 100 years ago. While polling indicates that sentiment is currently on the side of the teachers in this dispute, the future of public unions is under serious threat. Is the role of unions obsolete? Has the public dialogue achieved an equilibrium between the rights of workers and those of management?

At Lynch Ryan, we have great respect for unions, which have historically played a critical check-and-balance role in labor-management power dynamics. They have also been in the forefront of the fight for worker safety and other worker protections. We also admire and respect many employers we have been privileged to work for who are perceptive and wise enough to manage their companies so well that unions are not needed. We'd like to say that all employers are this enlightened and do not need union checks and balances to do the right thing, but unfortunately our experience tells us that this is not always the case.

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March 3, 2011

 

Jared Rhoads of The Lucidicus Project hosts this week's Health Wonk Review, and he dishes up a heaping helping of the blogosphere's best heath policy posts from the last two weeks. Check it out!

Happy Birthday - to David Williams at Health Business Blog for 6 years of quality healthcare blogging. David is one f the regular Health Wonkers. See his Best of the Blog post for a fine sampling of his work.

More sports-related head trauma tragedy - Earlier this week, my colleague posted about football-related chronic traumatic encephalopathy (CTE). Yesterday, the New York Times featured a story about how hockey brawler Bob Probert also suffered from CTE: "But the legacy of [Bob] Probert, who died last July of heart failure at 45, could soon be rooted as much in his head as his hands.After examining Probert's brain tissue, researchers at Boston University said this week that they found the same degenerative disease, chronic traumatic encephalopathy, whose presence in more than 20 deceased professional football players has prompted the National Football League to change some rules and policies in an effort to limit dangerous head impacts."

Bill review - Are you getting what you pay for with medical bill review? At Managed Care Matters, Joe Paduda takes some of the mystery out of the equation in his discussion about what your savings should be from your work comp medical bill review program.

Criminal indictment for Massey mine official - Hughie Elbert Stover, the chief of security for Massey Energy's Upper Big Branch Mine has been charged with two felonies related to the April 2010 explosion that killed 29 coal miners. He is accused of lying to investigators and destroying records. On his blog, reporter Ken Ward asks if this is just the beginning of indictments.

Don't mess with Texas - If you ever use the words "workers compensation" and "Texas" in the same sentence, you better think twice. TX law blogger John Gibson has been issued a "cease and desist" order and threatened with further legal action for his TX Workers Comp Law Blog for having the temerity to use the words "workers compensation" and "Texas" in his blog. We can't get Gibson's take because his blog appears to be down (www.texasworkerscomplaw.com), but Julius Young posts the scoop on the Texas workers comp language imbroglio at his Oakland Workers Comp Blog. If you don't see his post - or ours - please blame Texas. Just to be on the safe side, from here on out we may begin referring to Texas as "Exas-Tay."

Sedgwick acquires SRS - In a major move in the world of third party administrators, Sedgwick completed the purchased of Specialty Risk Services for $278 million. SRS was the claims TPA arm of The Hartford. In his bog on the Hartford Courant, Matthew Sturdevant reports that: "The deal makes Sedgwick CMS the largest independent North American provider of claims administration services. The combined companies will have annualized revenue of about $1 billion as well as almost 8,500 employees."

Devil's in the details - Yvonne Guilbert of Complex Care Blog posts two concrete incidents that show how one small detail missed in home care could easily end up costing $50,000 or more.

Safe hiring practices - As the economy ramps up, new hires will increase an employer's potential for workplace injuries. At MEMIC Safety Blog, Greg LaRochelle says that a new employee is 5x more likely to have a lost-time injury than a more experienced worker, and that 40% of all workers injured on the job have been on the job for less than a year. He posts about hiring practices to help mitigate risk.

Hiring Vets - HR Daily Advisor offers a good roundup of tips and advice for hiring returning veterans. The post includes questions to ask and to avoid during the interview.

Short Takes
AIG results and workers comp
Four steps to evaluate absence policies
Insurance Fraud Hall of Shame 2010
Smiling makes the world go round
7 wellness benefits employees want most

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March 1, 2011

 

Dave Duerson was a star safety in the NFL. He used his head in the way that aggressive defensive backs often do - as a battering ram to bring an opponent down, maybe even jar the ball loose. He was articulate, generous and in his post-football life, successful. So it saddened many of his friends and colleagues to learn that he had committed suicide last month. But even in this last, desperate act there was a method to the madness: he shot himself in the chest, so that his brain would be left intact. He was convinced that the downward spiral of his life over the past few years was due to football-related brain damage - chronic traumatic encephalopathy. He texted his ex-wife just before he shot himself, requesting that his brain be given to the NFL brain bank. Just in case she did not get the message, he left a written note with the same instructions.

We have blogged the issue of concussions in the NFL and their potential for long-term brain damage. As this prior blog pointed out, a changing of the NFL's medical guard indicates that the league finally appears willing to confront the issue head on (so to speak). They no longer systematically deny a connection between concussions on the field and severe cognitive problems after football careers come to an end.

Over the past few years, Duerson was in a downward spiral. He lost his business to bankruptcy. He (uncharacteristically) assaulted his wife, who soon felt compelled to end their marriage. While his friends did not see major changes in his behavior, he talked openly of his fears of dementia. He suffered short-term memory loss, blurred vision and pain on the left side of his brain. He looked into the future and despaired at what he saw coming. At the time of his death, Duerson was only 50.

Suicide as Political Act
Duerson's last gesture was an explicitly political act. He was convinced that his life problems - and the rapidly diminishing quality of that life - were directly connected to his years as a football player. So he not only decided to end his life, he made sure that suicide would leave his brain intact for research. The NFL has been (belatedly) collecting the brains of deceased players willing to donate them, to try and determine the impact of repeated violent collisions on aging. At this point, there is not much doubt of the causal connection - not in every individual who played the game, but surely in a significant percentage who suffered from multiple concussions.

With this connection medically proven, the burden falls on the NFL to improve player safety. That will not be easy. This past season, a number of players - most notably the Steelers linebacker James Harrison- complained about the newly implemented fines for helmut to helmut hits, defined as:

"using any part of a players helmet (including the top/crown and forehead/hairline parts) or facemask to butt, spear, or ram an opponent violently or unnecessarily; although such violent or unnecessary use of the helmet is impermissible against any opponent, game officials will give special attention in administering this rule to protect those players who are in virtually defenseless postures..."

Duerson the player would have agreed with Harrison about the rule. Duerson the retiree would have supported it. Experience is an exacting and often cruel teacher. As Duerson's sad demise demonstrates, what we choose to ignore in the prime of life may give birth to demons that haunt us as we age.


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