July 2011 Archives

July 28, 2011

 

When employees travel overnight for their employers, workers comp may expand into 24 hour coverage. Work put you on the road; comp covers you while you are working.

An unnamed (for soon to be evident reasons) woman in Australia has filed a workers comp claim for injuries incurred during sexual activity while on a business trip. She was having sex with a man (not that that matters) when a glass light fitting came away from the wall above the bed. The light struck her in the face, leaving her with injuries to her nose, mouth and a tooth, as well as "a consequent psychiatric injury". The relative positions of the man, the woman and the light are not detailed in either of two newspaper articles, one in the Sydney Morning Herald and the other in the Herald Sun.

The woman's lawyers argue that being injured while having sex "during an interval or interlude within an overall period or episode of work" was no different to being hurt while carrying out other recreational activities - some recreational activities evidently being "higher risk" than others.

Course and Scope
But Australia's ComCare, which says the woman was having sex with "an acquaintance, who had no connection with her work", will argue "neither legal authority nor common sense" could lead to a finding that the injury was sustained during the course of her employment. This implies, of course, that had the man been a work acquaintance, the injury might have been compensable. Hmmm. The devil, as always, is in the (salacious) details.

From the American litigation perspective, it might seem more logical to sue the hotel or the light manufacturer. But as Australia's comp law - unlike the American statutes - does allow compensation for pain and suffering, a liability claim might not add anything to the potential payout.

In the final analysis, this incident stands as a stark example of the dangers of mixing business and pleasure. In her expansive notion of the "course and scope of employment," the anonymous claimant has literally brought the workers comp system into the (hotel) bedroom, where it rarely resides. We await with great interest the final resolution of this intriguing case from down under.

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July 28, 2011

 

The Disability Management Employer Coalition is a non-profit dedicated to advancing strategies and resources that improve workforce productivity by minimizing the impact of absence and disability. The organization offers a variety of tools and research materials - and we've just discovered a stash of video clips on a variety of topics from recent presentations. We think they are well worth checking out - here's an index:

Best Practices in Return to Work
This presentation is from the Leadership Series, an employer-only, focus group approach to the investigation of high-profile issues. This 6/23/2011 session (Length: 1:16) deals with Return to Work. Employers share best practices in both work-related and non work-related situations that can be easily incorporated into a company's culture. it also explores common characteristics of several programs and identifies the pros can cons of plan design.

Stress & Resiliency: Applying Research of Employer Best Practices @ Your Workplace
From the "Tools & Tactics" webinar series, 6/09/11, length 1:01
A report on research conducted in collaboration with DMEC, the Partnership for Workplace Mental Health, and other organizations. Study participants included multidisciplinary representatives from 40 different workplaces, and offers specific examples from employers and strategies for applying best practices at your company.

What If There Were a Money Pill? Financial Security & Workplace Wellness
From the "Tools & Tactics" webinar series, 5/26/11, length 49:42
Dr. Ron Leopold explores both the financial and wellness aspects of disability and how it affects recovery and RTW. Learn how you can implement small changes to make the process run smoother and insure employees avoid costly disability events.

Absence, Wellness and Engagement: A Critical Link
From the "Tools & Tactics" webinar series, 5/12/11, length 57:27
What do patterns in absence and disability tell us about the health status of our workforce? And what can we do it about it? This talk Explores the results of research done at Nationwide Better Health to quantify the true impact of costly health risks and tells how several employers are getting results from a proactive management approach.

Johnny's Not Back at Work?: Corporate Strategies for the Less Than Motivated
From the Virtual Education Forum, 5/10/11, 1:12
The Virtual Education Forum is a series of web-based sessions where employers and service providers share their knowledge and first-hand experience in developing and running a successful disability and absence management program. This session deals with calibrating the likelihood of a successful RTW will be presented along with corporate worker's compensation and disability case studies applying a unique motivational model.

Managing Absence in Recessionary Times: Research Update
From the "Tools & Tactics" webinar series, 4/28/11, length 1:04
This session offers findings from Mercer's 2010 Absence Management Survey

I thought it could never happen to me
From the "Tools & Tactics" webinar series, 4/21/10, length 49:47
Dr. Ron Leopold on the emotional and financial impact of disability.

ADAAA Update: What the First Cases and New Regulations Tell Us
From the "Tools & Tactics" webinar series, 3/31/11, length 1 hour
This annual update provides insight into the implications of recent case law as well as offering suggestions on how to insure your program is set to respond appropriately.

Upcoming events
To learn about upcoming DMEC events, check the DMEC Virtual Education Forum events and the Tools & Tactics Webinars. Events are free to members; nonmembers can also attend for a reasonable fee.

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July 27, 2011

 

Cavalcade of Risk, the biweekly roundup of risk-related posts is posted at My Personal Finance - check out Issue # 136 - Riskiest Sports Edition.

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July 26, 2011

 

NIOSH Science Blog's recent blog post is taking on Hollywood - specifically, the summer's blockbuster Horrible Bosses, an irreverent and risque dark comedy in which abused and aggrieved employees decide to murder their psycho bosses. We'd make the case that real life bosses can compete with the ones that Hollywood dreams up any day.

Complaining about bosses is an age-old tradition, but few take the concept of boss bashing literally. According to NIOSH, "The situations portrayed in the movie are not typical--worker-on-worker (or boss) violence accounts for only about 8% of workplace homicides. More than half of all workplace homicides occur in retail or service settings such as conveniences stores, taxicab services, and gas stations with the majority of these homicides occurring during a robbery." The post author uses Horrible Bosses as a springboard to introduce and discuss the very real issue of workplace violence. It includes an array of links to related posts about professions that are particularly vulnerable to violent events, such as school personnel, taxi drivers, pharmacists, nurses.

This isn't the first time that The NIOSH Science Blog has turned to Hollywood to illustrate health and safety issues. They've previously featured an entertaining pair of posts: Occupational Safety & Health in the Movies and OSH at the movies: the sequel. In the latter, the post author lists the Top 11 Films Depicting Occupational Safety & Health Issues, the Top 7 Films with Occupation Safety & Health Issues During Production, and the Top 10 Films in [a risk-related] Special Category.

Other online forums have tackled the issue of risk related issues in Hollywood from various angles:

  • RiskVue features the Top Movies No Risk Manager/Insurance Professional Should Miss, saying that, "The simple fact is risk managers and insurance professionals lack solid role models in the entertainment industry. Nevertheless, plenty of films have delved deep into the principles of risk and insurance management, offering lessons, guidance and a form of entertainment that only those in the industry can truly appreciate."
  • A blog post at Consumer Insurance Blog deals with risks, hazards and liability issues involved in filmaking and production: Risk, insurance, & the movies. The post notes some of the risk issues involved in film making, which can include such disparate hazards as wild and trained animals, technology glitches, actors who have to leave the set mid-production to go to rehab, and weather related events that may delay production schedules or pose danger to the cast, the crew and the props.
  • Risk Management Magazine featured an article On Making Movies, highlighting insurane issues involved in the filmmaking industry. "The role of entertainment insurance is to determine the relevant risks of a project and create the necessary cushions and options to deal with whatever may come. Sometimes the crisis is large, such as that faced by A Simple Plan; other times it is one that requires minor alterations. An innovative and creative energy among all interested parties, from the director to the insurer, is vital to bringing audiences the kinds of movies so perfect in design, one cannot help but believe every minute."
Here at WCI, our focus has been on TV. We are still awaiting the debut of that wacky TV sitcom Workers' Comp. We haven't heard about it since the report of the April filming - presumably the show will air in the fall. We are a tad skeptical and we aren't the only ones:
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July 21, 2011

 

fan.jpgGiven the time of the year and the weather, you wouldn't blame our health wonks if there were all lazing around at the beach, but judging by this week's submission, they are all braving the heat and hard at work. And it is hot. It's sizzling outside and on fire in DC as the budget battle heats up and the debt ceiling deadline looms ever closer.

Our wonks are hot too. We kick off this week's edition with Health Wonk Review founder Joe Paduda jumping into the fray. In who passed Part D and why you should care posted at Managed Care Matters, Joe holds some feet to the fire for the deficit.

And before the budget cutting cuts too close to the bone, DC policy makers might consider posts from two of our wonks: At California Healthline, Dan Diamond reports on the recently released Oregon Health Study on Medicaid which some have called the "Most Important Study in Decades" and asks about its potential effect on health reform/health policy discussion. And in the first of a two-part series posted at The John A. Hartford Foundation blog's Health AGEnda, Chris Langston posts his concerns that in the current budget-cutting environment, we may be throwing out the baby with the bathwater with the recent focus on Medicare hospice costs.

While we're dealing with heated issues related to reform, next stop is Health Beat for a post in Maggie Mahar's series on myths surrounding medical malpractice. She deconstructs 7 "myths" which are used to support caps on malpractice awards and looks at the political underpinnings for the push for malpractice reform. She makes the case for meaningful reform under the Affordable Care Act that will achieve a balance of financial carrots and sticks designed to enhance patient safety.

The devil is in the details
As we move deeper into the implementation of the Affordable Care Act, many of our wonks have opinions on its progress. As would be expected on a complex initiative that continues to draw heat, not everyone would characterize the changes as progress.

To start, it can be helpful to look at the way the debate has been framed. Joseph White looks The Mixed (De)Merits Of 'Bending The Cost Curve' at Health Affairs Blog, tracing the development of the phrase. He argues the risks of this now ubiquitous metaphor outweigh its benefits - particularly in how it reflects the dominance of the debate by budgetary perspectives, favoring the interests that benefit from high costs now by devaluing approaches that would reduce costs more quickly.

And in another post at Health Affairs Blog, Tim Jost tackles the proposed regulations for Health Insurance Exchanges in the first of a three part-series of posts. Part 1 introduces the regulation and deals with the exchanges themselves; Upcoming posts will analyze the provisions of the regulations addressing qualified health plans (QHPs) and health insurance issuers (part 2) and the reinsurance, risk corridor and reinsurance regulations issued the same day (part 3).

At The Apothecary, Roy Avik offers a play-by-play replete with video clips of a recent congressional hearing on Independent Payment Advisory Boards (IPAB). Avik's take: "I thought that we had a fairly productive discussion about the ins and outs of Medicare's problems, and IPAB's role in addressing them."

At InsureBlog, Bob Vineyard looks at the numbers for the Pre-existing Condition Insurance Plan (PCIP) and finds them lacking.

Jaan Sidorov of The Disease Management Care Blog suggests that there is one question any hospital board should ask management about participating as an Accountable Care Organization (ACO), which are risk-bearing arrangements.

The Affordable Care Act contains requirements and deadlines for the implementation of electronic medical records, collectively known as Meaningful Use (MU). At Healthcare Talent Transformation, David Scher breaks down the truths and common fallacies associated with Meaningful Use of Electronic Medical Records: A Practical Overview.

Stateside
At John Goodman's Health Policy Blog, John takes a look at the difference that RomneyCare has made. He says that most conservative critics of Massachusetts health reform have focused on any piece of bad news about the program they can find. The thinking has been that if this is the model for the federal legislation everyone calls "ObamaCare" it's got to have a lot of defects, right? But he notes that "The real story coming out of Massachusetts is that the whole thing is a yawner."

Anthony Wright of Health Access Blog says that the real work of health reform is in setting up the Exchanges, and he reports on progress and milestones in the California Health Benefits Exchange.

At Colorado Health Insurance Insider, Louise Norris tell us that in Colorado, the rules are changing for employer funding of individual health insurance. The Division of Insurance's stance regarding the use of Health Reimbursement Account (HRA) funds has changed again, with rules appearing to to have has both relaxed and tightened.

Docs and dollars
Many of our wonks have been looking at the issue of how physicians get paid.

At Health Care Renewal, Roy Poses observes that having the former CEO of a health care corporation that paid more than $1 billion to settle fraud charges as Governor of Florida seems to have led to some interesting investigative reporting. In his post Would You Like Fries With That? - The Fast Food Model for the Corporate Physician he cites a story about the health care corporation with which Rick Scott was most recently associated as an example of what happens when the distinction between physicians and hamburger flippers is blurred.

Do physicians make more money when they treat more complex patients? Jason Shafrin, The Healthcare Economist, examines a recent study in Denmark to see whether this has proven true.

At Health Business Blog, David Williams helps us to understand the economics of health care credit cards for elective procedures: Why do doctors offer credit cards? It helps them avoid discounting

Over at the e-CareManagement blog Vince Kuraitis teams up with Jaan Sidorov to discuss the 100 year shift, in which they see the potential for "a tectonic realignment among physicians, hospitals and payers." In the first of a seven part series, they offer an overview of trends - noting that physicians' economic interests are increasingly aligning WITH payers and AWAY FROM hospitals. Will this result in doctors and payers eventually sitting on the same side of the negotiating table?

Consumer care
At The New Health Dialogue, director Shannon Brownlee makes the case that less is more when it comes to angiograms, the imaging test that precedes an angioplasty or stent. She discusses a report by Grace Lin and Rita Redberg, cardiologists at the University of California, on three focus groups with groups of cardiologists who talked about three hypothetical patients. If your cardiologist recommends you undergo an angiogram, this paper will likely give you a reason to question that recommendation closely.

At HealthNewsReview Blog, Gary Schwitzer has a pair of posts that raise questions about the proliferation of robotic surgery despite questions about evidence for benefits, harms - and costs. One talks about how Wisconsin hospitals with robots double prostate removals within 3 months and a second on the dearth of studies on the effectiveness of robotic surgery - a case of enthusiasm which has not been matched by comparative studies.

At Pizaazz Glenn Laffel makes the case that EMRs can help reduce racial disparities in health care. He discusses why and how Electronic Medical Records can help narrow the digital divide, and calls attention to some vendors who are offering tools to help providers enhance care for medically underserved communities.

At the Improving Population Health blog, David Kindig talks about environmental issues as a factor in public heath in the post Population Health and the Physical Environment: Beyond Air and Water.

Tinker Ready reports and interesting case study of ADA accessibility adaptations that go well beyond Braille and ramps in her post Universal design: The science of access at the Museum of Science at Nature Network Boston - a refreshing story of progress.

Occupational health
Here at Workers' Comp Insider, our focus is generally on the occupational health arena, and we recently looked at whether OSHA's Voluntary Protection Program (VPP) is broken. A recent study points out that several program participants have had multiple fatalities - should they retain their status that allows exemption from programmed OSHA inspections?

That concludes this issue of Health Wonk Review. Our next issue - and final issue of the summer season -- will be hosted at Joe Paduda's Managed Care Matters on August 4.

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July 20, 2011

 

Pop quiz: 1) In highway construction zones, do most fatalities occur A) to the vulnerable workers who are standing in the work zone while thousands of cars and trucks speed by, or B) to the motorists in the cars and trucks that are speeding by?

2) Are most highway construction workers killed by A) being struck by passing motorists or B) being struck by construction vehicles?

If you guessed "A" for both answers, you are correct.

Motorist safety in highway work zones
Highway construction projects pose hazards for drivers and workers alike, but about 85% of the vehicle-related fatalities that occur in work zones each year involve motorists. Lane changes,uneven surfaces, stop and go traffic, driver impatience at delays, unpredictable occurrences, and poor night visibility are all factors that make these zones hazardous. For those who need further incentive for caution than self preservation, bear in mind that 32 states and the District of Columbia double the fine for speeding (or committing other traffic violations) in a work zone. The Governors' Highway Safety Administration offers a handy state by state chart of work zone traffic laws.

One of the best safety strategies a driver can take is avoidance: seek an alternate route. The Department of Transportation offers national traffic and road closure information to help drivers plan in advance - or drivers can check with state transportation authorities - most offer alerts about major construction projects. For those who can't avoid a construction route, the Wisconsin DOT offers tips for safe driving in a work zone. The tip sheet notes that work zones requiring special caution encompass more than just highway construction projects. They include emergency vehicles at the side of the road, snowplows, garbage pickups, landscapers and any situation where workers are at risk.

Worker safety in highway work zones
This spring, the NIOSH Science Blog featured an excellent post by David E. Fosbroke about construction equipment visibility. In the post, Fosbroke cites a multi-year study of 844 fatalities at road construction sites. While 73% of these fatalities occurred when workers were struck by vehicles, victims were killed by construction equipment at least as often as by passing motorists. And of the incidents when workers were killed by construction equipment, at least 50% of those fatalities involved vehicles backing up.

To help prevent such fatalities, NIOSH offers downloadable blind area diagrams of of 38 pieces of construction equipment and 5 pieces of mining equipment. These diagrams map out the area around a vehicle or piece of equipment that cannot be seen from the operator's position. The post explains this and other issues related to highway construction safety - including some good observations in the comments section.

For additional information, The National Work Zone Safety Information Clearinghouse provides comprehensive information to improve motorist, worker and pedestrian safety in roadway work zones. Resource include links to related sites and training resources.

More safety resources:
NIOSH: Highway Work Zone
OSHA: Highway Work Zones and Signs, Signals, and Barricades

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July 18, 2011

 

Gary Veeder had the kind of job TV viewers love: for 31 years he was a scientist in the New York State Police Forensic Investigation Center. He specialized in trace evidence, examining fibers, arson residue, footwear impressions, glass, hair and other evidence gathered in criminal investigations. His findings carried significant weight in criminal trials. People went to jail based upon his evidence. Alas, a state investigation found significant problems in 29 percent of Veeder's 322 cases. That's a lot of problems - and a lot of jail time - for people who may or may not have committed crimes.

As the investigation into his work unfolded, Veeder first retired and then committed suicide by hanging himself in his garage. Given that the stress leading to the suicide was predominantly caused by work, his widow filed for workers comp benefits. The claim was denied, on the basis that the stress was the result of personnel actions, which are excluded from comp eligibility.

The case wended its way to the Appelate Division of the NY Supreme Court, where the decision to deny benefits was reversed and the case sent back to the workers comp board for reconsideration.

Nothing Personnel
The reversal was based upon a simple, rather stark conclusion: at the time of Veeder's suicide, no personnel actions had been implemented. The state was investigating the situation; they had uncovered problems in Veeder's work, but they were on a narrowly defined "fact finding" mission. No action had been taken against Veeder: he was not suspended or demoted or disciplined in any manner. Thus the stress was purely the result of the investigation, not of any personnel action.

In other words, had the employer simply announced to Veeder that the investigation was the initial phase of a disciplinary process, he would probably not have been eligible for workers comp. The only facts that count: he was under enormous work-related stress (of his own making) and he killed himself as a direct result of the work-related situation. And because comp is no fault, it appears that Veeder's widow will be eligible for burial and indemnity benefits.

Is this fair? Is this just? Maybe yes, maybe no, but these questions themselves are not relevant in the determination of compensability. The claim may still be denied, but some other basis of denial must be found.

Hard Time
Veeder did his job poorly, but he was never held accountable by his superiors. A case can be made that Veeder's widow is an innocent party, that she is entitled to benefits for her husband's "work-related" death - despite the fact that virtually all of the stress was of Veeder's own doing. Meanwhile, quite a few people convicted on corrupted evidence are serving hard time. Some were probably guilty, others completely innocent. But in cases where the lynchpin of conviction was Veeder's incompetent work, all deserve to go free. This is unlikely to happen. Is this fair? Is this just? Nothing "maybe" about it. Justice - to this point, at least - has certainly not been served.

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July 14, 2011

 

Risk roundup - This week's edition of Cavalcade of Risk - edition #135 - is being hosted by The Notwithstanding Blog. In that several countries celebrate their independence in the month of July, our host has a suitably related theme that may test the breadth of your geographic trivia. Oh, and there are some good posts this week, too!

bi-conference.JPGMark September 22 on your calendar now - Better yet, head on over to Business Insurance and register for Virtual Advantage 2011 - Workers Comp Trends & Cost Control Strategies. We're very pleased that our own Tom Lynch will be participating on a blogger panel with three other blog luminaries: Roberto Ceniceros, Joe Paduda, and Mark Walls. There will also be a keynote by NCCI's Harry Shuford, an expert panel on pharmaceutical cost controls for worker's comp - and more. It's a one-day virtual conference - and best of all - there is no charge to attend.

Presumption - And speaking of Mark Walls, congrats to him on his first column in Risk & Insurance. If you don't know Mark by name, suffice it to say he is the powerhouse behind LinkedIn's popular Work Comp Analysis Group. In Not all claims are created equal he talks about the thorny issue of presumption and how presumption laws fiddle with a basic tenet of the workers compensation pact: that the burden to prove an injury or illness "arose out of employment" falls to the employee.

Self Insurance - If the workers comp market continues to harden, as many are predicting, many employers might be looking to alternatives to the traditional insurance options. In Risk Management Magazine, Richard C. Frese, a consulting actuary from Milliman, tackles the topic in his article Does Your Self-Insured Program Need a Tune-Up?. It's a good overview of what you need to know if you are considering the move.

Employment law - Attorney Phillip Miles posts a handy SCOTUS Employment Law Year in Review 2011 - a summary of cases with links for more information.

New blog discovery - check out Texas Mutual's Blog. We particularly liked the recent post on The ABCs of new employee safety. This is an important issue - in their own claim analysis, they found that roughly 27% of job-related fatalities involve employees who have been on a new job for less than 90 days. They also cite the OSHA stat that 40% of all injured employees have been on the job for less than a year. They also note that "new employee" may not just be a new hire: "New employees include people who transfer to a new position, return to work after an extended absence, operate a new piece of equipment or implement a new procedure." Check out the post for tips on this topic.

Wow of the week - a little off topic, but check out this amazing video of the massive haboob (dust storm) that hit Phoenix on July 5.

Briefs

* Opioids, deaths, and workers comp

* LAPD prescription drug abuse tied to disabilities

* Consumer Reports: Can you read this drug label?

* The 10 worst states for P&C insurers

* Safety tip sheet: Livestock handling

* Safety on the loading dock

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July 12, 2011

 

Dr. Jean Zannoni, 77, runs a family practice in Parma, Ohio. It would be a mistake to assume that by specializing in families, she is not interested in treating injured workers. She treats them all right - to pill after pill after pill. She was recently sentenced to two years probation and ordered to pay more than $7,500 in fines and restitution after pleading guilty to theft, attempted workers' compensation fraud and telecommunications fraud.

According to authorities, two Ohio Bureau of Workers Compensation (BWC) undercover agents were provided narcotic medications without proper medical examinations and BWC was billed improperly for the office visit.

Dr. Zannoni instructed her staff (in writing!) to bill all injured workers under the same code and charge BWC $75, regardless of the circumstances of the visit. She also manipulated "pain" ratings to ensure that patients qualified for narcotics. And she continued to prescribe narcotics to patients who were known doctor shoppers, even after receiving warnings from pharmacies, parents, spouses, social service agencies and police departments. Some family, some practice.

A Microcosm
In the scheme of things, Dr. Zannoni is a bit player. But when you try to figure out how narcotics became such a major cost driver in workers comp, you have to take into account doctors like Zannoni, who parlay a little pain into big profits.

Given the scale of her crimes - she overbilled WBC by $65,000 - the penalties in this case (small fine plus probation) seem a bit modest. On the other hand, the (Feel)Good doctor, at 77, is probably nearing the end of her practice, which may well have played into the decision to let her off relatively lightly.

Ironically, if you Google her name, Zannoni's patient ratings are uniformly high (pun intended). One anonymous patient even commented on an article describing her conviction as follows:

This is one of the sweetest most nieve (sic) people on ths planet. I know her personally and she has no idea what goes on. All she knows is how to do is practice medicine and nothing about finances at all. God bless her and I hope everything works out for her sake.

We'll let that stand as written. And one thing is certain: those seeking pills in Parma may not be able to count on Dr. Zannoni any longer, but surely they will find other sources to make their pain go away, to get a little buzzed, and, who knows, make a little money on the side.

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July 11, 2011

 

OSHA's Voluntary Protection Program was implemented some 30 years ago and includes about 2,500 workplaces. Employers must qualify for participation by meeting certain criteria, including a demonstrated safety record that is better the than industry average and practices such as training and employee involvement that would indicate a serious safety culture. Companies that are accepted into the program become exempt from programmed OSHA inspections while they retain their VPP status -- a not insubstantial benefit that makes the program popular with employers and small government advocates alike. So popular that some legislators are trying to make the VPP permanent.

But many question the effectiveness of the program beyond its popularity. And now, some investigators are asking what a company would have to do to lose the VPP status. If a company experienced a preventable workplace fatality, would they be ejected from the program? Would they be subject to a higher level of scrutiny?

Apparently not. A recent investigative report by the Center for Public Integrity (CPI) revealed that at least 80 workers have died at VPP employers since 2001 yet have retained their "model workplace" status in VPP. Yet in 47 of these cases, inspectors found serious safety violations and, sometimes, tragedies that could have been averted.

Last week CPI and PBS's Need to Know ran the first report of their investigative series on OSHA's Voluntary Protection Program (VPP), Model Workplaces, Imperiled Lives. In addition to the number of deaths at VPP participants, the investigation found that:

  • Even when workers die and inspectors find safety violations, "model workplaces" often face minimal consequences and retain the special designation. At least 65 percent of workplaces where a fatal accident occurred remain in the special "Voluntary Protection Program" today.
  • As the program tripled in size over the last decade, OSHA cut the number of staffers overseeing it and weakened requirements for membership, raising questions about how well the program supplements the efforts of inspectors in safeguarding American workers.
  • Little widespread evidence exists that the 29-year-old program works. Despite calls by the Government Accountability Office and others for OSHA to complete a comprehensive evaluation of the program's effectiveness, none has occurred.

PBS featured this report on The Watch list: Safety matters: Injuries and fatalities at 'model' workplaces, which included this video.

This is not the first we've heard of the flaws in the VPP. In The Pump Handle's post entitled Investigators probe integrity of OSHA's safety recognition program, they link to a May 2009 GAO Report on OSHA's VPPs, which was extremely critical of OSHA's VPP program, noting that:

  • OSHA's internal controls are not sufficient to ensure that only qualified worksites participate in the VPP. First, OSHA's oversight is limited by the minimal documentation requirements of the program. Second, OSHA does not ensure that its regional offices consistently comply with its policies for the VPP.
  • OSHA's lack of a policy requiring documentation in the VPP files of actions taken by the regions in response to incidents, such as fatalities and serious injuries, at VPP sites limits the national office's ability to ensure that regions have taken the required actions. OSHA's VPP Manual requires regions to review sites' safety and health systems after such incidents to determine whether systemic changes are needed to prevent similar incidents from occurring in the future and whether the site should remain in the program.
  • OSHA's oversight of the VPP is limited because it does not have internal controls, such as management reviews by the national office, to ensure that its regions consistently comply with VPP policies for verifying sites' injury and illness rates and conducting on-site reviews.
  • OSHA's efforts to assess the performance of the VPP and evaluate its effectiveness are not adequate. First, OSHA has not developed performance goals or measures to assess the performance of the program. Second, OSHA contracted for a study of the VPP to evaluate its effectiveness, but the study was flawed.

Shortly after this GAO report, OSHA pledged to reform the VPP.

There's certainly a place for a "Centers of Excellence" program for workplace safety. Companies that have made extraordinary efforts to ensure safety should be recognized. But it looks like a program that began with good intent has morphed into something that is poorly managed at best and a mockery of the original intent at worst. How much of a distinction is it for the truly high performing organizations if weak or inappropriate entities are kept in the program? Before any expansion of this program occurs, Congress would do well to ensure that the program that exists gets fixed.

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July 6, 2011

 

All other things being equal, if you had a choice of paying $300 or $1800 for an abdominal CT scan just by going to a clinic or a doctor in a nearby town, would you? It seems like a trick question or a no brainer, but the reality is people are paying the higher cost every day... just because the transparency in health care costs just isn't there. And this lack of transparency gives rise to a situation where patients can pay as much as 683% more for the exact same medical procedure in the same town.

More and more people will begin to notice the cost differentials as the trend for consumers bearing increased responsibility for healthcare costs continues. Whether through insurance arrangements such as high deductible plans or through assuming a higher proportion of co-pays and other out-of-pocket costs in more traditional plans, more consumers have a direct stake in the cost of healthcare. Yet the average person with a healthcare insurance policy is in the dark about the costs for various procedures and treatments. First, many consumers have been insulated from the cost of anything beyond the price of the insurance policy itself. The unit cost of services and procedures has largely been a matter between the insurer the provider. Secondly, medical care is a highly complex service with little in the way of tools available for comparison shopping. It's complex enough that even the treating physicians themselves are often in the dark about costs about specific procedures, tests, or medications.

Change:healthcare, a national organization that is trying to establish more transparency in the cost of healthcare, recently released a cost comparison report for several common medical procedures such as MRIs, CT scans, ultrasounds and PET scans. The Q2 2011 Healthcare Transparency Index reports on what they learned about cost variations by examining claims data over the course of a year for 82,000 employees of small businesses. While it's been widely understood and acknowledged that price might vary greatly depending on what part of the country you are in, this study shows that the price can also vary greatly depending on which side of the street you are on: inter-regional costs fluctuate widely, too.

This wild divergence in pricing is probably less of a surprise to employers, many of whom who have been keeping a close and wary eye on skyrocketing workers' compensation medical costs. There are no co-pays or cost sharing mechanisms on the workers comp side of the house - the employer underwrites 100% of the associated costs of a compensable injury or illness. Many enlightened employers have been tackling costs on the macro level (outcomes) as well as on the micro level (unit costs) by seeking high-performing physician networks. But even with the buying power and the resources that a large employer can bring to bear, it can still be difficult to get it right when it comes to managing workers' compensation medical costs.

Whether in work comp coverage or in general health care, many employers have also recognized the role that the individual employee plays in helping to control costs and stem losses - through behaviors both on the job (safety compliance) and off the job (general wellness and healthy behaviors). Wellness and EAP benefits are widespread as a result. In a similar vein with a potential for a win-win outcome, employers should take every opportunity to help employees to become more savvy consumers of health care services.

Here are some consumer healthcare education tools / resources that might be useful in your wellness program:


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July 5, 2011

 

Work can be a killer when workers are asked to do too much: intense labor in the heat of summer, the stress of heavy repetitive lifting, moving too quickly among common workplace hazards. But can work kill us from doing too little? Can work-required inactivity lead to a compensable claim?

For twenty five years, Cathleen Renner worked as a manager for AT&T. With a heavy workload, she often brought work home and labored at her computer late into the night. In September 2007, facing a tight deadline, she appeared to pull an all-nighter; she sent an email to a colleague around midnight and was seen at her desk at 7 in the morning, at which time she complained about a pain in her leg. She labored on through the morning. Around 11 am, she had trouble breathing. By the time she reached the hospital, she was dead from a pulmonary embolism (which began with that pain in her leg).

The New Jersey workers compensation had to determined if work was the predominant cause of the death.

Risks in Doing Nothing
Back in May of 2006, we blogged the dangers of inactivity. If people sit still for a long time - for example, during air travel - they are at risk for deep vein thrombosis. It appears that Cathleen's prolonged and unrelieved sitting at her computer caused just such an incident. According to a medical expert, she experienced an "unorganized" blood clot which developed while she was sitting (as opposed to an organized clot, which takes much longer to form). Despite her other risk factors - obesity and the use of birth control pills - the court determined that her death was work related.

The defense argued that Cathleen lived a relatively sedentary life - that her sitting at the computer was no different than her sitting at other times. But her husband countered with the observation that they had school-aged children. Cathleen was always running around, taking the kids to school and appointments, cooking meals, cleaning the house and doing the myriad tasks that virtually all mothers must perform. That's a pretty compelling argument and it convinced the judges: the Superior Court determined that the prolonged sitting while performing work-related tasks caused her death.

Get Out of that Chair!
Savvy employers will note the risks of prolonged sitting and encourage - require! - employees to get up at least once an hour to move around and stretch. (Policies should cover workers in their home offices, too.) Moving around not only prevents blood clots, it also prevents injuries to the spine. Humans are not meant to sit in one place indefinitely. We are built to move and move we must.

With that being stated, I'm going to stand up and stretch a bit. Unless you are reading this on a treadmill, I recommend that you do the same.


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