March 2012 Archives

March 30, 2012

 

March 27, 2012

 

Here's a quick summary. In a 50 state overview, there were no "A" students.

The State Integrity Investigation is a $1.5 million public collaborative project designed to expose practices that undermine trust in state capitols -- and spotlight the states that are doing things right. It describes itself as "an unprecedented, data-driven analysis of each state's laws and practices that deter corruption and promote accountability and openness. Experienced journalists graded each state government on its corruption risk using 330 specific measures. The Investigation ranked every state from one to 50. Each state received a report card with letter grades in 14 categories, including campaign finance, ethics laws, lobbying regulations, and management of state pension funds."

Click on the U.S. map to see your state's corruption risk report card. No states scored an "A." New Jersey, Connecticut, Washington, California, and Nebraska scored in the "B" range. Eight states flunked, scoring 60% or less: Michigan, North Dakota, South Carolina, Maine, Virginia, Wyoming, South Dakota, and Georgia. All the remaining states were "C" and "D" students, with our home state of Massachusetts scoring a lackluster 74%, coming in at 10th "best" overall.

How did the insurance departments score?
As citizens, both corporate and private, we find the whole report fairly intriguing, but for the purposes of this blog, we were particularly interested in the ratings for State Insurance Commissions. PropertyCasualty360's Mark Ruquet did a good analysis of this in his article 16 State Insurance Commissions Fail Integrity Evaluation.

The state Insurance Commissions were evaluated on these questions:

  • Is the state insurance commission protected from political and special interest influence?
  • Does the state insurance commission have sufficient capacity to carry out its mandate?
  • Are there conflicts of interest regulations covering members of the board and senior staff of the state insurance commission?
  • Are the conflicts of interest regulations covering members of the board and senior staff of the state insurance commission effective?
  • Can citizens access the asset disclosure records of the state insurance commission?
  • Does the state insurance commission publicly disclose documents filed by insurance companies?

One of the things we like about the map and the site is that you can keep drilling down. Click your state, then click a specific category - such as "State Insurance Commissions," "Ethics Enforcement Agencies" or "Public Access to Information" and then click again to see the specific areas that were evaluated. Click any one of those criteria to see how the score was derived, and click again for further detail. You can also read or submit comments. On each individual state page, there is also a narrative story behind the score and a running list of related news articles.

We'll be spending some time exploring the site further, but our first reaction is positive and we applaud the effort: we love sunlight when it comes to the public good and think it benefits everyone. We'd love to hear reactions about how accurate or inaccurate readers think reports are relative to their own state scores.


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March 21, 2012

 

Healthcare Economist Jason Shafrin is this week's riskmeister - he hosts Cavalcade of Risk #153, the March Madness Edition. He has filtered this to a nice trim edition of what he calls the "elite 8." We're pleased that he thought our post made the grade!

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March 21, 2012

 

The Insider does not normally think of state workers comp insurance funds as hubs of criminal activity, but then again, we haven't been to Scranton lately. James McDonnell, 53, is a supervisor in the State Workers' Insurance Fund (SWIF). He makes about $51,000 a year - at least, that's his declared income. He has apparently been pulling in a whole lot more than that. He was arrested this week for running a kickback scheme involving premium discounts for Pennsylvania employers. In exchange for (undocumented) discounts in premiums owed, McDonnell secured cash kickbacks of one third to one half the discount. Between 1999 and 2011, McDonnell and his wife pulled in at least $80,000.

WorkCompCentral (subscription required) offers additional background on this case, including PDFs of the criminal indictment. McDonnell offered premium discounts to individual employers, in one case, a roofer, whose premiums, instead of going up $50K, came down $10K. He then insisted that the roofer join one of the three staffing firms with whom he did business. In exchange for steering clients their way, these firms paid McDonnell a relatively modest 1% commission, in addition to paying him substantial cash kickbacks on the premium discounts. In honor of family values, McDonnell's wife was given several jobs which apparently did not require that she perform any work.

Kickbacks and Harassment
McDonnell must have been a busy man, systematically exploiting his position with SWIF, but he allegedly found time to harass a fellow fund employee. Last September he was accused of "making sexual advances on the employee, identified only as Jane Doe, such as asking her to lick a piece of Twizzlers candy taken from her work desk before he ate it and telling her to bend over and pick up a time sheet he dropped to the ground." Would you be shocked to learn that the fund did not take these accusations seriously?

There may well be slow days at a typical state fund, but McDonnell sure knew how to make time fly. That skill will come in handy when and if he finds himself doing time in a bureaucracy of a different sort altogether.

Comp fraud takes many forms and encompasses opportunities for each and every stakeholder in the system: doctors, lawyers, insurers, state bureaucrats, business people, workers and, I suppose, even consultants. Today's little saga of greed arises from the midst of a state bureaucracy. But no matter where the crime originates, the result is the same: higher costs for the vast majority of people who play by the rules.

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March 20, 2012

 

Today, we slip back in time to 1925 and put on our Flash Gordon glasses to speculate about the future, a time when a doctor not only "sees what is going on in the patient's room by means of a television screen" but also employs a robotic-like instrument called the Teledactyl (Tele, far; Dactyl, finger -- from the Greek) to "feel at a distance."

1925-feb-science-and-invention-sm-cover

This image and the story comes from a delightful Smithsonian blog called Paleofuture in a post entitled Telemedicine Predicted in 1925. The post discusses an article by Hugo Gernsback that appeared in the February, 1925 issue of Science and Invention. You can read more about the intriguing robotoic Teledactyl device and Gernsback's predictions for medicine of the future.

Fast forward to 2010, and we see how remarkably prescient Mr. Gernsback's predictions were. Courtesy of a blog comment by Christoph Hadnagy, we find this link to a New York Times story on Denmark Leads the Way in Digital Care, in which 77-year old patient Jens Danstrup talks about what it's like to be a telemedicine patient:

"You see how easy it is for me?" Mr. Danstrup said, sitting at his desk while video chatting with his nurse at Frederiksberg University Hospital, a mile away. "Instead of wasting the day at the hospital?"
He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless -- his doctors enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.
All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago.

Adoption of Electronic Health Records in the US
The Centers for Disease Control issues an annual survey on the use of electronic health records in physician's offices. Last year, partly bolstered by meaningful use incentives in the Affordable Care Act, use grew by 6%. Dr. Elliot King blogs on the EHR increase, noting that:

"In 2011, 57 percent of office-based doctors used electronic medical records/electronic health records (EMR/EHR), according to the CDC. That number compares to the 50.7 percent of physicians' offices using EMR/EHR's in 2010 and 48.3 percent in 2009."

Some physicians are also taking to telemedicine via Skype, FaceTime and other video conferencing services. In Doctors who Skype: Renegades or Heroes?, Jean Riggle looks at the pros and cons of video chat as used by physicians. She notes that there currently aren't any guidelines for electronic communication between physicians and patients and there there are several important questions yet to be solved:

  • How can these chats be integrated into the patient's medical record?
  • Can the actual video be captured and inserted into the record or should a summary of the call suffice?
  • How should physicians be reimbursed for the time they spend using social media?

To follow developments in telemedicine, we offer a few sources:
HealthIT.hhs.gov
Federal Health IT programs
American Telemedicine Association
iHelathBeat
Healthcare IT News

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March 15, 2012

 

Guinness is good for you - That's the news from Tinker Ready, who is hosting the Health Wonk Review: Wearing the Green for the St. Patrick's Day Edition at her blog Boston Health News. We think it's pretty fitting to have a Boston blog hosting this particular edition!

From the bizarre file - Thomas A. Robinson ofRisk Management Magazine offers a list of the 10 most bizarre workers compensation cases during 2011. Robinson rightly notes that, "Despite their unusual nature, however, one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families." So true. We hope he'll follow with a collection of the 10 most bizarre employer acts - we've seen a few in our day.

OSHA whistleblowers - Just a reminder: Don't fire someone for reporting safety hazard. A Florida charter school is learning this lesson the hard way. OSHA is suing Manatee School for the Arts in Palmetto, Fla seeking reinstatement of the former employee with full benefits; payment of back wages, punitive damages, and compensatory damages, among other things.

New York's Reg. 194 - There's a big brouhaha in New York over N.Y. Reg. 194, with risk manager groups and agent groups coming down on opposite sides of the fence. N.Y. Reg, 194 is a broker-disclosure rule that requires agents to advise clients that they receive commissions from insurers. The ruling was proposed by the Division of Insurance in the aftermath of the Spitzer investigations against several large brokerage firms. Last week, a NY Appellate Court upheld the rule.

Exploding pig farms - We posted a link to this issue before - but the mysterious hog farm explosions continue to stump scientists. A strange, potentially explosive foam is surfacing near manure pits in about 1 ou tof every 4 hog farms, and has caused six explosions since 2009. According to the article: "This has all started in the last four or five years here. We don't have any idea where it came from or how it got started," said agricultural engineer Charles Clanton of the University of Minnesota. "Whatever has happened is new." The National Hog Farmer has more background: Foaming swine manure poses explosive risks.

Wellness focus - Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, and the number one cancer killer in non-smokers. Why not issue a reminder to your employees: Colorectal cancer screening saves lives.

Market conditions - Roberto Ceniceros notes that captives are thriving as the work comp market hardens. Rising prices for traditional insurance vehicles always means that alternative insurance programs see growth.

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March 13, 2012

 

Female nurses who have occupational exposure to sterilizing agents and chemotherapy drugs are at least twice as likely to have miscarriages as those who do not have such exposure. Elizabeth Grossman of The Pump Handle offers a summary of a recent study on chemical exposures and nurses' reproductive health, which was conducted by the National Institute of Occupational Safety and Health, Harvard School of Public Health, and Brigham and Women's Hospital. The study encompassed more than 7,000 female nurses.

Grossman notes:

Similar effects have been reported before, but this is one of the largest studies ever to look at these exposures, explained Christina Lawson, a reproductive epidemiologist with NIOSH and study author. Because these results reflect adjustment for a number of variables -- including age, hours worked, and shift-work -- and because the study was designed to avoid overestimation, its findings may be conservative, said Lawson.

While further studies are needed to determine the exact chemical exposures, high on the suspect list are a variety of chemicals used to disinfect medical equipment and surgical instruments, such as formaldehyde and ethylene oxide. In her post, Grossman also talks about the dangers of formaldehyde exposure to beauty salon workers, an issue that was a recent NIOSH Science blog focus: Hair, Formaldehyde, and Industrial Hygiene. Both the Food & Drug Administration and OSHA have issued particular warnings about the Brazilian Blowout, a highly popular hair straightening treatment.

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March 12, 2012

 

Here is a truly bizarre case from Illinois that will likely send our many attorney readers scrambling for their statute books.

Christopher Washkowiak worked as a pipefitter. He suffered a serious work-related injury in 2009. The following year, his marriage broke up (dissolved as of August) and he settled his workers comp case in December. The settlement totalled $365K, plus a Medicare Set Aside (MSA) for an additional $70K. Washkowiak's wife, Rosana, was entitled to 17.5% of the marital assets. She claimed not just 17.5% of the $365K lump sum settlement, but the same percentage of the MSA.

The initial trial court and the Illinois Appellate Court, 3rd District, ruled that Rosana was entitled to the money. Here is the Appeals Court ruling:

Unless there is something about an MSA that removes the MSA funds from the definition of "net proceeds," the funds fall squarely within the dissolution decrees's definition of "net proceeds" (paragraph 10).

The court goes on to say that "there is no question that the money is his [Christopher"s] and further that "it is not Medicare's or [the employer's] money" (paragraph 15).

Finally, the ruling goes on to state that "if he incurs no such [medical] bills, he gets the money back" (paragraph 17).

It is worth noting that Rosana apparently does not have to wait to see if the funds are needed for future medical expenses. The court has foreshortened this process to the point where she gets the money now, as part of the divorce settlement.

Attention All Attorneys!
There are a number of parties who will be alarmed by this ruling:
The Federal Government: Medicare will surely object to the expenditure of MSA funds for non-medical purposes, diluting what is available for future expenses (and thereby defeating the purpose of the MSA).
Insurers and self-insureds: will be shocked to see funds set aside for future medical expenses being used for other purposes; this will inevitably lead to further inflation of future MSAs. (Indeed, Medicare might hesitate to sign off on any settlement prior to determining the relative strength of the marriage - and we all know how much stress disability puts on a marriage...Yikes!)

What if this divorce entailed the conventional 50/50 division of assets? Half the money in the MSA could be spent before the account even got started.

I have never heard MSAs referred to as claimant assets. In my limited understanding, the amount awarded to the claimant is separate and distinct from the MSA. Funds in an MSA can be used only to pay medical bills. In addition, I have never heard of a situation where unspent MSA funds reverted directly to claimants; they would likely revert to the insurer or the self-insured, whoever set aside the money. (If any of our attorney readers have any knowledge to the contrary, please let us know!)

MSAs carry a lot of baggage already: the MSA process slows down settlements while stakeholders wait for federal bureaucrats to check the numbers; MSAs seriously inflate the current cost of settlements, complicating an already complicated process. If this ruling in Illinois is upheld, if MSAs are truly marital assets, then, as the saying goes, "we ain't seen nothing yet."

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March 8, 2012

 

Risk Roundup - Emily Holbrook hosts Cavalcade of Risk #152 at Risk Management Monitor

Florida's pill war - Timothy Martin and Arian-Campo Flores of the Wall St Journal take in the Florida landscape after the pill mill crackdown in New Front Opens in the Florida Pill War. They note that, "One former hot spot in Broward's Oakland Park now has just two pain clinics, compared with 26 a few years ago, said Lt. Pisanti. "It changed almost overnight," he said."
However, the addicts haven't gone away. The authors note that, " ... drug users and dealers adapt to the changing landscape and pill demand shifts to retail pharmacies and other establishments that appear to have been set up to skirt the new restrictions." The article talks about the pressure pharmacists are facing and an increase in forged prescriptions.

Pill pushing docs, take note - My colleague recently posted about the prosecution of Ohio's Dr. Paul Volkman, the single most prolific prescriber of Oxycodone and related opioids in the entire country. (Four life sentences) Individual states and the feds are starting to get tough about cracking down on this stuff. Joe Paduda talks about the prosecution of drug-dealing docs in CA, FL, CO and other states. Also see Roberto Ceniceros' blog post on the race to stop opioid abuse.

"Odd Lot" Doctrine - Dave DePaolo talks about the psychology of disability and the inter-relatedness of disability and mental health as illustrated by a case of a injured Wyoming worker. After his claim wended its way through the courts, the worker was granted permanent total disability benefits under the "odd lot" doctrine.

Is obesity getting a bum rap? - Maggie Mahar challenges assumptions about obesity in her post Obesity: Fact vs. Fiction at Reforming Health blog. As with everything Maggie writes, it's worth a read!

ADA and Veterans - The Equal Employment Opportunity Commission recently released a new Guide for Employers on Veterans and the Americans with Disabilities Act (ADA). EEOC says that, "The revised guides ... make it easier for veterans with a wide range of impairments - including those that are often not well understood -- such as traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD), to get needed reasonable accommodations that will enable them to work successfully." Related:
Guide for Wounded Veterans, which answers questions disabled vets may have about the protections and rights when returning to their former job or looking for civilian jobs.

Market Pulse - Clair Wilkinson of Terms + Conditions posts about more evidence of a slowly turning market citing new reports and studies.

Quick takes

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March 5, 2012

 

According to a recent NCCI Report on Violence (summary) (Full Report, PDF), "the majority of workplace assaults are committed by healthcare patients." While there is good news in the fact that workplace homicides and assaults are on the decline, the NCCI report says this:

"The decline in the rate of workplace assaults has lagged the steady decline in the rate for all lost work-time injuries and illnesses. This reflects a notable change in the composition of the US workforce and, in particular, the ongoing increase in the share of healthcare workers, who experience remarkably high rates of injuries due to assaults by patients. This is especially common in nursing homes and other long-term care facilities. In fact, 61% of all workplace assaults are committed by healthcare patients. For assaults, coworkers make up just 7%, and someone other than a healthcare patient or coworker comprises 23%. The remainder is unspecified."

In a post last year on healthcare workers and on-the-job violence, we talked about some of the perpetrators:

"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."

In the list above, we overlooked a huge and growing segment: elderly patients, patients with Alzheimer's, and people suffering from mental illness.

Prevention Tools
OSHA: Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. See also the slide show overview version

The Emergency Nurses' Association has issued a good Workplace Violence Toolkit.

We also found that WorkSafeBC has put together a series of excellent short video clips for various health care settings.

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March 1, 2012

 

Our colleague Joe Paduda has posted the latest and greatest edition of Health Wonk Review at Managed Care Matters, and it's a good one. If you haven't checked it out lately, you should - there are some really high quality participants and regulars - including a few newcomers like Wing of Zock, a blog with a name that makes us feel like our blog name is pretty pedestrian.

Joe featured a link to our post about the criminal probe related to the Upper Big Branch Mine Disaster and he added an editorial update via link to a new story posted today: UBB disaster: Ex-mine security chief gets 3 years in prison.

You can see more on this conviction and the judge's reasoning about sentencing over at our go-to blog on all mining-related matters - Ken Ward's Coal Tattoo.

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