WCRI 2017 Conference – Complete First Day Live Blog
Morning Sessions of WCRI 2017 Conference – Please excuse any typos, etc. This is a live conference blogging. It will be updated every 10 minutes.
Dr. John Ruser – CEO
- Launching new website next week.
- New Logo
- Grand Bargain
- Research the focal point
- Opioid epidemic
- Some data is preliminary – do not share
Impact of 2016 Elections on Healthcare and Workers Compensation
Dr. John Ruser – Moderator
The Honorable Henry Waxman – Former Member US House of Representative
- All three branches have to get along better
- President Trump has not reached out to the Democrats
- Dr. Tom Coburn and he are good friends
- Affordable Health Care Act -repeal and replace
- Now Republicans have majority much like Dems the first two years of President Obama’s term
Features of ACA
- More complicated than even President Trump anticipated
- President Trump may not be able to create a complete new market
- Mandate created
- Most people want to be insured – need to have a third party in the purchase
- Competition between insurers
- Mandate is to make sure that the healthy people also participate
- Catastrophic care and Healthcare Account (HSA)
- To make the system work insurers have to stay in the system
- Medicare Part D – was not that helpful
- Republicans wanted to shift money from poor to tax cuts
Workers Compensation Case Shifting
- Yes, there will be case shifting to Workers Compensation
- Deduction on tax returns is a very delayed benefit
- Medicaid covered a large number of ACA applicants
- Setting a limit on what states will get will make a skimpier Medicaid program
- Naturally will shift cases to Workers Comp if Medicaid is not there
- Medicare has been successful
- If people do not have insurance – going to other programs
Does not object to tax cuts – but have to borrow money from the future to fund tax cuts, never paid for the wars
The Honorable Dr. Tom Coburn – Former Senator from Oklahoma
- President Trump Executive Orders – Congress ceded much power
- Limited action by Federal Government
- 17th Amendment not good
Features of ACA
- Amish families buy healthcare at lower due to their own healthcare market they created
- Oklahoma City hospital – provides healthcare to indigents
- Disagree with Senator Waxman – have to create a marketplace
- $1,200 deductibles
- MRI at 10 PM for $100 in Tulsa
- Medicaid system does not provide quality – outcomes better if you self-pay
- Could fix ACA system -but Republicans/Democrats are too polarized
- Bill Hatch -Upton Bill in place to completely replace ACA – go look at the bill as it will likely be the new law
- $120 billion deficit on Medicare
Federal Government is out of control. Congress wants to look good not do a great thing for the US.
Workers Compensation Case Shifting – WCRI 2017 Conference
- Medicaid is working in Oklahoma
- Deductibles shot up under ACA
- Freedom always beats governmental control
- Rhode Island Medicaid system works
- Medicine is getting ready to change – precision care
- Workers Compensation will benefit from this care
- Most cancers will be cured in 15 years
- $105 trillion unfunded liabilities
- $1,700,000 per millennial over their lifetime
- Medicaid is not the answer – does not guarantee good care
- Medicare Part D not that great
Letter to DOL on Federal Oversight of Workers Comp -WCRI 2017 Conference
Senator Waxman – should be some type of oversight for minimum standards – not a big issue right now
Senator Coburn – let states handle it – not a big issue right now
Senator Coburn – If you are not taking care of a person’s injuries – 27,000,000 on SSDI – system bankrupt – 2004 most people were just approved for SSDI as the department was so far behind they were just approved – Opiates are a big problem
Senator Waxman- SSDI should not be a replacement for Workers Comp, 80% of people had insurance that were on SSDI, SSDI should not be a replacement for other insurance systems including Workers Comp
QUESTIONS
Senator Coburn
- Healthcare transparency – publish price and outcomes, no transparency, insurance companies have contract with hospital to not disclose prices,
- Healthcare is not an individual right but should be provided to all, great book on American Compassion – how people were personally responsible for the first 175 years
- North Carolina Medicaid program- holistic care but still requires responsibility, Oklahoma Opt Out will need to be looked at again
- SSDI is safety net for Workers Comp denials
- SSDI should not be a substitute
- $600 – $800 billion wasted in healthcare, eliminating waste would pay for everyone’s healthcare, price vs. quality
- ICD10 was a huge cost $12 billion with no benefit to healthcare
Senator Waxman –
- Healthcare is basic human right, single payer system, personal responsibility, social responsibility is part of being compassionate people,
- Repealing ACA would reduce public health, more money into prevention if there are cuts and increase to military spending
- Very worried about what is/may be coming out of Congress, whole healthcare system may be in dire trouble and headed in wrong direction
WORKER OUTCOMES AND RETURN TO WORK
Dr. Bogdan Savych, WCRI
Dr. Glenn Pransky, Liberty Mutual Research Institute for Safety
This is very similar to Six Secrets to Cutting Workers Comp costs – See Return To Work and Employee Treatment
I had performed studies on public entity files
- MA
- KY
- GA (18%) did not have successful Return To Work
Largest Predictor in Successful Return to Work was Trust In Workplace
22% of workers that did not Return To Work did not trust workplace
- firm shrinking
- poor relationship
- pessimist by nature
22% of unsuccessful return to work had attorney
Need to focus on worker – employer communication <<<<very important
People felt very positive about positive and early communications
Characteristics of return to work coordinators – most important was ability to communicate
This is very similar to my recommendation – adjusters main job is communication
Sheet on Communication Tips to Help Shorten Disability Leaves – the main concern once again is that the employee thinking they will be treated well. I will see if I can get a copy to share with everyone in the future.
Question from Peter Rouismainerre – any other factor that are as important? Unsure
AN ALTERED STATE: CALIFORNIA’S POST-REFORM OUTCOMES AND COMING ATTRACTIONS
Mr. Alex Swedlow, California Workers’ Compensation Institute (CWCI)
California is now several years into the post-2013 reform era. Placing the reforms in historical context, Alex Swedlow will unpack the intended and unintended consequences of the reforms and discuss some of the competing issues that continue to challenge the system, including fee schedule and utilization controls, confronting fraud and abuse, dispute resolution, cumulative trauma, the highly anticipated drug formulary, and the arrival of legalized marijuana.
SB 863 performance
Good news
- Medical cost increase trend has stabilized
Cannot cite this part of presentation – considered preliminary – but all positive results
- CA paying twice for spinal surgery hardware
- 30% reduction in spinal surgeries
- Opioids – 27% of all prescription are opioids , but an increasing trend
- 24% increase in opioid prescriptions
- Opioid strength has fallen
- 412% increase in average medical costs 1990 – 2015
- Still most expensive state for Workers Comp
- #1 in medical cost containment expense
- Loss Adjustment Expenses is almost as high as Indemnity and Medical Payments
Pharmaceutical trends
- Consist of 12% ?
- New state formulary
- July 2017 formulary implementation
- 40% of medical reviews are pharmaceutical
- 100% of all opioids are subject to mandatory UR
- Bulk chemicals are very controversial
- Most popular drug is Hydrocodone with Acetaminophen
Lien Filing fee correlates with reduction in liens filed,, repealing caused a sharp increase, reenactment dropped liens again
King vs. CompPartners – major case on UR physicians
- significant challenge to UR,
- medical relationship with UR physician and claimant
- should UR physician advise, warn, and inform claimant?
- CA supreme court will review it soon
Marijuana in Worker Comp Risk Management
Six States that allow marijuana for Workers Comp (reimbursement)
Six States that disallow marijuana for Workers Comp (non-reimbursement)
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