It is now time for the WCRI 2018 Conference live blogging. Please excuse any typos. I am doing this live while the conference is proceeding. If you want to check out any of the blogging live conferences I have done check here.
Thursday WCRI 2018 Conference Schedule
Dr. Erica Goshen – Visiting Senior Scholar- School of Industrial and Labor Relations – Former Commissioner of BLS
FUTURE LABOR FORCE TRENDS AND THE IMPACT OF TECHNOLOGY
March 22, 2018 | 9:15 a.m. – 10:15 a.m.
Dr. Erica L. Groshen, former head of the U.S. Bureau of Labor Statistics
The labor market is getting a great deal of attention these days. This is not surprising as the enormous, complex market strongly affects peoples’ lives.
They are asking: Is the economy as tight as a 4% unemployment rate suggests? How are artificial intelligence, robots, driverless cars, gig work, and more-fissured workplaces changing work as we know it? Should we trust and support official labor statistics in the era of big data and “fake news”?
Dr. Groshen will answer those questions. She will look at a variety of measures to assess current labor market conditions. Turning to the future of work, she will argue that much of the hype about the future of work is either far too optimistic or too pessimistic. In addition, she will talk about how official statistics are more important than ever. They are the information infrastructure that we all need to see through the haze, so that we make good decisions for our companies, our communities and ourselves.
Major workforce issues –
Conditions
Unemployment rate = 4.1%, 10% in 2010
Formula # unemployed/(#employed + # unemployed)
U-4 Discouraged Workers
U-5 Marginally attached workers
U-6 Part-time for economic reasons
Quits > actually a sign of strength
U6 is now 8.2%
Long term unemployment = 20.7% Still very high
Quits = 2.2%
Layoff = 1.2%
Inflation adjusted hourly wage = 0.0 Flat
2.5% Compensation growth
Productivity 241.8% but hourly compensation 115.4% – companies holding their money
Future of Work
Gig work – Short Jobs –
- Alternative Work arrangements – Multiple Employers or None
- Contingent Work – Temporary
Reasons for growth of Gig Jobs
- Efficiency
- Fast pace of change
Transfers Risk from Employer to Worker
- Weaker employer responsibility to protect workers
- Less stability for workers
- Less employer provided training
Mismeasurement of Gig Jobs may be due to misreporting by survey respondents
Contingent worker survey was last done in 2005, again in 2017 – needs to be update more often?
Artificial Intelligence
AI – replicates routine brainwork
Techno pessimists and optimists both wrong
Coming gradually to workplaces – increasing stress
BLS Mission
Labor Market Activity
Working Conditions
Price Changes in the Economy
Collect, analyze, and disseminate economic information
Support private and public decision making
Data needs to be AORTA- Accurate Objective
Users of BLS –
- Feds
- State and Local Government
- Businesses
- Households
Challenges –
- Measuring dynamic economy
- Maintain survey participation
- Preserving public trust and independence
- Protecting cyber-security and confidentiality
WCRI 2018 Conference
WHO IS READY FOR VALUE-BASED CARE?
March 22, 2018 | 10:35 a.m. – 11:20 a.m.
Dr. Randall Lea, WCRI
Healthcare reform has been associated with the emergence of new care delivery and payment models. Are stakeholders (payers, regulators, physicians, and health systems) prepared to use these post-reform models?
Major Theme – Stakeholder Readiness
Most providers were not that excited about value-based care:
- No opportunities
- Fee schedule attorney driven
Payers – not that enthused about value based care – could be faddish – not catch on
Regulators – self interest and educational
Conclusion – apprehension – but there is value based care in practice
Value based care needs a good regulatory environment
Payers +Regulators –
- Do not change the current rules
- Dispute resolution procedure
What providers would like use Value Based Care?
- Autonomous
- Innovative
- Competitive Edge
- Direct volume
- Conservative and qualified
Who are the most important parties in VBC? Patients
VBC in Workers Compensation changes the rules when looked at as a formula
Providers want to create new VBC codes or Board of Physicians
Desired Providers Workers Comp Outcomes:
Return to work speed
Level of work
Stable and sustained Return to Work
Possibly Workers Comp can create a model that health insurance will follow as the main determinant of social/mental recovery is returning to gainful employment
SAVING LIVES—BUILDING A MODERN PHARMACY PROGRAM AMID A DEADLY EPIDEMIC
March 22, 2018 | 11:20 a.m. – 12 Noon
Dr. Terrence B. Welsh, Ohio Bureau of Workers’ Compensation
In 2011, the Ohio Bureau of Workers’ Compensation (OBWC) found that more than 8,000 injured workers were opioid-dependent for taking the equivalent of at least 60 mg a day of morphine for 60 or more days.
By the end of 2017, that number was reduced to 3,315, which meant 4,714 fewer injured workers were at risk for opioid addiction, overdose, and death than in 2011.
- 8,029 injured workers on opioids
- 47,680 inured workers receiving an opioid RX
- 73% of injured workers population receiving opioids
- 39.9 million opioid doses prescribed
- 58 inured workers > 1,000 mg of morphine
Progress Notes
- Reduced heavy opioid use patients to just two (97% decrease)
- Reduced 28% from 2012 – overall RX’s
Ohio BWC Backround
- State Funded monopolistic carrier
- Pharmacy management in house
- 100,000 claims per year
Closed Formulary -truly closed formulary – covered all RX’s for WC
Questions –
- Tom Lynch – Lynch Ryan – 18 month treatment program – can that work for other organizations – Yes
- Are we over-emphasizing the reduction of opioids? – No
- Resistance from patients and physician how to handle – Still freedom of choice
- Any limits? 30 doses / 7 days
SCENARIOS: WORKERS’ COMPENSATION 2030
March 22, 2018 | 1:30 p.m. – 2:30 p.m.
Dr. Richard Victor, The Sedgwick Institute
The pace of change continues to accelerate. Globalization, the delivery and financing of healthcare, the aging workforce, immigration, political dysfunction, and the need to repay the enormous underfunded public debt Boomers have incurred. These forces will shape the next several decades.
Workers’ compensation systems represent one of this nation’s most successful social safety net programs. Workers’ compensation has evolved in response to external change over more than a century. However, can it successfully continue to evolve when faced with the convergence of accelerating external changes? Will these forces create existential challenges to workers’ compensation systems?
In this session, Dr. Victor will examine the external forces, their effect on workers’ compensation, and alternative scenarios wherein workers’ compensation systems are more and less successful in meeting the challenges.
One of my favorite Workers Comp authors
100 Years of Success
Social Safety net element for 100 years
2030 Workers Compensation
WC Costs Triple
External Forces –
Dominant Forces –
- Emerging Labor Shortages
- Case shifting to non-oocupational health insurance
Millions of workers losing health insurance
- Aging workforce
- Federal immigration policies and practices
# of claims = use 100% an an index
2030 -73% of claims than 2017
Effect of Aging workers has little impact
Labor shortage caused by retiring Boomers
WC costs will increase:
- Shortage of healthcare staffs delays medical care and RTW
- WC industry firms shortages to handle claims
Future Labor Force = .7 % growth vs. 2017 at 3.0%
Job fill rates has now gone below 1.2% index
Why Injury Rate Increase?
- Employers relax hiring standards – hire less capable or with a weaker connection to the workforce
- Recent Surveys 53% of managers hired people not really qualified
- 44 of employers are recruiting outside of the talent pool
Tight labor market increased indemnity claims by 5.3% – WCRI former study
Labor saving technologies will reduce labor force
Immigration and their Us-born offspring projected to drive growth of US Labor Force
After Brexit – 96% fewer European nurses ti Work in UK
Case-shifting – Dr. Victor wrote many article on this theory – Check one article here
Case shifting is not cost shifting
Case shifting does not require fraud
Case-shifting by inured workers increases claims by 25%
Rand Corp – 36% of high deductible people do not seek care
Uninsured workers have the strongest financial incentive to attribute their medical problem to work
The number of uninsured workers expected to increase as ACA provisions are repealed or weakened
Summary – cases increased by 55% by 2030 (Wow!)
State government has little influence
Solutions by state government are unlikely
- May fracture the grand bargain
- WC is too small
- May meet successful constitutional challenge
- Each year the legislators are becoming more polarized
Stakeholders may become more open to a paradigm shift if state governments have little effect
Who should be responsible for providing these benefits?
- Employers – e.g. . ERISA opt plans
- Workers – not sure what this would look like
- Academics – OMG!
- Hybrid approach
Employees + Employers work together
- Union carve outs
- Opt out with tort safety valve
- Make claims organization accountable to both employers and workers – similar to group health insurance
- Super carve out – both union and nonunion work place
IMPACT OF OPIOIDS AND PRESCRIPTION DRUGS ON THE WORKPLACE
March 22, 2018 | 2:50 p.m. – 4:05 p.m.
Dr. Bogdan Savych, WCRI
Jane Terry, National Safety Council
Joan Vincenz, United Airlines
In this session, Dr. Savych will discuss WCRI’s latest research on how opioid prescriptions impact duration of disability for injured workers.
Jane Terry from the National Safety Council will discuss the results from a recent survey they commissioned on how American employers are dealing with prescription drugs in the workplace.
Lastly, Joan Vincenz from United Airlines will share what her company is doing to address these important issues.
Dr. Savych – great variation in prescribing patters, 24 – 58% of workers with paid had TWO opioid prescriptions
Opiods – do they affect period of disability?
- simulated random assignment using statistical measures
- 62% of cases had opioid RX in Philadephia
- 71% had RX for opioid in Harrisburg PA
- 251% Change in TTD Period due to opioid use
- 3 or more opioid RX – 52% increase in TTD period
- Little effect of impact of small number or RX’s over short period
Jane Terry – National Safety Council
More than 70% of employers have been impacted by RX’s
28% of employers are unprepared to deal with the epidemic
33% of painkiller users do not know they were taking opioids
76% do not train employees to identify signs of misuse
29% of smaller employers are not prepared to deal with opioid RX effects
5 days less work days per year for non opiod using employees
Each employee who recovers from a Substance abuse disorders save an employer more than $3,200 per year
Every 24 minutes an American dies from a prescription opioid overdose
Last year 22,000 Americans died from RX opioids
Recommends Warn Me Labels to let pharmacist now if you are prescribed an opioid, then the pharmacist need to talk to you.
Joan Vincenz – United Airlines
United Airlines has Workers Compensation Mission Statement
Proprietary Statistics —–<<<<<<cannot blog them
Employees split among above the wing, below the wing, and flight attendants
Onsite clinics are invaluable – see my Six Keys #2
Questions –
What level is best to talk to / – State or Federal level – Answer – State level best, but most are out of session for this year
One or two RX’s are not that significant, but that varies from some of the other research. Answer – there are difference among studies, more questions than answers, need to have researchers talk to each other to figure out why the differences.
Adjournment of WCRI 2018 Conference for Thursday.
STATE OF THE STATES
March 23, 2018 | 9:30 a.m. – 10:15 a.m.
This session will feature selective findings from WCRI’s CompScope™ Benchmarks reports. With these studies, stakeholders, public officials, and policymakers can monitor their systems on a regular basis and make important interstate comparisons. By identifying incremental changes in system performance―either improvement or possible deterioration, goals can be set, improvements accomplished, and crises avoided.
The following are the titles and presenters for this session:
Trends in Physical Medicine Services
Dr. Rebecca Yang, WCRI
Findings for Tennessee from CompScope Benchmarks
Ms. Evelina Radeva, WCRI
Time From Injury To Medical Treatment: How States Compare
Ms. Carol Telles, WCRI
Tennessee Reforms and The Associated Data
Permanent Partial Disability
PPD Claims In Tennessee – Average PPD benefits were third highest in all study states
Before 2013 reforms TN had maximum PPD multiplier
Compscope(r) looked at TN with lagging data from 24 to 36 months during certain time periods
After 2013 reforms 24% decrease
Average PPD in 2013 14,090 After reform 10,708
TN created new court of WC claims in the reforms
TN claimant attorney decreased from 31% to 21% – Incredible Statistic
Rebecca Yang
From Compscope Medical Study
Shift from physical medicine from hospital to non-hospital
- Fee schedules
- Reimbursement Amounts
Hospital outpatient use decreased 6%
Cost Factor
- Physical Medicine $41 -Oupatient
- In hospital $60
Indiana
Physical Medicine Hospital outpatient decreased 9% after reforms
North Carolina
Physical Medicine Hospital outpatient – decreased 9% after reforms
Carol Telles
Time for the i injured worker to receive medical treatment
Faster the worker receives treatment the better the outcome
Administrative delays in the medical treatment system
Little variation in time to first medical treatment
Objective injuries and subjective injuries had great variation
Objective injuries = fractures, lacerations, contusions
Subjective injuries = sprains, strains, etc
Subjective injuries had a much greater delay in receiving medical treatment
Louisiana seemed to have the highest delay in providing medical treatment than other study states
North Carolina and California also had various delays
Wisconsin and Pennsylvania tended to had faster treatment timelines
NC CA, and Louisiana had more delays
Still more research needed in medical treatment delays between the states
Questions –
Have the researchers expanded the delay time study into other claims components – No
DO MEDICAL MARIJUANA LAWS CAUSE A SHIFT IN PRESCRIPTION DRUG SPENDING?
March 23, 2018 | 10:15 a.m. – 10:45 a.m.
Dr. David Bradford, University of Georgia
As medical marijuana remains a complex issue in both the workers compensation arena and elsewhere, we strive to find pertinent studies that will inform.
In this session, Dr. Bradford will share the results of his recent studies looking at the effect medical marijuana programs have on prescription drug spending. These studies review data from Medicare Part D and Medicaid and focus on drugs used to treat clinical conditions for which marijuana might be a potential alternative treatment.
Although Dr. Bradford’s studies look at the impact of medical marijuana on other social insurance programs, but not workers’ compensation, the results are suggestive of what might be found in workers’ compensation for work-related conditions.
Dr. W. David Bradford – University of Georgia
The effect of marijuana laws cause a shift in RX spending?
Intense policy debate – 9 states had medical marijuana on ballots
91% of Americans say that it is OK to have medical marijuana
Most states approved medical marijuana in 2014-2015
48 states have some type of medical marijuana policy
Oregon allows 24 ounces of marijuana
Marijuana is still a Schedule I drug – along the lines of LSD and Heroin
Study of 10,000 studies was performed by National Academies of Science – The Health Effects of Cannabis showed that it does have benefits
Are the cannabis policies just a backdoor to recreational access?
- 132,000,000 observations
- Medicare Part D data used
- When marijuana laws are enacted, RX’s reduced by a significant amount
- -1,826 RX’s per day for pain
- I f all states enacted Medical marijuana laws, the savings to Medicare D would be over $1 Billion
Medicare + Medicaid savings would be $3.4 billion if all states enacted MML.
9% reduction in opioids in states that have MML.
Mortality from opiates overdoes significantly reduced with MML.
25% reduction in opiate overdoses in New York (?)
THE WORLD OF WORK IS CHANGING―FAST. ARE YOU PREPARED?
March 23, 2018 | 11:05 a.m. – 12:15 p.m.
Denise Algire, Albertsons Companies
Charlie Kingdollar, General Reinsurance Corporation (GenRe)
Judge David Langham, Florida Office of Judges of Compensation Claims
Steve Tolman, president of the Massachusetts AFL-CIO
This session will leverage the panel’s insights as they identify future trends and predict implications for the workers’ compensation system, including how system features like safety, insurance, and the workplace will be impacted.
The following are some of the questions they will address:
- Will robots take our jobs?
- Will the workplace be safer with automation or less safe with undertrained independent contractors?
- How will we insure the new workplace?
- Will new legal cases arise around independent contractors and on-the-job injuries?
Roundtable Panel
AI – Views on how it changes the Workforce – Ruser
Algire – Will actually create more jobs, use automation in the heavier manual labor jobs Less injuries with automation, no 100% automation of truck drivers
Kingdollar – Robotics will replace white collar jobs, too. Truck drivers will be replaced by autonomous vehicles
Tolman – clearly threat to middle class, great if workers share in the prosperity, driverless cars not good automation, downward pressure on jobs and wages
Langham – attrition, same as the agrarian to industrial switch, 20th century law for 21st century decisions, job goals should be 5 years spans
Gig Economy – Effect on workforce – Ruser
Kingdollar – temporary situation
Tolman – Uber/Lyft should count contractors as employees, how do we allow Uber to come into a city with no regulations
Langham – Legislative response – TN passed laws that made Uber drive independent contractors, FL just passed laws on independent contractors , Grubhub in CA ruled not employees, but Uber drivers are – Which laws are interpreted – State of Federal? Labor is cheaper in other countries due to less regulations
Algire – GenX and GenY workers are used to short term span of work, should benefits be portable?
Saffety – Workplace safety – Ruser
Tolman – President Trump signed Executive Order that companies do not have to keep list of injuries(?), safety is not as important now, Gig economy has lowered safety
Ruser – uptick in MA and US death rates – due to opioids
Kingdollar – nanotechnologies – nanomaterials- certain companies provide no safety, 300 studies
Shifting demographics – Ruser –
Algire – quite a concern for older workers, increased injury frequency in the first 6 months, to be competitive grocery retailers are now using apps to shop for groceries, workers safety has changed, motor vehicles accidents increased
Langham – immigrants effect (Ruser) – immigrants stay very close to their communities – undocumented workers are being exploited by company owners from the same country, workers comp claims not reported then they go on public assistance, consumer are going to drive the change
Tolman – undocumented workers not even being able to seek treatment due to current immigration laws , retail businesses are facing tsunami of job losses due to automation
Kingdollar – average retirement age has increased greatly for Baby Boomers, still employed
Legal Challenges – Ruser
Langham – FL cap on benefits at 104 weeks ruled unconstitutional, states are now capping WC benefits, many claimant attorneys would rather be in a tort system, challenges will be repeated in other jurisdictions, decisions have been made on opioids,
Tolman – MA WC Board has a monitoring area for opioids, pharmaceutical companies have ruined workers, opioids should be banned,
Other observations – Ruser
Algire – Automation actually helps workers, will create more and different jobs, need to better educate workers
Kingdollar – White collar jobs – Japanese life insurer cut employees by 30% due to AI, 44,000 man-hours cut by Zurich UK
Langham – Change is coming, only constant will be change, how we react to changing workplace will be key, naive to think things will always be the same
Tolman – should be paying attention to all levels of government, no respect for human capital, allow workers to share in the prosperity of job change
Questions –
Steven Porches (?) has been doing studies in the area for many years – no bad behavior but instead adaptation
Exposure to nanomaterials i everyday living – would a claim be accepted?
Algire – engage all stakeholders, communication is the main required skill , OSHA has looked at severity of injuries when working with automation, customer service from retailer’s biggest mistake is to reduce service to a level where people will order online
Kingdollar – $2,5 billion in lost premium in WC, it is the concentration of nano-materials
Langham – WC job injuries and transferable skills analysis are appearing in claims, re-employing the injured workers is becoming more difficult ,
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