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Home » WCRI Annual Conference

WCRI 2021 State of the States Presentation – The Past Rules

March 25, 2021 By JL Risk Management Consultants

WCRI 2021 State of the States: Selective Findings

The WCRI 2021 State of the States was extremely informative as it has been every year that I have attended the conference.  

Speakers: Bogdan Savych, Ph.D., Rebecca Yang, Ph.D.

wcri 2021 state of the states

(c) Wikimedia – Norman B. Leventhal Map Center

Dr. Savych compared much of what happened in the current pandemic with the 2008 – 2009 great recession.    A few of the stark statistics on the current pandemic were: 

  • 6,000,000 jobs lost due to pandemic – I think this number will increase as adjustments are made by such organizations as the Bureau of Labor Statistics – BLS
  • 27% concerned about job security – this number may end up much higher after the pandemic has lessened. 

Dr. Yang presented the Workers Comp data.   Workers Comp fee schedules have always been one of my recommended ways that state governments can supply great medical care along with cost reductions for their state’s employers. 

The fee schedule results on outpatient facility charges:

  • AL was 136% above the median state in the 2018 study
  • NV was 60% lower than the median state

The fixed amount fee schedule states showed decreases in medical charges.  One can usually expect a decrease in medical charges when a fixed fee schedule has been enacted in the respective states.   

An example was VA with a 32% reduction in ASC fees.   (ASC – Ambulatory Surgical Centers)

I have written on VA needing a fee schedule since the mid-2000s.   One of the main concerns with having a fixed fee schedule is that physicians will turn away Workers’ Comp patients.   This has not happened in any state at any time that I can remember.  

 

Filed Under: WCRI Annual Conference Tagged With: ASC fees, Pandemic, stark statistics

WCRI COVID-19 Impact and Effect on Claims and Medical Treatment

March 24, 2021 By JL Risk Management Consultants

WCRI COVID-19 Session – Assessing the Impact

Impact of COVID-19 and the Shutdown on Claims and the Delivery of Medical Care

WCRI COVID-19 Session – Speakers: John Ruser, Ph.D., Olesya Fomenko, Ph.D.

Dr. Fomenko covered much ground very quickly in her presentation.  She is probably one of the best presenters on data in a webinar setting. 

WCRI COVID-19 session pic of Modena vaccine

(c) US Air Force – Public Domain

I took handwritten notes as I could not watch the video and type at the same time.  

MA, NJ, and SC – A dichotomy 

The percentage of claims that were COVID-19 was led by Massachusetts at 59% – likely due to the pay-without-prejudice payments made in the state.   New Jersey was a close second in the highest total of COVID-19 claims at 58% of reported claims. 

The pay-without-prejudice period in MA is a very long 180 days without having to accept liability or make a liability decision on a Workers Comp claim. 

South Carolina’s COVID-19 claim reporting rate came in the lowest at 5%.  

One has to watch the amplification of the percentages.  As the number of claims was reduced significantly, the percentages may be inflated when you divide out the total number of COVID-19 claims by the total of all claims.  

# of COVID-19 Claims / Total Number of Claims = COVID-19 % 

NM, IL, MI, and CT may have had an increased number of COVID-19 claims due to the presumption laws in effect during the pandemic.  

WCRI COVID-19 Shocking Statistic 

Nationwide, 60% of the claims came from high-risk industries.  Those claims mainly originated with assisted living centers, hospitals, and physician’s offices.    In CT, NJ, and MA 65% of the healthcare industry claims were COVID-19 related.  

A side statistic was that MA showed a 50% drop in non-COVID-19 claims during the pandemic. 

There were no or little delays in treatment for workers ‘ comp claims due to the COVID1-9 pandemic.  Even CT, MA, and NJ had no increases in medical treatment delays. 

Q&A WCRI COVID-19 session – The overall industry that was least affected when measuring the number of claims was the construction industries.

Filed Under: WCRI Annual Conference Tagged With: MA, prejudice, presumption laws

WCRI Session That I Attended – Shocking Topicals Numbers

March 24, 2021 By JL Risk Management Consultants

WCRI Session – Off-Label Prescribing and the Effects of Opioid-Related Policies

WCRI Session Speakers: Vennela Thumula, PhD, Bogdan Savych, PhD

The data from this WCRI (Workers Comp Research Institute) session yesterday provided indications of shocking increases in topicals.  The session also pointed out that the effects of state opioid-related policies were negligible.   

wcri session graph of diclofenac prescriptions

Wikimedia Commons – ClinCalc DrugStats

Topicals are anything that is applied to the skin such as patches, creams, and gels.   If one looks at the chart above for diclofenac, the use is also spiking for the overall market. 

South Carolina led the way with 40% of prescriptions having a dermatological component. 

Some of the numbers from this session were:

Opioid prescriptions 

  • 21% of prescriptions – 2015 – were opioids
  • 202o – the percentage of opioid prescriptions were reduced to 8% of prescriptions 

Topicals

  • 11% of prescriptions in 2015
  • 21% – that seems to be a rather large number for topicals 

I was not expecting the percentage to be that high.  

The two top topicals that were responsible for the topical prescriptions were Diclofenac and Lidocaine.    Approximately 91% of the topical prescriptions written were Diclofenac and Lidocaine. 

What is Diclofenac topical?

-next two sections not part of the presentation 

 According to Drugs.com, Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID).

Diclofenac topical (for the skin) is used to treat joint pain caused by osteoarthritis. diclofenac topical is for use on the hands, wrists, elbows, knees, ankles, or feet. Diclofenac topical may not be effective in treating arthritis pain elsewhere in the body.

What is lidocaine topical?

Lidocaine is a local anesthetic (numbing medication). It works by blocking nerve signals in your body.

Lidocaine topical (for use on the skin) is used to reduce pain or discomfort caused by skin irritations such as sunburn, insect bites, poison ivy, poison oak, poison sumac, and minor cuts, scratches, or burns. Lidocaine topical is also used to treat rectal discomfort caused by hemorrhoids.

Lidocaine topical may also be used for purposes not listed in this medication guide.

DE and SC have the highest use of topicals.  I would have to agree with this statement when analyzing claim payments.

The physicians in FL, GA, IL, MD, DE, SC, and VA supplied 20 – 30% of the topical medications in 2020.  

WCRI Session Best Question

What have states done to control the spike in topical prescription medications?    A few of the states have included topical prescriptions in their drug formularies. OH, NY and KY have included them recently.  

This WCRI session provided a great insight into what is now becoming a problem with Workers Comp treatment.   This was a great session with excellent presenters. 

Filed Under: WCRI Annual Conference Tagged With: dermatological, Diclofenac, lidocaine, topicals

WCRI 2021 Virtual Conference Next Week – For Data, Reports And More

March 18, 2021 By JL Risk Management Consultants

WCRI 2021 Virtual Conference -Definitely Worth It

The WCRI 2021 Virtual Conference will be broadcasting on March 23rd and 24th.  This is a great way to spend two afternoons if you have the time.  I always learn something from their PhDs. 

Three of my favorite researchers will be presenting their research.  They have always taken the time to talk with me during the conference and answer any questions that I have for them. 

  • Vennela Thumula, Ph.D.      Policy Analyst
  • Bogdan Savych, Ph.D.           Public Policy Analyst 
  • Olesya Fomenko, Ph.D.        Economist 

WCRI’s 2020 Conference was the last in-person conference that I attended until now.   I hope the 2022 Conference will be an in-person one – hopefully in Arizona.  

pic thumbs up for 2021 WCRI Virtual Conference

Wikimedia Flikr – Wakalani

They graciously invited me to report on this conference.  I will provide some of the info from the sessions next week.

Below is all the information on what is covered and how to sign up for one of the better data reporting conferences.   

WCRI also gives away a great report on pricing if you allow them to send you emails -sign up for that info even if you cannot make the conference.  Both are top-notch. 

NIOSH Director Dr. John Howard to Discuss Future of Work, COVID-19, and Worker Safety at WCRI Conference

Cambridge, MA, Feb. 24, 2021 ― The National Institute for Occupational Safety and Health (NIOSH) Director John Howard will deliver a keynote on the future of work, COVID-19, and worker safety at the end of the second day of the Workers Compensation Research Institute’s (WCRI) 37th Annual Issues & Research Conference, held virtually March 23 and 24, 2021.

“We’re excited to have Dr. Howard be the closing keynote speaker at our annual conference,” said John Ruser, WCRI’s president and CEO. “There are a lot of questions about the impact of COVID-19 and the vaccines on people returning to work. I look forward to Dr. Howard addressing these questions, as well as others, about how changes in work will affect occupational safety and health.”

The COVID-19 pandemic has demonstrated the need for a renewed focus on work issues today and in the future. NIOSH and other occupational safety and health stakeholders are leading the way in understanding the implications of future of work scenarios and translating effective interventions into practice for employers safeguarding the safety, health, and well‐being of their workforces. In this session, Dr. Howard will discuss NIOSH’s Future of Work Initiative and the role technology, automation, gig work, and remote workplaces play in emerging workplace safety and health issues. He will also address pandemic preparedness and what employers can do to help ensure employee safety and well-being.

In addition to serving as the director of NIOSH, Dr. Howard is the administrator of the World Trade Center Health Program of the U.S. Department of Health and Human Services in Washington, D.C. He was first appointed as NIOSH director in 2002, and was re-appointed to an unprecedented third six-year term as director in 2015. Previously, Dr. Howard served as chief of the Division of Occupational Safety and Health (Cal/OSHA) in the California Department of Industrial Relations from 1991 through 2002.

The WCRI conference is a leading workers’ compensation forum. The two-day program highlights the Institute’s latest research findings while drawing upon the diverse perspectives of highly respected workers’ compensation experts and policymakers from across the country. This year’s virtual conference will be shorter and feature four sessions per day in the afternoon from 1:00 to 4:00 p.m. ET. The following are among the other topics the conference will address: 

  • Economic Impact of COVID-19
  • Health Equity and COVID-19 Vaccinations
  • Impact of COVID-19 on Claims and the Delivery of Medical Care
  • Off-Label Prescribing and the Effects of Opioid-Related Policies 
  • Physical Therapy Treatment Patterns and Outcomes

The conference is free for WCRI members, state legislators, and members of the press, and $175 for non-members. To learn more or to register, visit https://www.wcrinet.org/news/events/37th-annual-wcri-issues-research-conference.

Filed Under: WCRI Annual Conference Tagged With: Economic Impact, ET, Health Equity, NIOSH, PhDs

WCRI Day Two Conference – Morning – What I Learned Today

March 10, 2020 By JL Risk Management Consultants

What I Learned Today at the WCRI Conference – 2020 

I decided to split out the Mental Health Session into its own article.    

State of the States Selective Findings

Benchmark WCRI Conference 2020 at 78 magazine lane

Wikimedia Commons – Rodhullandemu

This session features selective findings and trends seen across WCRI’s core benchmark studies, including our 18-state CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.  One set of findings will focus on readmission and reoperation rates as seen below.

Hospital Inpatient Metrics – Carol Telles, WCRI

Inpatient Hospital Payments account for 17% of Total Hospital Payments 

Long Term Decrease in Hospital Inpatient Payments 

Share of cases with 20,000 or less decreased, 20,000+ increased 

Major surgery rate decreased 6 – 7 %  2017 to 2019 

Iowa, Louisiana, and Massachusetts had increases in inpatient with surgery 

Inpatient reimbursement rates – Indiana Minnesota and North Carolina had reductions from 2010 – 2017 

Readmission and Reoperation Rates among Workers’ Compensation Patients

According to the Centers for Medicare and Medicaid Services, two of the main indicators of surgical quality are whether patients are readmitted or reoperated upon after a surgical procedure.

The parts of WCRI Conference 2020 Lumbar

Wikimedia Commons – Anatomist90

However, the research on these important indicators is limited for workers’ compensation patients who undergo lumbar spine surgery. In this session, we share preliminary research on this important topic.

Questions Addressed:

  • What are the readmission and reoperation rates in workers’ compensation for lumbar spine surgery?
  • How do these indicators vary across states as well as compare with other payor groups?
  • What are the implications of these indicators for payors, injured workers, policy makers, health care providers, and regulators?

Readmission and Reoperation Rates  – Dr. Randall Lea, WCRI  

Two main markers of quality by non-WC payors 

Readmission – unplanned hospitalization after a patient has been discharged 

90-day timeframes in the study

Discectomy and Fusion were the two surgeries studied 

Fixable/curable vs. non-fixable/manageable 

Dr. Rebecca Yang – WCRI 

Used the CompScope usual 18 states 

72% of patients had a discectomy 

28% had fusion 

Studied 30,000 claims – 11% of patients with low back conditions had surgery 

5.5% reoperation, 5.5% readmission, 4.9% both reoperation and readmission

California had 22% reoperation or readmission rate

7 – 8% of lumbar surgery cases had reoperation or readmission within 30 days and 90 days of surgery 

7.2% had readmission or reoperation within 30 days. 

56.4% decompression 43.6% fusion – reoperation rates 

With no readmission or reoperation, $33,775 discectomy  $90,614 fusion

With readmission and reoperation $120,472  discectomy  $144,272 fusion 

 

©J&L Risk Management Inc Copyright Notice 

Filed Under: WCRI Annual Conference Tagged With: 90-day timeframes, Discectomy and Fusion, readmission, reoperation rates

Prioritizing Mental Health for Workers Injured On The Job – WCRI Session

March 6, 2020 By JL Risk Management Consultants

I decided to place this session by itself as I had written on this session last week. 

Dr. Boden – Suicide and Opioid Mortality Related to Workplace Injury 

Injured Worker Mortality in New Mexico   

  • Women – Lost time injured -10%
  • Men – Lost time injured – 16%

Suicides and Opioids result in more deaths than auto accidents

Drug-related and suicide deaths within 20 years after injury – 300% higher in women

A study from West Virginia – same results 

Injured employees had a very heavy tendency for opioid dependency 

40% increase in depression post-injury lost-time claims

Injury prevention is tantamount. 

Mr. Callahan – MA Building Trades Council 

  • 93% male workforce
  • If you do not work, you do not get paid 
  • A lot of addiction due to return to work issues, need to work 
  • Peer-to-peer advisors have been successful 

Mary Christensen – Southern CA Edison 

  • Advocacy program – 360-degree outlook 
  • EAP provider teaming with claims department for services offered by EAP 
  • Non-occ claims reps brought in for training 
  • Identifying stuck employees 

Dr. Larsen – New England Baptist Hospital 

  • CBT Cognitive Behavioral Therapy – coping skills 
  • Pre-frontal therapy never addresses the limbic system 
  • Limbic approach EMDR- Rapid Eye Movement treatment 
  • Reteach breathing to lower stress 
  • Sense of learned helplessness <<<I have seen this often in Workers Comp claims >>>
  • Lew Millender, MD – Baptist Hospital – if you care about your patients, they will return to work faster 
  • Field Case Manager – Rehab Nurse on file always makes the file turn out better <<<my favorite WC Risk Management Technique>>>> 
  • Return to work always has to be the goal 
  • Trauma theatre – rewind effect of the trauma 
  • Physical therapists are invaluable to the psychological recovery 

©J&L Risk Management Inc Copyright Notice

 

Filed Under: WCRI Annual Conference Tagged With: 93% male workforce, Cognitive Behavioral Therapy, Mr. Callahan, Trauma theatre

Workers Comp Psychological Aftereffects – WCRI Conference Next Week

February 26, 2020 By JL Risk Management Consultants

Workers Comp Psychological Effects – WCRI Session Next Week 

Workers’ Comp psychological effects are one of the unmentionables that the industry never really considers at the time of a claim. 

workers comp psychological effects phrenology

Public Domain

One of the unmentionables that receives little consideration in Workers Comp is the effect that the claims process has on the injured employee.   No, I am not saying that carriers should have to treat the psychological components of a claim – better known as:

Physical >>>> Mental   

One question we have to ask is what happens to the injured worker once they file a claim and after the claim has been closed?  

WCRI Prioritizes Mental Health for Workers Injured on the Job at 2020 Conference

Cambridge, MA, January 30, 2020 ― The Workers Compensation Research Institute (WCRI) announced today that a panel at its 36th Annual Issues & Research Conference, March 5–6 in Boston, MA, will discuss the mental health challenges some workers face after a workplace injury, as well as initiatives to address those challenges.

“Serious workplace injuries can lead to anxiety, depression, and other mental health issues,” said John Ruser, president and CEO of WCRI. “Indeed, new research from Boston University (BU) Professor Les Boden found that an injury serious enough to result in at least a week off work almost tripled the risk of suicide among women, and increased the risk by 50 percent among men.”

Multiethnic business workers comp psychological people

StockUnlimited

The diverse panel ─ made up of a researcher, labor leader, clinician, and employer ─ includes BU Prof. Boden; President Steven Tolman of the Massachusetts AFL-CIO; Dr. Kenneth Larsen of the New England Baptist Hospital; and Mary Christiansen of Southern California Edison.

The following are among the questions the panel will address:

  • What is the relationship between occupational injuries and mental health?
  • What treatment options are available to address mental health issues arising from occupational injuries?
  • What can labor and employers do to promote mental health and, specifically, to assist workers injured on the job?

The WCRI conference is a leading workers’ compensation forum. The two-day program highlights the Institute’s latest research findings while drawing upon the diverse perspectives of highly respected workers’ compensation experts and policymakers from across the country. Conference participants will leave with new insights, valuable networking contacts, and a better understanding of key issues in today’s competitive environment.

 

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference Tagged With: clinician, policymakers, psychological components, unmentionables

WCRI 2020 Annual Conference Next Month – Show Me The Data + Secret

February 7, 2020 By JL Risk Management Consultants

The WCRI 2020 Annual Conference – Data and Study Paradise  –  Thursday March 5th – 6th   

The WCRI  2020 Annual Conference (Workers Comp Research Institute) heads back to Boston this year.  Last year, the Conference was held in  Phoenix.  

I will be there on the front row doing my Workers’ Comp Press duties.  The Conference will not be blogged live this year as in the past.  I will write articles from the day’s sessions.   

Worth wcri 2020 annual conference medal

StockUnlimited

The conference remains as one of the “worth it” places to be for all things Workers’ Compensation.  A few of the conferences have faded a little over the years – not this one.   The conference covers 1.5 days, sounds short but you will be overloaded with data that spark your own ideas and interests.  

Below is the conference happening sheet and a place to sign up.  The seafood alone is worth the trip.  Cold water seafood is the best. 

The secret – WCRI shows some of the data that has not been published yet – be ahead of the curve, and no they never asked me to place anything about their conference, studies, or webinars in this blog.   I do it because they have the best non-influenced data in the Workers’ Comp business – plain and simple.  

___________________________________________________

THEME: GAINING CLARITY THROUGH RESEARCH

 

Day 1 – Thursday, March 5, 2020

9:00 a.m. – 9:15 a.m. | Welcome & Introductions

Mr. Steve Perroots, Marriott International, Inc.       
Chair, WCRI Board of Directors

Dr. John W. Ruser, WCRI
President and CEO

9:15 a.m. – 10:15 a.m. | Generational Differences and Stereotypes in the Workplace

Professor wcri 2020 annual conference studying for upcoming report

StockUnlimited

In this session, Jennifer Deal ─ Wall Street Journal Experts panel contributor, author of several books, and senior research scientist at the Center for Creative Leadership ─ will discuss her research on generational differences and stereotypes in the workplace.

SHOW MORE >>

10:15 a.m. – 10:35 a.m. | Networking Break

10:35 a.m. – 11:05 a.m. | How Injuries, Claims, and Outcomes Change with Age

The age distribution of the workforce is projected to change in the next 10 years. The large cohort of baby boomers will have largely retired, shifting the age distribution toward younger workers. 

SHOW MORE >>

11:05 a.m. – 12:15 p.m. | Alternatives to Opioids for Pain Management

WCRI’s latest research finds the frequency of opioid dispensing is decreasing while non-opioid and non-pharmacologic pain treatments have increased. 

SHOW MORE >>

12:15 p.m. – 1:30 p.m. | Luncheon

1:30 p.m. – 2:25 p.m. | Economic Cycles and Their Impact on the Labor Market

Our keynote speaker is Dr. Michael Horrigan who is the president of the W.E. Upjohn Institute for Employment Research and a former Associate Commissioner of the Bureau of Labor Statistics.

SHOW MORE >>

2:25 p.m. – 2:45 p.m. | Networking Break

2:45 p.m. – 3:30 p.m. | Business Cycles and Their Impact on Workers’ Compensation

In this session, learn more from John Ruser from WCRI and Len Herk from NCCI about the impact of economic upturns and downturns on workers’ compensation claims and how macroeconomic factors influence the frequency of injuries, claims duration, and medical utilization and costs.

SHOW MORE >>

3:30 p.m. – 4:15 p.m. | Highlights from WCRI’s State Inventory Studies

This session will highlight information from WCRI’s inventory studies (e.g., prescription drugs, workers’ compensation laws, medical cost containment, etc.) to outline key regulatory provisions in today’s workers’ compensation environment. 

SHOW MORE >>

4:15 p.m. – 4:30 p.m. | Announcements & Adjourn

5:30 p.m. – 7:00 p.m. | General Networking Reception

Day 2 – Friday, March 6, 2020

9:30 a.m. – 10:30 a.m. | State of the States: Selective Findings

This session features selective findings and trends seen across WCRI’s core benchmark studies, including our 18-state CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.  One set of findings will focus on readmission and reoperation rates as seen below.

Readmission and Reoperation Rates among Workers’ Compensation Patients

According to the Centers for Medicare and Medicaid Services, two of the main indicators of surgical quality are whether patients are readmitted or reoperated upon after a surgical procedure.

SHOW MORE >>

Everything you need to know about the conference:

 Dates and Location

  • Thursday, March 5 – Friday 6, 2020
  • Westin Copley Place
    10 Huntington Avenue, Boston, MA
  • Telephone: 617-262-9600

 Conference Hours

  • Thursday, March 5: 9am to 4:30pm
  • Friday, March 6: 9:30am to 12:30pm

 Additional Details

  • Dress is business casual
  • Luncheon will be provided on Thursday, March 5th in America South, 4th Floor Westin Copley
  • A networking reception will be held from 5:30pm to 7:00pm on Thursday evening, March 6th in the America Foyer, 4th Floor Westin Copley
  • Information on CE credits will be made available shortly
  • By attending the conference, you consent to be photographed, filmed and/or otherwise recorded and to the use of any photos/film/recordings.

 Registration Hours & Locations

  • Wednesday, March 4, 2pm to 4pm in Carriage Entrance, Westin Copley Place
  • Thursday, March 5, 7am to 4pm in America Foyer, 4th Floor, Westin Copley Place
  • Friday, March 6, 7am to 12pm in America Foyer, 4th Floor, Westin Copley Place

 Registration Fees

Early Registration (by February 13, 2020)

WCRI Member: $525

WCRI Associate Member: $195

Non-Member: $875

Spouse: $80

 

Regular Registration (after February 13, 2020)

WCRI Member: $575

WCRI Associate Member: $225

Non-Member: $975

Spouse: $80

 

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference Tagged With: CE credits, cohort, macroeconomic, pharmacologic, Press duties

WCRI Annual Conference 2019 – Live Blogging – If My Wrists Hold Out

February 28, 2019 By JL Risk Management Consultants

First Day – Morning Conferences – WCRI Annual Conference 2019 – Live Blogging 

If I make mistakes in this live blogging of the WCRI Annual Conference 2019, please excuse, this is live and I do not really go back and change  anything

Beginning of WCRI Annual Conference 2019 Presenters

KEYNOTE: PROF. ALAN KRUEGER

 

WCRI Conference 2019 picture of Dr. Krueger

Considered one of the 50 highest-ranked economists in the world, Princeton University’s Professor Alan Krueger will kick off this year’s conference with a keynote focused on the future of work and the impact of technology on the economy, and how the opioid epidemic has affected the labor force participation rate ─ the proportion of people employed or looking for work in the U.S.

Krueger will also share his experience working in Washington as the former chair of the White House Council of Economic Advisers (CEA) and as a member of President Obama’s Cabinet from 2011 to 2013. He is the only economist to have served as the chief economist of both the U.S. Department of the Treasury and the U.S. Department of Labor.

 

Moderator: Dr. John Ruser, WCRI
 

Speaker: Dr. Alan Krueger, Princeton  

Dr. Krueger Presentation 

Opioids

  • Chart of Overdose rate – 250% increase in overdose 
  • 70,000+ American died of drug overdose – 2017 
  • Male drug overdoses seems to have increased more sharply in the last few years 
  • Mortality rate is rising for white non-Hispanic Americans 
  • Death of despair – Lower educated Americans tend to have much high rates of drug overdose mortality 

Fentanyl is responsible for over 30,000 deaths in 2017 <<<amazing 

Labor Force – Ages 25 – 54 

  • Men participation in labor force has dropped approximately 10% 
  • More than 40% of unemployed men report being unhealthy (fair or poor)

Men out of workforce reported taking pain medication yesterday – 47% 

  • Only 12% said that a work injury was responsible – Most chronic pain sources happen outside of work 

Women out of workforce reported taking pain medication yesterday  – 34% 

Regional use of pain medication varied by 3,100% by county across the US 

Macroeconomic effects – Opioid Crisis

  • Value of Statistical Life = $10 Million 
  • Cost of opioid crisis – $500 billion – $750 billion 

Public Policy

  • Trump administration declared public emergency
  • Limit number of pills prescribed 
  • Better emergency room treatment for those overdosing 
  • Alternative treatments for pain 
  • Beware of next drug epidemic 

Q&A 

Progress have been made in the area of pharmaceutical abuse 

  • More help for those addicted 
  • ?

Many of the jobs from lower educated workforce have been eroded 

Demographic transition – especially the aging of the workforce 

Dr. Ruser – Within 3 months – new study will be released by WCRI that shows a decrease in opioid use. 

WCRI Annual Conference 2019 – Morning Session 2

LATEST RESEARCH & EFFORTS TO ADDRESS THE OPIOID EPIDEMIC

 

2019 WCRI Conference Picture of pills on keyboard

During this session, WCRI will present its latest research on correlates of opioid prescribing to injured workers, which can help public officials and other stakeholders better predict which injured workers are more or less likely to receive opioids.

Next, the Massachusetts Department of Public Health will discuss the results from a recent study they published on factors that may contribute to differences in the rate of opioid-related overdose deaths among workers in different industries and occupations.

 

Then, the session switches from research to the efforts taken by Arizona Gov. Doug Ducey and the Industrial Commission of Arizona to address the opioid epidemic in their state.

 

Moderator:

  • Tim Hassett-Salley, WCRI

 

Speakers:

  • Vennela Thumula, WCRI
  • Letitia Davis, Massachusetts Department of Public Health 
  • Jacqueline Kurth, Industrial Commission of Arizona
  • Jason Porter, Industrial Commission of Arizona

Ages/Local Prescribing/Industry Differences in Opioid Use – Dr. Vennela Thumula, WCRI

Highest use

  • 40 to 54 age group – 38% 
  • 54 to 60 age group – 34% 
  • 72% of use in these two age groups 
  • County breakdown – Nevada seems to be very high
  • Mining and Construction workers had the highest rates of opioid prescribing 
  • Employed in smaller firms 
  • Older
  • Male 
  • Residing in rural areas 

Opioid-related Overdose Deaths in Massachusetts – Letitia Davis, Massachusetts Department of Public Health

  • Massachusetts has double the national average of opioid deaths
  • Used CDC info extractions for 2011 – 2015 
  • 5,580 opioid deaths in that timeframe
  • 9 industries with higher rates than normal
    • Construction – very high – 6 times the average
    • Fisheries – even though number of incidents much lower -6 times the average
  • No clear cut trend by income <<<interesting 
  • No race/ethnicity figures

 

Jason Porter, Industrial Commission of Arizona 

  • 2017 – Arizona had highest rate of opioid  death in 10 years 
  • 33 opioid pills prescribed for every AZ resident – what???<<amazing 
  • Governmental task force Act on opoiods enacted by Governor – Started January 1, 2019
  • AZ clamped down on opioid prescribing and use 
  • AZ Opioid Abuse Act 
  • 36% decrease in opioid prescriptions 
  • Opioid antidote – Naloxone 1,100 doses given with 97% 

Opioid Treatment Guidelines – Jacqueline Kurth, Industrial Commission of Arizona

  • Advisory Committee – had claim reps on committee<<good idea 
  • 10/1/2016 – Treatment guidelines and ODG went into effect 
  • Less use of opioids – Oxycodone reduced by large % according to NCCI 

FROM WASHINGTON STATE TO WASHINGTON, D.C. – A MODEL FOR COORDINATED SERVICES

 

Washington State has shown that creating a community-based program that brings together medical providers, employers, and injured workers helps ensure timely, effective, and coordinated services for injured workers. Now efforts are underway by the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) to pilot this program in eight other states.

A distinguished panel will talk about the origins of this program, what makes it successful, and the potential lessons that can be learned by stakeholders.

 

Moderator:

  • John Ruser, WCRI

Speakers:

Prof. Tom Wickizer, Ohio State University College of Public Health

  • SSDI – 1/3 were through Workers Comp system 
  • 90 days is a maximum timeline before return to work problems

Jennifer Sheehy, U.S. Department of Labor’s Office of Disability Employment Policy (ODEP)

  • RETAIN – Retraining Employment and Talent After Injury Network 
  • RETAIN Phase 1 Awards Announced
    • California
    • Connecticut
    • Kansas
    • Kentucky
    • Minnesota
    • Ohio
    • Vermont
    • Washington

 

First Day – Afternoon – WCRI Annual Conference 2019 – Live Blogging 

UNIONS AND MANAGEMENT: CREATING A SUCCESSFUL RETURN-TO-WORK PROGRAM

 

In keeping with our conference theme, Dr. Cameron Mustard, president and chief scientist at the Institute for Work & Health (IWH), will present his research on the challenges and successes in implementing a comprehensive and collaborative return-to-work program for a large acute-care hospital system employing 4,000 people.

 

The hospital became concerned about the high costs of workplace injuries and illnesses. Explicit policies and procedures had not been developed for supporting those on sickness absence to return to work. Accordingly, the number and duration of its workers’ compensation claims were double those of its health-care sector peers. To turn this around, the hospital and its three unions worked together to develop and implement an innovative, evidence-based return-to-work program.

 

The findings Dr. Mustard shares may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program.

 

Moderator: Andrew Kenneally, WCRI

 

Speaker: Dr. Cameron Mustard, Institute for Work & Health

 

Canadian Based 

Return to Work – Accommodation policy 

James J Moore   My personal experience is that Unions can be tough places to return an employee to gainful work due to the many agreements that caused complications on light duty, or modified work.  

7 evidence based principles for return to work 

  1. Safety driven
  2. Employer has to offer work
  3. Does not negatively impact coworkers 
  4. Early contact after return to work after accident by supervisor
  5. Supervisor are trained in work disability 
  6. Someone has the responsibility for return to work 
  7. Employers and providers communicate with each other 

 

Methods

Process evaluation – Qualitative interviews with supervisors

Outcome evaluation – quasi-experiment 

Outcomes 

Disability duration days reduced from 19 to 10

GROUP HEALTH DEDUCTIBLES AND WORKERS’ COMPENSATION

 

Previous research offers evidence that a sizable proportion of workers with work-related injuries do not file for workers’ compensation, suggesting that filing for workers’ compensation may involve some costs to the worker, whether actual or perceived.  
 
However, as high deductibles increase out-of-pocket costs for injured workers receiving medical treatment through their group health plan, they may find filing for workers’ compensation coverage more attractive, especially since medical care under workers’ compensation has no cost-share component.
 
In this session, WCRI’s Dr. Olesya Fomenko will present the Institute’s research on the relationship between deductibles in group health and filing in workers’ compensation.

 

Moderator: Ramona Tanabe, WCRI
 

Speaker: Dr. Olesya Fomenko, WCRI

I wrote an article on this study at this link. 

When workers are facing high deductibles for their health insurance, the employees may file for workers compensation coverage. 

No deductibles or co-payments in workers comp. 

In 2017 workers were responsible for over 81% of their deductible – it was 59% in 20018

Annual deductibles grew from * in 2008 to * in 2017 

Do workers actually substitute Workers Comp for health insurance  – case shifting 

Reasons for workers not filing Workers Comp claims 

  • Lack of info
  • Employers discourage filing a claim
  • Stigma and loss of bonuses/overtime pay
  • Availability of health care coverage

Findings

  • Workers respond to higher deductible insurance at the the time of injury
  • Increase in WC filing concentrated in states where workers choose their initial provider 
  • Not much difference in states where the employer controls initial provider choice 

INNOVATIVE EMPLOYER IDEAS WCRI Annual Conference 2019

Time: 3:15 p.m. – 4:15 p.m.

 

Across the country, employers are taking innovative initiatives to ensure those injured at work receive the support they need and return to work.

In this session, a panel of large, well-known employers representing different industries will engage in an open and free-wheeling conversation about the workplace, innovations they have implemented to handle workers’ compensation issues, and what significant challenges they’re focused on now and in the future.

 

Moderator:

  • Laure Lamy, WCRI

Speakers:

  • Dawn Goree, Director of Workers’ Compensation at The Home Depot
  • Marc Salm, Vice President of Risk Management at Publix Super Markets
  • Noreen Olson, Workers’ Compensation Claims Manager at Starbucks Coffee Company

Question on Innovations 

Starbucks – Injured workers receive the same level of care as the customers 

  • Advocacy Model
  • Transparency
  • Challenge Status Quo of claims handling 
  • Self Reporting without going through manager 
  • Call into claims center to file claim 
  • Direct deposit of claim payments 
  • Calls from claims examiner and from Starbucks contact 
  • Early Return to Work 
  • Telephonic Nurse Case Managers > Self Care
  • Physician partnerships – knowledge of barista job functions 

Home Depot 

  • Employee advocacy model
  • Nurse case manager involved early in the process 
  • Non-adversarial

Publix 

  • Full claims self administration 
  • Nurse Case Managers
  • Two industrial medicine clinics
  • Tele-medicine pilot
  • No TPA involved 
  • Nurse Case Managers – exception reporting 
  •  Physician scorecard provided by Encompass

Changes in Workforce – Aging, etc. 

Home Depot 

  • Nature of the work makes colleagues 
  • Very different workforce – melting pot 
  • Aging workforce challenges – comorbidities – pre-existing conditions 

Starbucks 

  • Most workers are younger than average 
  • Commitment to hiring veterans, the disabled,  refugees

Publix

  • Large amount of aging workforce 
  • Warehouse database of comorbitiies and other statistics 
  • Changed a large amount of employment forms 

Litigation Changes 

Publix 

  • Legal fees increasing in all states 
  • Increase in $150K+ (within 24 months) or greater claims
  • 2015 Supreme Court decision made Florida much more costly – increase legal fees 
  • Claimants’ legal fees have increased significantly, Employers’ legal fees flat 

Home Depot

  • Advocacy model including claim partner vendors 
  • Golden Rule 
  • Walk the Talk
  • Prevent distrust means lower litigation 

Starbucks 

  • Thinking about the end result of the process 
  • How will this life-change affect the injured employee? 
  • Education of the Workers Comp system lowers litigation 
  • Moment of opportunity

WCRI

  • From their studies – Trust is tantamount 

Q&A

Most pressing challenge – Publix Legal Fees,  Home Depot comorbities and  Starbucks return to work 

Communication with millennials –  Home Depot -, Starbucks – it is a problem, use smart technology, push text and regular texts, return call monitoring, Home Depot – captive audience (?) 

Medical control Publix In only medical control states, Starbucks – partnering with first in class physicians – local providers, text medical information guide

How immediate contact to the employee is managed post-accident Publix – workplace culture   Home Depot – workplace culture, help employees through the Workers Comp process

2nd Day – Morning Conferences – WCRI Annual Conference 2019 – Live Blogging 

STATE OF THE STATES: SELECTIVE FINDINGS

Time: 9:30 a.m. – 10:15 a.m.

 

This session will discuss some of the latest findings and trends seen across WCRI’s core benchmark studies, including WCRI’s 18-State CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.

This session will be helpful to stakeholders and public officials who are looking to better manage change and control costs while improving outcomes of injured workers.

Speakers:

  • Carol Telles, WCRI, Facility Costs and Use: Factors in Interstate Differences and Trends
  • Evelina Radeva, WCRI, Comparing Benefit Delivery Expenses
  • Rebecca Yang, WCRI, Frequency, and Costs of Lump-Sum Settlements

Carol Telles, WCRI, Facility Costs and Use: Factors in Interstate Differences and Trends

Facility payments Accounted for 17% of all medical payments 

44% of Iowa claims had facility payments 

Georgia had very high facility payments – ASC’s  >20%

25% of claims had facility payments in New Jersey-ASC’s 

Louisiana had highest facility payments – 12,500+ – ASC’s

North Carolina had largest decrease in Hospital Outpatient services – decrease of 10% 

  • Fee Schedule changed to Medicare Basis 
  • Immediate reduction in use and payments of Hospital Outpatient Services 

California had 5% decrease in major surgery between 2011 and 2017

  • Alternative to surgeries used 
  • Active payor management
  • Changing in surgical mix 

Neurological spine pain injury decreased from 28% to 21% 

Iowa had 20.8% reduction in Low Back disc surgery from 2011 to 2017 

North Carolina was only state with ASC reduction facility payments = -9%

New Jersey increased 50% payments to ASC facilities 

Increase of network may impact ASC payments 

Evelina Radeva, WCRI, Comparing Benefit Delivery Expenses

Benefit Delivery Expenses (BDS)

Typical Study State Lost time claim $42,000

BDS = 15% of claims cost

Medical Cost Containment and Litigation Costs 

TX, NJ, CA had highest BDS – CA = 22% 

NJ had highest Medical Cost Containment

LA had highest litigation expenses 

LA had 31,082 of medical cost containment and medical expenses 

Iowa and NJ have no fee schedules <<<

LA has highest defense attorney costs = $7,300

LA, CA, and NJ had highest growth rate  in BDS costs 

LA and NJ had highest growth in Medical Cost Containment costs 

Defense attorney costs almost doubled between 2011 and 2017 <<<<wow

Rebecca Yang, WCRI, Frequency, and Costs of Lump-Sum Settlements

Workers Comp system designs had effects on lump sum settlements 

  • Type of benefit
  • PPD benefits 
  • Limitations 
  • Speed of system 

Large variations of % of claims with lump sum settlements 

40% of claims have lump sum settlements in IL 

PA almost $60,000 lump sum settlement averages 

FL had the most early settlements 

MI had the most late-claim settlements 

14 states were flat in lump sum settlement growth 

 

CHALLENGES & OPPORTUNITIES OF TELEMEDICINE

 

Telemedicine can speed care to injured workers, especially those in remote areas; enhance the patient experience; and reduce costs for payors. However, there are also concerns about reimbursement for physicians, quality of care, privacy, and other issues. 

Our seasoned panel ─ made up of a senior policymaker from a large state, a veteran medical practitioner, a large employer, and a labor official ─ will discuss the opportunities and challenges associated with this innovative model for delivering medical care. 

 

Moderator:

  • Dr. David Deitz, David Deitz & Associates

Speakers:  Two others below 

  • Dan Allen, Construction Industry Service Corporation (CISCO)
  • Dr. Stephen Dawkins, Caduceus USA

Dr. David Deitz

Geography and Age were major determinants of Telemedicine use 

  • Older patients 
  • Rural patients 

Really no studies on Workers Compensation and telemedicine 

Telemedicine covers major intersections drivers 

  • Medical technology 
  • Value-based medicine 
  •  

Kurt Leisure, The Cheesecake Factory

Nurse Case Management Model – Nurse Triage >>transfer to tele-doctor 

24/7 accessibility to treatment – immediate medical care -RX to pharmacy of employee’s choice 

Bilingual physicians 

Employee may never have to leave worksite to receive treatment<<<Interesting 

Concern – Adoption by staff 

$153,000 (estimated) in 2018 hard dollar savings 

 

Amy Lee, Texas Department of Insurance

Senate Bill 1107 changed medical practice rules 

Before SB 1107 – only face to face Dr. appointments 

How to incorporate telemedicine into Work Comp medical network? 

How to make sure that employee has choice of medical practitioners 

Rule 133.30 – Defined telehealth and telemedicine 

Study data is limited – 100 claims as of 9/1/2018 

Q&A

Quality of care – when the employee asks for an in-person Dr. visit – 

  • Cheesecake Factory – employees always have the option to see another Dr. 
  • State of Texas – choice = satisfaction, full explanation to injured employee

Equipment Issue>>Bandwidth>late adopters to technology

  • State of TX – rural parts of TX have low quality internet, 
  • CISCO – Technology clinics at Union Halls 

HAS THERE BEEN AN EROSION OF WORKERS’ COMPENSATION BENEFITS?

WCRI Conference 2019 Picture of CEO John Ruser

Workers’ compensation benefits as a share of payroll are at their lowest level since 1980 and this share has been declining for over a quarter century. Some point to a legislated erosion of workers’ compensation benefits, but data suggest that many factors account for the decline.

 

In this session, WCRI CEO Dr. John W. Ruser will highlight contributors to this trend, emphasizing the ubiquitous declines in injury rates and workers’ compensation claim rates that are partially offset by increases in injury and claim severity. John will also identify factors responsible for these offsetting trends, including improvements in safety, changes in the mix of jobs and compensability rules, the aging workforce, and economic conditions. 

 

Speaker: John Ruser, WCRI

Now –  83 cents is paid in benefits for each $100 in payroll 

Many other factors may have been responsible for possible erosion in benefits 

Dramatic decline in frequency of workers comp claims 

BLS – injury rates are 1/3 of what they were in 1994

Decline in frequency in the US is very similar to European decline rates 

Global factors are responsible for decline in injury rates 

Reductions are industry-specific (internally)

  • Manufacturing 
  • Trade, transportation, and utilities 

Injury rates declined  41.9% for Construction between 2008 2017 

Overexertion injuries fell 69% between 1992 and 2010 

Contact with objects injuries fell 64% 

Underreporting of injuries 

  • Employer – Avoid OSHA inspections,, Lower WC premiums
  • Workers – fear of being fired, loss of wages 

Type of injury reduction – BLS – Sprains – 75% reduction

End of WCRI Annual Conference 2019

 

©J&L Risk Management Inc Copyright Notice

 

 

 

 

 

 

Filed Under: WCRI Annual Conference Tagged With: Alan Krueger, CEA, chronic pain, fentanyl, keynote focused, non-Hispanic Americans, Princeton University, refugees

2018 WCRI Conference – Top 10 Things I Learned Over Two Days Time

March 27, 2018 By JL Risk Management Consultants

Top 10 Bits of Information From The 2018 WCRI Conference

The 2018 WCRI Conference was a smashing success – as every year.   The data given out was next to amazing – as every year.  I live blogged the 2018 WCRI Conference on this webpage.   Please excuse typos, etc. as I was typing it as it happened.   This year was tough blogging for some reason. 

Boston Flag Picture 2018 WCRI Conference

Public Use License

 The Top 10 takeaways<<never liked that word<< were:

  1. The BLS is much more helpful than just spewing numbers and stats.  You can talk to someone on the phone.   This info came directly from the prior Director of BLS – found that out at happy hour.   I may write an article on how to call them.  They have digital librarians that will help you find the information – Cool!!! <<Data nerds take heart!!
  2.  The subject of Opioids can still dominate a conference.   I thought this subject had passed, but there are a ton of studies out that rank them as less effective once thought
  3. The attendance numbers at the conference were amazing with a winter storm in effect.  The winter storm consisted of a few hours of snow which is not a big deal for Bostonians.   I freaked out when I saw the snow going sideways.   Many incoming flights were canceled.   Next year’s conference is in Arizona.  
  4. Marijuana was a big subject at the 2018 WCRI Conference.  An economist from the state of Georgia and his daughter pulled together some very incredible numbers.  A father/daughter statistical team seemed cute until he produced tons of slides with great numbers.   The numbers seem to show that states with relaxed marijuana laws had lower opioid user overall.  
  5. Stacking projections on top of projections lessen the accuracy of the final numbers.   For example, if you are flying and making two connections, and the on time %’s are .9, .9, and .8 the likelihood of you being on time is multiplicative.  You have only a 64.8% chance of being on-time even with those high numbers.   Stop calling me a data nerd, please. 

    National Safety Council 2018 WCRI Conference Logo

    Public Domain by Kopiersperre

  6. The panel was outstanding this year.   Some people left early and missed a great panel.   I blogged live as hard as I could for an hour to get all the info and questions.   Dr. Ruser asked great questions and led the panel well.  I have seen some panels where the moderator loses control and the panel goes right into the toilet – not in this case. 
  7. One of the smoothest presentations (you can tell that she does it for a living) was from the National Safety Council.   I rarely compliment someones presentation at the end.  I did tell her she was good at what she did – from voice inflection to hand gestures.   
  8. United Airlines uses in-airport clinics at their major hubs.  The woman that runs the Risk Management Department had to absorb the Continental claimants in the merger.   Mergers can be nightmares on the Workers Comp departments.   The in-airport clinics go right along with my Six Keys To Saving On Workers Compensation Costs that I wrote in the 1980’s.  
  9. The conference is always a good one to network.  This goes to show that you do not have to slap up 100 booths to have a conference where you can actually talk to people that are very receptive to communicating with you.   
  10. I blogged the whole conference live.  This year was very tough for some reason.  I infused the introductory material but it seemed to be too preliminary to provide any benefit.   My wrist did swell for two days, but it was worth it to get out as much information as I could to the blog and newsletter readers.  
  11. Bonus – The people at WCRI are always more than gracious.  The Director Dr. John Ruser, Andrew Kenneally, and Dr. Thumula went out of their way to talk to me and make me feel very welcome at various points during the conference. 

I may have missed something in my Top 10.  However, I did this from memory so it was what stayed in my mind for five days.   

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference Tagged With: BLS, Bostonians, Continental, Dr Thumula, Dr. John Ruser, multiplicative

WCRI 2018 Conference Boston MA – Blogging It Live

March 22, 2018 By JL Risk Management Consultants

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

WCRI 2018 Conference Commisioner Groshen picture

 

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?

WCRI 2018 Conference Picture of Value Base Care Presentation

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

WCRI 2018 Conference Picture of Pharmacy Management Program

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.

In this session, Dr. Welsh, OBWC’s chief medical officer, will discuss the initiation of the Bureau’s interventions to address the opioid epidemic, the impact of those interventions, and what the OBWC has on the horizon to build on its successes.
 
Ohio Workers Comp vs Opioids-
  • 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

WCRI 2018 Conference - Dr. Richard Victor portrait photo ​

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 

  1. May fracture the grand bargain 
  2. WC is too small 
  3. May meet successful constitutional challenge
  4. 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

Picture of Opioids computer wcri 2018 conference

​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 

  1. Physical Medicine $41 -Oupatient 
  2. 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?

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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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Filed Under: WCRI Annual Conference Tagged With: Labor Trends, medical marijuana, monopolistic state fund, Ohio's state-run monopolistic, opioids, United Airlines, Value based healthcare, Workers Compensation Insurance

2017 WCRI Conference 2nd Morning Session Blogging Live

March 3, 2017 By JL Risk Management Consultants

2017 WCRI Conference 2nd Morning Session

Live Blogging – typing it as it happens

STATE OF THE STATES

The start of the 2017 WCRI Conference 2nd morning session will discuss some of the latest findings and trends seen across WCRI’s core benchmark studies, including WCRI’s 18-State CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.

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This session will be helpful to stakeholders and public officials who are looking to better manage change and avoid the historic pattern of crisis-reform-crisis that has frequently characterized workers’ compensation in the past.

Carol Telles  – WCRI

  • Less hospital use in the 18 states WCRI analyzed
  • Since 2000 33% increase in outpatient admissions
  • 2000 – 2008 increase in hospitalization – then decrease
  • Kentucky and Minnesota were the two most significant decreases almost 4%
  •  New Jersey back surgeries (outpatient) increased but inpatient decreased 
  • 2000 – 2014 60% increase in ASC’s – ambulatory surgery centers
  • North Carolina and Georgia had most significant decreases in inpatient surgeries
  • ASC’s are 50% cheaper
  • Wisconsin had highest charges for hospital outpatient physical medicine
  • Texas has highest decrease in radiological studies outpatient 

Will Browder 

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  • Indiana had one of  lowest indemnity payments per claim 
  • North Carolina had one of highest indemnity payments per claim 
  • Iowa has highest maximum weekly benefit level – $881
  • North Carolina House Bill 709 
    • 500 TTD week cap
    • 300 TPD week cap
    • Suitable employment definition narrowed  

Dr, Rebecca Yang 

Attorney Involvement 

  • Illinois had highest attorney involvement 52%
  • New Jersey had 49% attorney involvement 
  • Wisconsin and Texas had lowest attorney involvement 
  • Texas
    • limits attorney hourly fees to $200
    • Limits on lump sum settlements 
  • Wisconsin 
    • Clear standards for TD benefits 
    • Two PPD structure 
  • New Jersey 
    • PPD not paid voluntarily
  • Illinois 
    • No standards to PPD ratings 
    • Lump sums based on multiple factors not just PPD
    • PPD benefit is much lower so TTD benefit period lengthened 
    • Medical experts just one aspect in final determination of PPD 

COULD VALUE-BASED HEALTH CARE WORK FOR INJURED WORKERS?

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Currently, physicians and hospitals treating injured workers are paid using a fee-for-service approach, which reimburses based on the volume of services provided. Across the country, health plans and health care providers have been adopting the principles of “value-based health care” where providers’ compensation is based on the value of services and their impact on patients’ health and where alternative forms of reimbursement, such as bundled payments or capitation, are employed. Join us as we invite a leading expert on the topic to explain what “value-based health care” is and how it would apply to workers’ compensation.

Dr. Alexandra Page, Principal, Musculoskeletal Health Care Solutions

  • Value = Quality/Cost 
  • Components 
    • Evidence Based Medicine
    • Clinical Practice Guidelines 
    • Shared Risk 
    • Outcome Measures – Return to work 
  • Accountable Care Organizations (ACO’s) 

Questions

  • Doctors should share risk 
  • Kaiser at Work 

APPRAISING THE “GRAND BARGAIN” IN 2017

Grand 2017 WCRI Conference 2nd Morning Session bargain

Wikimedia Commons – AngMoKio

The workers’ compensation system was created over 100 years ago, and it has evolved over the years to meet numerous challenges. To lower costs, many states have enacted policies to control care and benefits (e.g., allowing the employer to choose the doctor or tightening eligibility for workers’ compensation benefits). For some, these measures have controlled costs without impeding care or access to benefits. For others, the policies enacted across the country have gone too far in reducing benefits and the amount and quality of care to injured workers, eroding the Grand Bargain and leading to constitutional challenges in some states. Join our diverse and distinguished panel of experts as they discuss whether the workers’ compensation system is still fulfilling its mission or needs revisiting.

Prof. Emily Spieler, Northeastern University School of Law
Dr. David Deitz, Principal, David Deitz & Associates
Dr. David Michaels, Former Assistant Secretary of Labor for Occupational Safety and Health (OSHA)
Mr. Bruce Wood, American Insurance Association

Why is Workers Comp being discussed nationally now? 

  • Workers compensation has been a flawed system
  • PPD compensation 
    • Many states went to an impairment-based systems
    • Used AMA guides – some with modifications 
  • Raising bar on compensability 
  • Utilization Review
  • TTD caps 
  • Is the Grand Bargain over? 
  • Many workers in the Workers Comp system are not doing that well
  • No generalized disability system – policy debate 
  • Employer cost vs. social insurance 
  • Workers comp credibility as social insurance 
  • Very complex system 
  • Oregon ruled that Workers Comp is unconstitutional – became a tort system – no avalanche of tort litigation
  • Causation issue becoming very thorny – bottom line is people need care

Do injured workers share a large brunt of the cost of being out of work?

  • Injured workers may not want to report an injury 
  • SSDI takes on quite a bit of the brunt of associated costs 
  • Are there impediments in the WC system that keep care/benefits/wage loss from being provided
  • Case shifting from SSDI to WC? 
  • 2010 Study – WC does not cause increases to SSDI costs 
  • NCCI – 12 weeks is average TTD period 
  • West Virginia – PTD awards-odd lot doctrine – system collapsed due to unsustainability 
  • What should the comp system pay for? 
  • Amputation study – 30 – 40% of amputation injuries not reported as WC? 

Level and Quality of Medical Care in WC

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  • Core problem – diverging from direction of general healthcare 
  • Don Burwick – triple aim – key – how are we delivering quality healthcare 
  • WC is headed in wrong direction 
  • Workers Comp medical system – should it be rolled into health?  Yes, but not the  disability system

Unsafe Employers 

  • German WC system has many more safety inspectors
  • Insurance carriers do bear some of the responsibility for safety
  • Better linkage between OSHA and insurance carriers
  • Many employers do spend funds on safety
  • Insurance carriers reporting to OSHA may not be good idea as injuries may not be reported
  • Experience Rating system has an element of confidentiality

Federal Oversight of Workers Compensation System

  • Disparity of benefits between state
  • Scheduled injuries is only one aspect of system
  • Some states have eliminated schedule
  • States have done a good job overall to move swiftly in the 1990’s  
  • All Federal systems in WC (FECA, Longshore, etc.) are very outdated and inefficient 
  • Lack of consensus may enable attorneys to expand to a tort system 
  • Indiana increased benefits 
  • Unemployment insurance is a good example of the Feds working with the states 

Questions 

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  • Technology is missing from WC agenda 
  • Is the safety net gone from the WC system?  Possibly with Opt Out
  • Subcontractor system has changed the system 
  • Impact of Fraud? – Fraud is not medical provider centered 
  • Statistics in Amputation study – OSHA logs – reporting issues? Data did not match – many studies that show amputations are not getting into the system
  • How does WC adapt to the future needs of workers? Need to think about TTD of workers that are not in present WC system.

Comments

  • Huge gaps in medical care in the Workers Comp system as compared to the healthcare system 
  • Indemnity benefits should be the focus – cash benefits- inequities across state lines-communication is the critical part as WC is not separate but included in the whole workplace scenario- if you wait until an employee is injured to be nice to employee, that is rather late 
  • Cannot adjudicate what is not filed in the system, credibility issue – how WC is viewed is critical to its survival 
  • Opt out is a big concern 
  • Injury prevention should not be ignored, how can we use the WC system to enhance safety 

End of 2017  WCRI conference 2nd Morning Session 

End of 2017 Conference 

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Filed Under: WCRI Annual Conference Tagged With: credibility, grand bargain, Longshore, State of The States, Value based healthcare

WCRI 2017 Conference Afternoon Sessions – Blogging Live

March 2, 2017 By JL Risk Management Consultants

WCRI 2017 Conference Afternoon Sessions – Blogging Live

Please note I only input the trends and not the exact numbers from some of the studies.  These studies are still in their preliminary phases. 

WCRI OPIOID RESEARCH & HOW STATES ARE COMBATING THE OPIOID EPIDEMIC

This is the start of the WCRI 2017 Conference afternoon sessions. Join us as we learn about WCRI’s latest research on interstate variations and trends in the use of opioids for workplace injuries across 25 states.

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We will also feature policymakers from different states who will share their initiatives to combat the opioid epidemic, to prevent inappropriate opioid use, and to provide help for those battling addiction.

Dr. Vennela Thumula, WCRI
Judge Omar Hernandez, Massachusetts Department of Industrial Accidents
Mr. William Emrick, Acting Commissioner, Kentucky Labor Cabinet

More Than 70% of injured workers with pain meds are still receiving an opioid 

Cannot live blog exact studies – preliminary 

Positive Results 

  • Arkansas had 83% of injured workers with pain meds prescribed had an opioid 
  • Kentucky and New York had largest reductions in opioid use
  • Michigan and Maryland had over 35% reductions in opioid use 
  • Kentucky and NY had PDMP requirements with the best results 
  • New York introduced Chronic Opioid Guidelines 
  • Quantity limits introduced in KY, -, – 
  • Kentucky shifted a large amount of pain prescriptions from opioid to non-opioid 

Negative Results 

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  • Louisiana and Pennsylvania have highest amount of opioids per claim 
  • Massachusetts and Wisconsin have the highest amount of mixing opioids with benzodiazepines
  • Louisiana and Florida have highest amount of mixing opioids and CNS Depressants  

Kentucky’s Battle with Opioids 

  • Kentucky, West Virginia , and West Virginia had an extremely high opioid epidemic
  • Senate Bill 176 was introduced in 2005 to created a PDMP
  • SB 176 was turned away
  • HB 1 introduced in 2012 – pill mill bill – not just Workers Comp claimants, general public 
  • KASPER – electronic reporting of all schedule prescriptions 
  • KASPER has to be checked regularly by physicians 
  • KASPER has to be in all medical records 
  • Criticisms – complicated the treatment system, etc. 
  • HB 217 to eliminate problems by HB 1
  • HB 296 requires Workers Comp Commissioner to establish a specific PDMP 
  • Heroin overdoses up in Kentucky, no studies related overdoses to reduction of opioid use as unintended consequences 

Massachusetts Opioid Crisis 

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  • Opioid Alternative Treatment Pathway 
  • Judges are in a dilemma – will usually send the case along to litigation, let the opioid alternative alone
  • One year to hearing
  • Post lump sum hearings – no compensation at risk
  • Medicals are lifetime in Massachusetts even if case settled 

Proposed Opioid Alternative Treatment Process 

  • Voluntary program 
  • Pilot program for two years 
  • Monthly status updates to Workers Comp Advisory Council 

ALTERNATIVES TO OPIOIDS IN TREATING PAIN

As injured workers are steered away from treating their pain with opioids, some in the workers’ compensation community have asked, “What is the alternative for treating pain?” Join us as we learn about two emerging alternatives: marijuana and evidence-based non-pharmacological treatments, including mindfulness-based and cognitive behavioral approaches. The session will feature the latest research on these alternatives as well as first-hand accounts from state government officials on how one alternative, medical marijuana, is being incorporated into the treatment of injured workers in their state workers’ compensation systems as well as what it is like to be managing a program that is very new and federally illegal.

Mr. Paul Sighinolfi, Executive Director of the Maine Workers’ Compensation Board
Mr. Paul Tauriello, Director of the Division of Workers’ Compensation, Colorado Department of Labor
Dr. Dawn Ehde, University of Washington
Dr. Dean Hashimoto, Chair of the Health Care Services Board, Commonwealth of Massachusetts

National Academy of Science Report  on Medical Marijuana 

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  • Improvement in chronic pan
    • Substantial evidence 
    • Very little known about efficacy 
  • Increased risk of vehicle crashes 
  • Development of schizophrenia and psychosis 
  • Marijuana cannot be associated with an increase in job injuries 
  • 25% decrease in opioid mortality rate in states that had medical marijuana
  • 20% decrease in opioid addiction rate in states with medical marijuana 
  • Federal laws are main obstacle
  • Lack of prescription standards, routes of administration, dosage
  • Difficult to conform to federal banking and other laws. 

Some states have allowed coverage in WC

  • California – Cockerell vs Farmers Insurance
  • Maine – Series of Cases 
  • Massachusetts – unpublished
  • Colorado – ? 
  • New Mexico 

Colorado

  • Obama administration – Ogden Memo loosened the Federal enforcement 
  • First to allow recreationally 
  • Smoothest harmonization 
  • Marijuana – $1.3 billion sales – 30% increase over last year

Maine

  • Certification as FDA has not approved, so no prescriptions can be written
  • Typical patient 58 year old with back pain 
  • Condition specific recommendation or certification 
  • November 2009 – 2.5 ounces
  • Added in intractable pain as a condition 
  • Burgoin case – ALJ ruled that marijuana was reasonable necessary, appealed to Supreme Court, cost of medications vs. just marijuana indicated a 75% in medication costs. 

Questions

Centered on concerns about

  • Operating a vehicle or
  • Being under the influence on-the-job 
  • Better way to treat pain that just prescribing marijuana – should be a total approach
  • Marijuana is another tool in the toolbox of  pain treatment

Non-pharmaceutical Pain Management 

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  • Biopsychosocial  Model of Pain 
  • Who manages the pain – the individual themselves 
  • Physical activity-Exercise 
  • Cognitive Behavioral Therapy – CBT –
    • changing the negative thinking 
    • better than no treatment 
    • magnitude of pain relief is similar to analgesics 
  • Mindfulness Meditation 
  • Should be integrated into overall pain treatment 
  • Collaborative Care – integrated healthcare – Care Manager is the hub of treatment 

Questions

How does one have the Workers Comp community accept the psychological treatment part of an injury as the attempt is to avoid this type of treatment  – screening at 6- 10 weeks of care for high risk to send to collaborative care 

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Filed Under: WCRI Annual Conference Tagged With: collaborative, Maine, non-pharmaceutical, opioid epidemic, Pain management, pharmacological

WCRI 2017 Conference – Blogging Live – Morning Sessions

March 2, 2017 By JL Risk Management Consultants

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 

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  • 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

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  • 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

Pharmacist And Woman With Baby WCRI Conference Picture

Wikipedia – Elmvh

  • 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 

United States Of America WCRI 2017 Conference Department Of Labor Logo

Wikipedia – U.S. Department of Labor

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 

Return to Work 

Man Talking To Colleagues WCRI 2017 Conference Room

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  • 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 

Woman Overjoyed WCRI 2017 Conference Room

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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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Filed Under: WCRI Annual Conference Tagged With: Democrats, Drl John Ruser, firm shrinking, HSA, Predictor, Republicans, SSDI

Opioids and Marijuana – WCRI Conference – Big Time Discussions

February 16, 2017 By JL Risk Management Consultants

Opioids and Marijuana Discussed @ Upcoming WCRI Conference

The sessions will run consecutively – two interesting topics for Work Comp 

Opioids and marijuana will be two of many great topics.  WCRI is hosting their annual conference on March 2 -3, 2017.   I have attended the last five meetings and will be at this one in Boston.  My main challenge in attending will be the high likelihood of Patriot fans. <<<kidding 

 

 

Picture of Opioids and Marijuana

Wikimedia Commons – United States Fish and Wildlife Service

According to a recent WCRI press release, a session on opioids will be followed by a session on marijuana as it relates to Workers Comp, specifically the control of opioid abuse, and the use of marijuana as it affects the workplace.   As you may know, many states have legalized the recreational use of  medical marijuana while a few have even legalized its recreational use – Think Colorado. 

According to WCRI –

The latest opioid prescribing trends, first-hand accounts of how states are combating the opioid epidemic, and alternatives to opioids will be discussed during two exciting sessions at the Workers Compensation Research Institute’s (WCRI) 33rd Annual Issues & Research Conference, March 2-3, 2017, at the Westin Copley Place Hotel in Boston, MA.

WCRI’s CEO John Ruser, whom I met last year at the conference made a very poignant point: 

The dangers of prescription drug misuse resulting in death and addiction constitute a top public health problem in the United States and the workers’ compensation community,”

The first session discusses WCRI’s latest research on:

  • Interstate variations and trends in the use of opioids for workplace injuries across 25 states
  • Features senior policymakers from two states, Massachusetts and Kentucky, who will share initiatives taken by their states to combat the opioid epidemic
Picture Of Opioids and Marijuana Leaves

Wikimedia Commons – User:Jennifer Martin

The second session will discuss two emerging alternatives to opioids:

  • Marijuana
  • Evidence-based non-pharmacological treatments – meditation?
  • First hand accounts from senior policymakers in Maine and Colorado on what it is like to manage a program treating injured workers with marijuana, which is very new and federally illegal.

The WCRI conference is a leading workers’ compensation forum for policymakers, employers, labor advocates, insurance executives, health care organizations, claims managers, researchers, and others. It is a great  two-day program.  If you have anything to do with WC data or want to explore a very different and fresh slant on some of the rating bureau data, you may want to consider attending the conference. 

For our readers, I will post some of the discussions, but there is so much good data and presentations, I may not do the conference justice.  See you in Boston. 

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Filed Under: WCRI Annual Conference Tagged With: Drl John Ruser, Maine, non-pharmacological, Patriot fans

WCRI Conference Blogging Live – Sharing Economy and WC

March 11, 2016 By JL Risk Management Consultants

WCRI Conference Blogging Live

The WCRI Annual Conference Blogging Live 2016.

Presenter – Dr. Robert Hartwig- Insurance Information Institute

Picture of Conference Blogging Live Sharing Economy

(c) 123rf

Angie’s List

On Demand Economy

Handy

TaskRabbit

Washio

Wedding Wire

My Move

AirBnB

lyft

Uber

Insurance solutions are increasingly available for the sharing economy.

Regulatory issues remain

Gig Economy – Employee vs Contractor – Uber Lyft, TaskRabbit

In 2020, 80% of adults may own smartphone

Temporary Work rate has grown heavily – peaked in 2010 at 13.6% growth rate

Technology is transforming labor

Good job was created in the Industrial Age

Two schools of thought –

Tech decentralizes employees

Haves >>>needs without the use of a corporate structure

Low skill workers are further left behind

Employee vs. Independent Contractor court decisions are going to be even more critical

Gig Economy

  • 61% make
  • Race
  • All attributes are higher injury risks

Offerors of Gigs think that the workers are being exploited

Half of Gig offerors oppose regulations

Missed opportunity for Workers Comp insurers 

Will robots and automation destroy the Gig economy

Who owns the data?  Where does it flow?  Who does the analytics?  Who is the capital provider?

Fitbit – Wearable tech

Ingestibles and implantables  

Insurance industry is not laggard in the economy – have always been on the forefront for coverage

Questions – any job that you do that is repetitive and has a database of your job duties makes you very replaceable

Surge in temporary employment affected full time employment

Download presentation at www.iii.org/presentations

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Filed Under: WCRI Annual Conference Tagged With: AirBnB, Dr. Robert Hartwig, Gig economy, Sharing economy

CompScope WCRI Blogging Live – State of States

March 11, 2016 By JL Risk Management Consultants

CompScope – State of the States – WCRI – Blogging Live

States of the States WCRI CompScope annual conference 2016 Blogging Live.

Preliminary  Research  – Subject to change –

Over view of Hug conference room CompScope in palace of nations

Wikimedia Commons – Tryfon Kar

Two New States  – Kentucky and Georgia are being added to the CompScope(R)

Wage Loss States that have wage loss and PPD – North Carolina and Georgia

Wage Loss states are not PPD states –

Georgia 

TTD = Temporary Total Disability

Georgia is a combined PPD and Wage Loss state

TTD benefits paid – No maximum medical (MMI) in Georgia

TTD maximum weeks = 400 weeks

Maximum 300 PPD Weeks

Georgia – one of higher states for TTD – median state $18,313

Georgia – Approximately $26,000 per claim average on TTD

Weekly TTD benefits rate lower than median state

Average duration of TD benefits  were lower than median state

40% lower statutory maximum

31% of claims were limited by maximum TTD rate – highest of all studied states

Georgia and North Carolina had the highest rate of lump sum settlements

Big Conference Room CompScope Empty

Wikimedia Common -Own work

Georgia had:

  • higher medical benefit involved in PPD settlements  than median states
  • higher litigation related expense than median state
  • higher  payments for defense attorney than the median state
  • is based on an administrative system

Kentucky 

No TPD – Temporary Partial Disability

Longer Temporary Total Disability period

Kentucky is close to median state for TTD length

Kentucky  was:

  • PPD benefit payments were higher than the median
  • Close to median state were for benefit delivery expenses
  •  Medical-legal services expense were much higher than the median state

Medical trends across the States 

Half of studied states – had a moderate growth rate in medical costs

The other half had very low growth rates in medical costs

What factors caused the very low growth rate?

  • Illinois –
    • 30% reduction in fee schedule rates 
    • 29 different fee schedules in the state (regions) were reduced to 4
    • 76% higher than Medicare fee schedule rates
  • North Carolina  –
    • Outpatient hospital -utilization per claim lowered
    • Fee schedule reduced outpatient charges from 95% of charges to 76% of charges
    • 2013 – froze rates – cut by 15%
    • Outpatient hospital rates were tied to Medicare rates in 2015
    • Goal – balance out hospital charges with non-hospital charges
  • California  –
    • SB 863 effects
    • Reduced ASC rates from 120% to 80% of Medicare outpatient hospital rates
    • Trend of billing frequent complex office visits stopped in 2014
    • Neurological testing fees reduced by 43.6%
  • Louisiana –
    • Colorado – based guidelines introduced
    • Decrease in medical visits per claim possibly due to changes in 2011

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Filed Under: WCRI Annual Conference Tagged With: highest rate, litigation, lump sum, neurological

Opt Out 2nd Panel – WCRI Blogging Live – Boston MA

March 10, 2016 By JL Risk Management Consultants

Opt Out 2nd Panel – WCRI Conference

These are the Opt Out 2nd Panel of WCRI conference  blogging live.

Rating of Opt Out 2nd Panel Events

Wikimedia Commons – Fabrice Florin (WMF)

Presenters –

  • Bruce C Wood- American Insurance Association
  • Elizabeth Bailey- Waffle House
  • Alan Pierce – Workers Injury Law and Advocacy Group
  • James Mills- Oklahoma Insurance Department

Great Panel

Bruce Wood- Basically not a proponent of Oklahoma Opt Out – Is flawed and should be enacted

Elizabeth Bailey – Waffle House- Texas Opt out only – no Oklahoma

  • Texas WC system was broken
  • Medical providers were cost drivers not attorneys
  • Lifetime medical benefits

Key Benefits-

  • Cost reduction
  • No litigation – virtually
  • Medical provider selection
  • Plan flexibility
  • Improved workplace safety program
  • Improved communication
  • Decrease in claim cost
  • Claims cost reduced 57%
  • Indemnity costs down 99%
  • Overall savings $9.7 million
  • Indemnity claims were reduced from $6,502 per restaurant to $65
  • 5  litigated claims since 2003
  • Last attorney involvement was 2011
Hand Illustrating Opt Out 2nd Panel Insurance Icon

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Waffle House = Impressive Employer with good communication 

Alan Pierce – we may be forgetting the employee in the process

  • Opt out is inconsistent with access  to administrative courts and due process
  • Workers compensation is not another Employer benefit plan
  • WC is a right owned by and owned to workers

James Mills – Oklahoma Department of Insurance

  • Consumer oriented
  • Most expensive Workers Comp state
  • Not data driven issue
  • Title 85 of Statutes
  • Work Comp Act Code
  • Used to be one of two court-based systems
  • Senate Bill 62 = Comprehensive reform > 200 pages
    • Opt Out
    • Residual Market reform

No more room at the table for any more parties in the Workers Comp process

Early medical treatment is a cost reduction driver

Oklahoma option will change and grow over time.

Question to James Mills concerning employee choice of medical treatment – is it a benefit?

Very good comment – lowering claim reporting does not equate to better safety

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Filed Under: WCRI Annual Conference Tagged With: due process, Texas non subscriber, Waffle House

WCRI – Blogging Live – Controversial Opt Out Panels

March 10, 2016 By JL Risk Management Consultants

Controversial Opt Out Panels

The blogging live controversial Opt Out panels in WCRI

Two Presenters –

Trey Gillespie – Property and Casualty Insurers Association of America

Bill Minick – PartnerSource

Graphic of Controversial Opt Out Panels Concept

123RF

Opt outs as a form of Workers Compensation coverage has been in Texas for quite some time.   Texas’s program has been successful.  Oklahoma is still the fulcrum of a recent controversial decision.

Opt out is ERISA based.

No admission of liability .

Many common exclusions.

Many of the cause of injury aspects  in the regular insurance market look very similar to the Oklahoma Workers Compensation Opt out rules.

However, there are  Conditions and Limitations:

  • Benefits stop if employee leaves the company
  • FMLA protections to 12 weeks
  • Reporting requirements (24 hour delay max)
  • NCCI say only 20% of  Lost Time injuries are reported within 24 hours.
  • 93% of costs are allocated to Lost Time vs. Medical Only claims
  • Medical plans are made by plan administrator
  • Medical benefits may be terminated before care ends- this varies greatly from regular WC coverage
  • Medically necessary – the cheapest way to treat, if no treatment in 60 day = termination of benefits
  • Continuing medical maintenance differs greatly from regular WC coverage.  Palliative care – whether required or not is not covered
  • Voluntary settlements are based on Plan Administrator evaluation
  • Often refers to “Dillard Decision”
  • Limited appeal rights
  • No payment of PPD (Permanent Disability) benefits are not covered.
  • Quote From Dillard’s decision – Injured workers not treated equally under opt out

Bill Minick presentation-

  • Same mutual goals
  • Determining Good Public Policy
    • Experiments -rigorous assessments
    • No anecdotal experiences
  • 1.5 million workers covered
  • 50,000 claims resolved annually
  • $0 spent by regulatory industries
  • $125 million annual claims cost
  • $1 Billion in direct written premiums over the past decade.
  • 1,000 private sector jobs
Woman Controversial Opt Out Panels At Office

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Benefits are mandated

Liability Exposures

Financial Security Requirements

Employee protections – safety such as OSHA

Disclosure rules

  • Written plan document
  • Definitely determinable benefits
  • Understandable

Fiduciary rules

  • Acting in employee’s interest

Claims Procedures

Enforcement- there are civil and criminal penalties

There is no perfect grand bargain

93 Texas settlements in Excess of $1 million

ERISA requires that Opt Out benefits are communicated to the employees in a language that they can understand  – Workers Comp has an issue with being mysterious

Immediate reporting requirement leads to better outcomes

Medical providers should be held accountable

Evidence based medicine

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Filed Under: WCRI Annual Conference Tagged With: fulcrum, palliative care, rigorous

WCRI Blogging Live- Crossing State Lines For Medical Care

March 10, 2016 By JL Risk Management Consultants

WCRI Blogging Live – Medical Care

This is the WCRI blogging live crossing States lines for Medical care

Ambulatory Surgical Centers (ASC’s) – in New York City vs. New Jersey

Preliminary Findings

Picture of WCRI Blogging Live People of science During Medical Conference

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Dr. Brogdan Savych – medical researcher and author  for WCRI

Shoulder Arthroscopies average ASC cost increased significantly from 2011 through 2014 – 25%+ per year.

Half of all surgeries in New Jersey ASC’s are from New York claimants

New York City injured workers treating in New Jersey – 326% more than New York.

Pennsylvania workers on the New Jersey border do not treat that much in New Jersey.

The questions I had on this session, but had to step away to take a phone call were:

  • Why did Pennsylvania workers not treat that much in New Jersey
  • Were the physicians from New Jersey recruiting the injured workers ?
  • What are the medical control statuses in Pennsylvania, New York, and New Jersey? 
  • Is there any upcoming legislation in any of these states that would change the treatment dynamics presented? 

I will definitely have to update this article after I read the conference manual on this presentation. 

____

Comment – Medical control in New York?   This article was from WCRI Blogging Live 

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Filed Under: WCRI Annual Conference Tagged With: Arthroscopies, Dr. Brogdan Savych, treatment dynamics

California Medical Review and Dispute – Blogging WCRI Conference

March 10, 2016 By JL Risk Management Consultants

California Medical Review and Dispute Blogging Live WCRI Conference

California Medical review and dispute is a white hot topic amongst risk managers presently.  One of the hot sub-topics now is the amount of money charged for UR (Utilization Review) in California.  

In our claims loss run analyses, we find that California ALAE Allocated Expenses to handle a claim can actually cost more than the benefits provided to the injured employee.  No other state comes close to this amount. 

Picture of California Medical Review National Healthcare System

123RF

One recent estimate showed that the cost for UR was more than the medical charges themselves.   The UR charges have grown steadily over the past ten years.  The employers have to pay the final bill for the UR charges either by paying an increased premium due to the rates and a higher XMod or budgeted funds for the self insureds.  

As this one is in the conference book, and there were so many great charts which covered so much great info,  I will cover this one soon.   I cannot give this section justice without reviewing the charts more closely.  I am trying to juggle doing interviews with the presenters and doing live blogging. 

Some of the more interesting statistics-

  • 1% of doctors accounted for 46% of IMR (Independent Medical Reviews)
  • 50% of pharmacy benefits go to IMR – no other medical service even close

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Filed Under: WCRI Annual Conference Tagged With: Independent Medical Reviews, UR

Blogging Live WCRI Comparing Workers Comp Outcomes Across States

March 10, 2016 By JL Risk Management Consultants

WCRI – Blogging Live

Comparing Workers Comp outcomes across states WCRI blogging  live. 

Subject to Further Research

One of my favorite WCRI studies – hard work on this one

Dr. Savych  and Dr. Thumula (WCRI) – presenters

These two presenters presented the initial study data last year- 2015.  It was groundbreaking as no one or company actually telephone-interviewed 6,000 injured workers – amazing study

Four Key Outcome Measures 

The four areas examined were:

15 State Median = 14% for no substantial return to work – workers did not return to work or did not stay at work for 30 days.

Indiana had lowest rate of no return to work- 9%

Georgia had highest – 19%

To be able to perform cross – state comparisons  data was normalized due to differences in state laws, industries, 400 interviews in 15 states = 6,000 kept n (number of interviewees  same).

The comparison were all for injured employees with more than 7 days out of work.

Used SF-12(r) measurement instrument

Average injury severity was similar across the 15 states studied

Reported Big Problems with Medical care = 17%  – 15 state median

Two common reasons of medical care dissatisfaction were:

  1. Employer did not want to provide the care
  2. Diagnosis dissatisfaction

14% – 15 State Median – for big problems with getting desired provider

  • 36% of those were discouraged by employer to use this medical provider

Wisconsin has lowest rate of dissatisfaction with medical care = 9%

Florida has highest rate of dissatisfaction with medical care = 20%

Aging was considered as a control factor.

One future consideration is the states that allow employer or employee medical control.

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Filed Under: WCRI Annual Conference Tagged With: Diagnosis dissatisfaction, groundbreaking

WCRI – Blogging Live – Do Fee Schedules = WC Case Shifting?

March 10, 2016 By JL Risk Management Consultants

WCRI – Blogging Live – Case Shifting and Fee Schedules

WCRI WC Case Shifting and do fee schedules.

Preliminary Findings

Dr. Osleya Formenko – Author – Impressive- Received Her Doctorate From Our HQ City  Raleigh – UNC

Dr John Gruber- Dartmouth Institute

Dr. John Ruser – Presenter

Picture Of Doctor Case Shifting Writing In Patient Chart

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There are many numerous articles on this blog concerning fee schedules

Workers Compensation usually pays more than Health.

Expect that claims shifting is more likely in the states that have higher WC rates than health.

Workers Comp is fee for service – more lucrative

The treating Dr. makes the work-relatedness call

Fractures lacerations contusions are obvious work relatedness

Back strain, knee strain, soft tissue

Dr. Gruber and Dr. Formenyko found that 20% increase in treatment prices  = 6% increase in WC claims vs health

The research indicated that there is a much larger cost factor than may be realized by the 6% when specific states are analyzed such as  Texas and Illinois.

The claims shifting for soft tissue injuries have more of an impact of case shifting to costs that are borne by employers in that state.

There will be further studies performed in the future to see if the number of WC cases / case shifting occurs in states that have a higher variability between health insurance and WC  rates ICD 10 codes, etc.

A great question- Some physicians have said that WC pays less than health insurance, research and data said WC pays more.

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Filed Under: WCRI Annual Conference Tagged With: cost factor fee schedule, Fractures lacerations, ICD 10 codes

Blogging Live WCRI 2016 Yearly Conference – Ground Rules

March 10, 2016 By JL Risk Management Consultants

Blogging Live WCRI Conference 2016 Ground Rules

OK, so there are a few ground rules with blogging live WCRI Conference.

Text Graphic Of Blogging Live WCRI Logo

(c) wcrinet.org

  1. Please excuse any typos or any weird looking info.   I am trying to follow the presenters, not necessarily the slides they present as to include info that will not be seen or heard elsewhere.
  2. Some of this is preliminary  information- may have further study results.  I will note that in the blogging when applicable.
  3. Please forward these onto any interested parties.
  4. I may not be able to cover all the sessions – if you see one you like, let me know and I will try to include it.  My wrists tire out after a few sessions.
  5. If you like the sessions, most, if not all, of the studies are available for purchase at  wcrinet.org   The price is usually very reasonable.
  6. I was the first one to blog Workers Comp Conference live starting with this one a few years ago. 
  7. There are many other live blogs from the prior years WCRI conferences.   You can find the by searching  wcri blogging in the search box at the top right of this webpage. 
  8. Blogging live is quite a bit of work

 

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Filed Under: WCRI Annual Conference Tagged With: ground rules, preliminary

Reforms – WCRI Conference Texas, Pennsylvania, Oregon and Florida

March 6, 2015 By JL Risk Management Consultants

Reforms – WCRI Conference

Reforms – WCRI – States – Texas, Pennsylvania, Oregon and Florida presented on the effects of reforms that were enacted in each respective state.

Reforms Conference for WCRI Emblem From Web

(c) wci360.com

Texas-

  • 270 insurance companies
  • 2.2 billion in direct written premiums

Texas had pre-reform-

  • High medical costs- over-utilization
  • Poor Return to Work outcomes
  • Poor access to care
  • High insurance premiums
  • Increasing Opt Out employers
  • Increasing number of medical disputes

Texas reforms-

  • Used data to identify medical cost drivers
  • Built medical infrastructure similar to health insurance
  • Evidence based medicine
  • Measured outcomes

Texas solution –

  • EDI (Electronic Data)
  • Administrative Dispute Process was initiated
  • pre-authorization requirements to have more carrier involvement
  • Adopted Medicare billing structure
  • Implemented certified networks
  • Implement closed pharmacy formulary

Texas results-

  • Average medical bill per claim was reduced significantly
  • Average premiums decreased 50% since 2003
  • Less employers opting out of WC system
  • Medical disputes fell 71%
  • Access to care improved

Pennsylvania

Act 44 – four areas of reform

  • Reduce medical costs, while not affected level of care
  • Address usage charges and utilization creep
  • Addressing litigation increases and related costs
  • Address the matter of who runs the insurance marketplace

Act 44 – results

  • Medical expenditures- patterned after most state systems and Medicare
    • Employer directed care expanded to 30 days
    • Medicare based fee schedule
  • Increasing litigation 
  • Competition in the WC marketplace

Act 57

  • Medical Management
  • Benefit Management
    • Offsets – SSDI , etc.
    • Limited PPD to 500 weeks
    • Dispute Resolution Management

Oregon

Reform  targets

  •  Ability to advise governor of bills that were not good for WC community.
  • Medical care improvement
  • Return to Work
  • AOE/COE – medical substantiation
  • Palliative care  limits
  • Timely Insurer benefit payments

Reform results

  • Rate reduction
  • Better medical care
  • MD and DO increased treatment, chiropractic care reduced

Florida 

System Success

  • Medical bills filed and paid timely 98.5% of the time
  • Petitions filed (litigation) has decreased by 2/3
  • Actual case litigation down by 50%
  • Coalition formed – 200 companies (carriers, employers, and associations)

Legislative continuity and leadership has been stable, no recent crisis

 

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Filed Under: WCRI Annual Conference Tagged With: chiropractic, infrastructure, respective state, utilization

Selected State Reforms And Their Effect – WCRI – Blogging Live

March 6, 2015 By JL Risk Management Consultants

Selected State Reforms And Their Effect

Selected State Reforms And Their Effect – The Effects of An Increase in Maximum Weekly Temporary Total Disability (TTD) Benefits or Fee Schedules Impact On Medical Costs –

Vector Of Injured Man Selected State Reforms With Broken Leg

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  • Indiana – 18% of injured employees had hit the maximum, after the reform – 12% of workers had their TTD benefits limited, a 6% difference and a 50% decrease
  • New York – 48% of injured workers had their TTD benefits pre-reform 2007, after the reform- 15% of injured workers had their TTD benefits limited by the maximum.  That is a stark figure.
  • Illinois – Fee schedule rates were decreased in 2010, the medical costs decreased 30%, was there actually a decrease as Illinois fee schedule charges were very high originally. 2006 fee schedule reform could be viewed as ineffective  Illinois was second highest fee schedule in the nation; office visits were affected more than many other types of services, WC office visits ended up being lower than Group Health or Medicare rates – (an over-adjustment?)

The two areas that seemed to have the highest impact were  the Illinois fee schedule subsequent changes and the New York maximum TTD benefit.

Q&A

TTD Limits – Why do limits even exist in WC?  The limits were sufficient in 1915.   What purpose does the limits now perform, are these limits irrational?

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Filed Under: WCRI Annual Conference Tagged With: Q&A, states reform, subsequent

State By State Analyses – ALAE Allocated Adjustment Expenses – WCRI Blogging Live

March 6, 2015 By JL Risk Management Consultants

ALAE Allocated Adjustment Expenses

The ALAE Allocated Adjustment Expenses of state by state analyses.

State by State Comparison of ALAE – represent 10 to 20% across States

Icon of ALAE Allocated Adjustment Expenses WCRI

(c) 123rf.com

Moderator- Ramona Tanabe

California highest overall

Medical Management ALAE – Highest states are Louisiana and New Jersey- interesting that the top two did not include California

There has been a steady Medical Management Expense increase over the last twelve years – 4-11%

Texas had an increase in ALAE medical management expenses even though medical costs decreased.   HB 7 caused a sharp increase in ALAE  medical expenses.    Informal networks were eliminated by Texas, only certified networks

In my humble opinion,  HB 7 harmed the WC community as the informal networks were very critical to cutting workers comp costs in Texas.

New Jersey actually had a 14% medical management cost in 2003.   By 2014, the medical management ALAE  increased to 23%.

The bottom line is that the medical management costs (ALAE) were justified by the decrease in medical costs- for most states. 

Litigation Costs

Defense attorney expenses were the highest across the states by far.    The state with the highest average amount of litigation ALAE was California.

The legal expenses seemed to be centered around:

  • The complexity of the state WC system
  • Length of process
  • Inefficiencies in the state WC system

Is there a right amount of medical legal medico-legal expenses across the states?  Is there a benchmark amount?  Are these caused by inefficiencies in the cost reduction systems.

ALAE is one of those areas where much more research needs to be conducted as it is not discussed as much as it should be overall.

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Filed Under: WCRI Annual Conference Tagged With: complexity, Inefficiencies, state analyses

Price Impact – Workers Comp Fee Schedules WCRI Blogging Live

March 5, 2015 By JL Risk Management Consultants

Workers Comp Fee Schedules WCRI Blogging Live

Workers Comp Fee schedules have long been discussed in this blog.  One of the best methods for a reduction in the premium employers pay for WC is by instituting or modifying fee schedules.

Vector Of Blogging Workers Comp Fee Schedules On Globe Icon

StockUnlimited

Workers Comp Fee schedules are a balancing act.  A fee schedule set too high means it will be basically ineffective.   A fee schedule set too low will heavily affect access of care.

Barry Lipton – Practice Leader and Senior  Actuary NCCI – Price Impact of WC Physician Fee Schedules

Even with discounts, the WC fees may not be a great reduction when compared to group health insurance:

  • One fourth of WC payments are 30%  more below the Maximum Allowable Rate (MAR)
  • One fourth of general health payments are 63% or more below the MAR

Fee schedules influence more than just the small portion of charges that exceed MAR

Fee schedules may have the unintended consequences  of increasing some payments

A discount from a fee schedule amount does not ensure a competitive price. 

To determine the effectiveness of fee schedules, it is important to consider market rates.

 

Woman Workers Comp Fee Schedules Calculating Bills

StockUnlimited

Perverse Effect Of Fee Schedules That Are Too Low

Do states that have low WC prices which pay lower than group health cause access to medical care complications?

42 states in US have fee schedule, 6 states have fee schedule rates below group health for intermediate physician office visits.

WC office visits in lower fee schedule states

  • usually bill as more complex office visits
  • physician-dispensed medications

From a California study, when the physician fee schedules are frozen,  then unfrozen, then frozen again, the physician stopped (while unfrozen) bill complex office visits.   When the fee schedule was frozen again, the physicians began billing for more complex office visits.

Radiological studies  that were reduced by fee schedules resulted in most billings for unscheduled services as the hospital would receive 75% of charges. (Florida Study).  Scheduled radiology was paid at a much-reduce fee due to the 2003 reforms.

Treatment and billing practices were changed to sustain revenue such as medical providers increasing the number of services and the intensity of the services.

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference Tagged With: Barry Lipton, MAR, maximum allowable rate, radiological

WCRI – Physician Dispensing Costs and Consequences

March 5, 2015 By JL Risk Management Consultants

Physician Dispensing Costs and Consequences

Picture Of Physician Dispensing Costs

Wikimedia commons – National Cancer Institute

WCRI – Physician dispensing costs and consequences major findings

  • Most reforms are price focused
  • Prices paid for physician dispensed drugs decreased substantially after post-reform
  • Fewer physician dispensed drugs after reform
  • Reforms may not be sustainable due to new drug strengths

18 states made changes to rules – reforms

Informs were mainly price focused

Not all reforms may have worked – Illinois had a large price increase post-reform on such drugs as Vicodin(r).  CA had increase in Cyclobenzaprine.

Price difference between physician dispensed and non-physician dispensed were reduced after reforms, but is still yet a sizable difference.

One of the main concerns is the sustainability of the reforms.

__________________________________

Does Physician Dispensing Lead to Unnecessary Opioid Use?

Florida banned Schedule II and III controlled substances was banned effective July 1, 2011.   Florida Pill Mill Bill (House Bill 7095)

Amount of physician dispensing of stronger opioids – fell in Florida from 3.9%to .5% post reform.  NSAID’s and weaker opioids that were physician dispensed remained flat or increased slightly.

————————————————————-

Pharmaceutical Trends, Lessons, and Injured Workers Outcomes in the California Workers Compensation System 

Physician dispensed  Zantac had a 900% cost increase over pharmacy dispensed during a pre-reform period.

Physician dispensing did not delay return to work periods when compared to pharmacy dispensed medications.

Pharmaceutical Practitioner

Workers Comp is a different world from health insurance in reference to physician dispensed medications.   The physician vs. pharmacy dispensed medications has been a long-standing turf war ever since doctors made house calls.

Q&A Session WCRI – Physician Dispensing

A great point was brought out that another area of cost shifting is WC as health pays much less for physician dispensed medications.

©J&L Risk Management Inc Copyright Notice

 

 

 

Filed Under: WCRI Annual Conference Tagged With: Consequences, Cyclobenzaprine, Vicodin, Zantac

Affordable Care Act (ACA) Impact on WC Case Shifting – Live WCRI

March 5, 2015 By JL Risk Management Consultants

Affordable Care Act (ACA) Impact on The Future of WC

WCRI – Affordable Care Act (ACA) Impact on WC – Case Shifting was presented by Dr. Richard Victor- the outgoing Director of WCRI. A very popular question that WCRI receives very often.

Picture of Doctor Hand Touching Affordable Care Act Sign on Virtual Screen

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Whether or not the Affordable Care Act as a cost shift from health to WC with the ACA  generating these additional WC claims.

Study by Dr. Dulcamin (?) – Shipyards – Indicated Cost Shifting by HMO’s to WC, as the amount of HMO’s covered shipyard workers, the amount of WC claims increased substantially.

The central part of the ACA’s is ACO’s – Accountable Care Organizations

ACO is basically a network of medical providers that work together in a network to provide care.

Fee for Services vs. Capitated vs. Workers Comp

Fee for services has no motivational aspect to increase WC as ACO’s due as they will end up paying less than Fee For Service or WC.

Accident treatment by Dr. heavily relies on the work relatedness as assessed by the Dr.

Capitation will likely generate claims-shifting due to higher fees paid by WC.

The states where capitation is common there has been a 30% increase in soft-tissue (30%).   That is a significant number.   States where there is no capitation – there was a 10% reduction in WC soft tissue industries

Interesting comparison –

  • Capitation – WC Soft tissue injuries up 30%
  • No Capitation- WC Soft tissue injuries down 10%

Fewer workers enrolled in capitated plans –  surprising fact

  • Year 2000 – Almost 30%
  • Year 2013- Less than 15%

High deductible plans (i.e. $2,000)

Has reached 35% of all workers – may have heavy cost shifting if workers has to choose between Workers Comp- first dollar paid or eating a $2,000 deductible.

©J&L Risk Management Inc Copyright Notice

Filed Under: WCRI Annual Conference Tagged With: ACA, ACO, HMO

Ambulatory Surgery Centers (ASC) Cost Factors – WCRI- Live

March 13, 2014 By JL Risk Management Consultants

Ambulatory Surgery Centers (ASC) Four State Comparison

Ambulatory Surgery Centers (ASC) Cost Factors.  Difference for same type of surgery = 300%  between the states. Neighboring states – MD and VA or NY and CT  have  large differences  in ASC charges.

Picture of Ambulatory Surgery Centers Wilford Hall

Wikimedia Commons – Dwayne Snader

Fee schedule states ASC’s usually charge less.  Variability of ASC charges in the same state is greater in non-fee schedule states

Injured workers actually have the same experience whether they have surgery in hospital or ASC.  

Four states were compared that had similar fee schedules.   There was little variability in costs  among the ASC’s in these four states.  Could that have been due to the states being in the same region?

ASC differs cost factors differ greatly across states due to fee schedules.   States with fees schedules had a greater level of predictable costs than states without fee schedules.   In fact, most states with fee schedules allowed for a higher level of predictably of charges. 

Network penetration rates are much lower for ASC’s  even though the surgeon is actually in-network.   This situation happens often in health insurance where the doctor is in-network but many of the associated physicians are not in-network with the insured bearing the brunt of the additional costs. 

©J&L Risk Management Inc Copyright Notice

Filed Under: ambulatory surgery center, WCRI Annual Conference Tagged With: four states, injured workers, neighboring states

Texas Reforms Results Analysis – WCRI – Blogging Live

March 12, 2014 By JL Risk Management Consultants

Texas Reforms – WCRI Conference – Live blogging 

The new Texas reforms  were presented along with the preliminary results. 

Graphic of Texas Reforms Analysis

123RF

This is a very informative conference-session. The current  session is pre- and-post reforms in the state of TX.

This example could be applied to other states with upcoming or in-place reforms

  • Total costs were lowered post-reform
  • Medical costs were the drivers for Texas and caused the need for reforms
  • Utilization of non-hospital services plunged.  Usually the utilization rates increase when the medical costs factors are lowered.   Other cost factors in Texas showed an increase in utilization vs. the pre-reform years 
  • Heavy pre-authorization requirements
  • Most impact were noticed in 2011 and 2012 claims
  • Decrease in chiropractic care (-8.5%).  This is a dramatic increase in such a short amount of time. 
  • Only California had higher cost claims that included chiropractic care.   
  • As with CA, TX medical cost containment costs increased, California cost containment became prohibitively expensive 
  • As compared with others states, more monitoring of expenses increase utilization review- this is an expected result that has appeared in most states. 

As a side note, I have performed many studies that indicate a decrease in medical rates is counteracted by an increase in utilization.   This is on a state-by-state and type of treatment basis.  We shall see more results soon on the Texas reforms. 

©J&L Risk Management Inc Copyright Notice

Filed Under: Texas, WCRI Annual Conference Tagged With: chiropractor, ost drivers, UR

WCRI (Workers Comp Research Conference) – Reporting Live

March 12, 2014 By JL Risk Management Consultants

WCRI (Workers Comp Research Conference)

Workers Comp Research Conference reporting live.

Graphic of Workers Comp Research Conference Reporting Live

123RF

First Session is ACA (American Healthcare Act) effects on Workers Comp.  Dr. Jon Gruber–  Wow this conference is packed.   Kudos to WCRI.   Everyone from WCRI was very helpful and hooked me up to the hotel wireless system so I could do this live (way cool).

I am here as the press with a press pass.  I just met Dr. Christine Yee – An economist with WCRI.  She performed some of the Texas studies for WCRI.  This is an interesting crowd.  It is a mix of data, management and general WC personnel.

Who shows up to hear about Workers Comp statistics?   I am seeing name tags from insurers.  There are some off-the-record presentations over the next two days.  I will likely not be able to live blog any off-the-record type of presentations. 

This is an interesting change from the usual rating bureau conferences.   Andrew Kenneally was nice enough to invite me for the last three or four years.   I decided to show this year as WC is changing not quickly, but steadily.

I will update these reports as it goes through the next two days.

©J&L Risk Management Inc Copyright Notice

Filed Under: Obamacare, WCRI Annual Conference Tagged With: Christine Yee, Dr. Jon Gruber, insurer, presentation

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James J Moore
Raleigh, NC, United States

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:
• Risk and Insurance Management Society (RIMS)
• Entrepreneur Magazine
• Bloomberg Business News
• WorkCompCentral.com
• Claims Magazine
• Risk & Insurance Magazine
• Insurance Journal
• Workers Compensation.com
• LinkedIn, Twitter, Facebook and other social media sites
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Recent Posts

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