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

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

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?

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

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