Piece Workers’ Comp Into the Enterprise Risk Puzzle

The term risk takes on a new meaning to forward thinking organizations. As noted by a leading Enterprise Risk Management software provider, Logic Manager, it is a Risk Based Approach to Business.

 

Risk is the overarching theme across all business areas. It resides in operations, shared services such as IT, HR, finance and other dimensions including, compliance, geographic regions and strategic initiatives to name a few. In addition to these risks, executives also face the risk of governance efficiency, things such as silo’d activity, scattered information, misalignment of priorities and unknown relationships that have a direct effect on the bottom line.

 

As companies get larger the challenges are real and there are many pieces to the puzzle. In fact, it appears so complex that some companies never make it to the point they start pulling the most important pieces together. Like a deer in the headlight they stand motionless doing what has always been done and can’t get started making valuable connections that have a bottom line impact.

 

 

Putting the Puzzle Together

 

How do you get started? In short you count the pieces, do the edges and look for the connections.

 

Count the Pieces

 

Did you ever do the hard work on a puzzle only to find that many of the pieces were missing. The starting point is pretty straight forward. Identify the pieces you are dealing with. In most organizations the pieces are known but not clearly defined.

 

 

Do the Edges

 

Start with the low hanging fruit. In a complex puzzle you go straight to the edges. It takes an overwhelming amount of pieces down to something you can manage. Once it gets started, there is still hard work but it makes it easier to pull together. Begin complex puzzles/ business initiatives in areas that can be used as a foundation to pilot and demonstrate repeatable processes.

 

 

Look for the Connections

 

As you are shifting through the many remaining pieces, the colors and shapes become very important. Build your foundations on taxonomy (systematic classification) that can help identify and take advantage of natural connections that do not normally get made.

 

Organizations may have the best people, resources and intentions to move initiatives forward, but if they can’t find a logical starting point, it all breaks down and the status quo never turns into a completed puzzle. A risk based approach to business should not take longer than 6 months to get off the ground. In fact, if the puzzle is mapped out correctly, significant value can be demonstrated in 90 days.

 

 

Author Mark Bennett, Founder of Risk Innovation Group (RIG), is dedicated to helping large employers face the complexities of risk through innovative Enterprise Risk Management (ERM) practices. ERM programs don’t just help large employers manage business risks more effectively; a well-developed ERM program can protect and create value as well as improve business performance and generate a strong competitive advantage.  Contact: m.bennett@riskinnovationgroup.com

CMS MSA Review Expansion to Liability Planned for 2018

We are not even a week into 2017, but already have news to share regarding Medicare’s planned expansion of its Workers’ Compensation MSA review process to liability in 2018. In its recently released Request for Proposal for the Workers Compensation Review Contractor (WCRC), the Centers for Medicare and Medicaid Services (CMS) includes an option allowing CMS to expand the responsibilities of the WCRC to review of Liability Medicare Set-Asides (LMSAs) and No-Fault Medicare Set-Asides (NFMSAs) effective July 1, 2018.

 

The CMS WCRC RFP Solicitation may be viewed here.

 

 

Background on CMS Review of MSAs

 

Since 2001 CMS has had in place an official voluntary review process for Worker’ Compensation Medicare Set-Asides (WCMSAs). A WCMSA, as CMS states, is a “financial agreement that allocates a portion of a workers’ compensation settlement to pay for future medical services related to the workers’ compensation injury.” The purpose of the review then is “to independently price the future Medicare-covered medical services costs related to the WC injury, illness, and/or disease and to price the future Medicare covered prescription drug expenses related to the WC injury, illness and/or disease thereby taking Medicare’s payment interests appropriately into account.”

 

These WCMSA reviews were initially handled by the CMS Regional Offices spread throughout the country, but eventually transitioned to a centralized WCRC in 2005 (The CMS Regional Offices must still approve the review recommendation of the WCRC before it is released to the WCMSA submitter). CMS’s RFP solicitation for the new WCRC contract indicates the contract is to be awarded by June 30, 2017 with a contract term running for five years from July 1, 2017 to June 30, 2022.

 

 

Expectations for Liability MSA Reviews

 

Presently, CMS allows its 10 Regional Offices to accept voluntary requests for review of LMSAs at each office’s discretion. Some Regional Offices have consistently refused to review any LMSAs while other offices agree to review based upon criteria that seemingly changes over time and bears no indication that it is indeed the official policy of CMS. It appears then that just as it did in 2005 when CMS took the responsibility away from the Regional Offices for reviewing WCMSAs, CMS is now considering centralizing the process of reviewing LMSAs with a contractor, leaving the Regional Offices to only approve of the contractor’s recommendations.

 

Some may recall CMS launched a prior initiative to establish a formal policy for consideration of future medicals in liability settlements when it issued an Advanced Notice of Proposed Rulemaking in 2012. This initial effort was ultimately withdrawn by CMS in 2014. CMS’s new initiative began with this June 9, 2016 notice on the CMS website:

 

The Centers for Medicare and Medicaid Services (CMS) is considering expanding its voluntary Medicare Set-Aside Arrangements (MSA) amount review process to include the review of proposed liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS plans to work closely with the stakeholder community to identify how best to implement this potential expansion. CMS will provide future announcements of the proposal and expects to schedule town hall meetings later this year. Please continue to monitor CMS.gov for additional updates.

 

No town hall meetings were scheduled in 2016, however, based upon this RFP indicating LMSA reviews will not begin until at least July 1, 2018, CMS has given itself 18 months to develop and implement a formal LMSA review policy. In terms of how many liability settlements such a review process would impact, CMS seems uncertain. A Statement of Work attached to the RFP indicates “reviews could represent as much as 11,000 additional cases (based on all FY2015 NGHP demands), or as little as 800 additional cases annually, depending upon industry response.”

 

 

Tower MSA Takeaways

 

Over the past 15 years, starting with the formalized review of WCMSAs, continuing with the implementation of Section 111 Mandatory Insurer Reporting and recent stepped up efforts at denying injury-related medical care and recovery of conditional payments for medical care related to workers’ compensation, liability and no-fault claims, CMS has expanded its enforcement under the Medicare Secondary Payer Act. It is not surprising then that CMS’s next objective is formalizing a voluntary review process for LMSAs.

 

It has been our experience that when CMS does implement new policy and procedures it does take a deliberative approach evidenced by the at least 18-month timeframe signaled with this RFP to expand the MSA review process to liability and no-fault. Our expectation then is over the next 18 months or longer, CMS will provide additional announcements concerning the rules and procedures around expansion of the review process.

 

Tower MSA will be involved in these discussions and will keep you abreast of relevant developments. In the interim, there remain important obligations of parties to liability settlements and no-fault claims under the Medicare Secondary Payer Act. Rest assured that you can rely upon Tower MSA’s team of MSP compliance experts for consultation and expert guidance in liability and no-fault matters.

 

 

 

Author Dan Anders, Chief Compliance Officer, Tower MSA Partners. Dan oversees the Medicare Secondary Payer (MSP) compliance program. In this position, he is responsible for ensuring the integrity and quality of the MSA program and other MSP compliance services and products. Based upon his more than a decade of experience in working with employers, insurers, TPAs, attorneys and claimants, Dan provides education and consultation to Tower MSA clients on all aspects of MSP compliance. Contact: (847) 946-2880 or daniel.anders@towermsa.com

10 Ways To Prevent Workers’ Comp Fraud

More and more cases are being publicized for successful prosecution of workers compensation fraud.  The more prominent cases are usually publicized due to their large monetary values.  However, fraud can occur at any level with it all adding up to a significant loss in dollar amounts.  Additionally, there appear to be more findings against employers than employees which means success rates may be woefully low in actual employee values.

 

It’s almost impossible to find accurate records of defrauded amounts, cases reported, prosecutions, or convictions.  Few organizations actually keep record and there is no federal central bureau or governmental entity compiling data.  Restitution recovery amounts (when reported) are dismal.  Most recovery amounts are less than 1% of the amounts ordered.  Many employees are unable to repay and others simply ignore the order considering recovery punishment is seldom enforced.

 

 

Workers’ Comp Fraud Drives Up Premiums

 

Since recovery dollar amounts are low, insurance premiums are increased.  The lack of restitution translates into claims impact by increasing experience and retro modifications.  The employer always ends up paying more.  Self-insured parties must retain more money for claims.  State guaranty funds lose out and pass this on to employers left in the system.

 

It is in every employer’s best interest to prevent workers comp claims to help stop the whole potential fraud spiral from starting in the first place.  There are several things an employer should do in order to keep claims at bay and protect their business from fraud:

 

  1. Hire the right employees. Contact previous employers. Check the references listed on their application.  Complete a through pre-employment background investigation.
  2. Report all claims immediately. Make sure the injured employee is receiving proper treatment, benefits, and is compliant.
  3. Keep in contact with both the employee and the adjuster during the duration of the claim and push for a speedy recovery and return to work. Intercede if the injured employee has problems, and conversely cooperate with the adjuster if any suspicions arise.
  4. Investigate the claim. Visit the employee’s work environment/accident site.  Talk with witnesses.  Check all equipment involved.  Address and correct any and all safety issues in the workplace to prevent further injuries.
  5. Train all managers and supervisors in proper policy and procedure for handling injuries.
  6. Be alert for common fraudulent claim filing: Monday morning, pre-layoff, pre-vacation, pre-holiday, unwitnessed claims should all send up red flags.
  7. Be sure all employees fully understand the workings of the compensation act. Explain their rights, benefits, and obligations as well as your own as an employer.
  8. Gain knowledge of traumatic injury and occupational disease. Learn normal recovery times, medical treatments, and average fees.
  9. Pull loss runs and review periodically for accuracy, proper payment, disability compliance, and injuries casually related to the current claim. Contact the adjuster for clarification of any discrepancies or issues.
  10. Obtain interface with unions or employee organizations for input and cooperation in preparing policy and procedure.

 

Preventing workers comp fraud starts with preventing claims.  Gain more insight from insurance agents, loss control experts, lawyers, and adjusters.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining.com

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Photo credit: CA Dept of Insurance via VisualHunt.com / CC BY-NC-ND

 

Opioid Addiction: The Painful Reality

For years, Express Scripts has been committed to managing concerns about long term opioid use, especially the risk for addiction.

 

new report from the U.S. Surgeon General highlights the rise of addiction to drugs and alcohol and calls for a deeper investment in pain management strategies. This first-ever report intended for health care providers, law enforcement, and policy makers focuses on numerous prevention and treatment methods available and the vision for a future with reduced stigma on alcohol, drugs and addiction.

 

The SAMHSA (Substance Abuse and Mental Health Services Administration), a federal agency charged with advancing the behavior health of the nation, contributed much of the data and analytics.

 

In 1964, a similar in-depth and prescient report regarding tobacco use is now considered to have been the catalyst for change in that industry, and many hope for a similar result from this Surgeon General report.

 

 

Express Scripts Commitment

 

For years, Express Scripts’ workers’ compensation team has been committed to managing both the clinical and cost concerns with long-term opioid use, especially the risk for addiction.

 

We have continued to build proactive solutions to address the issue from multiple angles. These solutions are focused on helping payers, physicians, risk managers and injured workers arm themselves with tools to ensure safe and cost-effective treatment.

 

Enhancements to the Express Scripts’ workers’ compensation program offering over the past year have focused on proactive intervention. New in 2016, ScriptAlert+SM, a bundle of point-of-sale edits can be used by workers’ compensation payers to review high-risk prescriptions before the injured worker leaves the pharmacy. This point-of-sale review is carried out in real-time, using OASIS – Express Scripts’ real-time connectivity platform, at the time that a prescription is submitted for filling at a pharmacy. In tandem with the Morphine Equivalent Dose program, Express Scripts proactive opioid programs attempt to tackle the potential of opioid addiction before it begins.

 

 

Looking Forward

 

Just as the Surgeon General calls for more advanced tactics to managing pain, we continue to evolve our solutions. We know that traditional opioid abuse programs identify suspicious activity that’s already happened – by which time behavior modification is extremely difficult. Looking forward, we’re leveraging our advanced analytics to identify and assign risk scores among patients, pharmacies, and even prescribers.

 

 

Author Brigette Nelson, MS, PharmD, BCNP, Senior Vice President of Workers’ Compensation Clinical Management, Express Scripts. In this role, Brigette provides strategic oversight for clinical programs for workers’ compensation PBM clients and leads a team of clinical pharmacists and technicians, with client-facing responsibilities for clinical program offerings. She also partners with the workers’ compensation product group in managing clinical programs and consults with clients regarding clinical outcome trend analysis to manage drug spend and appropriate therapy. http://lab.express-scripts.com/lab/insights/workers-compensation

Acclaimed Investment Banker Elected to the Ringler Board And Other News Tidbits

Acclaimed Investment Banker Elected to the Ringler Board of Directors

Ringler, the nation’s largest settlement planning company in the nation, is pleased to announce that Peter C. Jachym, a veteran investment banker, strategic advisor and private equity investor in the insurance and asset management sectors, is now a member of the Board of Directors.

 

Read more…

 

 

Express Scripts CEO: Many drug list prices are still too high

CNBC’s Meg Tirrell speaks with Express Scripts President & CEO Tim Wentworth on pharmacy benefit managers and drug pricing pressure. [Run time 3:28]

 

Watch CNBC Interview

 

 

 

 

Crawford hires COO from Hanover Insurance

Atlanta-based Crawford & Company, a provider of claims management solutions, has appointed Andrew Robinson as its global chief operating officer. In his new role, Robinson will have the responsibility of Crawford’s four business units, including Broadspire, US Services, International Operations, and Garden City Group, alongside information technology on a global basis.

 

Read more…

 

 

The Difference Between Workers’ Compensation and Occupational Medicine

The mention of workers’ compensation or occupational medicine conjures up images of debilitating injuries and payroll assistance. However, a majority of people believe that these two terms are interchangeable. In fact, there is a difference between workers’ compensation and occupational medicine. While workers’ compensation will help pay your bills, occupational medicine will get an injured employee back to work sooner.

 

Read more…

 

 

Are We Fulfilling Our Obligations to Injured Workers?

The workers’ compensation system here in the US has existed for more than a century. So how are we doing, after all that time? The US Department of Labor recently posed the question, “Does the Workers’ Compensation System Fulfill Its Obligations to Injured Workers?” They published their findings in an exhaustive report.  It is not flattering. In fact, the report offers what the DOL calls an “alarming” conclusion: “working people are at great risk of falling into poverty as a result of workplace injuries and the failure of state workers’ compensation systems to provide them with adequate benefits.”

 

Read more…

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Eliminate Most Frequent Cause of Seasonal Workers Comp Claims

Winter weather is upon us (at the time of this writing it’s 8 degrees in Kennebunkport, ME), and that often means an increase in claims. However, many winter weather claims are preventable. Whether it’s a slip/trip/fall, electrocution from using unfamiliar snow-removal equipment, or a temperature-related ailment such as trench foot, simple precautions can often protect workers — and your bottom line.

 

While you might not have control over the weather, you can at least control the risks faced by your employees. And you don’t necessarily have to spend a lot to reduce or even eliminate many weather-related workers’ comp claims.

 

Here’s a look at how to prevent the most frequent — and preventable — cause of seasonal claims.

 

Slippery Slopes

 

Icy, wet pavement and floors can wreak havoc for workers. Whether inside or outside, employers should seek to have the driest, safest surfaces for their employees.

 

Clear Snow & Ice

The most obvious solution for preventing slip and fall injuries in winter is to make sure snow and ice are cleared from all walkable surfaces and salt or other deicing material is laid down.

 

This includes sidewalks, entryways and parking lots. While state laws vary on whether injuries in outdoor areas are compensable through workers’ comp, making them safer can protect your employees as well as vendors and other visitors to your facility.

 

Place Signage Warning of Slippery Floors

In areas such as doorways, it’s also smart to place signage warning of slippery floors. Absorbent mats are another method to help keep inside walkways dry.  Good lighting should also be considered for areas where floors and pavements can be slippery.

 

Instruct Workers To Wear Footwear With Good Traction

Workers who are more likely to be outside should be given, or instructed to wear footwear with good traction, such as slip resistant shoes or boots. They should also be informed that taking shorter steps and walking slower will help them react better to sudden slippery spots.

 

Place Ladders Only On Cleared Surfaces

Workers who have to be on elevated surfaces, such as roof tops need to take extra precautions. They should be provided and trained on fall protection methods. Ladders should be placed only on surfaces that have been cleared of snow and ice. Where possible, outside vendors should be employed to remove snow from roofs and other areas.

 

Conclusion

Employers should try to avoid sending workers outside in frigid temperatures and where snow or ice is problematic. Scheduling work for the warmest part of the day is advisable. For employees who must work outside, they should be trained about the injuries and illnesses that can affect them and understand the hazards of any equipment they may use, such as snow blowers.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining.com

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

4 More Keys To A Healthier Workforce Through Wellness

As reported in yesterday’s blog “4 Keys to a Healthier Workforce”, comorbidities in your workforce add significant costs in workers’ compensation claims.  While our New Year’s resolutions are still alive, take action today to consider these 4 more keys to a healthier workforce:

 

Lifestyle Management Programs

 

Employers can do a variety of things to get people moving. In addition to such things as workshops on various wellness issues, companies can allow breaks for workers to engage in physical activities. Or set up walking or other exercise programs. Smoking cessation programs can be done either onsite, or at a local hospital or other community facility.

 

Convenience

 

Getting employees to participate in wellness programs is nearly impossible if it’s not easy for them to be involved. Third shift workers, for example, might feel left out of group activities that take place during the day. Using technology such as internal websites and mobile apps, can help these workers feel more involved. Encouraging workers to eat better can be made easier by providing healthy snacks onsite, such as in vending machines and during meetings.

 

Fun

 

Employees are much more inclined to participate in wellness activities if they enjoy them. Competitive teams can be established to challenge one another to walk X number of miles, or to lose the most weight in a given time period.

 

Confidentiality / Privacy

 

Many employees are concerned their health information may get into the wrong hands, causing them embarrassment or even to lose their jobs. Any health related information provided to the employer needs to be in the aggregate, with no indication a health issue is related to a specific individual.

 

Research shows for every $1 spent on wellness programs, the cost of medical care is reduced overall by $3 to $4 – an excellent return on investment an employer cannot ignore. Ref. Workplace Wellness Programs Can Generate Savings

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining.com

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

4 Keys To A Healthier Workforce Through Wellness

Comorbidities may be costing you a bundle. There’s overwhelming research that shows employees with certain health conditions are more likely to get injured on the job, and then take longer to heal and return to work. Consider the following effect on workers’ compensation:

 

  • Diabetes average workers’ comp medical costs 5x higher
  • Smokers are 40% more likely to have a work injury
  • Obesity is associated with 2x likelihood of a workplace injury, 7x higher workers’ comp medical costs, and 13x more days away from work

 

Employers can take a multitude of actions to help workers become healthier. And now’s a good time, as many people put ‘a healthier lifestyle’ atop their New Year’s resolution lists.

 

 

Wellness Programs

 

An effective wellness program can not only save money, but it can expand the bottom line through increased productivity from healthier workers. However, employers need to understand it is a long-term investment and the return might not be seen for several years.

 

Companies of any size can implement some type of wellness program. In fact, a recent survey showed more than half of employers with at least 50 employees have adopted a program. Most important is to make sure the program is specific to the company’s culture and needs. That said, there are several elements that can help result in a successful wellness program.

 

 

4 Keys To A Healthier Workforce Through Wellness

 

Executive Buy-In

 

Getting employees to participate in a wellness program has to start at the top. C-suite executives need to be engaged or the effort will have little chance of success.

 

Senior managers need to understand the business case that prevention can reduce injuries and mean more money for the organization. Larger companies may have the advantage of being able to use claims data and health plan utilization showing healthier workers have fewer claims and shorter recoveries. For smaller companies, information from organizations such as NCCI or WCRI can help make the case. There is also publicly available evidence from OSHA and NIOSH.

 

 

Goals

 

A look at various company records and reports — absenteeism, productivity, health insurance costs and biometric screening, for example, can help determine what types of things are needed for a company. Goals should be SMART: specific, measurable, agreed upon, realistic and relevant, and time based. Goals can be set by a group of workers representing many or all departments and at all levels to help ensure employee buy-in to the program. The group can be a formalized wellness team, in which each participant has various roles and responsibilities.

 

 

Integration With Safety

 

Reducing workplace injuries and improving overall employee health should go hand-in-hand with safety programs. Breaking down silos can expedite the effectiveness of both programs. Departments should be instructed to share information and resources. In larger companies, that means departments involved in any aspect of health benefits and health protection should communicate.

 

 

Communication and Education

 

Newsletters, emails, and posters are among the ways employers can let employees know about all the various components of the wellness program. They can also be used to help instruct workers on healthy lifestyle changes they can make. For example, low-calorie does not necessarily equal healthier foods, such as fruits, vegetables and whole grain products. People who understand how to read food labels are more inclined to buy food that offers good nutrition. Various health recipes can also be included, along with information on the importance of, and how to get a good night’s sleep.

 

When effective, wellness programs can reap significant financial benefits for companies, such as reduced injury rates and the number of lost work days. The key is to get buy-in by working with employees throughout the organization.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining.com

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Christmas Miracles Can Happen in Workers’ Compensation

For those of us who deal with MSAs, it’s all too common to see claims at settlement time that started out as basic and simple, then spiraled downward as a result of bad prescribing habits, increased drug use and opioid addiction.  We hope for a different ending, but can  miracles really happen?

 

 

Background

 

In late 2015, Tower completed a pharmacy project for a small employer in California.  In the course of the project, drug triggers were identified, physicians were contacted and claimants were challenged to settle or make changes in treatment.  As you might imagine, many of the physicians fought the request for change.  But through perseverance, and working in tandem with the client, we pushed forward.

 

 

The Story as Shared by our Client

 

Dear Hany,

 

A few weeks ago, I was looking over the  case for one of the California claimants and wanted to share the amazing results we have achieved with this gentleman.

 

This case involved a 26 year old man at time of injury. He sustained a minor back injury but was taking Hydrocodone, Testosterone, Celecoxib, Lyrica, Nortriptyline, Methocarbamol, and FENTANYL.  With the recommendations and assistance from the Tower MSA Partners team, as well as support from his wife, we were able to get him into a new treating physician who agreed with our goal. He was weaned off of the Fentanyl, Methocarbamol, testosterone, hydrocodone, and Celecoxib. He has even started an exercise program.  He is now both proud and happy to report how well he is doing.

 

The injured worker is now 51 years old and he sadly notes that he missed out on 25 years of his life and his children’s lives because he was so “drugged”.   On a positive note, however, his new treating physician has been wonderful to work with and we see only good things for this claimant.

 

On the financial side we have now realized a reduction in the monthly Rx spend from $1,200 per month down to $600.  The injured worker is now only taking Nortriptyline, Lyrica and Celebrex and we expect to reduce reserves next year and approach him for a settlement in June, 2018.  None of this would have been possible if not for the Rx project and your team’s expertise, guidance and follow up assistance.

 

While we have had great success with many of the claims that we partnered on, this particular claim was really about improving his quality of life.  So please share my THANK YOU and gratitude with your team. Let them know that what they do can save a life and that is priceless.

 

 

It’s True….Miracles Can Happen in Workers’ Compensation

 

What a wonderful way to end the day and begin our holiday celebrations!

 

From all of us at Tower MSA Partners, our best wishes for a wonderful holiday, and a safe and prosperous 2017!

 

 

 

Author Rita Wilson, CEO, Tower MSA Partners, LLC. Rita oversees all business development, sales, marketing and operational activities, IT systems development, and identifies new product offerings in support of Medicare Secondary Payer Compliance. Prior to co-launching Tower MSA Partners in 2011, she founded and ran Select MRI, LLC, a diagnostic company, and Speedy Re-employment and Medicare Set Asides, an MSP compliance company. Previously, Wilson built out the operational and technology model for another startup, DirectCompRx, Inc., a subsidiary of Fiserv, Inc., ultimately becoming its CEO. Wilson is a Board Member for the National Association of Medicare Set Aside Professionals (NAMSAP). http://towermsa.com

Utilize Different Return To Work Approach For Different Employees

During the course of business, employers will find that all employees are not the same.  Speaking differently to each employee in order to get the same result is normal and necessary to keep business flowing steadily each day.  It only stands to reason that the same approach should hold true when working with employees to get them quickly and safely back to work after a worker’s compensation claim.

 

 

Different Return to Work Approach For Different Employees

 

There are many different return-to-work programs that can be utilized, but they should be matched with specific employees’ personalities to get the most successful results.  While one employee may respond well to several phone calls a week, another may find that to be too intrusive.  Finding the balance is the key to getting employees back to work.

 

There are primarily four different employee personality types ranging from fully satisfied to completely unsatisfied.  The four types of employees:

 

  • Satisfied-Active– one who is happy and needs no coercion or prodding to return to work.
  • Satisfied-Passive– one who is happy, but complacent with staying out of work.
  • Dissatisfied-Passive– one who is unhappy, but does not willfully concoct schemes to stay out of work. However, they may take advantage of the system to stay out longer.
  • Dissatisfied-Active– one who is very unhappy with his/her situation and will actively attempt to take advantage of the system.

 

The majority of employees will fall under one of these description categories and will respond similarly to different return-to-work strategies.  Handling each situation according to the personalities of the employees is the best tactic.

 

 

Suit The Personality Of The Employee

 

For example, a satisfied-active employee might be someone who has not missed a day of work in 10 years, plays on the company softball team, and is always looked to as a go-getter.  A workers comp claim might be perceived as a setback to this type of individual and little or no interaction from the employer will be necessary in order to get him to return to work. A recommended strategy is to send a get well card and work in partnership to provide a productive transitional duty position; activity such as aggressive surveillance can have the opposite effect and make the employee unwilling to return to work.

 

An active-dissatisfied employee in the same situation will take a completely different approach and have a higher likelihood to abuse the system.  Employers of active-dissatisfied employees will need to take a much more agressive approach including implementing fraud prevention measures, hiring investigators, and having almost constant contact with the employee in order to get him back to work.

 

Without using a different return to work approach to suit the personality of the employee, the employer can inadvertently stall the process.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining.com

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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