Medcor Announces the Acquisition of TalisPoint

Chicago-based Medcor, Inc., the leading health navigation firm, has acquired San Francisco-based Talisman Systems Group, Inc., the leading provider of network management services for workers’ compensation and other industries. Talisman will operate as an independent subsidiary of Medcor, retaining its leadership and TalisPoint brand and will remain based in San Francisco.

 

Medcor navigates patients to optimal care through onsite clinics and virtual health services, using evidence-based medicine, proprietary clinical systems and patented processes. Medcor clients include employers from a wide range of industries and insurance carriers. The TalisPoint system validates, updates and manages network data and produces referral documents for insurance carriers, claims administrators, provider networks and employers.

 

Through this acquisition, Medcor expands its innovative health navigation services. These begin with rapid, convenient access to health assessment at the onset of symptoms or injury, followed by guidance to appropriate care. Often, Medcor can provide the care directly or guide patients in self-care. When referrals into the healthcare system are necessary, Medcor’s systems help ensure patients receive the care they need and avoid overtreatment and unnecessary costs. Sophisticated algorithms help Medcor identify serious cases quickly. TalisPoint data helps connect patients with the right provider in the proper network to improve clinical and financial outcomes.

 

Medcor President and CEO Philip Seeger explained, “We are combining two best-in-class businesses whose services are very complementary to one another. This is a powerful way to bring more value to our clients; the fact that we already have mutual clients shows that our customers have independently come to the same conclusion. The high-quality network information that TalisPoint provides will help us more efficiently navigate patients to the right place, at the right time, to receive the right level of care.”

 

Talisman President and CEO Monique Barkett said, “TalisPoint allows for fast, accurate and up-to-date access of vendors and medical networks. This facilitates Medcor’s service delivery by providing person-specific information and pinpointing the exact facility and provider called for by Medcor’s care protocols. To stay at the forefront of our industry, we prioritize innovation to ensure our systems will continue to be best-in-class in the years to come. With Medcor, Talisman now has a proven information technology partner to help us develop the next generation of TalisPoint.”

 

The two companies share reputations for transparency, high customer service, and operating without conflicts of interest. For more information, watch the short video at this link https://youtu.be/AvAFzJJqjSI, contact media@medcor.com or call 815-759-5442.

 

 


 

Medcor operates 240 clinics at or near client worksites and provides virtual health services to over 309,000 worksites throughout the United States and Canada. Medcor serves clients across a wide range of industries, including private firms and government agencies. Medcor helps employers and patients navigate the complexities of healthcare to achieve better clinical and financial outcomes. Learn more at medcor.com.

 

Talisman’s core product, TalisPoint, offers web-based customized network management tools to assist users in selecting medical providers and other vendor types. Access to verified provider data is a key to effective communication between patients, providers and employers. Learn more at talispoint.com.

 

 

 

The Intersection of Medicine and Disability: A Doctor’s View & Other Top WC Tidbits

The Intersection of Medicine and Disability: A Doctor’s View

Whether we are a health care practitioner, an employer or a claims professional, disability is something we deal with on a daily basis. What are the nuances of a disability claim and how can the roles and responsibilities within these claims be better understood?

Dr. Iglesias breaks down what goes into a disability determination and how employers, claims administrators, and physicians can make better and more timely disability determinations that will benefit all the stakeholders in a disability claim.

 

 

Facetime With Phil — Introduction To Analgesics

What are the different drugs available and how does a prescriber make a choice? Join myMatrixx Chief Clinical Officer Phil Walls as he begins a discussion on Analgesics. In this vlog, Phil covers the basics on this topic and begins a deeper dive into the treatment of pain management.

 

 

 

Dan Anders: Building a Better Relationship with your MSA Vendor

Let’s face it. When you realize that settlement of a workers’ compensation claim will require a Medicare Set-Aside (MSA) you may let out an audible groan or even a choice profanity. An MSA will no doubt add cost and time to settlement of a claim. This is why it is so important to partner with a Medicare Secondary Payer (MSP) compliance vendor that can effectively work with you to limit those costs and reduce the time involved with the MSA to the greatest extent possible while still ensuring you are compliant with Medicare requirements.

 

 

 

Opioid Litigation Update

Two-thirds of the deaths from drug overdoses in the U.S. involve opioids. This has been declared a crisis in America. On this Ringler Radio podcast, host Larry Cohen and co-host, Heather Anderson discuss how the Beasley Allen law firm’s attorney Rhon Jones is joining forces with the Attorney General of Alabama in litigation to put a halt to this devastating crisis that touches so many lives today.

 

 

 

Workers’ Compensation Cost Reduction Starts with Better Medical Care

Seek the best possible care for employees with workers’ compensation injuries, because better care will result in fewer treatments and ultimately lower costs. So said Margaret Spence, president and CEO of C. Douglas & Associates in West Palm Beach, Fla., during a June 20 concurrent session at the SHRM 2017 Annual Conference & Exposition in New Orleans. Spence recalled one employer in the panhandle of Oklahoma whose workers were told they had to use doctors in the rural area. When Spence got involved with the handling of the firms’ workers’ compensation claims, the company concluded that the doctors in that area were less qualified and every employee was sent to Oklahoma City for treatment.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

Important Safety Improvements to Avoid Severe Injury or Death in Logging

Logging remains one of the most dangerous industries in the United States.  Every year approximately 800 American workers die as the result of workplace accidents.  The logging industry accounts for about 24% of these claims.  Most of these deaths are the result of employees working as fellers, limbers, buckers, choker setters, truck drivers, laborers and material machine operators.  Now is the time for all parties in the logging industry and their workers’ compensation insurers to take note and continually strive for safer work conditions.

 

 

The Dynamics of a Logging Work Injury

 

Work injuries in the logging industry fall into several general categories.  These include injuries resulting from falling objects, falls from heights and crane accidents.  Common injuries involve trauma to a person’s back/neck, fractured bones, TBIs/other brain injuries, paralysis, amputations, disfigurements and permanent scarring.  Beyond the physical component, the average workers’ compensation claim involving someone within the logging industry includes an underlying mental competent that includes psychological or psychiatric trauma.

 

The bottom line is clear – workers’ compensation injuries sustained by a logger are generally more severe and costly to a program.  Any steps that can prevent injuries or reduce costs following an injury have a significant impact on the sustainability of an employer’s bottom line.  Now is the time to take proactive action.

 

 

Moving Beyond the General OSHA Requirements

 

OSHA safety standards have a positive impact on making an inherently workplace safe.  Specific rules have been implemented under 29 C.F.R. §1910.266.  These regulations apply to all types of workplaces regardless of the end use of the forest products such as sawlogs, veneer bolts, pulpwood and chips.  Covered under these regulations include the following safety requirements:

 

  • Extensive first-aid training for all employees;

 

  • Requirements for the use of personal protective equipment;

 

  • Requirements that include the use of rollover and falling-object protective structures; and

 

  • Improved techniques for manual felling procedures. This includes instruction on how to properly undercut and back cut to prevent premature twisting and falling of trees.

 

In addition to following these safety requirements, employers and other interested stakeholders can take additional steps to improve workplace/site safety and prevent injuries.

 

  • Compulsory adherence to safety standards. This includes consistent enforcement of safety policies and termination of employment for repeat offenders.  Safety must also apply equally to all employees;

 

  • Continual evaluation of workplace performance when engaging in work duties. This includes an evaluation of felling techniques by loggers to ensure training is being used on work sites;

 

  • Proper maintenance of all tools and equipment. This includes a commitment to storing equipment in a location that prevents excessive wear and tear.  It also means fixing equipment when problems arise and not continuing to use it if safety is a concern; and

 

  • Commitment to safety with the implementation of a safety committee.

 

 

Avoiding Other Common Safety Hazards

 

Loggers are exposed to countless dangers on a daily basis.  Paying attention to one’s surroundings is only the beginning when it comes to injury avoidance.

 

  • Work boot safety: Loggers must wear steel-toed work boots.  Problems arise when boots are not labeled correctly to avoid potential electrical hazards or are subject to product recall;

 

  • Review of Safety Reports: Interested stakeholders can learn a lot about the anatomy of common and avoidable injuries by reading OSHA injury reports.  Learning how to avoid these issues is key; and

 

  • Education, education, education: Logging remains a dangerous occupation notwithstanding the inclusion of safety standards, regulations, and  Interested stakeholders need to make education a priority.

 

 

Conclusions

 

The nature of the logging industry makes it a hazardous workplace activity.  The result of an injury in this occupation is life-changing.  Interested stakeholders need to be proactive when it comes to workplace safety and strive to reduce the prevalence of injury and death through ongoing efforts.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

U.S. Workers’ Compensation Prescription Drug Spending Decreased 3.3 Percent in 2017

ST. LOUIS /PRNewswire/ — Workers’ compensation pharmacy spending decreased 3.3 percent in 2017, according to new data released by myMatrixx, an Express Scripts (NASDAQ: ESRX) company.

“By merging the core capabilities of Express Scripts and myMatrixx to deliver superior clinical expertise, market-leading client experiences and innovative technology-based solutions, myMatrixx is now uniquely positioned to serve workers’ compensation clients and injured workers,” said Phil Walls, RPh, Chief Clinical Officer for myMatrixx. “We’re doing more to help clients balance appropriate care for injured workers while keeping costs down.”

 

More than half of myMatrixx Workers’ Compensation plans reduced drug spending last year.

 

 

Curtailing the Opioid Epidemic

 

Spending on opioids declined 11.9 percent for workers’ compensation payers in 2017.

 

For decades, myMatrixx has championed safe and appropriate use of opioids through solutions that leverage data, educate those at risk for adverse events and ensure connectivity across the care continuum. In addition, many states have taken action to address the opioid crisis through a multifaceted approach involving state-specific formularies, opioid guidelines and limits on initial opioid dispensing days’ supply and/or morphine equivalent dose.

 

These factors resulted in 74.2 percent of workers’ compensation payers spending less on opioids in 2017 than in 2016.

 

“While a decrease in the utilization of opioids is a positive sign for the workers’ compensation industry, there is still work to be done,” said Brigette Nelson, senior vice president of workers’ compensation clinical management at myMatrixx.

 

myMatrixx research found dangerous drug combinations and long-term use of opioids still pose care and cost concerns. Nearly 40 percent of injured workers took an opioid along with a muscle relaxant, while nine percent took an opioid and benzodiazepine. Taking these medications together can increase the risk of side effects and death from respiratory depression.

 

By deploying a holistic approach to manage opioid use, myMatrixx works with physicians, pharmacists and injured workers to mitigate the concerns of drug interactions or overuse.

 

Additionally, myMatrixx noted by the eleventh year of injury, the cost per injured worker reached $3,402.07, with $1,862.36 spent on opioid medications. Among those with age of injury of 10 years or more, more than half filled an opioid medication in 2017.

 

 

Compounded Medications Decline Further

 

For the third year in a row, spending on compounded medications decreased – a decline of 37.9 percent in 2017, falling out of the top 10 therapy classes.

 

While compounded medications continue to be a focus because of their high cost, it is clear that effective management strategies can reduce unnecessary costs and waste associated with clinically unproven ingredients.

 

 

Specialty Medication Utilization Remains Low, but Growing

 

Spending on specialty medications to treat conditions such as HIV and osteoarthritis increased 3.8 percent in 2017. While these drugs represent less than 1 percent of all medications used by injured workers, the extreme high cost per prescription requires payers to stay vigilant.

 

“Payers who have injured workers with occupational exposure to needle-sticks often include HIV medications on their formulary to ensure quick access to work-related HIV prophylaxis therapy,” Nelson said. “This therapy class saw the highest spending among specialty medications.”

 

 

Other Key Findings of the Workers’ Compensation Drug Trend Report include:

 

  • Generic fill rate increased to 85.6 percent across our workers’ compensation payers in 2017. Yet, payers could have saved $80.8 million through an optimal mix of clinically appropriate generic options.

 

  • The average cost of a physician-dispensed medication was $270.70, compared to $108.49 for a pharmacy-dispensed medication. This means plans paid a $162 premium for physician-dispensed medications which bypass pharmacist review at the point of sale. Of the medications dispensed by physicians, nearly half are used to treat pain.

 

  • On average, payers spent $1421.36 per injured worker for prescription medications in 2017.

 

 

About the 2017 myMatrixx Drug Trend Report

 

The 2017 myMatrixx Workers’ Compensation Drug Trend Report is among the industry’s most comprehensive analyses of workers’ compensation drug spending in the U.S. In its 12th edition, the research examines de-identified prescription drug use data of injured workers with a pharmacy benefit plan administered by myMatrixx. The report also includes analysis of state and federal government regulations and their impact on pharmacy-related challenges in workers’ compensation.

 

In calculating trend, prescription drug use was considered for legacy Express Scripts clients with a stable injured-worker base, defined as having a change in user volume of less than 50 percent from 2016 to 2017.

 

The comprehensive review of trends in prescription drug spending for workers’ compensation plans is available at myMatrixx.com

 

 

About myMatrixx, an Express Scripts company

 

myMatrixx® is a full-service workers compensation pharmacy benefit management company focused on patient advocacy. By combining agile technology, clinical expertise and advanced business analytics, myMatrixx simplifies workers’ compensation claims management. Located in Tampa, Florida, myMatrixx has positioned itself as a thought leader in the workers’ compensation industry.

 

For more information, visit myMatrixx.com

 

Media Contacts:
Phil Blando
202-258-4978
PJBlando@express-scripts.com

 

Ellen Drazen
314-684-5355
EVDrazen@express-scripts.com

 

 

SOURCE myMatrixx

Related Links

http://www.mymatrixx.com

The Christina Grillo Case and Lessons Learned: Why Families Facing a Medical Malpractice Lawsuit need a Structured Settlement

The Christina Grillo Case and Lessons Learned: Why Families Facing a Medical Malpractice Lawsuit need a Structured Settlement

 

 

 

 

 


Speaker 1: This is Ringler Radio, where you get all the latest news and information about settlement solutions, litigation, mediation, and structured financial security from Ringler, the largest and most experienced company of settlement consults in the United States.

 

Ringler has been helping injured people and their families since 1975. Ringler Radio is made possible in part by American General, Liberty Mutual, MetLife, Mutual of Omaha, New York Life, Pacific Life, and Prudential.

 

Now, join Ringler Radio host, Larry Cohen.

 

Larry Cohen: Hello, and welcome to Ringler Radio, everyone. I’m Larry Cohen, the head of Ringler Northeast Operations, and we’re certainly glad you could join us again today.

 

Well, Christina Grillo Sullivan was born on January 9, 1982. In what should have been a normal delivery for her mother, Josephine, turned into an emergency C-section, leaving Christina severely brain damaged, resulting in cerebral palsy, seizures, and blindness.

 

Soon after, Christina’s family filed a medical malpractice lawsuit, citing negligence by her physician. But Life Care Plans estimated the lifetime cost of medical care for little Christina to have been an excess of $20 million. The defendant’s attorneys offered a structured settlement, costing $1,267,000 that would have, over the lifetime of the child, paid out well over $100 million dollars. Quite a tax-free ability for Christina to be taken care of.

 

But Christina’s lawyers rejected the structured settlement offer, and settled the case for a lump-sum cash payment of $2.5 million, from which they took a $1 million fee and $77,000 in expenses.

 

They also failed to protect the availability of governmental benefits and sadly, as we’ve seen so often before, the money, unfortunately, was gone within a few years, and the family left to pick up the pieces and pay millions for medical treatment.

 

Christina’s family nurtured and cared for her relentlessly and lovingly at home for 32 years until she passed away on September 17, 2014. Today on Ringler Radio, Christina’s mother, Josephine Grillo Sullivan, now the executive director of the Christina Grillo Sullivan Foundation, will share with us how she’s honoring Christina’s life by assisting families living with a brain-injured loved one.

 

We’ll also discuss the high-profile and precedent setting case of Grillo Vs ] and what its outcome has meant for others who are faced with a choice, at settlement, of taking cash or structure.

 

Joining me today in this discussion as my cohost is my Ringler colleague Anne Lawter, from the Troy, Michigan office. Anne has nearly two decades of experience in medical malpractice and personal injury litigation.So with that, welcome to the show Anne. Thanks for being my cohost.

 

Anne Lawter: I’m very happy to be here with you and Josephine today.

 

Larry Cohen: Thank you.

 

Josephine, welcome to the show. It’s a pleasure and an honor to have you here. We’re really looking forward to hearing what you have to say, today, about your daughter and about what’s transpired with your foundation.

 

Josephine G. S.: Thank you for having me. I really look forward to being your guest, with Anne, and your listeners.

 

Larry Cohen: Terrific.

 

Josephine, let’s begin by having you tell us a little bit about Christina and the impact she had on you and your family. She seems like an unbelievably fascinating and wonderful girl.

 

Josephine G. S.: Well, how long do you have Larry and Anne?

 

Larry Cohen: (laughs)

 

You take as long as you want. I’ll stop you when it’s time. Go ahead.

 

Josephine G. S.: She was an absolute angel here on earth. I visually see her laughing and smiling. They were absolutely contagious, and that’s without ever speaking a word. She just inspired so many people around her. It’s where we are today.

 

It didn’t matter that she didn’t speak a word. She taught us so much, truly: what was important in life, which is unconditional love. I guess she really gifted us with her innocent trust and her dependency upon us.

 

I’ll tell you what, Larry: she really, really taught us how very, very precious this life is, and not to take one moment for granted. I just can go on and on about her, but she truly taught us about hope and faith and that’s truly what’s gotten me this far in this moment in life.

 

Larry Cohen: She was a blessing. For your family to have nurtured her as you did is wonderful to see and you to be commended for that too.

 

Anne Lawter: Josephine, I understand that Christina’s birth is what led to a medical malpractice case. Is that correct?

 

Josephine G. S.: That is correct.

 

Anne Lawter: If you could, just give us an overview of the main portions of the case.

 

Josephine G. S.: It was an evening that I had arrived at the hospital and the nurse on duty wanted to send me home. As I recall, she was saying I was having Braxton Hicks which is false labor pains. The doctor was asleep down the hall but the nurse didn’t want to disturb him. And that was until Christina’s heart rate started to drop. And then the last thing I remember there was that my body was going into shock and jumping up and down on the gurney. Then I had awoken to two nurses talking an saying that my precious baby wasn’t going to survive the night. It had taken over seven minutes to resuscitate here.

 

So I guess three weeks in the hospital neonatal unit, the doctor came up to me and said that they had done all that they could and that they were terminating life support. They were going to administer Christina last rites, and I’m sitting here thinking back as I do from time to time … There was a room off the neonatal unit and we were put in there, my family and I. We were all to say goodbye, and gently passing her from one loving family member to the other and we were just kissing her soft little newborn face.

 

But she surprised us all. She started breathing on her own and obviously was left here to do all the things that she has done for so many. We actually lived in Fort Worth at the time, in Arlington, and I had heard about a case, an attorney, and had gone to see him in Houston. He said if the baby was still alive to take the case. They had came back and said that the nurse was credible and the hospital had made an offer of $50,000 and they suggested that I take it.

 

Looking at both of them I just said there was just no way I could care for Christina over her lifetime. Two weeks later I get a phone call and they told me to come pick up my papers, that they were withdrawing from the case.

 

So that’s when I had located new counsel which was Tom and Tommy and they too delayed about two years until the hospital saw the motion to dismiss and then at that they prepared the case for trial.

 

Larry Cohen: You know Josephine, through this trauma of the injury to your daughter and through the birth etc., finally you received an offer from the defendants’ attorney which included a tax-free structured settlement as a part of it and yet your own attorney rejected that offer and decided to go with a lump sum settlement. Of course that decision had some severe consequences as you moved down the road. Tell us about the impact of that decision on your family as you moved along. What was the impact?

 

Josephine G. S.: To clarify to your listeners, the attorney decision to go with that lump sum settlement, it was so insufficient to cover her basic medical needs, but also was not conveyed in writing, nor did I have a clue what a structured settlement was or the benefit of the weighted age as I do today. That $1,267,579 was with a Cost of Living Increase (COLA) of 7.2%.

 

Larry Cohen: Wow.

 

Josephine G. S.: Yeah. That’s the looming increase. It would have paid Christina in excess of $200 million-

 

Larry Cohen: Yeah, with that kind of a COLA it’s amazing.

 

Josephine G. S.: And today, of course we all know how devastating that was not to have done that. The attorney’s fees would have been based on the cost of the structure, not the gross amount received, so actually Larry 40% of $2.5 is double the attorney fees. I guess that was their answer.

 

Larry Cohen: Wow. Wow. Am I right in that you were never given the opportunity to understand what a structure was? It was never really explained to you, is that right?

 

Josephine G. S.: No, not at all.

 

Larry Cohen: Wow.

 

Anne Lawter: So Josephine as I understand it, after that experience of taking that settlement, there came a time that you and your family had exhausted your funds and yourself and you instituted a malpractice case against the attorneys and that guardian ad litem for legal malpractice, regarding the fact that Christina’s case should have never been settled for a lump sum and the consequences that followed. Can you tell us about that?

 

Josephine G. S.: Yes I can. It was for the longest time, because we knew something was wrong, not until I spoke with an attorney named Todd who is in Dallas … He told me that he had never heard of a brain-damaged baby case not being settled with a structured settlement. Again, I had told him, “What does that mean?” And he kindly gave me the phone number of a structured settlement broker that has now become my friend over the past 25 years and that’s Mr. Neil Johnson.

 

I can remember meeting with Neil in an Italian restaurant over in Dallas and over two hours he explained in detail what a structured settlement was and the benefit of a rated age and what that would have meant to the value of Christina’s settlement. Larry and Anne, I left that meeting in tears. I wasn’t angry, I was just saddened that someone could do something so unconscionable.

 

I had filed a cause of action [inaudible 00:11:50] because I was unable to find counsel that would represent Christina because everyone that I had spoken to was fearful of retribution with judges and other attorneys in the future. So the two-year statute of limitations was tolling so I filed a lawsuit.

 

The odd thing is Neil, he believed in us and researched and found one of the companies that actually has quoted a structured settlement in the underlying case. So I actually went to go and deposition John [Camp 00:12:26]. He was a defense attorney for the hospital. When I was asking him the question, “Was Christina ever offered a structured settlement?” And Larry and Anne, just sitting there and looking across at this attorney for the hospital … He just snapped his pencil in half like it was a twig and he looked me in the eye and said, “As I sit here today, I do not recall.”

 

I was just-

 

Larry Cohen: Yeah, sounds like he knew the bad news was coming. It’s interesting.

 

Josephine G. S.: Right, right.

 

Larry Cohen: You know Josephine, what’s resulted from your fight against your attorneys for doing what they did is given rise to what’s now commonly called the Grillo waiver. It’s a document that acknowledges in writing that the plaintiff understands the potential consequences of accepting a lump sum settlement in lieu of a portion of it being structured. I kind of think it’s akin to informed consent, where you really understand what you’re turning down if you want to turn it down, or what you’re getting if you decide to accept it. That seems so logical today but obviously wasn’t back there when you were in need of something like that. It’s through your situation that people in the future are not going to have to suffer through that circumstance like you did. At least something came out of that that hopefully will help others.

 

Josephine G. S.: And I sit here and I smile. I smile that her little life was for a reason and it was to help so many actually become better loved and taken care of by their families. Because, Larry and Anne, a family taking care of someone like Christina, it is so tolling on everyone. If the funds would have been there … You think about it, just momentarily, that life could have been different, but actually when you do think about it a little bit more it’s where it needed to be. Because if we had not have experienced that  we wouldn’t be here today and she would not have already started to help thousands of people.

 

Larry Cohen: Your story’s a humbling one, it really is, for all of us, to have gone through what you did and taking care of Christina for those many years. It’s as I say, a humbling story.

 

We’re going to take a quick break right now, and we’ll be right back in a minute right here on Ringler Radio with more with Josephine Grillo Sullivan. We’ll be right back.

 

Speaker 1: This is Ringler Radio, brought to you from Ringler, the nation’s leading provider of fair settlement solutions. Did you know that Ringler is involved in a third of all structured settlement cases in the country? Ringler advisors work with all the parties in a lawsuit settlement to find the best possible financial solution for the people involved. Everybody wins. There’s a Ringler consultant in all the major cities in the US. No one had more experienced experts in the settlement business than Ringler. Check out our website at www.ringlerassociates.com for the best information for injured parties, attorneys, and claims professionals to find the Ringler advisor nearest you.

 

When it’s your interest at stake in a lawsuit settlement, you want only the best, most objective financial plan. You can count on Ringler advisors to create customized plan that meets the financial needs of you and your family for the future. Visit ringlerassociates.com to learn more.

 

Larry Cohen: Welcome back to Ringler Radio. Glad you could join us. I’m joined today by my co-host Anne Lawter and our special guest, Josephine Grillo Sullivan, executive director the Christina Grillo Sullivan Foundation. Josephine, you and your family, your husband Craig and your son Christian, have devoted your lives to the memory of Christina in many ways. Of course one of them is the mission to influence legislation to encourage structured settlements. You even set a precedent with the second court of appeals case opinion holding guardian at litems accountable for breaching their fiduciary duty.

 

Talk to us a little bit about how you’re looking to change the law when it comes to structures versus lump sum payments when people have to make that pretty momentous decision.

 

Josephine G. S.: That process actually had been started by the passage of Senate Bill 731 in 1999. For three legislative sessions, that’s six years, we fought for that legislation that would make it mandatory for a structured settlement to be presented in writing when it involved a minor child or a non-competent adult. That was in a 76 Texas legislative session. It was passed and codified into Texas Section 139.001-5. Larry, I believe that probate courts truly, truly have too much power without accountability. I actually have proposed a five-member oversight panel when it comes to the health, safety, and wellbeing, consisting of a physician, a lawyer, two citizens, and legislative member because the abuse of the probate system has been well-documented and persons are being stripped over their rights with limited recourse.

 

Larry Cohen: Well I know who to nominate as one of the citizen members of that commission. (laughter) That’s for sure.

 

Josephine G. S.:  

 

Anne Lawter: That sounds like a great idea, Larry. Josephine, you had an opportunity to be right there with the legislature and give testimony. You and Christina both testified at the time that the law was being discussed. Can you tell us about that experience and how it affected you to be able to take Christina with you to talk to the legislators?

 

Josephine G. S.: I guess it was just one of the many times she was by my side, again for the six years we traveled back and forth to Austin and other hearings across the state of Texas. To describe it, she was instrumental in I think them actually listening and seeing because when you have someone that is severely brain-damaged, it actually … You’re creating an awareness. I don’t think people can really completely understand until they walk or see your shoes, just for a bit. So it was very important and the response was what was needed, when she was traveling with me.

 

Larry Cohen: Christina’s memory also takes shape, Josephine, in the form of your foundation’s work to support families with brain injured loved ones. I know we all want to hear about that, and also tell us about the Life Care Resource Guide. These are pretty inspirational things you’re doing.

 

Josephine G. S.: Well the Life Care Resource Guide actually takes into account the medical diagnosis of an individual. What we do as a foundation, because the stress of family helping to support that person … We actually help them because it’s so daunting. We have volunteer nurses, therapists, and they actually go in and look for the resources around their demographic area and that’s how we create their life care plan. The therapies, the equipment, do you need dealers, doctors, hospitals, day-habs? It’s just whatever is needed for that family to be able to take care of their loved ones.

 

Larry Cohen: That’s interesting, Josephine. That’s tremendous work you’re doing for the brain injured families. I’m sure they appreciate everything that your foundation and the Life Care Resource Guide can provide for them.

 

On your foundation’s website, there’s an interesting yellow butterfly which we’ve learned has some special significance, but I’m not sure what that is. So talk to us about Christina and the significance of the yellow butterfly. What is that?

 

Josephine G. S.: Well Larry, they say that our Heavenly Father allows our loved ones that have gone to heaven to come through the veil. It started after Nina had gone to heaven. From time to time when we would be at the point of such unbearable grief, a yellow butterfly would come and appear. I guess the first time was at a football game, oddly enough, ’cause Nina went everywhere with us. She loved to cheer on her brother’s college team and to encourage him because he was so devastated after losing her. He was about to graduate from college. So we went to the football game, trying to make it as normal as possible and went and even stood in the handicapped section where she used to stand, where we rolled her up in her wheelchair. And here comes this yellow butterfly, and I started crying.

 

I guess to me it was a symbol that maybe she was saying, “I’m okay. I’m here.” And it had landed on the railing where her wheelchair used to sit. There was a lady standing next to me and she hugged me and I explained to her. If you can imagine … Of course a football stadium’s all concrete. It’s not like there’s trees or anything around that a butterfly would show up. But there again, here comes another football game and here comes this yellow butterfly landing on the same spot. So to me it was more Christina saying, “You know Mom, I’m okay. I’ll always be here with you.” And it just to this today really means a lot.

 

Larry Cohen: Oh, no question. It gives you goosebumps, that story. It’s really amazing. And you know you hear stories like that, and I think it all comes down to having faith that things are a little bit better up there. I think that’s what she is telling you. That’s a very interesting and heartfelt story.

 

Josephine G. S.: I really would love to share with your listeners, the one day … Because there is an angel that the butterfly is in the wing of the logo … I was running on the beach one day … I’m a runner. And I just couldn’t bear to see Craig crying over the loss of Nina and when I got back in the car, just shut the door and was yelling at the top of my lungs. And it’s so out of nature for me to do that, but I guess grief took over. Asking her where she was … That day we were actually donating one of her wheelchairs. So we had gotten back in the car and drove back home and got the wheelchair out and was putting it in the car of a lady that actually has helped us for many years. She started crying and then I started crying uncontrollably, and then there goes Craig.

 

Then all of a sudden she says you know, “Look up.” And I would invite your listeners to go to the website. It was the shape of an angel cloud. There wasn’t another cloud in the sky. It was absolutely breathtakingly beautiful. There again, it was another sign that … “You know Mom, you’re on the right track. We’re doing okay, and keep going.”

 

Larry Cohen: It’s amazing stories.

 

Anne Lawter: Yes, Josephine. The perseverance that you and your family have shown in carrying on Christina’s legacy is amazing and the work that you’re doing to help other families that take care of brain injury victims is just amazing. Can you tell us how if someone wanted to get involved with the foundation and volunteer, how they could do that?

 

Josephine G. S.: I surely can. I just wanted to say one more thing in regards to her logo. Her loving brother Christian actually did those strokes of love on his tablet and created that logo. I wish I had more time to tell you about Christian, because what an amazing young man and what an amazing brother he was to her and still is.

 

Larry Cohen: Well you know they have an amazing mother too, don’t forget that.

 

Josephine G. S.: Thank you. And in regards to, Anne, thanking you for how people can assist Christina’s foundation, the foundation that bears her name and the foundation that has helped so many not only changing the structured settlement industry but allowing structured settlement brokers to assist so many. If you could please go to her website, because the foundation is helping so many families and we just need their support, and through donations. It’s www.tcgsf.org. Because we’re a 501(c)(3) public charity, anything that you donate can and will be tax exempt as allowed by law. I guess not only as the executive director but as a mom who loved and cared for her daughter for so many years, almost 33 incredibly blessed years, this is the way that you can honor Christina. Become a Nina moment, and please go to her foundation and donate.

 

if you want to talk to me personally, I would love that. You can dial the 1-866-637-8392, that’s extension 21. And my email address is Josephine@tcgsf.org and I would love to hear from you. Again, Anne and Larry, I cannot thank you enough for allowing me to be a part of Ringler Radio and I just-

 

Larry Cohen: It’s our pleasure, believe me. This has been an inspirational show. It’s not just educational but inspirational and I think all of our audience would respond positively to that statement. Anne I know is someone that’s been in this industry, and we all deal every day with these issues of, “Are they gonna take a structure or are they gonna take a cash settlement?” We’ve seen the pain that comes from those who don’t really have the decision explained properly to them. I think what you’ve done Josephine, not just through your foundation helping others, but also through the toughness and the fight, having to file the pro se litigation even, that just shows the spirit you’ve had. You really helped a lot of people. I just want you to know that.

 

Josephine G. S.: The appeal case, as well, it was just-

 

Larry Cohen: Oh yeah, oh yeah. No question about it.

 

Anne Lawter: Josephine, having practiced as an attorney for almost two decades, I just cannot commend you enough for having the courage to be able to take something on yourself and having the courage to move forward with that or striving to make a difference in others’ lives as you have. My heart just bursts with joy in knowing what a major contribution you and Christina have made.

 

Josephine G. S.: Thank you so much. I will tell you, last night we had our second practice for the adaptive tennis program that we just started with the Special Olympics. At the end, because those children are so intellectually and physically disabled, at the end when you’ve got the smiles and the success and their parents are cheering them on, even if it’s just to hit a ball one time with the tennis racket, it just enlightens your heart. At the end when they took the picture, and the reason I’m saying this, is I had gotten everyone in the stands. We all got together and it was like one, two, three, and then everyone said, “Nina!”

 

Larry Cohen: Oh wow.

 

Josephine G. S.: The picture was taken and it was absolutely beautiful. So I will end on that note-

 

Larry Cohen: No question, no question. That’s terrific. Terrific way to end it. And I just want to say again, Josephine, tremendous having you here and I’m glad you gave out all the information to how to reach you and the foundation. Anne, if someone wanted to reach you, how would they do that?

 

Anne Lawter: They can reach me in the Ringler office in Troy at 248-457-1212 or at alawter@ringlerassociates.com

 

Larry Cohen: Terrific. All of you out there, you can reach any Ringler associate. You can find them, you can even look at their pictures if you want, by going to the Ringler website, ringlerassociates.com. On that website you’re going to find tremendous amount of information, helpful information, the kind of explanatory information that we only hope that at one point back in the day that Josephine might have had.

 

Josephine, you’ve been an inspiration to us. If you want to hear any of the Ringler Radio shows, ringlerassociates.com, ringlerradio.com, legaltalknetwork.com, or an iTunes where you can download the show and listen at your leisure and hopefully be inspired by Josephine as we all were today.

 

So with that I want to say thank you Josephine for being a tremendous guest and inspiring all of us. And as I said before, humbling all of us too at the same time. Thank you very much for being here.

 

Josephine G. S.: Thank you both and many blessings to you both as well.

 

Larry Cohen: Thank you. And Anne, thanks for being a great co-host.

 

Anne Lawter: Yes, thank you Larry and thank you Josephine.

 

Larry Cohen: And for the rest of you out there, be inspired and go have a great day. Bye-bye.

 

Speaker 1: The views expressed by the participants of this program are their own and do not represent the views of, nor are they endorsed by, Legal Talk Network, its offices, directors, employee, agents, representatives, shareholders, and subsidiaries. None of the content should be considered legal advice. As always, consult a lawyer.

 

Thanks for listening to Ringler Radio, celebrating more than a decade of podcasting, and over two million listeners. Think of Ringler, the objective settlement advisors with more than 140 consultants in 60 cities nationwide. Visit ringlerassociates.com today.

 

 

4 Things to Consider in Complex Work Comp Causation Cases

work comp causationMembers of the claims management team are challenged daily to run an effective operation.  One of these issues claim handlers confront are questions of medical causation before admitting primary liability on a workers’ compensation claim.  Unfortunately, most members of the claims management team do not have a medical degree, but they do have many resources at their disposal to meet these challenges and make even complex decisions with certainty.

 

 

To Admit or Deny Primary Liability

 

Questions of medical liability for a work injury are often more complex than those that involve a “legal” basis for denial.  When reviewing questions of medical causation, claim handlers need to consider the following issues:

 

  • Evidence of clinical medical findings to substantiate a work injury;

 

  • Evidence of the requisite workplace exposure—which are often complicated by claims or repetitive use allegations; and

 

  • Medical literature that connects or links the work activity to the alleged injury.

 

In many instances, claims handlers are left to rely on training, experience and gut instinct to make decisions.  Time is of the essence given statutory parameters following receipt of the First Report of Injury.  Failure to do so can result in admissions against interest and/or penalties.

 

 

4 Things to Consider in Complex Work Comp Causation Cases

 

Members of the claims management team need to be proactive when it comes to admitting or denying a workers’ compensation claim that boils down to issues concerning medical causation.  There are important steps one can take to make a reasonable and well-informed decision.

 

  • Investigate the mechanism of injury: This consideration includes the question of “how” an injury occurred.  The claim handler will have medical records that detail how the injury took place.  In other instances, they may have the opportunity to conduct a more in-depth investigation.  This can include a recorded statement from the injured worker or witnesses.

 

  • Determine the exact medical diagnosis: This includes obtaining as many medical records as possible immediately following the work injury.  This starts with learning where the employee received post-injury care and the names of prior medical providers.  In many instances, state and federal privacy laws allow claim handlers to receive medical records without a signed authorization.

 

  • Review all diagnostic tests and studies: Reviewing the reports from medical studies can provide insight into the origin of an injury.  Examples of this include injuries to the upper extremities, shoulder areas and cervical spine.  A review of EMGs, CT scans and MRI can narrow the point of injury and its origin.

 

  • Roundtable with the claims team: This is a value resource to review the facts and question the plausibility of a claim. Roundtable sessions with a claims management team are important for many reasons.  This includes the ability of claim handlers to learn from each other’s experience and plot claim strategy.  It can also be an opportunity to poke holes in the employee’s version of events and plan a defense.

 

 

Battle of the Medical Experts

 

In many litigated claims involving injury causation, there is a “battle of the experts.”  While the employee always carries the burden of proof, many jurisdictions view the evidence in a light most favorable to the employee.  The result in the need to provide the medical expert with as much information as possible prior to the adverse examination.  A well written IME report and excellent bedside manner for courtroom testimony is a must.

 

 

Conclusions

 

In every workers’ compensation claim, a strong defense starts with the claim handler working the file.  This requires that person to use their skills and resources to conduct a diligent investigation and examine the important issue of medical causation.  Claim handlers have many resources.  By using them, they can position their file load for success and reduce costs in their workers’ compensation program.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

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.

Dr. Jacob Lazarovic Joins Amaxx As Medical Advisor

Kennebunkport, Maine. September 13, 2017 – Amaxx, the nation’s leading resource for workers’ compensation cost containment best practices is proud to announce the addition of Jacob Lazarovic, MD as Medical Advisor.  Dr. Lazarovic will work directly with Amaxx Virtual Consulting professional services clients on the evaluation and implementation of workers’ compensation medical cost containment best practices.

 

Jacob Lazarovic, MD brings to Amaxx 30 years of experience in medical management and managed care. He has been published extensively in industry journals and has held several senior medical management positions at companies including HealthAmerica, Blue Cross/Blue Shield of Florida and Vivra Specialty Partners.

 

Dr. Lazarovic comes to Amaxx from Broadspire, where he spent 18 years as Chief Medical Officer. In this role, his department produced clinical guidelines and criteria to support sound medical claim and case management practices; participated in analysis, reporting and benchmarking of outcomes and quality improvement initiatives; developed educational and training programs that updated the clinical knowledge and skills of claim professionals and nurses; provided expertise to enhance the medical bill review process; and operated a comprehensive and unique in-house physician review (peer review) service.

 

“I am thrilled to be working with Dr. Lazarovic,” said Michael Stack, CEO of Amaxx, adding, “I’ve worked with Dr. Jake for many years in his role as Chief Medical Officer at Broadspire prior to his retirement, and have tremendous respect for what he accomplished for that organization.  I value the opportunity to work with him more closely, as well as share his knowledge and expertise with my client base.”

 

Dr. Lazarovic, who is based in Boca Raton, FL stated “it is a pleasure to be working with Michael and Amaxx.  I look forward to focusing on the clinical aspects of its consulting activities, enabling clients to better ensure that the medical services they manage are of optimal quality, availability, and cost-effectiveness.”

 

 

Workers’ Comp Mastery Training

 

Join Michael Stack & Dr. Lazarovic in their Workers’ Comp Mastery training session “How to Leverage Evidence Based Medicine to Create Better Workers’ Comp Claim Outcomes” on Tuesday, September 19, 2017 at 2:00 pm EST.  Learn how to leverage evidence based medicine tools, review case examples, as well as best practices on integrating evidence based medicine into your program.

 

 

About Amaxx

 

Amaxx helps employers in all industries reduce workers’ compensation costs through education, publishing and consulting. The injury management system taught is a best-in-class process based on 25 years experience lowering employer’s workers’ compensation costs while improving overall program efficiency.  Contact Michael Stack, mstack@reduceyourworkerscomp.com.

 

 

 

Safe Patient Handling and Mobility Claims Coding: A Pragmatic and Functional Approach

Authors: Vicki J. Missar, Michael Fray, Candy Raphan, Mary Matz, Wendy Weaver

 

Whitepaper originally published by The Association of Safe Patient Handling Professionals (ASPHP). All of the authors of this white paper are members in good standing with ASPHP and serve as Board members.  

 

Reference: https://www.choosebroadspire.com/media/11899/safe-patient-handling-white-paper.pdf

 

 

Abstract

 

Healthcare organizations are now engaged in Delivery System Transformation (DST), whereby performance-based incentive payment programs are used to support and reward hospitals for investing in projects that advance care and population health while lowering costs. In these efforts, it becomes critical to understand causes of patient handling and mobility workers’ compensation injury claims. Until now, programs that are self-administered or utilize a Third Party Administrator (TPA) have differing, if any, codes to determine employee injury trends. Unfortunately, these coding structures, particularly when it comes to causes, lack any real, actionable data to establish investment needs for safe patient handling interventions. Healthcare organizations are left to drill down to the accident-description level and extract key causes of the patient handling injury, a time-consuming and unrealistic option given the human resources demand within healthcare. This paper proposes a condensed, yet powerful, sub-level coding structure for safe patient handling claims that any claims reporting system can easily adopt. As a result, this coding structure will eliminate the need to manually sort through lines and lines of data for relevant trends. Adopting this proposed coding structure nationally will reward the safe patient handling community with a consistent and transparent approach to claims. As a result, it will enable facility-level comparison of key functions and tasks associated with patient handling claims, peer-to-peer benchmarking of these causes and return on investment calculations at the fingertips of the end user.

 

 

Introduction

 

Healthcare companies in today’s business environment experience an unprecedented amount of change in terms of change drivers and pace of change: technology, shifting workforce demographics, global opportunity and competition, new sources of competitive advantage and rapidly evolving risk and regulatory requirements. Healthcare is an industry in the midst of fundamental transformation across the entire value chain and to all sectors, including physician groups, individual hospitals, senior care facilities, managed care organizations, insurance companies, wellness organizations, and integrated healthcare systems. As organizations address new business realities driven by healthcare reform and DST, they must reassess their data-mining capabilities around leading loss drivers that impact employee health and safety. With the right data and trending capabilities, safe patient handling claims can be easily dissected and solutions funded.

 

An apparent need exists to develop a standardized coding method focusing on the sub-category of activity type associated with patient handling injuries. So far, no national standard addresses the way these claims are coded in a Risk Management Information System (RMIS). This lack of uniformity leads to time-consuming efforts to extract key trending and cause analysis for meaningful solutions.

 

Standardization is applicable to overall workers’ compensation management, as well as risk managers, safety practitioners and occupational health professionals concerned with preventing safe patient handling and mobility (SPHM) injuries. The current mechanism to track injury types and occurrences proves neither healthcare specific nor customized by individual stakeholders. In addition, there’s a lack of detail-level standardization to provide easily identifiable and actionable data. Table 1 shows a snapshot of a healthcare organization RMIS loss run. The vague nature of the injury and cause descriptions provide little intelligence on the tasks (e.g. transfer type, toileting, bathing, etc.) performed at the time of injury. Therefore, a significant blind spot remains for safe patient handling professionals, and need for improvement on a national level is evident.

 

 

Table 1: Snapshot of a RMIS Loss Run for a Healthcare Organization

 

 

Current State: The Era of Big Data

 

Claims administrators require the ability to pare down injuries to focus on cost and frequency. Data available through loss run or other high-level data output provide only a general understanding of cause (See Table 1). The table does not provide sufficient detail to describe how the action being performed caused the injury. Technology is available via RMIS to affect change, but it cannot be used productively without changing and improving the information captured. A small addition to the current coding will make patient handling claims/injuries more transparent and actionable, create a best practice in the industry and produce long-lasting benefits.

 

Multiple methods are used in an attempt to address the need for this transparency which will bring patient handling claim trends forward. The following are examples:

 

  • Manually reviewing narrative reports to ascertain cause, associated circumstances and activities performed at the time of injury
  • Creating manual methods to map injuries with specific sites within a facility
  • Manually creating and using customized codes specific for a healthcare system or facility
  • Benchmarking national research reports that take years to publish
  • Using the National Institute for Occupational Safety and Health (NIOSH) Occupational Health Safety Network (OSHN) coding system (NIOSH, 2015)

 

Manual attempts at transparency are generally labor-intensive and may be highly burdensome. In an environment where human resources are stretched and patient and staff safety have become national priorities, the current state requires change.

 

 

Patient Handling Claims

 

Frequent injuries to patients and residents—regardless of the healthcare setting—have created a national call for action as demonstrated by several laws passed over the past few years. In addition, the American Nursing Association has issued an interprofessional national standard with the goal to put an end to these life-altering and career-ending injuries. The Occupational Safety and Health Administration (OSHA) points to manual patient handling as the cause of the high incidence, and severity, of injuries in the healthcare industry (OSHA, 2003). In 2013, the most frequent national, nonfatal occupational injury and illness, as well as injury and illness requiring days away from work, transfer, or light duty, were within healthcare and social assistance categories (Bureau of Labor Statistics (BLS), 2014). BLS data for 2013 demonstrate this impact  on caregivers. As seen in Figure 1, nursing assistants and orderlies accounted for some of the highest rates of nonfatal injuries and illnesses resulting in lost work days. These rates are approximately three times that of construction laborers and similar to that of firefighters. Compounding the personal and organizational impacts of such severe injuries, the financial cost of these injuries is profound (Institute of Medicine, 2011).

 

 

Figure 1: BLS Musculoskeletal Injury Rates for 2013 (per 10,000 work hours)

 

 

As illustrated above, injuries to caregivers, who are providing essential services for the infirm, are clearly significant. A typical certified nursing assistant, one who provides the majority of direct patient care, averages 4.5 injuries per year, according to a study by Khatutsky et.al (2012). However, while the study listed patient handling as a key loss driver, the study did not define the cause or activity (toileting, repositioning, etc.) involved in the injuries. Lack of easily accessed injury details on a sub-category level is a significant disadvantage for many SPHM professionals. Without that detail, there is no mechanism to facilitate implementation of effective Safe Patient Handling and Mobility Programs using RMIS data. Practitioners are left with manual, time- consuming data-crunching processes.

 

 

Reaffirming the Core Problem

 

There is a significant lack of easily accessible, detailed causative factors related to patient handling and mobility incidents available to healthcare sectors and stakeholders on a cumulative level. Patient handling and mobility incident causality data is generally a labor-intensive extraction effort using manual processes Without key elements, justification for the financial support of development, implementation and maintenance of SPHM programs may not be attained.

 

Collection and reporting of patient handling and mobility injuries must be easily implemented, concise and user-friendly to be sustainable. Above all, this proposed standard collection and reporting of more detailed data elements associated with patient handling and mobility injuries must also address the realities of the normal working environment and the various documentation requirements posed to the practitioner on a daily basis. In the era of big data, we must simplify the approach.

 

 

Future State:  Keep it Simple and Transparent

 

Figure 2 provides a basic workflow for any healthcare system to investigate and adjudicate claims. The current U.S. workers’ compensation structure lacks uniformity across casualty claim service organizations related to patient handling and mobility injury identifiers. This inconsistency prohibits the ability to affect change through benchmarking or modeling at the local, regional and national levels. These critical data elements promote effective resource allocation, pre- and post-loss program development and implementation. Some of the key data elements not currently documented range from the most obvious, such as making an occupied bed, to other notable elements such as managing aggressive behavior. These causes provide the information to propel effective change and mitigate costs of these pervasive and many times debilitating injuries.

 

Other categories used to define specific types of movement and activities will create consistency across claims platforms as well as the much needed transparency for better injury cause identification and implementation of relevant, impactful solutions tied to the visible trends. This provides a mechanism to quickly and credibly identify a host of benefits:

 

  • Trend injuries by patient handling task/activity (e.g. repositioning up in bed, limb holding, toileting, vehicle transfers)
  • Identify predictive causes of injury
  • Track frequency of specific injury types
  • Effectively simplify big data into actionable elements
  • Measure return on investment with SPHM programs
  • Identify impact of patient handling and mobility equipment and programs
  • Add additional dimension to the description of injuries
  • Provide a method to benchmark outcomes
  • Develop a sustainable best practice

 

Clearly the benefits demonstrate the need for moving forward with a simplified method. This approach will have a broad appeal as it closes a significant gap in the scope of the data being collected and allows SPHM professionals to compare data across peer groups in a consistent manner. Collecting more detailed information regarding the injury will also streamline RMIS coding constructs and allow providers to set up identical coding for all healthcare-related clients.

 

 

Figure 2:  Current and Proposed Claim and Reporting Processes

 

The detailed injury information proposed to be added to the intake process and RMIS systems will have a profound impact on the ability to extract actionable data elements. By instituting standard coding for the type of “Patient/Resident Handling and Mobility Activity” and “Patient/Resident Handling and Mobility Equipment Use” as shown in Table 2, risk managers or consultants to healthcare companies can retrieve actionable data from their claims administrators or internal systems.

 

Table 2 also shows the proposed national standard for additional elements, and it comprises a simple, yet easily implemented coding structure to add increased value to the claims intake and reporting process. By adding these critical categories, the benign loss run categories of “patient handling” or “strain—pushing/pulling” for example, bear more meaning and record vital information. (‘Patient’ is used in this paper to include all healthcare recipients; patients, residents, clients, etc.)

 

 

Table 2:  Proposed Patient Handling and Mobility Injury Codes

 

 

It is accepted that some patient handling injuries are difficult to classify and fall into the “no defined/listed cause (21)” category because they are cumulative in nature and may not have a specific cause. It is not uncommon to hear a caregiver say she has been lifting patients all day and now experiencing back pain. No specific task is identified as the cause nor can the caregiver suggest what caused the pain or injury other than, “lifting patients all day.” Such cumulative injuries are included in the “no defined/listed cause” sub-code. Additionally, RMIS includes cumulative trauma as a cause, so that code was not included in the proposed structure. Importantly, although cumulative trauma codes do not provide a clear understanding of what activity led to caregiver discomfort or pain, knowledge of trends in cumulative trauma provides actionable data in and of itself.Table 2 shows the codes defining patient handling, which will provide a clearer picture of the injury the caregiver experienced while performing a specific patient handling and mobility task. These definitions are supported by other incident reporting systems (e.g. NIOSH, Veterans Health Administration (VHA), etc.). Only a single code is required from each column. Ultimately, the data will provide information that may point to a single causative factor for that injury, such as the use or non-use of a SPHM assistive device.

 

Some workers’ compensation personnel may not be entirely familiar with the range of equipment used to support SPHM including ceiling and floor-based lifts, air-assisted lifting and lateral transfer devices, slippery sheets, friction reducing devices, roller boards, powered wheelchair/bed movers, powered toilet lift seats and more. Some beds, stretchers and gurneys are also included as SPHM equipment when they perform functions to help move and handle patients. However, walking aids such as walkers, canes, and crutches, as well as push wheelchairs and fixed or manually adjusted beds/trolleys/gurneys are NOT considered SPHM equipment. Slings (Table 2, Item 12) are used with patient lifting equipment to move and/or lift a patient or body part.

 

 

Stakeholder Value

 

Evidence-based information clearly demonstrates that certain categories of the data are linked to cost drivers. It is important to effectively utilize that information to more globally understand the overall results. Understanding the collection, reporting and data available to SPHM injury stakeholders and the impact that this information will have is imperative. The information in Table 3 will guide the improvement of the SPHM program functioning overall and reduce the negative effects of unnecessary patient handling and mobility injuries.

 

 

Table 3: List of Stakeholder Benefits and Corresponding Details

 

When Table 3 was developed, each of the named stakeholders’ perspectives was assessed through its own respective lens. For the reader to clearly understand how standardization of coding will impact each of the named stakeholders, a brief description and situational illustration is offered for each label in Impact of Coding Improvements.

 

 

Impact of Coding Improvements

 

Data Integrity and Consistency – Accurate, complete and concise capture and report of all requested data elements. Without standard data elements that are practical to obtain and easily recorded, the risk of incomplete and inaccurate information increases, reducing the possibility of any analysis or conclusions to be drawn organizationally or nationally.

 

Benchmarking – Comparing one’s SPHM program and performance metrics to industry bests or best practices. Comparative analysis provides a point of reference to internal and/or global results that may be either compared or assessed. Benchmarking provides a method through which each organization/facility may measure its SPHM program success against that of others; providing information to facilitate change.

 

Predictive Analytics – Extracting information from existing data sets to determine patterns and predict future outcomes and trends. Through the use of a set of standardized data elements, these trends may be used to draw sound conclusions and provide direction for future program decisions, such as determining SPHM program and equipment needs.

 

Claims Management – Advice or services related to claims for compensation, restitution for loss or damage due to injury or illness incurred in the practice and performance of patient handling and mobility activities. Standardized data elements provide claim managers valuable information to complete a thorough investigation and adjudication of each claim.

 

Capital Equipment Purchase Justification – Typically capital equipment is defined as items of considerable value that have durability and that are used to provide a service or increase revenue over the lifetime of the item. This may also be considered a tangible corporate asset. For the subject at hand, the justification of capital equipment purchases may be considered the more significant obstacle to development of a SPHM program. Data collected as a result of customized coding identifies cost drivers that in turn provide justification and validation for SPHM program capital expenditures.

 

SPHM Program Operating Cost Justification – Operating costs are expenses related to the operation of a business, or to the operation of a device, piece of equipment, or facility. They are the cost of resources used by an organization to maintain its existence. SPHM Program and equipment costs are considered operating costs. In healthcare, there is much competition for these funds. For this reason, there must be iron-clad justification/s for SPHM program and equipment costs. SPHM justification must include direct and indirect SPHM operational costs including equipment, staff training, staffing, and others. As well, benefits and cost savings for both patients and staff must be included. Staff cost savings relate to decreases in the rate of injuries, lost time, and modified duty injuries. Decreases in patient adverse events result in huge cost savings for an organization when there is an effective program.

 

Direct and Indirect Operational Costs – Direct costs of medical care (including rehab), indemnity (lost wages) and legal services are only several line item expenses to consider when assessing the fiscal impact of a musculoskeletal workers’ comp injury incurred due to SPHM activities. To be included with these obvious core costs are other expenses that must be accounted for when evaluating at the entire monetary effect of these injuries. Professionals also acknowledge injury indirect costs which include wages paid to injured workers for absences not covered by workers’ compensation insurance; administrative time to investigate the incident and perform other related supervisory duties; employee training and costs for replacing the injured workers; and lost productivity and accommodation of injured workers. While specific stakeholders are able to use data on certain line items to provide financial and other useful information, all stakeholders need to see the full picture of how SPHM injuries can affect the facility’s fiscal health and overall employee satisfaction.

 

Identification of Specific Cost Drivers – Specific activities or actions that have been identified to have costs associated to them. Customized coding will provide detailed activity descriptions to allow quantification of data and associated costs resulting from injuries.

 

Labor Retention and Recruitment Efforts – Data supports the fact that successfully competing for educated, trained and experienced healthcare workers in today’s market does not just depend upon wages, salaries, benefits, work shifts or available days off. Musculoskeletal injuries, cumulative or traumatic, have a significant effect on the professional and personal lives of the injured. Some injuries can disable and/or destroy a career. Competent caregivers also acknowledge that their safety and health closely relates to the welfare of their patients/residents. Having a SPHM program in place within a culture of safety demonstrates to recruits and affirms to current employees that the facility supports and protects them.

 

Patient Safety and Quality of Care – Currently, organizations must pay for negative patient outcomes related to hospital stays. Increasing evidence points to the importance of mobilization of all patients in the recovery process, which patient handling equipment facilitates. Falls, skin breakdown, UTIs, pneumonia, and other hospital-acquired injuries/illnesses are positively impacted when SPHM programs foster equipment use.

 

Utilization of Best Practices – There are tried and true processes for SPHM program development, implementation and maintenance. The ANA Safe Patient Handling and Mobility Interprofessional National Standards relay those national experts agree upon. The Veteran’s Health Association has the largest and most successful SPHM program in the United States, incorporating best practices found to be valuable in other organizations as well. When these best practices are supported, patient and staff injuries are impacted positively.

 

Quality Improvement Programs – These specific and defined process-based, data-driven approaches to improving the quality of a product or service are significant in all modes of healthcare provision. In the context of this paper, patient handling injuries drive many of the quality improvement programs’ focus. Customized coding will provide a consistent method from which data may be obtained and analyzed in the context of performance-based measurements.

 

Caregiver Safety – Occupational health and safety programs continue to identify risk factors and specific interventions to mitigate injuries due to patient handling. Rates of musculoskeletal injuries from overexertion in healthcare are among the highest when compared with other industries. A primary focus of this paper is to identify those data elements, which will provide sound and reproducible data to drive the continued development and improvement of SPHM programs.

 

Public Relations and Brand Protection – Communication systems provide immediate and up-to-date information to the consumer seeking products or services. These channels, whether newswires or social networking sites, provide the conduit for widespread public relations and positive branding. Public acknowledgment and reporting of a SPHM program developed, installed and maintained in the facility bespeaks the culture of safety that has been promoted and secured by administration. Knowledge that the facility cares not just for the patients/residents but also for the employees focuses on the humanity of the healthcare entity and instills consumer trust.

 

 

Engagement Blueprint

 

To gain consensus and buy-in for consistent coding, first think and act locally, then move to global applications. Figure 3 shows a simple process for adopting the proposed category in a gradual yet meaningful way. Step 1 involves adding proposed codes to the incident reports and other data capture processes to get consistent points adopted on the front end. As with any change, stakeholder education is critical. Steps 2 and 3 are at the administrator level, whereby stakeholders gain approval to institute the new coding in RMIS or other data capture systems. For example, adjustments to intake scripts would need to include the new coding, ensuring these questions are answered at the claim-reporting level. Because the new coding is simple in nature, there should be minimal impact to a data warehouse/RMIS system.

 

 

A Call to Action

 

Early adopters of more detailed coding practices have clearly demonstrated a positive impact on overall loss costs when compared to those that have yet to embrace this practice. These organizations are likely to garner peripheral and significant benefits such as staff retention, attraction of clinical talent in an environment with skilled nursing and medical professional shortages and productivity drains to name a few. However, administrators require tangible metrics to support the business case for development and maintenance of robust SPHM programs.

 

 

Ongoing state legislative activities are gaining momentum to encourage development, adoption and standardization of programs. This movement will likely continue. Federal adoption and support of SPHM standards and practices have yet to be enacted. However, without a standard from which to measure outcomes, comparison and trending, enumerable losses will continue. Moving forward, stakeholders will need to take a pragmatic and incremental approach to engage all participants in the process. As engagement increases and results are measured, further expansion of codes may be introduced as practically appropriate.

 

 

Conclusion

 

Fundamentally, caregiving is a humanitarian effort based on respect and concern for others. As science and the ability to treat and cure has progressed through the years, longer lives lived with chronic, debilitating and frail conditions and the needs for more challenging rehabilitation efforts have resulted.

 

The caregiving workforce and the patients/residents are all aging. And more than ever, the condition of the financial bottom line is tenuous and difficult to control.

 

It can easily be acknowledged that the implementation of a successful SPHM program, led by an expert in the field and supported by others who are educated and experienced in the scope and practices of the program, makes a significant difference in the health and welfare of the caregivers, the cared-for and the service-providing entity.

 

Be reminded of Table 3, illustrating the value of this proposition, and all the ways that patient handling and mobility injuries can negatively affect lives, jobs and the bottom line. The proposal for standardized coding herein is simple and easy to implement so that healthcare organizations can maintain the practice and contribute meaningfully to decreasing staff injuries, improving patient/resident care and prolonging solid careers.

 

With inclusion of the proposed categories, improved data and its analysis will become consistent and available to all; providing the information necessary to improve safety programs. Assistive patient handling and mobility equipment is available and will continue to improve when the exact needs for the implicated tasks are consistently coded and brought to light.

 

 

References

 

  • American Nurses Association (ANA). (2013). SPHM Interprofessional National Standards Across the Continuum. Publisher: Nursebooks.org. Silver Springs,
  • National Institute for Occupational Safety and Health coding system [Occupational Health Safety Network (OHSN) (2015) http://www.cdc.gov/niosh/topics/ohsn/injury.html
  • Bureau of Labor Statistics 2014 BLS Newsletter 2014. http://www.bls.gov/news.release/archives/osh2_12162014.pdf
  • S. Department of Labor, Occupational Safety and Health Administration. (2013). Hospital eTool: Healthcare Wide Hazards – Ergonomics. Available at: https://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html. Accessibility verified 1/29/2016.
  • Institute of Medicine (IOM) (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies
  • National Institute for Occupational Safety and Health (NIOSH). NIOSH Standard Occupational Data Architecture (SODA 2.0) Draft document dated June 24,
  • Khatutsky, G., Wiener, J. M., Anderson, W. L., & Porell, F.W. (2012). Work-related injuries among certified nursing assistants working in US nursing homes. RTI Press publication No. RR-0017-1204. Research Triangle Park, NC: RTI Press. Retrieved from rti.org/rtipress.

 

 

Disclosure Statement

 

The Association of Safe Patient Handling Professionals (ASPHP) does not endorse one particular company or organization. Reference within this paper to any specific commercial or non-commercial product, process, or service by trade name, trademark, manufacturer or otherwise does not constitute or imply an endorsement, recommendation, or favoring by the ASPHP.

 

The views and opinions of the authors of content provided in this paper do not necessarily state or reflect the opinion of the ASPHP and cannot be used for advertising or product endorsement purposes.

 

 

Acknowledgments

 

All of the authors of this white paper are members in good standing with ASPHP and serve as Board members.  Wendy Weaver is the past Executive Director of the organization.

 

 

 

 

Mike Fray PhD, BSc(Hons), BHSc, MCSP, FHEA Senior Lecturer

HEPSU, Design School, Loughborough University UK

 

Vicki  Missar,  MS, CPE, SSBB, CSPHP, CHSP

Associate Director, Global Risk Consulting Aon 

 

Candy Raphan, RN, BSN, ARNP-C, MAOM Regional Vice President

Client Services Medical Management Broadspire®

 

Mary Matz, MSPH, CPE, CSPHP

Patient Care Ergonomics Consultant President, Patient Care Ergonomic Solutions

 

Wendy Weaver, MEd

Gateway Coaching & Consulting, LLC

Medicare is Taking Action… and Other Workers’ Comp News Tidbits

Medicare Set Aside Compliance – Medicare is Taking Action

As the Centers for Medicare and Medicaid Services (“CMS” or “Medicare”) ratchet up their active monitoring of Medicare Set Aside (“MSA”) accounts, using a professional administrator to help make sure reporting is in order is becoming even more critical.

 

There is no doubt that CMS is taking compliance with the Medicare Secondary Payer Guidelines more seriously these days.  Just take a look at the sequence of initiatives they have put into motion over the past several years to prevent wrongful payments from the Medicare fund – from implementing mandatory reporting to earlier recovery processes to expanding the scope of MSAs to liability and non-fault cases. (see Exhibit A for a brief timeline of Medicare’s actions)

 

 

The Mission of WILG to Help Injured Workers

The Workers’ Injury Law & Advocacy Group also known as WILG, is the national non-profit membership organization dedicated to representing the interests of millions of workers and their families who, each year, suffer the consequences of work-related injuries or occupational illnesses. In this podcast, Ringler Radio host Larry Cohen and co-host, Duke Wolpert talk to attorney Michael K. Gruber, President of WILG, about his mission for 2017 and what to watch for in legislation that might impact workers.

 

 

Elite Women in Insurance 2017

Despite women’s growing presence in the insurance industry, few have successfully broken through into leadership roles – but the women featured on the following pages prove that’s slowly changing. Nearly 20% of the 2017 Elite Women hold top CEO or leadership positions, including the first female to start an insurance provider in the US. But the list doesn’t end there – it also includes countless executive officers, division heads, agency managers and more who have overcome obstacles and broken barriers to become some of the industry’s top professionals.

 

 

2017 RAND Study Evaluates Occupational Disability Guidelines (ODG)

RAND Corp. published its review of the (1) Technical Quality and (2) Clinical Acceptance of the Occupational Disability Guidelines (ODG) published by Work Loss Data Institute (WLDI). This paper briefly discusses the RAND report. WLDI publishes the ODG, arguably the most successful treatment guidelines in the occupational medicine space. Over 100,000 users support the platform. Continually updated, ODG incorporates over 10,000 ICD-9 codes, 65,000 ICD-10 codes, and 10,000 CPT codes

 

 

Optimistic Voices

Workers’ comp industry optimists expect that President Trump’s economic policies will help propel additional insurer premium volume growth through 2017 and even beyond. Recent growth in employment and wages are expected to generate billions in new workers’ comp premiums written. Factors like lower business taxes, reduced regulatory burdens and shifts in trade policy espoused by the president could fuel further growth.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

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.

Why “Abuse Deterrent” Is A Misnomer

Instead of mandating first-line coverage for ADF opioids, we must remain committed to reducing opioid misuse through a comprehensive, well-coordinated solution that includes law enforcement, providers, plan sponsors and patients.
 

According to the U.S. Food & Drug Administration (FDA), opioid formulations with abuse-deterrent properties are meant to target expected routes of abuse, such as crushing in order to snort or dissolving in order to inject. However, the FDA fully acknowledges that these products are not abuse proof.

 

Over the last two years, approximately 50 pieces of legislation requiring coverage of Abuse-Deterrent Formulations (ADF) of opioid products have been introduced in more than 30 different states.

 

Although the bills around ADF varied, the legislation generally seeks to address common objectives:

 

  • Mandate preferential formulary placement for ADF products, and/or
  • Prohibit utilization management tools like step therapy and prior authorization for ADF products.

 

The proffered goal of these bills – to reduced opioid abuse – is laudable in light of our nation’s crisis of opioid misuse and abuse. However, this type of legislation presents several problems:

 

  • The FDA fully acknowledges that these products are not abuse proof. Last week, the agency held a public workshop to gather data and methods for evaluating the impact of ADF.
  • A legitimate worry is that ADF opioids will lead prescribers into thinking the products are less addictive and overprescribing patterns will continue.
  • While ADF opioids make tampering more difficult, these products cost a lot more than their non-ADF counterparts. Required ADF legislation has been estimated to cost the state of California $4.5 million, with another $3.2 million borne by plans sponsors and patients in the state. By enacting these bills, states deprive plan sponsors from exercising some of their control over formulary design.

 

Instead of mandating first-line coverage for ADF opioids, we must remain committed to reducing opioid misuse through comprehensive, well-coordinated efforts among providers, payers, state and federal governments and law enforcement – with an emphasis on drug safety, counseling and patient support.

 

 

Author: Express Scripts Lab team—a diverse group of dedicated and passionate healthcare professionals. Some of us are behavioral scientists, some pharmacists, some statisticians, and some doctors. Together, we’re committed to the Express Scripts mission to make the use of prescription drugs safer and more affordable for the tens of millions of patients who rely on us.

 

About: Express Scripts Advanced Opioid ManagementSM solution works across the care continuum from safe disposal, to tools for physicians at the point of care and safety checks for dispensing pharmacies. This solution helps to significantly reduce unnecessary prescribing, dispensing and use to help avoid unnecessary hospitalization, ER and drug treatment costs, while ensuring access to medication patients need.

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