WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis

WCRI Recap – 3 Part Series

  1. WCRI Recap – Impact of Donald Trump and 2016 Election
  2. WCRI Recap: 3 Factors That Most Impact Worker Outcomes
  3. WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis


It’s been two weeks since the WCRI Conference recently held in Boston. I’m Michael Stack with Amaxx. Today I want to give you some highlights and recap from that recent conference from the notes that I took and the perspective that I had on it.


The next session that I took some detailed notes on was how are states battling the opioid epidemic. I took a lot of different notes in this session, but Dwight Lovan who was formerly with the Kentucky Department of Workers Comp Claims made one statement that I think is the only statement that really needs to resonate with our industry and with state lawmakers.




Single Biggest Factor To Turn-Around Kentucky Opioid Crisis


We all know, or a lot of people know, that Kentucky was the epicenter of opioid overdose deaths and opioid drug problem, so they took this head on. He talked about really how they addressed it in Kentucky and the progress that they’ve made, which has been significant. He made one comment, and he said, and he kind of almost said it in passing, but I wrote it down and I highlighted it and I starred it and I bolded it, because he said, “The biggest impact and the one thing that they did that made the biggest difference was they required their physicians to check the PDMP data.” They made a mandate that required their physicians to check the PDMP data. If you’re not familiar with the prescription drug monitoring program it’s a database that basically doctors can check. It takes maybe 5-15 seconds to see what other drugs that injured worker is taking so they don’t overprescribe, so prevents doctor shopping. A lot of those biggest challenges that cause overdose deaths, so they made a mandate that required the physicians to check this PDMP data before they prescribe the drugs.


That made the biggest impact at the epicenter of opioid overdoes deaths and the significant progress that they have made. I checked this research. I researched it a little bit online. I’m not sure how accurate this data is, but it said 16 states have since implemented this mandate and it should be implemented in every single state, in all 50 states. If this made the biggest impact at the biggest problem area in our country, it’s an easy fix and it only takes five to 15 seconds to save a life, so hugely important point on this how states are combating opioids. If you have not implemented this in your state talk to our lawmakers. Let’s make this mandatory across the board.



Non-Pharmalogical Treatment of Pain


The last session was non-pharmacological treatment of pain as alternatives to opioids. This was a fantastic session. The information covered was very impactful and very moving for the results that it can give for each individual injured worker.


Dr. Dawn Ehde and I apologize because I’m probably pronouncing that wrong, from the state of Washington. She gave a tremendous presentation. Here’s the highlights of what she covered. She covered the idea that this medical model, or the currently medical model as far as the treatment of pain. It just doesn’t work. It doesn’t work because the biopsychosocial factors in all the different elements that go into how an individual perceives their own pain. This reinforces that idea of the do you think you’ll be back to work in four weeks. It reinforces that same idea, the perception of that individual person is such a huge factor on how well they’re going to do, and a huge predictive indicator of how well that claim’s going to go.


She talked about some of the current different options of what’s currently being used out there today. She talked about cognitive behavior therapy and she talked about mindfulness, so two different popular options which you may or may not be familiar with. What she went into a more detail, which I thought was extremely interesting and compelling was this idea of collaborative care. That’s what I want to cover here today.



Collaborative Care Model


It’s very much in sync with the best practice that I recommend, which is the weekly claims round table. It’s about looking at an individual claim, bringing in perspective some different experts to collaborate and come up with the best solution for that individual person because the solution for Tom’s going to be different than the solution for Sally is going to be different than the solution for Joe. Each individual person needs their own path and their own direction. You get the perspective from different experts to work together, collaborate for that outcome. That was really what she reinforced here.


She drew out this picture of the injured worker really being at the center of this model. You’ve got the providers up here. You have a care manager down here, and over here you have what she called consultants, and these consultants and everyone ties into here to service the injured worker. These consultants are psychiatrists, they’re different experts that can bring in and share some expertise with this care manager and with this provider to all work together to collaborate on the different elements that maybe needed to suit that person’s needs, to meet them where they are, to move them towards this positive outcome.


I’m oversimplifying this conversation, I’m oversimplifying this presentation, but you get the idea of what we’re trying to accomplish here and what she’s talking about and how they’re addressing this in the state of Washington to hopefully provide a model for the rest of the country to follow for these outcomes. The idea is to collaborate, connect with this injured worker regularly, have conversations with him, set those expectations. We talked about that in the worker outcome studies of how trust is such a huge factor so you build this huge level of trust with this care coordinator and they’re talking to them, that injured worker, about their expectations that do you think you’ll be back to work question is a huge factor in how they’re dealing with their pain, and how they’re going to recover.


They implemented, they haven’t done a ton of studies on this idea yet, but they implemented in a case of multiple sclerosis patients. There was 188 patients and it achieved what the medical community deems is the triple aim, which is better outcomes, lower cost, and higher satisfaction. That was the only study and they’re starting to roll this out in work comp, so very exciting for the solutions that can be brought to the table. Very impactful, very practical information as always from the WCRI Conference. I hope that you can take this information and put it into practice today.



Pick One Idea & Implement!


My recommendation is to start with one thing, start with one thing. What is it from that conference that you want to implement today and build that momentum, which is how significant change happens. Again, I’m Michael Stack with Amaxx, remember your success in Workers Comp is to defined your integrity, so be great!




4 Questions On Urine Drug Testing To Deliver Better Work Comp Outcomes

Urine drug testing (UDT) is one of the more controversial and misunderstood tools in the workers’ comp system. While medical guidelines support the tests for injured workers who are prescribed opioids, stories of over testing injured workers —and overcharging payers — abound. There are also questions about what type of testing to use, the frequency of the tests, and what to do with the results.


UDT used judiciously and paired with clinical expertise can be invaluable in ensuring injured workers get the right medications at the right time. Understanding some of the basics will help you get the best bang for your UDT buck.


Types of testing


  • Forensic. UDT has been around for decades, beginning with its use to identify illicit drug users in criminal and civil proceedings as well as the workplace. This forensic, or ‘gotcha!’ model is designed to determine yes or no that someone is taking certain, typically illegal drugs. An initial screening — presumptive — test is performed and any positive results are sent for confirmation. The types of tests include in-office point of care. Results from these tests can come in minutes. However, they are not necessarily designed to detect the use of medications at therapeutic doses, something critical in a clinical setting. Also, the tests are not available for all drugs, such as synthetic drugs of abuse. Since oxycodone is a semi-synthetic opioid, it may not always be detected in these tests.
  • Clinical. This model puts the focus on the patient-provider relationship and is used as part of patient care in various settings, including pain management. The idea here is to identify the presence of specific prescribed medications, non-prescribed medications and illicit substances to benefit the therapeutic goals of the patient. Definitive testing, typically used in this model, provides information about specific drugs and metabolites and can detect drugs at much lower concentrations, which presumptive tests do not. The results of these tests, however, may not be available for 24 hours or more.


The type of test used for an injured worker depends on a variety of factors, including the physician’s assessment of the patient’s risk. The types of medications also has a bearing on the most appropriate tests. If there are multiple opioids, for example, presumptive tests may not provide enough information to help the physician.


Why Test:


Guidelines published for prescribing opioids to injured workers support the use of UDT to help identify safe and effective treatment options.  Some of the reasons to undertake UDT include:


  • Risk assessment. Research shows many prescribing physicians are not aware of their patients’ past and current drug-taking behavior. Clinical UDT provides clear evidence of the patient’s drug taking behavior, which is vital to the provider’s treatment plan, risk assessment, and interaction with the patient.
  • Clarification. In addition, patients often do not know specifically which drugs they are taking. So the drug test can add to the provider’s understanding of the patient’s current medical treatment.
  • Data consistently shows about 18 percent of workers’ comp patient samples do not indicate they are taking the prescribed drug. Given the problems with diversion, misuse, and abuse, it is clear that workers’ comp patients may be complicit — wittingly or not — in the inappropriate consumption of prescription drugs.


How Often to Test


How often should an injured worker on opioids be monitored through UDT? This is one of the key questions and problems surrounding UDT. Too much testing is a waste of money, while too little testing may lead to missed opportunities for intervention and cause the claim to deteriorate.


Physicians can determine how often UDT should be conducted based on the injured workers’ risk of medication misuse, abuse or diversion; and the importance of adherence, such as if the injured worker is being weaned off certain drugs.


  • Low risk. Injured workers who have little to no risk should be tested annually.
  • Moderate risk. Injured workers who have some red flags indicating they are potentially at risk should be tested a few times per year.
  • High risk. Injured workers with a high propensity for medication abuse should be tested frequently, in some cases even monthly.



What to Do With The Results


One of the problems with UDT is the lack of follow through after an unexpected or inconsistent test result. Faced with evidence that the injured worker is not taking her medications as prescribed, and/or is taking medications that were not prescribed — including illegal substances — some intervention is necessary. The results may be a clue that the injured worker is getting medications from more than one provider. At the very least, the provider should discuss the results with the injured worker. Unexpected results occur on average more than half the time.


Once the test results are available there are several steps that may be beneficial.


  • Work with a PBM. A pharmacy benefit manager can help interpret the test results and provide guidance on what the next steps should be. An unexpected test result may be due to a variety of factors; such as drug-drug interaction, or a contaminated or diluted sample. The answer is not always black and white, and a PBM or other expert can help decipher what the results actually mean.
  • Additional clinical outreach.
  • Follow-up testing.
  • Peer-to-peer review.
  • Change in medication therapy.




UDT can provide much needed information to help guide a claim. However, it should be part of an overall strategy and not the only tool used. It’s important to know the benefits and limitations of UDT and use it to help understand the whole picture of the injured worker.



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


©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.


Tower MSA Partnership with American Airlines and PRIUM Yields Legacy Claim Settlements

In a widely acclaimed presentation at the recent 2016 National Workers Compensation and Disability Conference, Jennifer Saddy, Workers’ Compensation Director for American Airlines and Mark Pew, Senior Vice President of PRIUM, detailed the successful cooperation among American, PRIUM and Tower MSA to reduce pharmacy costs, litigation referrals and Medicare Set Aside costs ultimately leading to significant claim settlements.  Tower MSA is grateful to Jennifer and Mark for highlighting how Tower MSA’s Identification, Intervention and Involvement services were a key contribution to the success of this legacy claim reduction program.


For more information on American’s program please read the Risk & Insurance article Make a Decision and Move the Needle: American Airlines needed to take aggressive action to resolve 6,000 lingering workers’ compensation claims.



For more information on Tower MSA’s legacy claim reduction services please contact us at 888.331.4941 or info@towermsa.com.



Author: Daniel Anders, Tower MSA Partners


Kids’ Chance of America and State Organizations Celebrate 2016 Awareness Week

Kids’ Chance Awareness Week 2016 kicks off today, November 14, 2016 and continues through November 18. The White House and President Obama have recognized the importance of Awareness Week and our mission to provide scholarships to children of workers who have been catastrophically or fatally injured on the job.  Collectively, Kids’ Chance organizations have awarded 5,593 scholarships across the country, totaling over $16,592,000 dollars.


At Kids’ Chance of America, we believe we can make a significant difference in the lives of all children affected by a workplace injury by helping them pursue and achieve their educational goals. In 2015, scholarship applications increased significantly but we know there are more students in need of assistance. Kids’ Chance Awareness Week is designed to increase visibility through outreach events in each state to spread the word about Kids’ Chance scholarship opportunities.


There are currently 36 Kids’ Chance state organizations with several others in development. Kids’ Chance of America’s goal is to establish a Kids’ Chance presence in every state so that all eligible students have the opportunity for assistance. Find out if there’s a Kids’ Chance in your state.


We welcome you to join our community of supporters and help us spread the word about this great organization.  Together we can bring more money to more kids!


For more information, please visit our website at www.kidschance.org.



Media Resources


Kids’ Chance Awareness Week is November 14-18, 2016. A Media Kit is available to download as well as an Awareness Week button to place on your website to help us gain momentum and broader visibility.


As members of the workers’ compensation community, we appreciate your consideration in sharing this story. If you have any questions, please contact the Kids’ Chance office at admin@kidschance.org.



Ringler Rings In Their New Brand

Companies from time to time rebrand their look and messaging to connect better with audiences. We’re excited to tell you about our own rebranding at Ringler that’s being launched today! It’s the first real change that you can see since Ringler was founded in 1975. Ringler is still the largest settlement planning company in the nation with the experienced and trusted advisors creating the most objective settlement plans for all parties. Listen as Ringler Radio host Larry Cohen along with Geoffrey E. Hunt, Ringler’s President and CEO and Mark Vogel, head of the Ringler Leadership Team talk about what’s new and what it means for claimants, attorneys and our partners.


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Pay-As-You-Go Solution for Workers’ Comp from The Hanover Lets Insureds Pay Premiums in Real-Time

WORCESTER, Mass., Aug. 19, 2016—The Hanover Insurance Group, Inc. has launched Hanover EZPay, a pay-as-you-go solution for workers’ compensation policies that allows insureds to pay their premiums in real-time, based on payroll, helping independent insurance agents provide better service to their clients.


This new payment solution offers businesses the option to pay their premiums as part of their payroll processes, either by self-reporting payroll at the end of each pay period or by linking Hanover EZPay with their payroll company.


“Hanover EZPay allows agents to provide their clients with increased flexibility and peace of mind by offering a payment option that fits with the flow of their business,” said John C. Roche, president of commercial lines at The Hanover. “For many agencies, this also helps increase customer satisfaction and retention, making it beneficial for both the agent and the customer.”


Business owners can now pay their workers’ compensation insurance premiums as each payroll cycle is processed, helping to improve their businesses’ cash flow and reduce audit exposures with real-time premium calculations. This option also offers businesses automatic premium withdrawals and does not require down payments or monthly billing fees.


The introduction of Hanover EZPay is further commitment to The Hanover’s workers’ compensation business, helping to enhance its agents’ ability to provide high-quality, easy-to-use products to their customers. This new payment option is available exclusively for The Hanover’s elite agent partners across the country and cannot be obtained directly through the company.


To learn more about The Hanover or Hanover EZPay, please visit hanover.com or hanover.com/billing.



The Hanover Insurance Group, Inc., based in Worcester, Mass., is the holding company for several property and casualty insurance companies, which together constitute one of the largest insurance businesses in the United States. For more than 160 years, The Hanover has provided a wide range of property and casualty products and services to individuals, families, and businesses. The Hanover distributes its products through a select group of independent agents and brokers. Together with its agents, the company offers specialized coverages for small and mid-sized businesses, as well as insurance protection for homes, automobiles, and other personal items. Through its international member company, Chaucer, The Hanover also underwrites business at Lloyd’s of London in several major insurance and reinsurance classes, including marine, property and energy. For more information, please visit hanover.com.



Emily P. Trevallion


Abby M. Clark


Henry Stimpson, Stimpson Communications, 508-647-0705, Henry@StimpsonCommunications.com


All products are underwritten by The Hanover Insurance Company or one of its insurance company subsidiaries or affiliates (“The Hanover”). Coverage may not be available in all jurisdictions and is subject to the company underwriting guidelines and the issued policy. This material is provided for informational purposes only and does not provide any coverage. For more information about The Hanover visit our website atwww.hanover.com.

Personal Comfort Doctrine Does Not Provide Comfort In Workers’ Comp

Under any workers’ compensation act, an injury is compensable if it “arises out of” and occurs within “the course and scope” of an employee’s work activities.  One area that is subject to frequent litigation is instance where an injury occurs during work breaks, or other non-work related activities. These personal comforts give members of the claims management team pause as to whether such an injury is compensable.



A Not So Uncommon Scenario


It is break time at the Acme Widget Company. Joe Friday missed breakfast and the company cafeteria is not yet open for lunch. Thankfully, there is a great coffee and donut shop across the street, which is frequented by employees before, during and after work. Joe decides to head over and grab a fresh jelly donut and cup of coffee. While carefully crossing the street he is struck by a car that did not stop for a traffic signal and suffers a broken leg. Would this claim be compensable?



Understanding the “Personal Comfort” Doctrine


The “personal comfort doctrine is a legal principle created by the courts to address the nature of typical workplace environments. Under this doctrine found in most jurisdictions, employees can engage in activities to provide personal comfort and still be covered under the protections of a workers’ compensation act. Such common activities include using a restroom, smoking or coffee breaks, eating food and drinking non-intoxicating beverages.


Application of this doctrine varies in every jurisdiction. In reviewing such matters, courts will examine various issues. These factors include:


  • Whether the activity was “contemplated” as part of the employment;


  • The nature of the activity prior to the accident; and


  • Any benefit to the employer when the employee engages in the activity resulting in injury.



Application of the Doctrine


Most workers’ compensation acts are interpreted in a light favorable to the employee. This result in injuries occurring during normal work hours, but off the employers premises or not directly related to one’s position, to be compensable.


Examples of injuries successfully using the personal comfort doctrine are numerous. In one example, an employee was crossing a street to get a pack of cigarettes. Although the injury did not occur on the employer’s property, the court found injuries similar to Joe Friday’s to be compensable.  Holly Hill Fruit Products, Inc. v. Krider, 473 So. 2d 829 (Fla. Dist. Ct. App. 1st Dist. 1985).


The reasons for this finding include the following:


  • The employee’s conduct was an “inevitable attendant danger;”


  • The actions of the employee were conducive to a pleasant work environment; and


  • While the employee was off the worksite for a short period, he did not remove himself from his employment activities.



Avoiding Unnecessary Workplace Exposures


Proactive members of the claim management team can work with interested stakeholders to reduce exposures and avoid “personal comfort” doctrine issues. Proactive steps can include:


  • Providing or making essential items available to employees on the worksite or premises. This includes having refreshments available free of charge or at an on-site store. By doing so, they maintain more control of their worksite;


  • Prohibiting smoking on company premises. Employers are recognizing the health benefits of tobacco-free workplaces. They can also coordinate with their health plan providers on accessibility of smoking cessation products or services to reduce the dependence on cigarettes; and


  • Establishing clear company policies regarding departure from the company premise during the workday. This can include a clear statement that leaving the workplace for any non-work related reason removes them from their employment and workers’ compensation activities.





It is important for interested stakeholders to understand the “personal comfort” doctrine.  This can assist with properly managing a claim where it is at issue and help employers minimize their risks to promote a safe work environment.



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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.



©2016 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.




NAMSAP Presents “Opioids in the Life of the MSA” Webinar on June 21

The National Alliance of Medicare Set-Aside Professionals continues its three-part webinar series “Opioids in the Life of the MSA”on June 21 starting at 2 p.m. Eastern.


The series explores the issue of long-term opioid use for noncancerous pain in workers’ compensation MSAs and how the Centers for Medicare and Medicaid Services are addressing it. Part one discussed how applying evidence-based medicine improves MSA outcomes.


Part two focuses on current policy and federal efforts to manage the opioid epidemic.  Presenters are Mary Nix, health science administrator, National Guidelines Clearinghouse, Agency for Healthcare Research and Quality and Pamela Schweitzer, assistant surgeon general and chief pharmacist officer, United States Public Health Service, along with the Workers’ Compensation Research Institute’s Policy Analyst Vennela Thumula and Economist Dongchun Wang. The 90-minute webinar covers:


  • WCRI’s new research on interstate variations in opioid usage;
  • Real CMS-approved MSAs allocating for high opioid dosages;
  • Applying evidence-based guidelines to policy;


“In light of the recent evidence-based studies demonstrating the long-term impact of opioid prescriptions for chronic, non-cancer pain, our industry needs to come together to ensure we neither condone nor institutionalize the problem,” said NAMSAP President Gary Patureau. “All the players in the MSA process have an obligation to aged and disabled injured persons to work toward healthier, safer and more effective patient outcomes.”


NAMSAP has recommended that CMS adopt limits on opioids in MSAs based on opioid guidelines published by the Centers for Disease Control.


“We regularly triage cases where an injured employee takes both short- and long-acting opioids for chronic, non-cancer pain,” said Rita Wilson, NAMSAP board member and CEO of Tower MSA Partners. “We hope this webinar series will heighten awareness among policy makers of inappropriate opioid use in workers’ compensation and encourage CMS to align its WCMSA review policies with evidence-based medicine.”


There is a $63 webinar fee for NAMSAP members and an $83 fee for non-members. For more information, please see http://www.namsap.org/events/EventDetails.aspx?id=820324.



Headquartered in Illinois in NAMSAP is the only non-profit association exclusively addressing the issues and challenges of the Medicare Secondary Statutes and its impact on workers’ compensation and liability settlements.  Its members are comprised of MSA providers, insurance carriers, and third-party administrators. Contact NAMSAP at 855-677-2776 or via www.namsap.org.

# # #


Media Contacts:  Helen Patterson, 813-690-4787; helen@kingknight.com

Gary Patureau, President, NAMSAP & Exec. Director, Louisiana Association of Self Insured Employers; 225-338-0705; gary@lasie.org


Sleep Deficiency and Fatigue Causing More Workplace Injuries

This infographic was provided by Eastern Kentucky University:

Sleep-Deficiency-and-FatigueThe number of health risks in the United States is incredibly high. When employees feel sick or need medical attention, they are entitled to sick days, which means there will be less productivity at the workplace while labor costs will remain the same. Furthermore, other employees will have to do extra work to cover for the sick employee. That is why integration of health and wellness strategies in the workplace is highly recommended. To learn more, checkout this infographic below created by Eastern Kentucky University’s Online Bachelor of Science in Occupational Safety program.



Americans are Sleeping Less


A team from the University of Chicago conducted a study on the sleeping habits of people and how these are affecting their work. They found that Americans have significantly reduced their sleeping time over the years. In the 1970s, the average was 7.1 hours per night. Nowadays, this has been trimmed down to just 6.1 hours per night. Many sleep between one and two less than they did sixty years ago according to the researchers. The statistics regarding those who are currently employed are even more worrying. About 3 in every 10 workers are only able to sleep for about 6 hours or even less.



Workers Short Sleep Duration


The time of work, number of jobs, and number of hours on the job all contribute towards shorter sleep duration. For instance, 44% of them turned out to belong to the night shift while only 28.8% belonged to the dayshift and the rest occupying other time slots. Around 37% of the respondents said that they are juggling two jobs or more and 36.2% declared that they were working more than 40 hours every week.


With these figures, it really is no surprise that their responsibilities are eating away at their resting time. The transportation and warehousing industry is the number one culprit while healthcare and social assistance, along with manufacturing, also contribute greatly to the sleep deprivation of US workers.



Reasons for Sleeping Less


It’s not only the quantity of sleep that is plunging but also the quality. Research shows that between 50 and 70 million adults in the US suffer from sleep disorder. Insomnia is particularly common. Individuals with this condition have difficulty falling asleep or stay sleep throughout the night. Billions of dollars are lost due to absences, accidents, and decreased productivity as a result.


Sleep apnea is another major problem. This breathing disorder can attack for brief periods during the night. These intervals are often enough to wake the person up and prevent restful slumber. It is a fairly widespread condition affecting 22 million Americans.


Some of the problems can be traced not to medical issues but to the working conditions themselves. According to the Bureau of Labor Statistics, at no point have Americans been working longer hours than today. As much as 22 million work outside the typical 9-to-5. These graveyard and rotating shifts result in less than ideal rest. Some are on-call 24/7. Their schedule cuts into their sleeping time by 2 to 4 hours.



Workers with Sleep Problems


Lack of restful slumber has troubling consequences. People become increasingly prone to being injured because of their diminished state. In fact, a look into the accident data shows that most of them occur during periods that are traditionally devoted to sleep: between 12 midnight and 6am, as well as the siesta hours between 1pm and 3 pm.


Working in jobs that have overtime schedules has been linked to a 61% increase in injury hazard rate. Going a little deeper, the risk is greater for people who are over the age of 30 and are sleeping for just 7 hours a night or less. The National Sleep Foundation recommends 7 to 9 hours. Deficit is associated to large-scale disasters like the Chernobyl nuclear tragedy and the Exxon Valdez oil spill.



Steps to Reduce Sleep Problems


For employers, it would be helpful to limit scheduled work to no more than 12 hours a day. Take the leadership in creating a culture that values sleep as a vital part of ensuring productivity. Promote education programs about the subject. Try to reduce shift work, if possible. Devote spaces for quick naps and encourage workers to use them. When the workday is over, let people unplug completely so that they don’t have to bring their tasks at home.


For employees, create healthy habits that will ensure enough rest every night. Avoid late engagements, food, and caffeine prior to bedtime as these will make the body more hyper. Set a period that can be consistently be devoted to slumber. Get in bed, keep the phone away, shut down the computer, and turn off the lights before to scheduled time to eliminate distractions. – See more at: http://safetymanagement.eku.edu/resources/infographics/sleep-deficiency-and-fatigue-causing-more-workplace-injuries/#sthash.IcgLm8ux.dpuf


Brigette Nelson of Express Scripts & Michael Stack of Amaxx To Speak On Opioid Abuse Solution

Managing Morphine Equivalent Dose to Address Solutions for Stakeholders Seeking to Reduce Work Comp Costs


HINGHAM, Massachusetts – Stopping the prescription drug epidemic in the United States and its devastating impact on the workers’ compensation system is the focus of an upcoming presentation at the National Rx Drug Abuse & Heroin Summit in Atlanta March 28-31st.  Brigette Nelson, Senior Vice President of Workers’ Compensation Clinical Management at Express Scripts, and Michael Stack, Principal of Amaxx, a national leader in reducing workers’ compensation program costs, will be headlining the discussion on the effective use of Morphine Equivalent Dose (MED) management.


“Notwithstanding all the discussions about the drug epidemic within the workers’ compensation system, interested stakeholders are failing to implement common sense reforms within the programs,” said Brigette Nelson, Senior Vice President of Workers’ Compensation Clinical Management at Express Scripts.  Nelson continued, “I am excited to be a part of the discussion and look forward to offering solutions to address real issues driving up costs in the workers’ compensation system.”


Morphine Equivalent Dose (MED) is a calculation used to compare and contrast different pain medications to one another. Express Scripts’ MED program calculates the narcotic medication’s morphine-like potency, or MED, at the time it is being filled (before it has been dispensed to the injured worker).  This helps reduce the chances an injured worker will become addicted to prescription pain medication, and can be particularly effective in preventing overdose in those claimant’s consuming 100mg or more of narcotic pain medications.


According to Stack, “The goal of effective MED management is to make sure the injured worker receives the care they are entitled to, but at the same time avoid future problems of addiction.”  The concept is gaining acceptance nationwide in addressing the issues faced by countless workers’ compensation programs.  “The key to the program is controls at the point of sale to ensure only safe medications are dispensed. This program is helping injured workers avoid problems related to prescription drug abuse, and cutting costs” said Stack.


Nelson added, “The goal of the MED program is to not only start a discussion, but provide some real life examples of how MED management works.  Studies demonstrate that when properly implemented, workers’ compensation programs not only reduce the medical portion of a claim, but return employees to work faster.”  Stack also pointed out other benefits of implementing MED management in a workers’ compensation program.  “Everyone has a win through MED management, including the injured worker.”


The presentation titled Pharmacy Pain Points: Ensuring Safety of Morphine Equivalent Dose will take place on Wednesday, March 30, at 3:30pm as as part of the Third Party Payer track at the National Rx Drug Abuse & Heroin Summit.




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