Case Study: $774,583 in Work Comp Savings through MSA Triage

Medicare Secondary Payer compliance has created several challenges for interested stakeholders in workers’ compensation programs that seek to reduce cost and improve efficiencies.  One of the common failures of many workers’ compensation programs when it comes to building an effective compliance program is the inability to assess the situation, prioritize troublesome files and position those files for settlement.  Now is the time to change the direction of your program and reduce costs by considering a triage process that is similar to how emergency rooms treat patients when they come through the door.

 

 

Emphasis on Case Triage and Care Prioritization

 

Applying the concept of triage to files involving Medicare Secondary Payer compliance matters is important when it comes to prescription drugs, which has been a main cost driver since the addition of the Medicare prescription drug benefit in 2006.  This allows a workers’ compensation program to understand the exposure and take effective steps to mitigate the future risks.

 

 

Implementing an Effective Triage Program to Reduce Program Costs

 

Like an injured person entering the emergency room, an MSP compliance case requires triage to assess the condition and effectively guide care.  Recommendations can also be made to reduce future exposures through the implementation of an effective plan.

 

  • Use a clinical team to review and understand the employee’s complex medical issues;

 

  • Understand state specific rules for prescription drug use, in conjunction with evidence based medicine to ensure best practices are included in the treatment/drug weaning plan; and

 

  • Evaluate the need for the recommended future medical care and treatment and take the necessary next steps to reduce program costs.

 

By taking the above steps, a proactive workers’ compensation program can coordinate care with the employee’s treating doctor.  This can include the removal of certain future care recommendations, implement steps to reduce prescription drug usage or change certain drugs from name-brand medications to generics, which are often less expensive.  The result of early case evaluation and triage can ensure quicker employee recoveries, promote settlement and add savings to a workers’ compensation program.

 

 

CASE STUDY (Provided by Tower MSA Partners): $774,583 in Savings from Pre-MSA Triage

 

Challenge:

 

Case submitted to Tower for Pre-MSA Triage to assess Medicare exposure.  In 2010, worker was doing electrical line work when he was struck by lightning.  Injuries included electric shock with pain, insomnia, depression and seizure activity.  Treatment included prescription drugs as follows:  Hydrocodone/APAP (7.5 / 325 mg at 4 / day), Baclofen (muscle relaxant), Topamax (anti-seizure), Cymbalta (anti-depressant), Keppra (anti-convulsant), Naproxen (pain), Clonazepam (anti-anxiety).  Cost drivers included Keppra and Topamax, both with generic available, but being prescribed, filled and paid by carrier as brand.

 

Total MSA Exposure – $1,416,513. 

 

 

Solution

 

As part of the standard Pre-MSA Triage process, Tower’s clinical team identified the key cost drivers, made recommendations within the context of the state of jurisdiction to optimize the drug regimen, documented recommendations to achieve the desired result, and calculated the optimized MSA value at $641,930.

 

In this case, recommended next steps included Tower’s Physician Follow Up service to contact the injured worker and treating physician to request a change from ‘Brand’ to ‘Generic’ formulation for Topamax and Keppra. Tower’s legal team worked with defense to facilitate the switch by obtaining attestation of acceptance of the generic formulation by the injured worker (he had previously requested brand), then communicating with the prescribing physician to obtain written confirmation of the substitution of generic formulations of both drugs for the previously prescribed brand drugs.

 

 

Results:

 

With client approval, Tower used the information prepared with the Pre-MSA Triage, added the attestations obtained from both injured worker and physician noting that substitution was allowed for both Topamax and Keppra and finalized the MSA for submission to CMS.

 

In its review, CMS accepted the attestations as confirmation of the change in drug therapy and approved Tower’s submitted MSA at $641,930.

 

Total savings = $774,583.

 

 

Conclusions

 

Changing the mindset of a workers’ compensation claims program needs to include the willingness to explore options when it comes to Medicare Secondary Payer compliance.  Using a triage program on all files where future medicals are part of the equation adds value to a claims management program and promotes savings.

 

 

 

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.

Follow Evidence Based Medicine on Every Work Comp Claim With This Simple System

Hey there, Michael Stack here CEO of Amaxx. So I’m not a doctor, right, I have no medical training. I’ve never even particularly liked science very much; biology, chemistry, those classes in high school, just not my thing. I was much better at math, I was always good at math and I was always very interested in business.

 

 

Medical Component Significant in Workers’ Compensation

 

So, fast forward over 20 years later and now I’m in an industry where the medical component of it is a huge piece to what we do in creating these best outcomes. The costs are only continuing to rise and the complexity of the health care system is following right along with it.

 

So, while I’m not a doctor and you might not be either, I do know how to read. I also know how to use a phone and I even know how to use email and if you have these three skills as well, there is no reason that you should not be following the best practices of evidence based medicine on every single one of your medical injuries, which are your worker compensation claims.

 

 

Simple System to Follow Evidence Based Medicine

 

Now let me lay out a very simple system for you to ensure that that happens. You start with reading the evidence based guidelines for that injury. John Smith’s injury, which has a rotator cuff injury, these are published in MD guidelines, also published in ODG guidelines, both of those are paid subscriptions. You can also use a free resource at guidelines.gov.

 

So either you yourself or someone else on your claims handling team, read the guideline on what it says for rotator cuff injuries for that particular ICD9 or ICD10 code. You then have a weekly meeting with your claims handling team, your risk manager, your adjuster, maybe your account representative, case manager, possibly, possibly an attorney if it made sense on that particular day.

 

 

Compare Injury to Evidence Based Guidelines

 

You talk about John’s injury, where is he now, where is he going, what has happened, how does it compare to those evidence based guidelines and you’re holding this meeting on the phone. If it starts to look like he’s going off the track or there’s some elements that when you compare them to the guidelines, it’s outside of what’s recommended or outside of what’s typical.

 

Now, that might be relevant, that might be right, based on John’s scenario but you don’t know that because you’re not medically trained and your adjuster isn’t either. So the next thing you do is, you send an email to your medical advisor and you say doctor medical advisor, can you take a look at this case based on John’s history, based on John’s circumstances, based on the comparison to those evidence based best practice guidelines for what should be expected in this case. Is that right or is there something else we should be doing, some different interventions, maybe it’s an IME, maybe it’s a UR, maybe it’s further case management, maybe it’s something else that your medical advisor would recommend.

 

Following this simple system, in a systematic way will ensure that every one of your medical injuries, which are your worker compensation’s claims do follow the best practices of evidence based guidelines.

 

Again, I’m Michael Stack with Amaxx and remember your work today cannot only have a dramatic impact on your company’s bottom line but it will have a dramatic impact on someone’s life. So, be great.

 

Learn more: HOW TO USE EVIDENCE BASED MEDICINE TO CREATE BETTER WORKERS’ COMP CLAIM OUTCOMES

 

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.

 

 

Hiring Unqualified People Is Big Worker’s Comp Mistake

Hiring Unqualified People Is Big Worker’s Comp MistakeHiring unqualified people to fill positions within the workforce is by far one of the biggest mistakes made in maintaining low workers’ comp costs.

 

The trucking industry and bus drivers for school buses, over the road or municipal buses is a perfect example of how applying ability standards as conditions of employment help maintain work comp costs, while maintaining productivity and high safety standards.

 

The Department of Transportation (DOT) requires medical exams to ensure a driver is physically capable and qualified to operate a big rig truck. Using a variation of these standards in hiring can help companies protect their workers’ comp budgets by making sure they hire an employee who can do the job!

 

 

Adapt DOT Approach to Meet Your Company Needs

 

DOT’s approach can easily be adapted to meet the needs of all companies. Place the emphasis not only in performing background checks and drug screening, but also make sure potential employees are qualified to perform the job they are hired for. If the position calls for someone with above average hand-eye coordination, would it be wise to hire the next candidate who walked through the door without qualifying him/her for the job?

 

When a company suffers from too many employee accidents, the nature of the accident needs to be examined. Policies need to be put into place to prevent reoccurrences. Accidents do happen and with proactive policies dictating how these events are handled, management personnel has tools to help them fine tune employee training and accident avoidance policies.

 

Many companies have strict procedures requiring the immediate reporting of all accidents, whether there was injury or not, followed up by detailed documentation of the event. Where there is an injury, these policies ensure the injured employee receives prompt medical treatment, timely filing of required workers’ comp paperwork and claims forms, and the employee’s recovery is monitored to ensure a prompt return to work, even if into modified duty.

 

Additionally being on top of all work related accidents and injures affords greater control of these situations and provide the means to monitor and evaluate employee qualifications and adherence to workflow procedures.

 

 

Cost Savings Are Easy to Calculate

 

Cost Savings is easy to calculate. Enter the total incurred losses and your profit margin, and when you calculate, it will show the sales to pay for accidents. For example, it will take 11 Million dollars to replace $500,000 in incurred losses if your companies profit margin is 4.5%. So, it’s cost effective to put a program in place to screen new hires and make sure they are physically and psychologically suited to the job.

 

The focus of administration is on fostering safety within the workflow and encouraging employees to follow procedures and help newer employees do the same. By making employee safety as important as meeting production quotas and timelines, you, the employer, show your employees you care about them. The employer’s sincere concern is then perceived by the employees as their company caring about their welfare.

 

By establishing qualification testing and standards in the workforce, a company can ensure safety and work procedures are not compromised, keep the workforce safe while maintaining workers’ comp costs and workforce productivity. There are numerous companies that help set up employment screening programs. Interview several, and ask them to come to your facility to meet them and let them see the jobs your company performs.

 

 

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.

 

 

 

Five Things to Include in Your Workers’ Comp Communication Policy

workers' comp communicationPart of managing your workers’ comp budget is reducing indemnity payments to your injured workers. There are a variety of reasons why some workers may not return to work as soon as they can, such as disagreements with the doctor’s recommendation, complications with treatment, and in some rare cases, employees simply trying to stay out of work.

 

 

Proactive Communication Improves Outcome & Limits Costs

 

Whatever the case, company administration must use proactive communication and monitoring of injured employees to ensure treatment is progressing well and the treating doctor has projected a return-to-work date. In cases of disagreements with either State workers’ comp claims or the doctor’s prognosis, help your employees to resolve these issues as quickly as possible. A quick resolution equals a quick return to work and limits your costs. Think: modified duty.

 

Some people may think — Why do I need to bother with such a plan, when the insurance company is paying off the claim?

 

The insurance company is paying the claim, but you still cover your deductible (or premium in guarantee cost). And, depending upon per incident costs, an employee suffering a moderate injury could cost as much as $35,000.00.

 

Take the approach of a well-informed and concerned employer concerned with both safety in the workplace, but also with the injured worker’s recovery and return to work after an injury. Weekly or monthly safety and work practices meetings help reinforce company policy and procedure for safe work related conduct and maintaining a safe work environment.

 

 

Five Things to Include in Your Workers’ Comp Communication Policy

 

Your communication policy as a part of your injury reporting and claims process must include:

 

  1. A first day phone call or visit to the injured employee.
  2. Communication with the doctor on prognosis, a reasonable treatment plan, and estimated date for a return to work.
  3. Documentation of every accident/injury.
  4. Investigate any claims raising “red flags” for potential fraud.
  5. Close communication with your insurance claims adjuster to make sure all claims are reviewed before processing.

 

By getting your employees back to work before the mandatory waiting period for indemnity payments, you reduce your claims costs and protect your profit margin. Suspicious claims should be thoroughly investigated and brought to the attention of your claims adjuster.

 

Injuries occurring without witnesses or off company property while the employee was on duty may be hard to investigate. However, failure to do so could easily cost the company a substantial amount of money. That is not to say all accident claims falling into these categories are false or attempts at fraud, but in the event they are, investigating helps you to protect the company by detecting them before they affect your bottom line.

 

 

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.

Navigating the Perils of Work Comp, ADA, & FMLA Laws

The workers’ compensation landscape is filled with pitfalls that can trap the uninformed.  In addition to the many procedure hurdles presented under a workers’ compensation act, other challenges including complaints or penalties under FMLA, ADA and other discrimination claims.  Proactive members of the claims team need to be informed on these issues to run an efficient operation and prevent troubles for the people they seek to serve.

 

 

Common Pitfalls Associated with Work Comp

 

There are many legal issues surrounding a workers’ compensation claim.  Some of the most common include:

 

 

Family Medical Leave Act (FMLA)

 

FMLA is a federal law that applies to qualified employees and employers.  Employers covered under this law generally must have over 50 employees, or are a public agency or a school.  In order to qualify, an employee must work for the employer for one year, work 1,250 hours during a 12-month period and have a “serious health condition” personally or with a family member.  This can include most work-related injuries.  Problems arise in the context of a workers’ compensation claim when:

 

  • The employee qualifies for leave in disputed workers’ compensation claims and proper communication on their rights is not provided by the employer;

 

  • The employee is off work due to disability and never receives official notice of hours remaining in their leave “bank.”

 

 

Americans With Disabilities Act (ADA)

 

The ADA has been in existence since the 1990s and impacts employers with more than 15 employees.  The law prohibits an employer from discriminating against a prospective or actual employee based on their disability.  Common areas where claims arise under this law are in the context of workers’ compensation claims that include:

 

  • Return to work or written job offers that do not take into consideration the employees work restrictions or limitations; and

 

  • Employment practices where questions are asked on an application or during an interview regarding an employee’s physical limitations or restrictions. Injured workers seeking post-injury employment fear this situation as they are walking a fine line between being honest and not being excluded from an applicant pool.

 

Employers seeking to comply this law must make “reasonable accommodations” to all persons, regardless of their ability.  Questions remain as to the extent these accommodations are appropriate or place an “undue hardship” in the process.

 

 

Implementing Proactive Compliance to Avoid Problems

 

The workers’ compensation claim management team can be a resource for the employers they work with on these complex issues.  Legal advice from an attorney practicing in these areas should be sought when doubt or questions arise.

 

Best practices for FMLA compliance:

 

  • Create a FMLA checklist that outlines the various timelines and employee eligibility requirements;

 

  • Designate one person in the human resources department who understands and is familiar with this law. This person should be a point of reference for all supervisors and managers who have employees potentially subject to this law; and

 

  • Conspicuously display U.S. Department of Labor approved notices in office common spaces regarding an employee’s rights and responsibilities.

 

Guidance regarding ADA issues can be more difficult.  Proactive stakeholders should consider the following:

 

  • Understand that the ADA may allow an employee to take additional leave time, beyond FMLA;

 

  • Have a designated HR representative engage employees on suggestions for workplace modifications. Remember that this is only one step in making “reasonable” accommodations; and

 

  • Foster a culture that views all employees regardless of ability as a human being. Being courteous and respectful to all is something everyone deserves.

 

 

Conclusions

 

The workers’ compensation system impacts a number of federal laws that demands attention from all interested stakeholders.  Claims management teams can be proactive on this issue by partnering with their employer-clients to foster a workplace that complies with these rigorous laws.  It can also drive changes for the better in company culture that promote goodwill among the workforce, including those suffering from a work injury.

 

 

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.

September 11th Remembered – Tribute To Marsh And AON

Article republished from a previous post.

 

Everyone remembers where they were the when they learned the World Trade Center crumbled to the ground. I was scooping ice cream at the Mansfield Center General Store. Having recently retired from the risk management and insurance industry, I had moved back to the area, built a house in Mansfield Center and worked from my home office. I was helping my family restore and run the General Store.

 

I had an exciting career in risk management and insurance working for two of the best insurance brokers in the industry. BOTH companies had sizeable offices located in the World Trade Center. So, when Bill called and asked me if I was watching TV, did I know a plane flew into the World Trade Center, I was alarmed. Initially I thought he meant it was a small plane, but when I turned on the TV, I could see it was a huge plane and the building was on fire. And then another plane had flown into the other tower.

 

 

We Never Knew How 9/11 Could Affect An Entire Industry

 

Everyone in the risk management field “plans”… we plan for every eventuality, thinking things through. That’s what we do. We help our clients, which are large companies such as The New York Times, Universal Orlando, and USAir, etc. plan how to provide safer workplaces, safer products and safer environments. But we never planned for Sept 11. We never knew how it could affect an entire industry.

 

AON and Marsh are the two largest insurance brokers in the world and I – with a loyal team of consultants – was responsible for development of the workers’ compensation practices at those companies. Workers’ comp insurance is the largest line of insurance coverage – a huge cost to most employers – and I had found the solution to reduce those costs significantly. Helping a wide-variety of types of organizations was gratifying, and there was a new challenge every day. I had written, published, traveled, and worked hard for 25 years, so I looked forward to scaling back.

 

When a retirement opportunity presented itself, I left the workforce to enjoy being a mom. My daughter was 17 and Glastonbury High School had not gone well. Against her will, we had moved her to a private school, and she and I were getting reacquainted during the long drive to and from school in Farmington, CT. Life was good.

 

 

Many Former Employees Went Back To Work

 

It wasn’t part of the plan to go back to work, but two weeks after Sept 11, I went back to AON, filling in for Lisa Ehrlich. Lisa was an outsourced risk manager who worked on-site at a company in Stamford, CT. On 9/11, she had gone into the NY office for a meeting and was killed that day. I was honored to be able to help in some small way. Many former employees went back to work in the intervening years to help the brokers rebuilt their practices. Here is a remembrance of my colleagues.

 

In the 15 years since Sept 11, a new generation has taken over. Some hardly know our industry lost so many that day, key leaders and pioneers in the field of workers’ compensation cost containment. In the intervening years, my niece and nephew, Kori and Michael Stack, have taken over a leadership role in my company and become industry leaders in their own right. I am very proud of them for carrying on the legacy and memory of our beloved colleagues lost on that fateful day.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the co-author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@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.

 

 

 

Effective Medical Cost Management in Workers’ Comp Programs

effective workers comp medical cost managementWorkers’ compensation is a complex system with varying laws in each jurisdiction and a changing American workforce. While there are many things that change, the fundamentals of a best in class workers’ compensation management program generally stay the same.  One of those elements is the need for effective Medical Cost Management.

 

 

What is Medical Cost Management?

 

“Medical Cost Management” is a term that describes various operations carried out by a workers’ compensation third-party administrator or insurance carrier to reduce the cost of medical claims.  It includes a number of different features that meets the needs of the employer that considers the nature of their industry, the workforce population it employs, injuries common to the work the employees perform and trends in health care that reduces the number of visits to health care professionals.  It also must provide the medical care and treatment injured parties are entitled to as the result of a workplace injury.

 

Common features of a medical cost management program include, but are not limited to:

 

  • Preferred Provider Organizations (PPOs);
  • Nurse case management, including web-based and telephonic hotlines and access;
  • Injury case management, including medical and vocational experts;
  • Utilization review of medical care and treatment. Given the dangers and overuse of prescription drugs, a complete review of prescription drug usage is essential;
  • Independent Medical Exams (IME) & Peer Review;
  • Pharmacy / Opioid Management
  • In-Home healthcare services; and
  • Medical billing review.

 

 

Implementing Medical Cost Management in Your Program

 

The implementation of an effective medical cost management program requires buy-in from a number of interested stakeholders.  This includes an employer concerned about providing quality care and benefit delivery to injured workers.  It also requires a third-party administrator or workers’ compensation insurer that cares about the service it provides to the employer/client and the workers served under the program.  It also includes the effective implementation of the following program components.

 

  • Prompt Reporting of Work Injuries: Any cost-effective program must include a number of different methods for employees to report a work injury.  Advances in technology have moved the industry beyond paper forms that confuse even a trained claims professional.  The use of web-based portals or smartphone apps can assist employees and their supervisors in prompt reporting of all workplace injuries.  It can also include features that allow impacted parties and potential witnesses to preserve evidence related to the injury.  One of the most important features of any injury reporting system needs to include access to immediate and appropriate medical care and treatment.

 

  • Expedited Medical Care and Treatment: Beyond the issue of compensability, all workers are entitled to immediate and effective medical care and treatment following any work related injury.  It should also include steps to monitor and manage the care so that drivers in healthcare (including fraud, waste and abuse) can be eliminated without sacrificing quality.

 

  • Return-to-Work. Return-to-work is an often overlooked component of medical cost containment.  Sadly, interested stakeholders who do not include effective return to work in their cost containment programs are doing a complete disservice to all interested parties involved in a claim.  Implementation of a return to work program should be something that is re-evaluated frequently to meet the needs of each individual client and employee.  It should also include an industry specific review of all processes and options.

 

 

Conclusions

 

Medical cost management in workers’ compensation is an important part of running an effective program focused on compliance with the law and supporting the needs of all interested stakeholders.  A multi-pronged approach requires buy-in from the employer and execution by the third party administrator or insurance carrier.  When done correctly, it will reduce costs and promote program efficiency.

 

 

 

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.

 

6 Steps to Mitigate PTSD Workers’ Comp Claims after Trauma

Escape, hide, fight back. Those are the suggested reactions — in order — to an active shooter situation provided to employees of one of the nation’s largest supermarket chains. In a dramatic, realistic-looking video, a man with a gun walks into a grocery store and begins shooting.

 

The fact that the video is part of required training for all company employees underscores the very real threat of violence in many workplaces. While employers can and should take any and all precautions to prevent violent incidents from occurring, there are still situations that arise all too often.

 

One thing companies can do is prevent such a situation from escalating into long term claims involving post traumatic stress disorder. Identifying and intervening early after a workplace trauma will help ensure employees recover and get back to work as quickly as possible.

 

 

Who Gets PTSD

 

Just about everyone will have stressful reactions to a traumatic event, such as workplace  violence. But the vast majority will recover and have no symptoms within several months.

 

A segment of the population — around 7 to12 percent will have a more difficult time recovering. They may improve, only to see their symptoms recur with a new stressor. Some may develop a lifelong illness that affects every aspect of their lives.

 

Diagnosing PTSD is not an exact science, as its symptoms often mirror other conditions. Generally, experts say having the following for more than one month are clues:

 

  • Reliving the event. Internal or external cues that resemble any aspect of the incident may cause images, perceptions, dreams, or dissociative flashback episodes.
  • Avoiding certain stimuli. The employee may refuse to discuss the incident, or avoid places or people associated with it, including coworkers.
  • No interest in participating in group activities.
  • Feeling detached from others.
  • Emotional overload. The worker may be irritable or have outbursts of anger, or trouble concentrating, and may be easily startled.
  • Physical symptoms. Headaches, high blood pressure or gastrointestinal issues may be present as well.

 

The risk of developing PTSD depends on many factors, including the presence of psychosocial issues. Even many of those who recover slowly and are at increased risk can be helped and recover, often within 8 to 12 weeks. The key is to get them into appropriate treatment as soon as possible.

 

 

Crisis Intervention

 

Traumatic incidents can happen in any industry, but are especially prevalent in certain ones. Employers in fields such as healthcare and retail are wise to consider implementing a post trauma crisis intervention protocol to help employees immediately after a traumatic event.

 

The plan should include the following elements:

 

  1. Early contact. Within 24 hours of a workplace trauma, employees should be contacted by a trained trauma specialist. That contact should continue until there is a face-to-face meeting for acute psychological intervention. Responding early shows the employer cares about the employees, which can help prevent delayed recovery and require less use of medical and mental health services.
  2. Face-to-face assessment. A psychologist should perform an assessment and begin trauma recovery of care. In most cases, no more than three visits will be needed before the employee can return to work.
  3. PTSD determination. If symptoms persist for more than one month, the psychologist should conduct a criterion-based PTSD diagnostic assessment to help determine whether the workplace trauma was the actual cause of the employee’s symptoms.
  4. Trauma interventions. An employee diagnosed with PTSD may find his work and daily living is disrupted. Increased absenteeism and decreased productivity may be among the results. Once a PTSD determination is made, the worker should be referred for specific treatment.
  5. Long, drawn-out therapies are not necessarily needed to help injured workers with PTSD. Cognitive behavioral therapy, for example, has been shown to help. It includes principles of learning and conditioning to help injured workers change their negative beliefs about themselves while gradually exposing them to the thoughts and situations they fear. Exposure/desensitization therapy is also effective in treating PTSD. This may involve imaginal exposure, where the worker is exposed to the traumatic event through mental imagery; or in vivo therapy, in which the worker confronts the actual scene or similar events associated with the trauma.
  6. Short term use of certain medications may be helpful, depending on the severity of the symptoms and the worker’s preference. Some antidepressants have been approved by the Food and Drug Administration to treat PTSD. However, benzodiazepines such as Valium and Klonopin should be avoided, as there is no evidence they are beneficial and can even increase the likelihood of developing PTSD when they are prescribed in the acute aftermath of trauma exposure.

 

Conclusion

 

Workplace trauma can take a devastating toll on all affected employees and an organization as a whole. But it does not need to result in long term disabilities.

 

The vast majority of people who are exposed to traumatic events recover with limited help. Of those who need further follow up, many will be able to return to work and function. Employers who are proactive about identifying and intervening can better protect their workers and their bottom lines.

 

 

 

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.

The Single Biggest Mistake With BIG DATA in Workers’ Comp

 

Hey, there, Michael Stack here, CEO of Amaxx and founder of Amaxx Workers’ Comp Training Center.

 

Today is an exciting day in the Stack household. It’s back to school day. We have four children, a daughter going into second grade, a son going into first, another daughter in pre-K and a youngest son in first year of preschool. Everyone is excited, we did the first day of school pictures and the whole nine yards and they got on the bus just this morning.

 

 

Proper Sequence Is Critically Important

 

What if I told you that our seven-year-old daughter, instead of putting her into second grade, we actually enrolled her in Kennebunk High School? The odds of her being successful in that environment are basically very slim, if not, impossible. It’s not that the information taught at the high school level isn’t critical to her educational journey which hopefully then leads on to a successful life and career. It just that it’s taught out of sequence and she needs that foundational knowledge taught at the elementary level to be able to properly use and utilize that information.

 

 

Biggest Mistake Companies Make with BIG DATA

 

Now, I want to talk to you about a topic in worker’s compensation which is very popular: big data and analytics. I see a lot of companies making that same mistake. It’s not that the information or the tool of leveraging big data and analytics isn’t critical to your journey to a best in class work comp management program. It’s just that it’s typically implemented out of sequence and most companies don’t have those foundational, fundamental, necessary elements in order to be able to properly use and utilize the information both inputted into that big data tool and extracted from that tool. If you don’t know how you are measuring success, if you have no clear goals in your organization and a way to understand if you’re being successful or not and you’re spending all your time and resources researching and implementing this tool, then you’re out of sequence and I encourage you to go back and look at some of those fundamental elements in order to be able to properly use and utilize that extremely valuable tool.

 

Again, I’m Michael Stack with Amaxx and your work in workers’ compensation cannot only dramatically reduce your workers’ compensation cost but it will dramatically impact someone’s life. Be great.

 

To Learn more, check out The Step by Step Process to Master Workers’ Comp in 90 Days

 

 

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.

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