Workers Compensation Around the U.S. This Week

Work Comp Roundup Wants to Meet You at RIMS Booth 1425
The Philadelphia RIMS 2012 Annual Conference & Exhibition will provide a unique opportunity to gather information and resources to help minimize workers comp costs. This year there are sessions for many experience levels and the exhibit hall will have US! Yes! Held at the Pennsylvania Convention Center located on 1101 Arch Street will be Amaxx and WorkCompRoundup at booth 1425.
 
 
“If anyone wants to stop by to say hello or chat about workers compensation issues, I welcome them to do that,” says Becki Shafer, CEO. “For companies struggling with high WC costs, the exhibit hall is a great place to see all the different solutions that are available in the marketplace and attend seminars. One of the best things I did when I began my career in workers compensation was attend RIMS in Atlanta, it was the first conference on Workers Comp I attended, and I was pleasantly shocked at everything that was available — it was like walking through a supermarket of ideas.”

[WCx]

 
 
Learn more about the convention here.
 
 
Keystone Case Management Could Give you a PINCH this Spring
Keystone Case Management is a young company in the Workers’ Compensation World, says owner and president, Kelly Haile, RN, CCM, WCCM. This team of nurses has developed PINCH, a solution that uses employer education and aggressive case management to help employers and injured workers
 
 
PINCH has resulted in a decrease in claim report numbers, out-of-work time and fewer litigated claims, Haile says. “The program has also shown increased satisfaction by injured employees, and employers are delighted at the clear, consistent and timely information that is provided,” she writes.
 
The company recently announced it is a finalist in Dorland Health’s Case In Point Platinum Awards for Workers’ Compensation Case Management and will be hosting a half-day educational workshop for employers April 4th, 2012 in Drexel Hill, PA. For more information contact info@KeystoneCaseManagement.com or (610) 469-NURSE.
 
 
LexisNexis Communities Offers This Week Work Comp In Review
The Workers Compensation Law Community Powered by Larsons on LexisNexis offers several great pieces this week:
 
 
  1. Larson’s Spotlight, found here, focuses on the following recent cases, compiled by Thomas A. Robinson, staff writer for Larson's Workers' Compensation Law:
 
TN: Truck Driver Deviated From Employment by Leaving Truck to Search for Object With Which to Assault Driving Partner
TN: Court Affirms Denial of Benefits Related to Unexplained Fall to Level Floor
OH: Physician's Opinion Was Not Equivocal Where Physician Modified Opinion in Light of Videotape Evidence of Injured Worker's Capabilities
FL: Judge May Not Sanction Homeless Claimant for Failure to Pay Prevailing Party Costs-Failure to Pay Was Not Willful
 
 
  1. Robin E. Kobayashi writes The Sticky Wicket That Is Home Health Care: Why It’s a Hotly Contested Issue in the Workers’ Compensation Arena
 
The article, found here, asks, “An injured employee’s entitlement to home health care is oftentimes a hotly contested issue in the workers’ compensation arena. Home health care issues can vary in nature. For instance, at what point does the marital obligation cease and the paid nursing services begin?”
 
 
The author looks into these types of issues in Nebraska, Iowa, Arkansas, and California.
 
 
  1. Lastly, the LN Community recommends these WC fraud blogs this week:
 
Workers' Comp Fraud Blotter: Mechanic Covered With Grease Claimed He Was Unemployed and Unable to Work,by LexisNexis Workers' Compensation Law Community Staff. Here.
 
“The Case of the Purple Robe … and a Little Motion Day Magic” in Delaware, by Cassandra Roberts, Esq. Here.
 
Missouri: Employer Penalized for Lapses in Prescription Payments, by Martin Klug, Esq. Found here.
 
 
Broadspire Combats Physician-Dispensed Drugs
In a recent release, Broadspire draws from the Workers Compensation Prescription Drug Study: 2011 Update by Barry Lipton, Chris Laws and Linda Li, National Council on Compensation Insurance, August 2011.
 
 
They write, “The price of physician dispensed drugs increased by 300 percent  between 2005 and 2009. In contrast, the average price of medications dispensed by pharmacies grew by only 23 percent during that same timeframe.”
 
 
The company goes on to say the percentage of workers compensation medical costs going toward physician dispensed prescriptions increased to 28 percent in 2009, up from 23 percent in 2008. “Physician dispensed medications have become prevalent in almost every state,” Broadspire concludes.
 
 
To combat this medical cost driver, Broadspire has created the following jurisdictionally specific strategies:
 
1. Through data mining, Broadspire identifies physicians who are dispensing prescriptions from their offices.
2. Targeted communications are sent to these physicians promoting the clinical safety and efficacy offered by Broadspire’s network of retail pharmacies.
3. Safety checks, through network pharmacies, help physicians ensure medications they prescribe are not duplicated by other physicians and that no adverse drug interactions are present.
4. Case managers visit and communicate with physicians to share the Broadspire message and support the use of network pharmacies.
5. Where jurisdictionally possible, Broadspire re-prices provider-dispensed medications to our network pharmacies contracted rate.
 
 
 
 
Texas Department of Insurance – DWC Seeks Public Comment on Amendment Proposals on MDR
The Texas Department of Insurance Division of Workers’ Compensation is accepting public comments on proposals to amend 28 TAC §§133.307, 133.308, 144.1–144.7 and 144.9–144.16 Regarding MDR of Fee Disputes, MDR by Independent Review Organizations, and Arbitration.
 
 
According to a release, the amendments relate to medical dispute resolution (MDR) activities conducted by the TDI-DWC. “The purpose of these amendments is to conform the rules to various statutory amendments that concern medical fee dispute resolution and the resolution of disputes of independent review organization (IRO) decisions by the TDI-DWC. Specifically, these proposed amendments are necessary to clarify existing rules and implement and enforce statutory provisions of House Bill (HB) 2605 and Senate Bill 809, enacted by the 82nd Legislature, Regular Session, that impact the appeal of medical fee dispute resolution cases and decisions issued by IROs,” it says. [WCx]
 
 
The proposals will publish in the March 23, 2012, issue of the Texas Register and may be viewed on the Secretary of State website at http://www.sos.state.tx.us/texreg/index.shtml once published. A courtesy copy of the proposals is currently available on the TDI website at http://www.tdi.texas.gov/wc/rules/proposedrules/index.html.
 
Note: If your company has any developments you'd like to share, please send them up us at: RShafer@ReduceYourWorkersComp.com

 

 

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 author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR:  
www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Medical Provider Performance Indicators for Workers Compensation

By Karen Wolfe, BSN. MA, MBA
President, CEO
MedMetrics, LLC


 
Workers' Comp is Different
While rating providers in group health is a long-practiced endeavor, its elements and parameters have not significantly migrated to workers compensation. Efforts to translate group health provider quality measures to workers’ compensation have fallen short of the mark because they omit several factors crucial to workers’ comp. Quality medical performance indicators in workers’ comp encompass medical treatment, outcome, and cost factors similar to those in general health, but they also include non-medical functions. In workers comp, those non-medical elements can be primary drivers of cost, quality, and outcome.


Return to Work: An Indicator of Performance
A major quality goal in workers' comp is return to full work. Responsibility for achieving that goal rests with the treating physician. Another major quality goal in workers’ comp is return to maximum or full work capacity at the least cost. This article explores the many non-medical functions of treatment that spell quality in workers’ compensation, factors that must be considered in rating doctors’ performance.[WCx]


For instance, multiple and repeated studies have shown that early return to work is a major indicator of better outcomes in workers comp. (Google search:  “Return to Work studies in workers’ compensation.”) The overwhelming take-away from these studies is that the sooner employees return to work after a work-related injury, the sooner they are re-acclimated to the job and the lower the overall cost of the claim. Alternatively, the longer the employee is kept off work, the higher the cost of the claim, with reduced chance of successfully returning to work. Studies show a 1:1 correlation between length of time off work and returning to work — ever. Treating providers are the major driver in returning claimants to work. Therefore, early return to work and reduced overall work loss are key indicators for evaluating medical provider performance.
 

Cost Measures of Performance
Also important to rating provider performance in workers’ compensation is the issue of cost. Two quantifiable generators of unnecessary costs are frequency and duration of medical treatment. Because PPO, MCO, and MPN networks discount each unit of service delivered, the tendency of some providers is to exploit both frequency and duration of treatment to overcome their discounted fees. Individual provider’s frequency and duration of medical treatment for specific injury types should be measured and compared with the performance of their peers treating similar injuries.


Another comparative quality indicator is direct medical costs. Billed costs are not a true performance indicator by themselves. However, assessing billed costs with paid amounts or percentage reduction of charges recommended by bill review is a more accurate measure.

 
Prescriptive Practices
Recent research indicates a problem of opioid misuse or abuse in workers comp. Evaluate prescribing practices of individual physicians by monitoring current data, thereby creating an opportunity to intervene. Prescribing practices are a valid indicator in measuring performance.
 

Outcome
Of critical importance is evaluating providers in terms of outcome like how did things turn out in the claims where they were involved? Is the employee back at work, permanently disabled or somewhere in between? What is the provider’s record? If a provider is associated with a high rate of litigated claims, that should also be considered in the descriptive mix.
 

Create Algorithms to Measure
Providers can be rated specifically for workers' comp by creating a set of algorithms measuring these factors using data. An algorithm is simply a defined process, often mathematical, used to solve a problem or reach a conclusion. Algorithms should be used to compare similar types of providers who have treated like injuries in the same jurisdiction during the same time frame. Consistency is achieved because the computerized algorithms apply the same standards to all medical providers who meet a set of conditions.
 

Analyze Data from Multiple Sources
The data used to evaluate provider performance should be derived from more than one source. Raw billing data or bill review data should be integrated with claim data in order to reach a valid conclusion. Billing and treatment data must be integrated with loss time and outcome information, usually found in different systems, in order to reach legitimate conclusions regarding providers. 

Ratings for medical providers must be transparent, fair, and objective. Fairness and accuracy in developing and measuring provider performance is critical. The indicators can be found in the data. The data must be integrated and evaluated using computerized algorithms that measure and monitor provider performance based on a combination of workers’ compensation-specific values.[WCx]


Measuring Provider Performance Is a Good Thing
A post was submitted by Joe Paduda last year, “Like it or not, physician ratings are coming”. The title suggests rating doctors is a bad thing. It is actually a good thing, unless you are a poorly performing provider. Using legitimate workers comp-specific rating systems to provide objective evidence for selection and for weeding out the less effective or even fraudulent providers is positive progress. A poorly performing provider guarantees complexity and cost in the claim. Informed decisions about medical providers based on data will replace personal biases and unknown outcomes. Basing provider selection decisions on objective data is imperative.


Author Karen Wolfe, BSN, MA, MBA, is President/CEO, MedMetrics®, LLC. Karen is founder and president of MedMetrics® LLC, an Internet-based Workers’ Compensation medical analytics company. She applies her medical knowledge to gathering, understanding and applying Workers’ Compensation data to the operational process. MedMetrics imports, integrates, and analyzes its clients’ medical billing and claims level data. MedMetrics uses several tools such as Predictive Intelligence Profiling and Medical Provider Performance Assessment to gather and analyze data. Contact: Phone: 541-390-1680; Karenwolfe@medmetrics.org; www.medmetrics.org.

 



WORKERS COMP MANAGEMENT MANUAL:  
www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Workers Compensation News in Brief for February 2012

How Can You Find Quality Providers?
According to a recent MedMetrics blog, finding quality providers in your data has never been easier. See the complete blog here.
 
 
Author Karen Wolfe explains in the blog there are several steps, including:
1. Identify and avoid the poorly performing doctors
2. Having good data.
3. Keeping a historic perspective.
4. Provider performance evaluation is essential.
5. Defining good data.
 
6 Record proliferation.
7. Data entry procedures.
8. Provider performance suite.
 
 
To learn more, visit MedMetrics and to learn how, contact KarenWolfe@MedMetrics.org
 

The Texas Department of Insurance Offers New Rulebook
Texas Department of Insurance, Division of Workers’ Compensation just supplemented its Rulebook for 2012-02. It is now available online for amendments and new rules to 28 TAC chapter 180 regarding the monitoring and enforcement authority of the division of workers’ compensation.
 
 
The supplement can be printed from the TDI website here.
 
16th Annual Texas Safety Summit for Employers and Employees April 10-12 in Austin
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) will host the 16th Annual Workplace Safety Conference, the Texas Safety Summit, on April 10-12, 2012 in Austin at the Doubletree Hotel Austin, 6505 IH-35 North. The TDI-DWC is hosting the conference to help all employers reduce injuries and their associated costs through workplace safety and return-to-work programs, whether or not they subscribe to workers’ compensation insurance.
A pre-conference session entitled Workers' Compensation 101 and Return to Work will be offered from 1 p.m. to 4 p.m. on April 10.
 
 
Conference general sessions include Technology in Collision Reconstruction presented by Clifford McCarter of Rimkus Consulting Group; Occupational Safety and Health Administration (OSHA) Region VI Update presented by John Hermanson, Regional Administrator of OSHA, Region VI; Generational Issues in the Workplace presented by Dr. Richard Lewis of Round Top Consulting Associates; and Personal Fitness for Work presented by Petti Redding of the Redding Group.
 
 
In addition, over 20 breakout sessions are planned to address pertinent issues facing Texas workplaces, including:
Accident/Incident Investigation;
Asbestos Awareness;
Combustible Dust/Respirable Dust;
Components of Effective Safety Programs;
Drug and Alcohol Awareness for Employees;
Effective Safety Committees;
Fatal Driving Distractions;
Federal and State Reporting Requirements;
Fire Safety in the Wild and Urban Interface;
Hazard Communication and Material Safety Data Sheets for Small Employers;
Heat Illness Prevention and Response;
ICS402 Incident Command System (Disaster Planning);
Job Safety Analysis;
Lockout/Tagout;
Management’s Role in Slips, Trips and Falls;
Material Handling;
Office of Injured Employee Counsel;
Personal Protective Equipment: Employer Responsibilities;
Tips for Safety Trainers;
Top Ten New Traffic Laws;
Uses of Injury/Illness Data Requested by OSHA and the Bureau of Labor Statistics (BLS);
Traffic Work Zone Safety; and
Workplace Violence Prevention
 
 
Conference rates for hotel reservations are available at the Doubletree Hotel until March 19 or until the conference block of rooms is full. To make hotel reservations, call the hotel at 512-454-3737 and reference “Texas Safety Summit” or register online using the Doubletree Hotel website here.
 

Texas Supreme Court Grants Rehearing in Ruttiger Case
Feb. 22, the Texas Supreme Court issued its long-anticipated option in Texas Mutual Insurance Co. v. Ruttiger. A divided Court held that some, but not all, “bad faith” claims based upon alleged violations of the Insurance Code are “at odds with” the works’ compensation system and, thus, may not be presented to, or considered by, the district courts. To read more on this case, click here.
 

Study Provides Baseline to Measure Impact of Reforms on Illinois Workers' Compensation System
A new study, CompScope™ Benchmarks for Illinois, 12th Edition, by the Workers Compensation Research Institute (WCRI) shows baseline data to measure the future impact of 2011 reforms in Illinois, which are designed to ensure that the state’s workers’ compensation costs are reasonable and competitive.
 
 
According to a WCRI release, “The reform legislation addressed key cost drivers in the workers’ compensation system, especially medical prices, by reducing fee schedule rates by 30 percent, introducing preferred provider networks for selecting treating physicians, implementing American Medical Association (AMA) guides for evaluating impairment, and requiring clinical reports by physicians.”
 
 
For more information about WCRI or to purchase this study, visit: http://www.wcrinet.org.
 

The Texas Department of Insurance Shows Proposed Revisions
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is accepting comments on proposed revisions to the following employer and self-insured political subdivision forms:
 
 
1. DWC Form-005, Employer Notice of No Coverage or Termination of Coverage;
2. DWC Form-007, Employer’s Report of Non-covered Employee’s Occupational Injury or Disease;
3. DWC Form-020SI, Self-Insured Governmental Entity Coverage Information.
 
 
These proposed form revisions are not a formal proposal and comments received will not be responded to in accordance with the Texas Administrative Procedure Act. The proposed draft form is available from the TDI-DWC website here.
 
 
Informal comments may be submitted to the TDI-DWC by e-mailing
informalrulecomments@tdi.state.tx.us.
 

The Texas Department of Insurance Seeks Comments
The Texas Department of Insurance Division of Workers’ Compensation formally proposed in February new Rules Relating to Notice and Reporting Requirements for Subscribing and Non-Subscribing Employers; and Rules Relating to Notice of a Texas Labor Code §504.053(b)(2) Election by a Self-Insured Political Subdivision.
 
 
TDI-DWC is accepting public comment on the proposals to add new 28 Texas Administrative Code (TAC) §§110.7, 110.103, 110.105, and 160.1, and to amend 28 TAC §§110.1, 110.101, 160.2, and 160.3.
 
 
The proposal relates to various notice and reporting requirements imposed upon subscribing and non-subscribing employers, specifically requirements for notifying the TDI-DWC of non-coverage status, termination of coverage, and occupational injuries, illnesses and fatalities; and requirements for notifying employees of the employer’s coverage status.
 
 
The primary purpose of the proposal is to update and clarify these notice and reporting requirements. The proposal also contains a new rule that would require a self-insured political subdivision that elects to provide medical benefits in accordance with the manner described by Texas Labor Code §504.053(b)(2) to notify the TDI-DWC of its election to provide medical benefits in that manner. [WCx]
 
 
The proposal will be published in the February 24, 2012, issue of the Texas Register and may be viewed on the Secretary of State website at http://www.sos.state.tx.us/texreg/index.shtml once published. Public comments may be submitted by e-mailing rulecomments@tdi.state.tx.us.

 

 

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 author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

What Insurance Agents Need to Know about Workers Compensation

 If you are going to sell business insurance  to the business community, you need a strong basic understanding of workers compensation insurance. While companies will be concerned about having insurance for their buildings, inventory, and vehicles, and will understand the need for various types of property insurance, the same companies will look at work comp insurance as a governmental mandated cost of doing business.
 
 
As their agent, you need to be able to explain to your client business the importance of workers compensation and how it works.
 
 
While your clients, the companies, will think about their property insurance exposures, they will have a far higher frequency of workers compensation claims then property claims. Therefore, selling and servicing workers compensation insurance can be challenging for any agent, even experienced ones. The successful insurance agent will be the agent who can explain the advantages of all types of business insurance including workers compensation.(WCxKit)
 
 
A major part of the challenge of workers compensation insurance is the way it is different from the other various business lines. With property insurance, the cost of the claim can normally be ascertained fairly quickly and easily. The longer life of some work comp claims, along with the variables of medical treatment, income replacement, and a third party (the employee) who has a different perspective and different motivation, makes the evaluation of the cost of the work comp claim much more complex.
 
 
The complexity of work comp is what often keeps insurance agents from being as educated in workers comp as they are in the other insurance products they sell and service. However, learning the parameters of work comp is not nearly as difficult as you might think. To assist you in becoming more proficient in work comp, we have put together a guide that has become quite popular both with agents/brokers and with risk managers/corporate financial control management.
 
 
Our guide will assist agents in better understanding the entire work comp process which will assist you, the agent, in providing a higher level of service to your clients when they have a claim or even when they just want a better understanding of workers compensation. The chapters of the guide that will be of special interest to insurance agents include:

1. How an employer should assess their work comp program.

2. How the employer should structure their work comp team.

3. The forms and documents the employer will need to process/submit their work comp claims.

4. The training the employer will need in their work comp program.

5. The management and monitoring of the employer’s work comp program.

 
Additionally, as the agent, you will want to understand what is going on with the client’s work comp claims. Learning more about the claim progress will allow you to answer the questions your clients have about their claims. Knowing the differences between the way property and work comp claims are handled will allow you to better service your clients. Some of the topics that benefit insurance agents and allow for a better understanding of workers compensation include:
 
1. The role of the third party administrator in the work comp claim.
2. The differences between bundled and unbundled services.
3. The importance of proper account handling instructions.
4. The role of medical management in the claim.
5. The best practices of work comp claim handling.
6. The ability of the employer to control the selection of the medical providers.
7. The importance of a return to work program at the client.
8. The importance of a solid safety program.
9. How to fight fraudulent claims.  WCxKit
 
It is important that the agent can answer all of their client’s insurance questions including the questions on workers compensation. We encourage you to learn work comp to the point that you can answers all your client’s questions. If you want to know more about cost containment, learn more about our book Workers Compensation Management Program: Reduce Costs 20% to 50%.
 
 
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 website 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 author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Top Industry Exec Offers Workers Compensation Year-In-Review

 
 
Two-thousand-eleven has been an interesting year in the workers compensation industry. New software has helped many administrators take better control of their costs, studies on safety have led to an increase in preventative measures and legal changes have led to unusual and sometimes controversial administration in some states.
 
 
Here at Roundup we asked one of our favorite experts, Curtis Smith, executive vice president of Medcor, Inc., a national on-site health services company, what he thought the top WC issues were for 2011. What follows are his conclusions:
 
Conflicts of Interest Inherent in the Industry
The very organizations employers depend on to help manage and reduce costs depend on claims for their core revenue – and this can lead to potential conflicts of interest, according to Smith. He offers these examples: contingent commissions for brokers and consultants, TPAs (third-party administrators) and MCOs (managed care organizations) who select network providers and share revenue from provider discounts. Smith also cautions against pharmacy chains that put pharmacies on-site in large worksites for convenience also employ the practitioners who write the prescriptions.
 
 
Prescription Drug Abuse
Thousands of people incur illness and injury each year from abuse of prescription medications, especially pain medications. Addictions and overdoses are increasing, as are deaths, Smith wrote. Addictions often arise from treatment after a work-related injuries but the medical community is not policing or restricting doctors who write these prescriptions. What’s more, TPAs are not excluding these unrestricted doctors from networks of approved providers for fear of litigation.
 
 
Prescription Drug Costs
The same medication can cost 10 times as much in workers compensation cases as it does in general health applications. Medications’ fee schedules have been negotiated down and controlled in group healthcare far more than in workers comp situations. Consequently, drug companies and others are moving into the comp space to take advantage of increased profitability, Smith said.
 
 
Increased Litigation in the Industry
The fundamental premise behind the workers compensation system is falling apart in many states (e.g. California and New York) where an increasing percentage of claims are contested and litigated. Huge settlements out of proportion to true economic need are forcing employers to be defensive and deny claims; denying and resisting legitimate claims forces employees to seek counsel and litigate. The comp system is turning into a battleground of plaintiff and defense attorneys working the system.
 
 
Injury Triage
Smith said he would be remiss if he did not mention injury triage. “This truly is an effective way to reduce unnecessary claims and costs, to identify serious cases, and to provide early intervention for all cases,” he wrote. Financial and health outcomes are improved with the use of triage. “It’s also innovative – wining several U.S. patents — are there any other WC methods that have been patented in the last 10 years? Or ever?” he asks. Thousands of companies are using triage and many competitors have joined the market, providing a variety of service and pricing models. Yet, many employers (even most) still don’t use it and the claims-driven industry still resists it.
 
 
Even those who offer injury triage often do so begrudgingly to satisfy their employer-clients, to block another triage provider from taking claims away, or to acquire business – but they are slow to introduce triage to an existing book of businesses, or, once introduced, often let implementation and utilization languish so claims can continue to flow.
 
 
In conclusion, look to hear more about these important topics in 2012. Though they may not be resolved in short order, they are certainly going to be on the minds of those of us in the industry in years to come.
 
Curtis Smith is Executive Vice President of Medcor and can be reached at csmith@medcor.com or 815-363-9500 Ext 5558. Visit Medcor at www.Medcor.com
 
 
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 author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
2012 WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

LexisNexis Work Comp Law Community Experts Sound Off About Top 10 Myths of the Workers Comp Industry

 

pic9LexisNexis Workers Compensation Law Community directed by attorney Robin Kobayashi recently teamed up with Work Comp Roundup to deliver expert opinions on the 10 most critical myths and facts about workers compensation.

 

 

What Kobayashi found were 10 top representatives from varied segments of the WC industry. Questions and comments to these experts are encouraged on the LexisNexis Workers’ Compensation Law Community, which provides all the contact information one would need.

 

 

The article goes into depth on the following 10 myths, in no particular order:

 

 

Myth #1: Large discount networks are the key to success in workers compensation managed care – from Kenneth F. Martino, president and CEO of Broadspire Services, Inc.

 

 

Myth #2: The employer’s role ends once the workers’ comp claim is paid from Emily Holbrook, editor, Risk Management and co-editor of Risk Management Monitor.

 

Myth #3: Workers compensation claims improve with age, by Mark Walls, assistant vice president of claims at Safety National.

 

 

Myth #4: Technology will cure all of our ills, from Robert Wilson, president & CEO of WorkersCompensation.com, LLC.

 

 

Myth #5: Because FECA is so different from state workers compensation systems, private sector case management best practices won’t work, contributed by Marianne Cloeren, MD, MPH, FACOEM, and medical director of Managed Care Advisors, Inc.

 

 

Myth #6: The vast majority of all medical reports using the AMA guides are inaccurate, from Robert G. Rassp, Esq. of the Law Office of Robert G. Rassp and author of The Rassp Report and The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation (LexisNexis).

 

 

Myth #7: CMS’  approval of an MSA is binding from Jennifer C. Jordan, Esq., general counsel at MEDVAL, LLP.

 

 

Myth #8: Doctors prescribe narcotic pain medications because of concerns they may be sued if they don’t treat pain from Stuart D. Colburn, Esq., shareholder in Downs Stanford, P.C.

 

 

Myth #9: Workers Compensation Costs Are Out of Control, discussed by Rebecca Shafer, Esq., president of Amaxx Risk Solutions, Inc. author of WCManual.com and LowerWC.com.

 

 

Myth #10: The exclusive remedy defense is being eroded from Thomas A. Robinson, J.D., author of the WorkCompWriter.com.

 

 

Remember, these are all MYTHS! The article itself goes into depth explaining why they are not FACTS. Work Comp Roundup considers it required reading for everyone in the field – it’s a great way to start the new year.

 

 

 

 

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 author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contactInfo@ReduceYourWorkersComp.com.

 

Experts Sound Off on Hot Medical Topics

The LexisNexis Workers Compensation Law Community Powered by Larson's often offers insightful commentary into our industry. Below, we compile three of the most interesting contributions of late.
 
Stuart Colburn
Stuart Colburn, an attorney for Downs Stanford recently shared  a blog  regarding a November 2011 Centers for Disease Control and Prevention (CDC) report that described prescription painkiller abuse as “a public health epidemic.”
 
 
Colburn noted the CDC feels that changing the the way prescription painkillers are prescribed would reduce misuse, abuse and overdose but still allow access to safe, effective treatment.(WCxKit)
 
 
 
Colburn frankly citizens the workers compensation system as contributing to these addictions and indirectly by contributing to lost time and injuries “attributable to decreased alertness and other ill effects of working while abusing prescription drugs.”
 
 
Colburn continues, “America's prescription drug abuse (PDA) problem is not nearly as well known as our War on Drugs. No war has been declared and yet American lives are being lost. The statistics are well known. American citizens make up 4 percent of the world's population. Yet, we consume 66 percent of the world's illegal drugs.”
 
 
His blog continues to site fascinating drug statistics not only from the CDC but also the U.S. Military, various states and many others. It is well worth a read.
 
 
 
Brian J. Caveney
Doctor and lawyer, Brian Caveney also writes in the LexisNexis communities’ blog an article titled, “Another Busy Year for Workers’ Compensation and Occupational Health.”
 
He concludes that the Patient Protection and Affordable Care Act (PPACA) of 2010 has changed much for the workers compensation industry including The United States Department of Health and Human Services adding eight substances to its Report on Carcinogens.
 
 
“Formaldehyde and aristocholic acids are now listed as known human carcinogens, and six other substances-captafol, cobalt-tungsten carbide, inhalable glass wool fibers, onitrotoluene, ridelliine, and styrene-are now considered as reasonably anticipated to be human carcinogens. This brings the total to 240 identified substances in the listings demanding thoughtful approaches to minimize exposure to workers,” Caveney wrote.
 
 
He also said the Fukushima Daiichi nuclear power plant in Japan has had great affect on the WC industry. “Readers of Occupational Injuries and Illnesses (LexisNexis) can refer to Chapter 44 for recent updates on the physics of radiation contamination and possible human health effects of exposure,” he wrote.
 
 
For WC matters regarding low back claims, Caveney directs readers to the updated Chapter 15 in Occupational Injuries and Illnesses (LexisNexis. And, lastly, he noted 2011 is the 30th  anniversary of the identification of the human immunodeficiency virus (HIV). “The infection has transcended its original death sentence upon diagnosis to a chronic disease state when adequately treated with the panoply of various treatment options these days. Once widespread fears of transmission in a host of occupational situations has thankfully now been limited to mostly preventable scenarios. Chapter 46 of Occupational Injuries and Illnesses (LexisNexis) reflects these advances,” he wrote.
 
To read more, follow the above link to Caveney’s article.
 
 
“Workers’ compensation is no stranger to controversy,” writes attorney Robin Kobayashi in her LexisNexis blog Workers’ Compensation in a Medically Overtreated Society.
 
 
She cites physician Nortin M. Hadler, MD new book Rethinking Aging: Growing Old and Living Well in an Overtreated Society. “Dr. Hadler continues his no-holds-barred approach, warning that the Baby Boomer Generation and Generations X and Y hold unrealistic notions about defying the aging process with medical technology, thereby making them more susceptible for ‘medicalization and overtreatment,’ “ she wrote.
 
 
Kobayashi notes that marketing has become “sophisticated and pervasive in playing off people’s fears about health and longevity. … It’s no secret that Dr. Hadler has had it with insurance companies and even the AMA Guides for that matter. He once argued that attempts to adhere to the AMA Guides to quantify impairment were, in his opinion, ‘an unappealing, if not Orwellian, exercise, and not just for musculoskeletal diseases but for all diseases.’ “(WCxKit)
 
 
Read more of Kobayashi’s research and opinion by following the link above. She concludes, “Here, in our world of workers’ compensation, we can’t deny the fact that workers’ compensation medical costs are soaring. Whether you’re an injured worker, attorney, judge, or claims adjuster, we need to make the right choices about medical care, to educate ourselves, and to stop being conditioned into believing that medical treatment can always help/save us.”
 
 
The material above is contributed by Lexis Nexis Workers Compensation Law Community.
 
 
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 website 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 author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

ABC's of WORK COMP COST REDUCTION Book:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

WCRI Releases Medical Price Index Data for Three States

The Workers Compensation Research Institute (WCRI) recently released medical price index data geared toward thee specific states. Regardless of where you are based, we all can learn from them.
They are:
 
 
In the Virginia study, WCRI found the 2010 price for non-hospital services was nearly 30 percent higher than the median price in states with fee schedules. The original nine-year study, Medical Price Index for Workers’ Compensation, Third Edition (MPI-WC), showed prices grew much faster than the typical growth rate of 11 percent in states with fee schedules.

The study further showed in Wisconsin, their system had the highest prices and fastest growth in their WCRI’s Medical Price Index. “The price for non-hospital services in Wisconsin in 2010 was the highest of the 25 study states, more than twice the prices in the 25-state median, and nearly 50 percent higher than the median of the 6 states with no fee schedules,” the study says.

A WCRI press release indicated, “The prices in Wisconsin increased 42 percent, much faster compared to median growth rate of 11 percent of the states with fee schedules, also faster than the 28 percent typical growth rate of the states without fee schedules.”(WCxKit)


Lastly, the Indiana portion of the larger study indicated the 2010 price for non-hospital services in that state was the third highest of the 25 study states, more than 50 percent higher than typical prices paid in the study states with fee schedule regulation. The nearly 30 percent growth in Indiana was much faster than the typical growth rate of 11 percent in states with fee schedules, according to a WCRI press release.


ABOUT WCRI:
The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Since 1983, WCRI has been a catalyst for significant improvements in workers’ compensation systems around the world with its objective, credible, and high-quality research. WCRI’s members include employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia and New Zealand.
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 website 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 author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.

CLUES TO WORK COMP COST REDUCTION:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

WCRI Provides Unbiased Research to Industry

Few people realize the workers’ compensation industry is actually 100 years old. It’s one of the most-successful public-private partnerships in U.S. history.
 
 
Since 1983, the Workers Compensation Research Institute (WCRI) has been providing the public with research on WC public policy issues. Based in Cambridge, Mass., the organization includes among its members employers, labor organizers, public and private insurers, health care providers, managed care companies, and state government representatives from the U.S., Canada, New Zealand, and Australia.
 
 
Dr. Richard Victor, WCRI executive director, oversees the institute’s studies and analysis that has added ammunition for the reforms to various aspects of the workers' comp system. Prior to working at the institute, he spent seven years conducting research at The Rand Corporation in Washington , D.C., and Santa Monica , Calif. His law degree and Ph.D. in economics is from the University of Michigan.
 
 
LowerWC recently asked Victor for his impressions of the industry. What follows are some of his comments:
 
 
“One of the most important, and troubling, areas for workers’ compensation systems is to find the appropriate ways to use narcotics – and to discourage abuse and diversion. A second critical issue is to find new and innovative ways for help workers return to productive employment,” Victor says.
 
 
To this end, WCRI is conducting several research phases to help find answers for WC narcotic use and return-to-work issues, he says.
 
 
Victor says the latest trends in workers’ compensation also include medical cost management. “Medical costs now represent more than half of workers’ compensation costs in most states. There is increasing focus on pharmaceutical costs and utilization and the payments made to hospitals and ambulatory surgery centers,” he says.
 
 
Further, everyone wants to know how to save the employers money. Victor says, “Most large employers are focused on three legs of the four-legged cost containment table – risk financing, injury prevention, and claim management. The fourth leg is a large opportunity because employers have underinvested in it – improving the ‘rules of the game’ to make the system more effective for workers and more cost effective for employers.”
 
 
He continues, “This requires that employers join together to formulate political positions and strategies and gather available evidence about how a given state system is performing, how it might be improved, and what lessons can be learned from other states.”
 
 
California and Texas are good examples of where employers have taken collective action and costs have fallen significantly, Victor says. One of the chief objectives of the WCRI CompScope benchmarking studies is to help stakeholders and public officials set priorities and debunk myths.
 
 
One important part of this research is an upcoming conference. The WCRI Annual Issues and Research Conference will be Nov. 16-17 in Boston with keynote speaker Peter Barth, professor of economics emeritus at the University of Connecticut. This will be its 28th year.
 
 
The goal there to present new ideas and alternative views, Victor says. “Whether you are managing workers’ compensation claims, involved in strategic planning, concerned with medical costs and utilization, or just looking for a better understanding of workers' compensation – this is the conference for you.”
 
 
All of the sessions highlight the first presentations of the latest research findings from WCRI while drawing upon the diverse perspectives of highly-respected workers’ compensation experts and policymakers from across the country, he says. “Attendees tell us that they value the large attendance because it allows them to leverage their time while at the conference. There are also opportunities to meet and interact with WCRI researchers.”
 
 
“The most important advice I can give remains a secret until the WCRI conference, when I (present) ‘The Elephant in the Room.’ It will highlight some things that are underappreciated, but are likely to shape workers’ compensation systems for the next decade. The future is not always like the past,” Victor says. “Of course, I would like to see your readers attend to stretch their thinking, gain a competitive edge, and network with peers.”
 
 
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 website 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 author of  Manage Your Workers Compensation: Reduce Costs 20-50% on cost containment techniques.  www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

Our WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

Manitoba Focuses in on Workplace Violence

Workplace safety is set to get a boost as changes to Manitoba's occupational health and safety provisions will soon make it mandatory for employers to implement violence-prevention policies, according to a report from Canada OH&S News.
 
 
Employers in specific sectors will be required to monitor, track, and report annually on violent incidents in the workplace. They will have to put in place procedures enabling employees to get immediate help when a violent or threatening situation occurs. Employers can also release personal information when deemed necessary to protect employees from the risk of violence, according to Joe Czech, a spokesman for Manitoba Labour and Immigration in Winnipeg.(WCxKit)
 
 
The changes cover the following sectors: health care, security, policing, corrections, crisis counseling and intervention, financial, pharmaceutical, education, and public transit and taxicab services. Workplaces that are not included in the elevated risk category will still be required to assess the risk of violence. "If a risk is identified, the employer must put in place measures to protect their workers," Czech said.
 
 
The new rules are based on recommendations from the Minister's Advisory Council on Workplace Safety and Health, and consultations with a number of stakeholders, including representatives from the health care sector.
 
 
Sandi Mowat, president of the Manitoba Nurses Union (MNU) in Winnipeg – which partnered with the provincial labor department to address the issue of workplace violence in health care facilities – said she is "very pleased with the changes." Findings from MNU focus groups investigating the extent of workplace violence incidents in the sector indicates many of these incidents are underreported, Mowat said.
 
 
In her blog entry for Working Families Manitoba, a community campaign launched by the Manitoba Federation of Labor to raise awareness of issues of concern to workers and their families, Mowat cites research that health care providers are victims of violence at an increasing rate. National studies also show that 48 percent of all non-fatal injuries from occupational assaults and violent acts occur in health care and social service settings.
 
 
"This fact is extremely alarming to us, since nurses were identified as the most likely of all health care workers to be assaulted," she writes.
 
 
With the regulatory amendments, it becomes clear that health care providers can flag a patient’s file who has exhibited violent behavior in the past. This measure, which also applies to mental health patients, will make information more readily available to the caregivers concerned, Mowat said.
 
 
"Health care workers, and in particular nurses, have a right to know if this individual has put a health care provider at risk in the past," she said. While existing regulations have provisions enabling health care providers to flag patients with violent tendencies, "most employers didn't do it because they believe that it was a breach of confidentiality," Mowat said.
 
 
A system to annually review and report violent incidents, which will include results of investigations and the measures taken, will help ensure that such occurrences cannot be ignored. "Literature does say that in places where the incidents were tracked, there was a decrease in those incidents," Mowat said.(WCxKit)
 
 
In addition, changes to the provincial employment standards regulation will require police services to provide adequate transportation home, within the boundaries of a city or town, to members who have to work after midnight and before 6 a.m. The move, notes Czech, is aimed at reducing the risk to law enforcement members from potentially violent situations while commuting to or from work during late-night shifts.

 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.


Our WORKERS COMP BOOK:  www.wcmanual.com

WORK COMP CALCULATOR: www
.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

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