You’re Fired! Employment Releases in Work Comp

You’re Fired! Employment Releases in Work CompThere are many challenges to settling a workers’ compensation claim.  One of these challenges includes the possibility the employer may desire to seek a voluntary resignation of employment.  It is important for members of the claims management team and defense attorneys to carefully navigate the complex maze of laws and regulations during this process.  Failure to do so can result in program sanctions or other unwanted legal matters, which negatively impact your program’s bottom line.

 

 

When is Voluntary Resignation Appropriate?

 

Seeking the voluntary resignation of an employee as part of a global workers’ compensation settlement should not be a part of every claim.  There are a number of legal and practical barriers that warrant careful consideration when making this a part of the negotiation and settlement process.

 

When evaluating a claim, it is important to be in contact with trained legal counsel.  Examples of this include several state workers’ compensation acts that explicitly prohibit this practice.  If there is the appearance of even suggesting an employee resign as part of resolving their workers’ compensation claim, the employer and insurer may be subject to additional legal sanction.  This can include paying punitive compensation benefits to the employee and other legal causes of action under a state’s discrimination laws.

 

Even in instances where the practice is allowed, careful legal guidance is required.  Matters to consider include:

 

  • Careful drafting of the legal document being signed by the employee as part of the voluntary resignation;

 

  • Adequate monetary consideration paid to the employee, which is beyond the settlement of the workers’ compensation matters. Attorneys may resist these measures as monies received under an employment release/resignation are considered taxable income;

 

  • Understanding the legal considerations of paying additional funds to the employee. This is an issue regarding employment law and no necessarily a service or protection covered by a workers’ compensation insurance policy.  All monies paid as consideration for a resignation must come from the employer.

 

 

Employer Involvement in Termination Decisions

 

Beyond the legal aspects of including a voluntary resignation, employers play a key role in this process.  In many instances this is a business decision that must take into consideration several factors:

 

  • The physical demands of a position and whether the employee will be able to perform certain job duties upon their return to work;

 

  • Other return to work considerations, including whether modifications can be made to accomplish the goals of a work hardening, vocational rehabilitation or job search efforts; and

 

  • Overall workplace morale. If employees view themselves as being “expendable” following a work injury, efforts to recruit and maintain a diverse talent base may diminish.

 

 

Other Considerations for Attorneys

 

There are also issues workers’ compensation defense attorneys must consider as part of the voluntary resignation process.  These issues are ethical matters and include consideration of the rules of professional conduct.  Matters for the defense attorney to consider include:

 

  • Who is the client and whether adding another distinct legal task changes the nature and scope of whom the client might be in employment related matters;

 

  • Who is responsible for paying for legal services rendered in the negotiating and drafting of an employment release in the global settlement; and

 

  • Whether adding a client to a related case creates even the potential of a conflict of interest.

 

Failure to consider these matters can result in loss of business and one’s professional reputation.  It can even result in an ethical complaint or malpractice exposure.

 

 

 

Conclusions

 

The workers’ compensation claims process is complex and requires interested stakeholders to remain proactive.  One such area includes the consideration of a voluntary resignation and employment release as part of the global settlement.  Everyone involved in the process must be proactive and consider the risks and rewards of this important issue.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Smoking, Depression, and Substance Abuse Wellness Programs in Workers’ Comp

wellness in workers compensationIt has been proven many times that employers can reduce their workers’ compensation costs by investing in a wellness program.  Notwithstanding the imperial data that demonstrates the effectiveness of these programs, many interested stakeholders are resistant to them based on the perceived cost or other imaginary barriers when it comes to improving the health of their workforce.  Instead of focusing on these hurdles, thought leaders within the industry should focus on the bigger picture to reduce costs in their programs.

 

 

Smoking Cessation Programs

 

Notwithstanding nationwide efforts to curb smoking, tobacco use remains a popular habit in millions of Americans.  It is well-documented that smoking and the use of its other forms, including smokeless tobacco have significant negative health consequences.  These include many common issues Americans struggle with such as cancer, heart disease and other respiratory problems.  The use of tobacco also reduces the effectiveness of physical rehabilitation and healing following a work-injury.

 

Access to smoking cessation programs is now more affordable following the passage of the Affordable Care Act (ACA).  Under the ACA, all qualifying individual and group health plans are required to include these programs as an “essential health benefit.”  This means that health plans must allow participants access to programs and services with no copay.

 

Changes in health care have also had a positive impact on people who remain without insurances.  In many instances, employers have taken the initiative to provide their employees, regardless of health instance coverage, access to programs that assist people kick the habit.  This also includes access to patches, gum and other devices that promote smoking cessation.

 

 

Depression and Mental Health Awareness

 

Americans as a who have also become more sensitive to mental health related issues.  This includes greater access to care and parity of coverage when compared to treatment to physical ailments and injuries.  The essence of the awakening and change in attitudes is better resources for employees to receive the care they need.

 

While Americans now have more options when it comes to purchasing health insurance, many remain without.  This has led to opportunities for proactive employers to provide resources when it comes to psychological and psychiatric issues.  This includes:

 

  • Training for employees on how to recognize a coworker suffering from a mental health related issue;

 

  • Greater access to mental health care and services, including treatment by specialists; and

 

  • Easily accessible outreach programs such as supportive and non-judgmental telephonic services for thoughts struggling with mental health needs.

 

 

Substance Abuse Prevention and Treatment

 

Use and abuse of substances, included those that are legal, can have a negative impact on the workplace.  This includes decreased productivity, diminished service of customers and injury.  Failure to address these issues in the context of a workers’ compensation program can only hurt the bottom line and dramatically increase costs.

 

Proactive employers need to take this issue seriously.  This starts with the implementation of a substance abuse policy that is consistently applied.  It must also apply to all employees, regardless of their position within a company.

 

It is also important for employers to assist employees who may use and abuses these substances.  This includes the following methods to implement:

 

  • Reporting of substance abuse issues within the workplace via confidential means;

 

  • Drug testing that is performed in a manner consistent with state and federal laws; and

 

  • Resources such as help lines and other medical/mental health professionals who can assist employees impacted by use/abuse issues.

 

 

Conclusions

 

There are many benefits to any workers’ compensation program when interested stakeholders look for creative and cost-effective measures to improve employee wellness.  They not only cut down on the frequency or injuries within the workplace, but they have many other benefits.  Among these include an increase in morale and reduce turnover.  The bottom line also includes lower workers’ compensation program costs.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Leverage Post-Settlement Professional Administration for Truly Optimal Outcomes

Leverage Post-Settlement Professional Administration for Truly Optimal OutcomesEvery now and then an idea comes along that makes so much sense you wonder why it hasn’t been around all along. In the case of professional administration to handle post-settlement medical fund management, it actually has; but it’s now been perfected so it makes logical and financial sense for injured workers and payers alike.

 

For the injured worker it means they’ll continue to have someone to manage their medical care and assure appropriate compliance with Medicare. For payers, it means finally settling claims that have been on the books for months or even years. For both sides, it means significant dollars saved, it is truly a win-win for all parties involved.

 

 

What Is a Post-Settlement Professional Administrator?

 

Many injured workers get frustrated with the workers’ compensation system, but are nevertheless leery about settling their claims. They are concerned they might not have enough money to handle their future medical and indemnity needs; they may additionally fear they won’t be able to fully comply with Medicare reporting requirements, if a Medicare Set-aside is included. In many cases, as much as they dislike the workers’ compensation system, they are even more fearful of navigating their medical care on their own without someone with expertise to help. This is where professional administration comes in.

 

The level of care the injured worker is used to continues to be provided when a quality professional administrator is involved. In many cases, the care may even be better. The administrator coordinates medical treatment, but without the frustration of utilization review; i.e., providers, treatments and pharmaceuticals are not denied. Deep discounts on treatments and medications are available because of the administrator’s networks. With some companies, there is even a 24-hour support line available. The administrator helps ensure that the money lasts, and the injured worker has an advocate for their medical care and finances.

 

A comparison between the typical services involved in a workers’ compensation claim and those available after settlement through a professional administrator shows they are nearly the same:

 

  • Provider bill review. The discounts provided through the professional administrator’s network can be the same or even better than those available in the workers’ compensation system.
  • Pharmacy benefit manager and durable medical equipment networks: Again, the savings on these can be substantial through the administrator’s network.
  • Phone support.
  • Provider recommendations.
  • Reporting – with a professional administrator all Medicare Set Aside reporting is 100% guaranteed.
  • Bill administration.
  • Utilization review – with a professional administrator, there is none!

 

What makes the idea of a professional administrator even more appealing is that having greater discounts on medical treatments means there is more likelihood the case with settle and the administrator will earn the business. Therefore, it behooves the professional administrator to have a strong network and do the right things for the injured worker, to maintain the relationship and be able to offer further discounted services.

 

 

Benefits to Payers

 

A professional administrator can be brought into the process at any time, and there is no cost unless the case settles. With a solid, experienced group, payers are finding their long-term, seemingly endless claims are settling. But it’s not only the fact that there is a settlement that saves the payer money, it’s also the ultimate dollar amount.

 

Calculations for future medicals can be tricky. There must be accounting for the medical procedures, medical providers and the cost of pharmaceuticals. Add to that the expenses of unexpected complications and inflation, and the amount for the medical portion of the settlement can be staggering.

 

Bringing a professional administrator into the discussions before the settlement is reached can be advantageous to the payer and the injured worker. Because of the network discounts, the future medical costs can be substantially lower than would be typical. Also, the professional administrator can demonstrate real costs to the injured worker, making them more comfortable with the final number.

 

 

Conclusion

 

Many injured workers simply lack the expertise, or interest, to manage the responsibilities of their own medical care, nor do they have access to discounted services and treatments.

 

Professional administration can fill the gap and make a settlement attractive to both parties. A company with solid experience and proficiency in all aspects of workers’ compensation claims can be the right solution for all concerned.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

4 Times When a Workers Comp Claim Should NOT Be Settled

4 times when NOT to settle a workers comp claimIn the workers’ compensation claims world, a common held belief is “the more settled claims, the better”.  However, there are several times when, a claim should NOT be settled — at least not yet:

 

  • When you are not sure the claim is legitimate – if you are still questioning in your own mind whether the claim is legitimate, or whether your company is “being taken for a ride”, hold off settling the claim until you are SURE. There’s nothing wrong with “going with” your gut instinct. This means you should do two things:

 

  • have your own medical advisor review the file and
  • do a thorough sub rosa investigation over an extended period of time (I don’t mean ONE day — I mean “extended”).

 

  • When it sets a bad precedent in the workplace – If you have the type of workplace that one or two settlements could draw in a whole pack of other claims, then I would tend not to settle the claim. Your company may become known as “an easy mark.” You want to pay the exact benefits due, when they are due so the employee receives what he/she is supposed to. Explain this policy in your Employee Brochure.  If employees think the only way they can get their full benefits is to hire an attorney, they are much more likely to do that. When that’s how things transpired for other injured employees in your workplace, it sends the message that is the only way the employer will pay benefits to which employees are entitled.

 

  • When the employee’s condition could still improve – The appropriate time to settle in cases which should be settled is after the employee has reached MMI (Maximum Medical Improvement). Only at this time will it be known how much the employee will be disabled, how much cost he will incur for future medical care, future lost wages, and other expenses such as home-care.

 

  • When the claim is being settled only because it’s a “nuisance” – Your company will want to determine if they want to take a stance in “nuisance cases” and settle them for “nuisance value” (insignificant amounts) or “defense costs” in order to close the matter. Some companies do, some don’t. Although being in litigation is inconvenient at best and a nightmare at worst, that does not mean you want to settle every inconvenient claim.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Porter Leslie Announced As The President of Ametros

WILMINGTON, Mass. – Ametros, the industry leader in post-settlement medical administration, announced the promotion of Porter Leslie to President of Ametros. The announcement was made by Marques Torbert, CEO of Ametros.

 

“Porter has a track record of executing strategic initiatives with remarkable success,” remarked Marques, “In his new role, he will help the company get closer to achieving its mission of revolutionizing the insurance and healthcare services industry by developing more cutting-edge products and innovative services to benefit our clients and members.”

 

Porter joined Ametros in 2015 and in his previous role as Chief Strategy Officer, had been instrumental in driving growth and change across various disciplines within the company, including IT, marketing, new product development, and strategic partnerships.

 

“We have built a phenomenal team with close to 50 employees, who provide nationwide support for anyone who needs help managing their healthcare after settlement,” commented Porter. “I feel privileged to be asked to lead some of the smartest and dedicated minds in the industry.  There is no limit to what we can accomplish together.”

 

 

About Ametros

 

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make savvy decisions on how to spend their medical funds. Ametros’ team works closely with patients, insurers, employers, attorneys, medical providers and Medicare to create a seamless experience for their clients. Their depth of expertise in the Medicare Set Aside, property and casualty insurance, healthcare, legal, financial and software industries positions them to offer the best solutions in the marketplace. Their flagship products, CareGuard and Amethyst, are revolutionizing the way funds from insurance claim settlements are administered after settlement, for Medicare Set Aside accounts and any other medical allocation. Ametros is backed by Clarion Capital Partners, LLC, a New York based private equity firm. For more information, visit www.ametroscards.com.

Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

Controlling Work Comp Transportation Expense Is More Than Ordering an UberMonitoring and managing workers’ comp transportation expenses can drastically improve the claim expense cost, especially on larger work comp claims. Unfortunately, claims adjusters and/or nurse case managers often overlook this important expense, thinking to save money by not using a transportation service.

 

Attempting to cut costs in this category is not an option, and here’s why.

 

 

Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

 

Controlling transportation expense is more than ordering an Uber for the employee to get to the doctor or writing the employee a check for personal automobile mileage.

 

When the employee is physically unable to travel unassisted or does not have access to transportation and will have multiple visits to the treating physician or other medical providers, a transportation company specializing in workers’ compensation claims is needed. Services of a transportation company are arranged by the adjuster or nurse case manager, not by the employee.   The selection of a transportation company is based on the company’s ability to provide safe and reliable transport service whenever needed.

 

A full service transportation company saves the claims office a significant amount of time, since the adjuster or the nurse case manager can spend many calls and emails coordinating employee transportation needs. Often employees reschedule doctor appointments for their own convenience and the transportation must be scheduled all over again. Or worse, employees “forget” their medical appointment and are not ready to go when the transportation arrives, knowing the doctor will not see them if they are very late arriving.

 

Experienced work comp adjusters know the more subjective the employee’s injuries are the higher probability they will miss their medical appointments, cancel medical appointments or reschedule them without advising the adjuster.

 

 

The professional transportation company will:

 

  1. Schedule the transportation with the employee as soon as they are notified of the medical appointment.
  2. Contact the employee the day before the medical appointment to confirm the pick-up time and the return home time.
  3. Contact the employee the day of the appointment before they leave their business location to confirm the appointment is still the same.
  4. Notify the claims office if there are any changes in the scheduled medical appointment, or if the medical appointment is missed by the employee.
  5. Provide the adjuster or nurse case manager with a documented trip history as to their departure time from their business location, the time they picked up the employee, the time the employee arrived at the medical location, and the time they delivered the employee back to the employee’s residence.

 

While automobiles are the most common mode of transportation for injured employees, other modes of transportation are occasionally needed for the severely injured. The full service transportation company specializing in workers’ compensation claims is able to provide the work comp adjuster or the nurse case manager with other alternatives including ambulances, wheelchairs and stretchers.

 

 

Employee Has No Incentive To Locate Best Price for Transportation

 

In addition to saving the claims office considerable amounts of time, the professional transportation company also saves the claims office money. The employee has no incentive to locate the best price for transportation, as the employee is not paying for it. Also, the employee is not concerned about the cost for missed appointments. By the claims office controlling the transportation needs of the employee, the transportation cost is properly managed.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

 

Case Study: 60% MSA Savings From CMS Re-Review Process

While the Workers’ Compensation Medicare Set-Aside (WCMSA) review process remains voluntary, it is an excellent tool to provide certainty in your settlements.  The major downfall of the process is the lack of a formal appeal from an adverse WCMSA decision by CMS.  CMS nonetheless provides a limited “re-review” process which, in the hands of a capable Medicare Secondary Payer service provider, can often yield a favorable result, reducing your MSA costs and helping you realize significant savings.

 

 

Understanding the Re-Review Process

 

If CMS responds to the submission of a WCMSA with a counter-higher (that is, it increases the proposed MSA amount), you can request a re-review in the following instances:

 

  • You believe CMS’ determination contains obvious mistakes (e.g., a mathematical error or failure to recognize medical records already submitted showing a surgery, priced by CMS, that has already occurred); or

 

  • You believe you have additional evidence, not previously considered by CMS, which was dated prior to the submission date of the original proposal and which warrants a change in CMS’ determination (emphasis added).

 

Knowing how to effectively use the re-review process is key and should include using a trusted MSP service partner to drive settlements when CMS disagrees with the original allocation.

 

 

Case Study (Provided by Tower MSA Partners): 60% MSA Savings From CMS Re-Review Process

 

CMS may increase prescription medication allocation in a WCMSA if there are inconsistencies in the medical records or the prescription histories, variances in pricing based upon the fluid movement of Redbook medication pricing, or prescription medications are left open-ended in the medical treatment records. This case study considers the challenge and solution to a re-review presenting both inconsistencies in medical records as well as open-ended prescription medications.

 

 

Challenge

 

CMS countered higher to include Gabapentin 600 mg tablets (AWP-$2.28/per pill), increasing the CMS approved MSA amount to $98,054. The physician had increased prescribed strength from 300mg to 600mg.  However, the injured worker had not filled 600mg prescription. The prescription drug history showed consistent fills of Gabapentin 300 mg capsule (AWP -.03/per pill).

 

 

Solution

 

Tower MSA prepared a letter for submission to the treating physician confirming continued fills of Gabapentin 300 mg capsules. As required in Montana, notice was given to the injured worker and his counsel prior to initiating contact with the physician. The letter was submitted to the physician’s office via fax and was placed on physician’s letterhead and executed by the physician with language as follows:

 

“The above captioned patient is under my care for treatment of chronic back pain and neuropathic pain. He will be prescribed Gabapentin 300 mg capsules taking 2 capsules three (3) times / day to help him manage his pain”.

 

The executed physician letter, which emphasized the consistent history of Gabapentin 300mg refills, was submitted to CMS for Re-Review.

 

 

Result

 

CMS accepted Tower’s physician letter and reduced its CMS approved MSA amount from $98,054 to $33,319, resulting in a savings of $64,735.

 

While CMS stipulates in its guidelines that documentation obtained post CMS submission will not be accepted, the use of the rationale that the injured worker had not filled the 600 mg strength was effective to obtain a positive CMS Re-Review outcome.

 

 

Conclusions

 

The WCMSA review process is unavoidable when the settling parties require the assurance of CMS’s stamp of approval   Claims management teams and other interested stakeholders can save their programs time and money by fully understanding and properly planning and coordinating both the MSA submission and re-review of a counter-higher if necessary.  An experienced MSP service provider is recommended as the planning, coordination, and execution will be included at no additional charge in a best-in-class program.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Leverage Pharmacy Controls to Reduce Opioid Spending 13.4%

The workers’ compensation industry has been a leader in addressing the national opioid epidemic. Nevertheless, medical providers continue to prescribe these drugs for chronic pain, despite research and recommendations that caution against using them as a first line of treatment.

 

The good news is that payers can take steps to reduce the unnecessary use of opioids. In its latest Drug Trend Report, Express Scripts said its clients saw an average 13.4 percent decrease in spending for opioids — even though the drugs continue to be the most expensive and highly utilized class for work-related injuries.

 

Armed with more evidence of the dangers and with increased persistence, payers can further reduce the prescribing of opioids for injured workers.

 

 

The Problem

 

The Centers for Disease Control and Prevention ( CDC)  released a new study that shows the more days for which opioids are prescribed, the more likely a person would become a chronic opioid user. The risks for chronic opioid use increases with each additional day of prescription. The days most associated with chronic use of the drugs were the 3rd, 5th and 31st days of the prescriptions.

 

Starting a patient on a long-acting opioid showed the highest probability of continued opioid use at 1 and 3 years. Patients who were started on the drug tramadol were the second most likely to have continued opioid use.

 

Additional potential triggers for abusing the drugs were:

 

  • A second prescription or a refill. Authorizing a second opioid prescription was shown to double the risk for opioid use one year later.
  • A morphine equivalent cumulative dose of at least 700 milligrams.
  • An initial supply of 10 or 30 days.

 

Opioids cause changes to a person’s brain. They have a chemical structure similar to a natural substance in the body. The drugs go to the pleasure center of the brain and release dopamine, a neurotransmitter that can cause depressed breathing, blood pressure and alertness, as well as decreased pain and a euphoric effect. Eventually, the drugs can result in a compromised ability to regulate unsafe or risky behaviors.

 

Over time, the body can become tolerant and dependent on the drug, meaning the patient must take more of the drug to achieve the same pain relief results.  Some people then become addicted to the drugs.

 

Opioids can be life threatening, even for a first time user, due to depressed breathing. Other side effects associated with opioids include depression, constipation, confusion, insomnia, and sexual dysfunction.

 

 

What to Do

 

Adoption of strategies addressing morphine equivalent dose (MED) led to significant decreases for Express Scripts’ clients, the company said. “Payers who adopted the MED program had a 32.7% reduction in cumulative MED >100 and a 24.7% overall decrease in cumulative MED,” according to the Drug Trend Report.

 

The company also uses a proprietary “point-of-sale and concurrent drug utilization review (DUR) edits to identify dangerous drug combinations (such as benzodiazepines and/or skeletal muscle relaxants with opioids) or other therapy concerns (duplication, use of long-acting opioids as a first choice and more).” Benzodiazepines in combination with opioids “should be avoided whenever possible due to respiratory depression and greater risk for potentially fatal overdose.”

 

Additional best practices to control over use and abuse of opioids are the following:

 

  • Real-time monitoring of MED and payer notification prior to any opioid fill that exceeds predefined MED thresholds.
  • Patient education and prescriber outreach for certain prescribing patterns, dangerous combinations and MED thresholds.
  • Leveraging opioid prescriber and patient trends with sophisticated reporting and analytics to identify fraud, waste and abuse and other risky behavior.
  • Coordinating efforts among providers, governments and law enforcement.
  • Ensuring providers prescribe opioids for the shortest duration possible when used to treat acute pain. Three days or less is ideal, while more than 7 is rarely needed.
  • Inform providers and discourage them from unnecessarily prescribing tramadol for chronic pain.

 

 

Summary

 

Opioids have a place in the nation’s healthcare system. However, their use for chronic pain has clearly been exceeded in recent years.

 

Payers that stay abreast of the latest research findings and establish protocols based on the information can go a long way to help prevent an injured worker from developing chronic opioid abuse, and save significant dollars.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

9 Questions to Ask Injured Worker’s Treating Physician

Leaving no stone unturned is critical to managing your workers’ compensation costs. With the number of steps from injury to resolution; the number or people involved from physicians to adjusters; and the number of possible outcomes from a band-aid to a large insurance settlement you cannot leave any single step to memory.

 

 

Create System to Ask All the Right Questions

 

Certain questions must be asked, forms must be filled out, and precautions should be taken. Your injury management system should ensure all the questions one should ask the physician on the telephone to be sure every “i” is dotted and ever “t” is crossed.

 

Formalize your questions in a checklist so these questions are asked uniformly; it’s not something that should be done on an ad hoc basis.

 

9 Questions to Ask Injured Worker’s Treating Physician

 

  1. Introduce yourself and give the injured employee’s name, mentioning the employee has authorized you to speak with the doctor
  2. Get and give all contact information.
  3. Offer to email authorization so the doctor may discuss the employee’s condition.
  4. Ask for diagnosis and whether it is work related.
  5. Ask how the employee is responding to treatment.
  6. Ask if prescribed medications could interfere with the employee’s job.
  7. Does the physician recommend any significant limitations?
  8. Can the employee perform a transitional duty job? If yes, obtain the employee’s work restrictions.
  9. Is there anything else that I should know, that would help our employee recover more quickly?

 

This open-ended question gives the doctor an opportunity to provide information that is additional and helpful to the employer or the employee.

 

Keeping up with all these details assists your company in getting your employee healthy and back to work.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Broadspire® Names Dr. Marcos Iglesias Chief Medical Officer

ATLANTA, June 22, 2017 (GLOBE NEWSWIRE) — Broadspire®, a division of Crawford & Company®, and a leading global third-party administrator, today announced that Dr. Marcos Iglesias has been named the company’s new chief medical officer, effective June 26. Dr. Iglesias assumes the position from Dr. Jacob Lazarovic, who announced his retirement after 18 years with Broadspire.

 

“Providing appropriate clinical oversight for injured employees is a critical aspect of the services we provide, and so we are excited to have Dr. Iglesias join Broadspire to provide strategic leadership in this area; his extensive medical and business background, particularly in injury management, makes him an excellent fit for us,” said Neil Lentine, chief operating officer at Broadspire.

 

Dr. Iglesias brings with him extensive practice and administrative experience in a number of medical areas, including occupational medicine, workers compensation, utilization management and disability management. Prior to joining Broadspire, Dr. Iglesias practiced medicine for 16 years and then held a number of senior management positions with insurance companies; most recently he served as vice president and medical director at The Hartford Insurance Company. Prior to that he held the positions of medical director at Midwest Employers Casualty Company and Lincoln Financial Group.

 

“Broadspire is known in the industry for its successful medical management approach, which includes making certain that injured workers receive clinically appropriate and cost effective care,” said Dr. Iglesias. “I am excited to join a company that has always been at the forefront of managed care thought leadership, and I look forward to working with the entire clinical team, as well as Broadspire customers, as we work to provide the best care for those affected by injury.”

 

Among his professional achievements, Dr. Iglesias is Board Certified in Family Medicine (ABFM) and Utilization Review and Quality Assurance (ABQAURP). He is a Fellow of the American Academy of Family Physicians (AAFP), the American College of Occupational and Environmental Medicine (ACOEM) and the American Institute of Healthcare Quality (AIHQ). He is also certified in Health Care Quality and Management (CHCQM).

 

Dr. Iglesias received his medical degree in Medicine and Family Medicine from the University of Toronto and later received a master’s in Medical Management from the Marshall School of Business at the University of Southern California.

 

 

About Broadspire®

Broadspire®, a leading global third-party administrator, offers casualty claim, medical management, accident and health, and disability and leave management solutions, helping increase employee productivity and reducing the cost of risk through early intervention, professional expertise and data analytics. As a Crawford Company, Broadspire is based in Atlanta, Ga. Services are offered by Crawford & Company under the Broadspire brand in countries outside the U.S.

 

 

About Crawford®

Based in Atlanta, Crawford & Company (NYSE:CRD‐A) (NYSE:CRD‐B) is the world’s largest publicly listed independent provider of claims management solutions to insurance companies and self‐insured entities with an expansive global network serving clients in more than 70 countries. The Crawford Solution® offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines including property and casualty claims management, workers’ compensation claims and medical management, and legal settlement administration. More information is available at www.crawfordandcompany.com.

 

For more information please contact: Nancy Hamlet/404.300.1918 Nancy_hamlet@us.crawco.com

 

 

Professional Development Resource

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