Opioid Abuse is Hot Workers Comp Topic
The hottest workers’ compensation topic currently is the run-away cost of opioids, which are very strong narcotics, in the treatment of employee injuries. Key findings from the recent WCRI conference state that most injured workers received opioids for pain relief, over 80% in some states. In addition, the amount of opioids received per claim has been unusually high in some states with fewer longer-term users of opioids receiving services for monitoring and management.
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“The 6-Step Process To Determine Workers’ Comp Injury Causation”
Whether an employer is self-insured for workers’ compensation, or has a work comp insurance company, the cost of opioids can have a significant impact on the employer’s overall workers’ compensation cost. Unfortunately, too many employers take the approach that they cannot do anything about the impact of opioid costs on their work comp claims. Employers do not have to accept the conventional wisdom that there is nothing they can do to control the cost and abuse of opioids. There are several approaches an employer can take to deal with these issues.
Steps Employer Can Take To Control Opioid Abuse
Control Selection of Medical Provider
The first step employers should take to control opioid abuse and opioid cost is to control the selection of the medical provider. In the states where the employer has the right to select the medical provider, and in the states where the employer is required to provide a panel of doctors for the employee to select from, all medical providers should be prescreened. This is to eliminate doctors that are too quick to prescribe narcotics and doctors that keep injured employees with chronic pain on narcotics.
There are several other approaches doctors can use to treat pain besides narcotics. Physical therapy, exercise, injections, acupuncture, neural blocks, implantable devices and psychological intervention can all be used as alternatives to narcotics.
Empirical evidence also shows that the opioid problem is much worse in the states where the employee is free to select their own medical provider. This is especially true in states where the medical provider cannot only prescribe an opioid, but can also dispense it (and make an additional profit in doing so). If your state law allows the employee to select their own doctor, you can still post on the work place bulletin board a list of nearby recommended (not required) doctors that have been screened to eliminate medical providers who over-prescribe narcotics.
Initiate Drug-Free Workplace Program
As stated in the “Effective Interventions” presentation at WCRI, employers with an actively managed Drug-free Workplace program have significantly lower percentage of injured employees utilizing opioids. Employers who do not hire people who use illicit drugs and employers who have random on-going screening for illicit drugs have far fewer employees who are predisposed to developing an opioid addiction when they incur an on-the-job injury.
Pain is subjective, and there is no diagnostic test to measure it. This often results in the injured employee being asked to self-rate their pain on a zero to 10 on a ten point scale with zero being no pain, and 10 being pain that is totally incapacitating. Watch out for the employee who rates their pain 9 or a 10 but was able to transport themselves to the doctor’s office. An extremely high pain self rating that is not supported by objective findings is a red flag pointing to a desire for secondary gain or a desire to obtain narcotics.
Nurse Case Manager Should Be Assigned to Red Flag Cases
When an employee reports a high level of pain, especially after a medical provider has prescribed an opioid, it is imperative that close supervision of the injury claim be maintained. If a nurse case manager (NCM) is not already working on the claim, one should be assigned. The nurse case manager should review the medical diagnosis to verify there is acute musculoskeletal pain supported by significant objective evidence of injury (as opposed to “my back hurts”).
The NCM should discuss with the medical provider the reason for the opioid treatment, the anticipated length of time the opioid will be provided, the quantity being provided on a daily basis and most importantly, the possibility of alternative non-narcotic medication or alternative pain management treatment methods. If the medical provider is non-cooperative with the NCM, the NCM should bring in a doctor that specializes in pain management for a peer review of the treatment, and if necessary, a doctor to doctor discussion of the opioid treatment be provided to the injured employee.
Review Opioid Usage with Pharmacy Benefit Manager
The employer should review opioid usage with their Pharmacy Benefit Manager (PBM) company. The PBM processing the prescriptions submitted to them need to do much more than see whether or not the prescribed opioid is on their formulary list. The PBM should:
- provide utilization review to prevent the consumption of a narcotic faster than the manufacturer’s recommendation or faster than the medical provider’s prescription amount
- be able to prevent prescriptions from multiple doctors being processed for the same drug or duplicate use drugs
- have the capability of preventing multi-pharmacy submissions (where the employee fills the opioid prescription at one pharmacy chain using the paper prescription received in the doctor’s office, then calls the doctor’s office claiming to lost the prescription and having the doctor’s office call the prescription into a different pharmacy chain)
- the ability to provide correct pricing for any opioids dispensed from the doctor’s office
Engage Employee Assistance Program for Opioid Users Longer Than 60 Days
While there is a debate over when the use of opioids becomes an addiction problem, if the injured employee has been receiving opioids for more than 60 days, and the employer has a Wellness Program, the employee should be referred to the Employee Assistance Program. While the employee may be initially reluctant to seek assistance with their use of opioids (as many addicts will lie to themselves to justify their addiction), the employee needs to be educated about the long-term negatives of opioid addiction. The Employee Assistance Program will provide the employee with positive support, behavioral modification, encouragement and guidance on how to break the opioid addiction. This can include counseling, information on alternative treatments and if needed, drug rehabilitation.
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.
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