We have a drug problem.

Americans consume more opioids than anyone else in the world. We are also among the highest consumers of marijuana. As a nation, we continue to rely on passive treatments for chronic conditions, instead of active management.

There is widespread acceptance of marijuana in the United States. A recent Quinnipiac University poll of US voters found that 63% of respondents believe that marijuana should be legalized and 93% support its use for adults with a medical prescription by a physician. The 2016 National Survey on Drug Use and Health estimates there are almost 38 million marijuana users in the United States. Thirty states and the District of Columbia currently have legalized marijuana in some form (most of these are so-called medical marijuana states). Eight states and the District of Columbia have legalized marijuana for recreational use.

Yet marijuana continues to be classified as Schedule I drugs under the Federal Controlled Substances Act and, therefore, illegal to manufacture, distribute, or dispense.

When it comes to the legality of medical efficacy of marijuana use, there are a number of factors at play. These include:

• Pharmacology — how exactly do the relevant chemical compounds, THC and CBD, interact with the body? And, given the non-traditional routes of administration for marijuana (usually inhalation or ingestion), how can we anticipate or regulate what the response will be?
• Adverse effects — we’ve all heard about the euphoria and impairment of memory, judgement, reaction, and other mainstream effects. But what about adverse physical effects? Or, the link to psychological disorders like depression, schizophrenia, or psychosis?
• Efficacy — in some circles, marijuana is touted as a harmless cure with the ability to cure everything from cancer to chronic pain. The challenge with these claims is that there are few methodologically rigorous trials that can back the claims up. Is there something here for doctors to work with or should the claims be dismissed as nothing but rumors from idealistic hippies?
• Workplace impact and safety — with additional increases in marijuana use, both recreational and otherwise, seeming inevitable, what is the link to workplace safety? And how can employers, insurers, and claims handlers respond?

As part of our dedication to staying at the forefront of medical advancements and opportunity, we have prepared a white paper and recorded webinar to dive deep into these questions. Using evidence-based research, we separate fact from fiction and seek to find out if there is legitimate use of marijuana in our industry’s future or if all the claims will go up in smoke.

• Download the white paper
• Access the webinar replay

Author: Dr. Marcos Iglesias is Broadspire’s senior vice president and chief medical officer with more than 25 years of experience in workers compensation, disability evaluation and treatment, and insurance leadership. Iglesias has a special interest in the prevention and mitigation of delayed recovery and disability. He is driven to help ill and injured workers live active, productive and fulfilling lives, which has led him to develop innovative, comprehensive disability management solutions that focus on returning workers to preinjury function. Iglesias is board certified in family medicine and utilization review and quality assurance. He is also a fellow of the American Academy of Family Physicians, American College of Occupational and Environmental Medicine and the American Institute of Healthcare Quality.

Members of the claim management team are called upon to evaluate the medical evidence and determine issues of reasonableness and necessity of medical care and treatment, along with determinations of causation and primary liability.  These decisions have a significant impact on an individual claim and the effectiveness of a workers’ compensation program.

Evaluating the Medical Evidence from a Physiological Standpoint

Imagine the next claim that lands on your desk involves a meat production worker.  The employee is a 62-year-old man who’s work activities requires him to process meat on a bench that is no higher than their waist.  During this process, the employee will turn in one direction to place the finished product for further processing and sale, and turn in the other direction to place the undesirable portions of the product for disposal.  None of their work activities require the employee to lift objects above chest level or over his head.  The employee is now claiming a progression of symptoms that involve stiffness, which has now culminated in “frozen shoulder” syndrome.  Should the alleged injury be accepted?

While the cutting of meat and its processing are repetitive, not all claims of repetitive trauma are compensable.

Making the Right Assessment

Claim handlers deal with many barriers when reviewing matters and determining questions that have real consequences.  This includes rigid timelines that can result in sanction or penalty if not done right or within a timely manner.  Questions that must be considered include:

• Did a work injury actually occur – even if it only aggravated or accelerated an underlying condition?

• What role if any, did the work activity contribute to the injury, disability and/or need for medical care and treatment?

• Even taking into consideration the employee’s age and possible prior injuries, did the work activity advance the underlying condition to the point of compensable injury?

• Does the overall medical evidence as presented fit the alleged injury?

In terms of the above scenario, the claim handler worked with a medical expert to review the claimed mechanism of injury, prior medical records and other information to allow for a primary denial.  It was noted that the contemporaneous medical records and work history did not support a work injury and the claimed mechanism was inconsistent with the subsequent medical diagnosis.  In sum, because the physiological body mechanics in question did not fit injury, the proactive claim handler was effective and proactive in denying the claim.

Application in Claims Handling Practice

It is important for members of the claim management team to review their files and determine if the medical evidence fits in not only workplace exposure/repetitive injury claims, but also specific incident injuries.  Examples of how this can be used in specific injuries include:

• How the employee fell or what they were doing when they fell;

• Angles of fracture and the type of fracture following a slip/fall; and

• The nature and extent of an injury based on pre-existing conditions such as degenerative disc disease for back and neck claims, and claims involving joints such as knees, shoulders, and

The list of possibilities is really endless.

Conclusions

Members of the claim management team face many challenges in their position on a daily basis.  It is of utmost importance that claims handlers make proper decisions after having investigated a claim in a timely manner and making evidence-based decisions.  This includes taking the time to obtain information on how the injury took place, they can save time and money for their program and clients.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

©2019 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.

A common method to control costs in workers’ compensation claims is the designation of a primary treating medical provider.  This is important for a number of reasons and is something claim handlers need to understand.  Failure to recognize its significance can result in excessive costs in the claim management process.

Threshold Issues to Consider for Primary Care Doctors in Work Comp

Determinations regarding the establishment of a primary care doctor are usually defined by statute or administrative rule under a jurisdiction’s workers’ compensation law.  In many instances and employee establishes their primary doctor based upon the number of times or frequency an injured employee receives medical care and treatment following an injury.

Time to Consider a Change in Healthcare Providers?

A health care provider is typically considered the “primary doctor” once they direct and coordinates the course of medical care provided to the employee. Employees are usually allowed to only have one primary health care provider at a time.  Once an employee establishes a primary treating physician, their ability to change that provider are limited.  Circumstances that permit change without initiating a legal process include the following:

• Death or retirement of a physician, doctor or other health care provider;

• Termination or suspension of a provider’s health care practice; or

• Referral from the primary provider to another provider.

Failure of an employee to receive advance approval of a change in health care provider can have a significant impact on a workers’ compensation claim.  One common consequence of this action is the ability of the workers’ compensation insurer to avoid legal liability for medical care and treatment received by the employee even if the medical care is reasonable, necessary and causally related to the work injury.

Other Factors to Consider When a Request for Change Occurs

If a change is not approved by a workers’ compensation insurer, employee’s generally have the ability to initiate a legal process to change their primary health care provider.  While factors to consider in this process vary, they generally include the following issues:

• Whether the requested change is an attempt to block reasonable treatment or avoid acting on the provider’s opinion concerning the employee’s ability to return to work: A change is sometimes requested when an injured employee is hesitant about proposed medical care and treatment.  Failure to follow the proposed treatment plan can also delay recovery.

• Development of a litigation strategy rather than to pursue appropriate diagnosis and treatment: This can occur in instances where an employee is malingering or exhibits unsafe habits such as seeking opioid-based prescription medications.

• The provider lacks expertise to treat the employee for the injury: Medicine is complex.  Sometimes a medical provider may lack the necessary training or experience to properly care for an injured employee.  There are also health care providers known to enable an employee by seeking excessive care or unnecessary procedures.

• Other factors to consider: It is important to evaluate a request for change in a health care provider in terms of travel costs to see a particular health care provider and other unnecessary expenses.  Members of the claim management team should be skeptical of a request for change when it is certain the employee does not require additional care.

Members of the claim management team also need to consider the best interests of all parties.  What these means is often vague and uncertain.  This requires the application of the “smell test” to determine if such change is really necessary.

Conclusions

Claim handlers need to be vigilant of excessive medical costs as long as it continues to drive workers’ compensation program costs.  One area of focus should be a determination on the employee’s primary medical provider following a work injury and what circumstances truly necessitate a change.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

©2018 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.

Nurse case managers can be invaluable to an injury management program. They can have a tremendous impact by helping organizations attain better outcomes for their injured workers and saving significant dollars.

But far too often industry stakeholders misunderstand how and when to use them. Like many aspects of claims management, Nurse Case Managers are a tool that should be employed judiciously and with forethought to garner the most value.

Expectations

NCMs are not miracle workers. However, when incorporated into the right types of claims they can be instrumental in getting the injured worker healed and back to work in a timely fashion, resulting in the types of savings reported above.

Here are the many ways NCMs help with a claim:

1. Patient advocacy. This is where NCMs shine. Injured workers are often confused and scared, especially if the injury is severe. Unlike being injured at home and going to see whatever physician they choose, the rules for injured workers are different. They are often told what doctor to see and when. They may also be concerned about how they will get money if they are out of work for any length of time. And they may fear losing their job. A NCM can guide the injured worker through the process, allaying his fears and answering his questions. They can

• Explain the process and restrictions
• Discuss likely recommendations from doctors
• Provide options for various specialists, regardless of the rules for physician choice in a jurisdiction. Where the injured worker has the option to visit any physician, the NCM can recommend physical therapists, orthopedists, or others. In employer-directed care states, the NCM can discuss various in-network providers known to her.
• Review meds. The NCM can explain the medications that are prescribed and look at possible interactions with other pharmaceuticals the injured worker may be taking.

2. Reduce litigation rates. One of the benefits of NCMs is the trusting relationship they develop with the injured worker. Research shows injured workers who work closely with a NCM are much less likely to sue their employers.

3. Increase engagement and ensure compliance. Injured workers can be notoriously unfaithful to the treatment plans — forget to take their medications, miss PT or other provider appointments, failing to do assigned exercises that aid recovery. Again, having a trusting relationship with a NCM who is clearly advocating for the injured worker is likely to result in better adherence to a treatment regimen.

4. Communicate. Because he is closely involved with the injured worker, the NCM is the best person to act as the liaison to all stakeholders.

• With the employer. The NCM can keep the employer updated on the injured worker’s progress. He can discuss restrictions and ways the employer can accommodate the worker. He can also discuss the capabilities the injured worker has during the recovery process to help identify light-duty work.
• With the treating physician. Especially in states where workers have a choice of providers, the NCM can explain the workers’ compensation system and the emphasis on return to work.
• With the claims adjuster. The person handling the claim may be unaware that the injured worker has been released to return to work, for example, requiring a change in the benefits.

5. ID then need for peer review. Sometimes claims go off the rails because the treating physician is not following evidence-based medicine guidelines, or doesn’t understand the goal of return to work. A medical provider who is not an occupational physician may continually say the injured worker should not go back to work in any capacity. The NCM can detect such incidents and get a medical provider from the insurer or third-party administrator to review the case and possibly talk with the treating provider.

6. Coordinate interventions. Psychosocial issues may be present that could derail the claim unless they are addressed. The NCM may be the first person able to detect these and seek cognitive behavioral therapy or other intervention. A pain management program may be warranted, which the NCM can coordinate.

Conclusion

NCMs are one of the most effective ways to achieve best win-wins for injured workers and employers. But it’s important for stakeholders to know how and where they can add value. For example, they should not be used on every claim.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

©2018 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.

A combination of ibuprofen and acetaminophen does a better job of relieving acute pain than opioids. Despite clear evidence that the combination of the less dangerous medications provides equal or greater pain relief, many physicians still prescribe opioids for injured workers with pain.

This statement was just one point made in a recent session at the Workers’ Compensation Institute’s Annual Conference in Orlando presented by:

• Marcos A. Iglesias, Chief Medical Officer of Broadspire
• Mark Pew, senior VP for Product Development & Marketing at Preferred Medical.

The Problem

The opioid epidemic in the U.S. has been well documented in recent years. Researchers say Americans consume more opioids than any other country, regardless of the myriad physical and psychological problems associated with their unnecessary use.

While stakeholders in the workers’ compensation system have made progress in curbing the unnecessary use of opioids in recent years, it will take a concerted effort of educating providers as well as employees about chronic pain, and effective treatment alternatives said Iglesias and Pew.

Findings released by the Society for Internal Medicine on a one-year comparison of patients with chronic low back pain who were treated with either opioids or ibuprofen included:

• No difference in function
• Those given opioids had statistically worse pain control

Among the side effects of opioids are

• Drowsiness
• Confusion
• Nausea
• Constipation
• Euphoria
• Slowed Breathing

Because opioids repress the respiratory system, using them can result in hypoxia — a condition in which too little oxygen reaches the brain. It can lead to coma, permanent brain damage or death. The drugs can be especially dangerous when combined with other medications, such as benzodiazepines, certain antidepressants, some antibiotics, and sleeping pills.

Expectations

Even in the face of the research and statistics, many providers continue to look to opioids as the gold standard for pain management. One of the biggest problems is the mindset of western medicine and civilizations.

“There is an expectation in the U.S. that we shouldn’t feel pain, we are reducing the supply of opioids, but not limiting the demand,” Pew said. “There needs to be an effort in this country to educate people and change their minds about pain, so they realize opioids are not the answer” added Iglesias.

Eliminating all pain forever is just not realistic for many people. But they can — and do — learn to cope with their pain and live happy, normal, and functional lives.

Education

In addition to realigning expectations, education is key to reducing unnecessary opioid use. Many people may not be aware of the extent of the problem. “One-third of individuals that are taking an opioid do not know they are taking it,” Iglesias explained. “There needs to be more awareness in the population.”

Additional points stated include:

1. Locus of control. Unlike in some other countries, many people in the U.S. have a passive acceptance of medical treatment and believe somebody or something should take care of the problem. Typically, many think a pill is the answer. However, drugs often mask the problem rather than addressing the root cause.
2. Employers can take actions to improve the fitness levels of employees. Encouraging more walking, providing healthier foods in vending machines and making all programs free of charge are suggestions to get started.
3. Self-advocacy. Injured workers and others should be encouraged to take charge and be responsible for their medical care.
4. Reduce unrealistic expectations. Employers can work with medical providers to create and send a letter to injured workers outlining what to expect after an injury occurs. It can include suggestions on how to manage pain and some options.
5. Sleep hygiene. Sleep is crucial for recovery from injuries. There are a variety of non-pharmacological recommendations to help people get more and better sleep.
6. Education on dealing with depression can go a long way in helping injured workers cope with their pain and injuries. They should be encouraged to work with the Employee Assistance Program, if applicable, or given community resources that may be helpful.
7. Behavioral techniques. Cognitive behavioral therapy (CBT) has been shown to be one of the most effective ways to help people cope with chronic pain. It is short term, skill-based, and typically does not incur a psychiatric diagnosis. Along with CBT, additional behavioral techniques include:
   • Mindful meditation.
   • Deep breathing skills.
   • Increased physical activity.
8. Focus on function rather than pain. Focusing on pain only makes the level of pain increase. Discuss function rather than pain with an emphasis on progress.
   • Iglesias example “you told me you picked up the mail, last time we talked you weren’t able to get off the couch.”

Conclusion

The persistent opioid crisis has taken years to develop and will take a multifaceted effort to reduce and eliminate.  An improved focus by employers and payers on the education of opioid alternatives is a positive step toward better treatment and outcomes.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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: https://blog.reduceyourworkerscomp.com/

©2018 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.