It's a pop quiz style risk roundup this week where you can match wits with the riskmeisters. The Notwithstanding Blog hosts the Cavalcade of Risk #149: Single Best Answer edition.

In other matters, we will use this week's roundup here at Workers Comp Insider to highlight some useful gizmos and gadgets that have been accumulating in our bookmarks folder: a grab bag of work-related mobile apps and calculators that we hope you'll find useful!

There's an app for that

DOL data apps - Backed by prize money, last summer the Department of Labor issued an Occupational Employment Statistics challenge to developers to use DOL data in innovative, creative, and useful ways that would empower job seekers and consumers. Winning apps were recently announced - they include job trackers and occupational wage watchers - but our favorite is Eat Shop Sleep, an app that allows you to geographically shop for hotels and restaurants, and to narrow your results based on health and labor violations, as well as local reviews.

The DOL itself offers a few mobile apps - a labor statistics tool, a timesheet, and an OSHA heat safety tool. See the full menu of USA.gov features various mobile apps - a few that look particularly helpful include PTSD Coach, MedlinePlus Mobile, and U.S. Federal per-diem rates. And we can't resist pointing out the MEanderthal, a Smithsonian app that allows you to upload a photo and morph into a neanderthal - not particularly work-related, unless you want to create an unusual portrait bulletin board for your work team. (See a fun video of MEanderthal in action).

Accessibility App - Another app development challenge sponsored by the Knight Foundation and the Federal Communications Commission yields a tool with great potential for people with disabilities. Access Together, is a crowd-sourced Foursquare-style app, which incorporates user information about accessibility of various locations. All answers will be saved and become part of a searchable dataset, map and open API to be used by people with and without disabilities.

Distracted Driving - DriveSafe.ly is a mobile application that reads text (SMS) messages and emails aloud in real time and automatically responds without drivers touching the mobile phone. DriveSafe.ly bills itself as "the solution to texting while driving." It's available in either a personal or a business/enterprise edition.

Calculators

Push Pull Carry Calculator - Canada's WorkSafeBC is a great source of quality health and safety resources. Check out the Push Pull Carry Calculator, a tool designed to help prevent musculo-skeletal injuries.

Ergonomics Cost Benefit Calculator - The Puget Sound Chapter of the Human Factors and Ergonomics Society has developed an Ergonomics cost-benefit calculator that helps you to estimate ROI by comparing three intervention options that offer estimates of benefits and payback periods.

Diabetes cost - The Agency for Healthcare Research and Quality (AHRQ) has created Diabetes Cost Calculator for Employers, an evidence-based tool that employers can use to estimate how much diabetes costs them and the potential savings that would result from better management of diabetes. In a similar vein, see Blueprint for health, a free web-based tool for making value-based decisions for health and productivity management. This tool was developed by the Health as Human Capital Foundation in collaboration with ACOEM, and the National Business Coalition on Health (NBCH).

R.O.I. - Wellness Return on Investment Calculators are designed to help you to estimate the effect that a good wellness programs can have on health care costs, absenteeism, and presenteeism. For another tool variation on the theme of wellness program ROI, see the Calculate your Savings.

The cost of doing nothing - Quantifying the Cost of Physical Inactivity Calculator estimates the financial cost of physically inactive people to a particular community, city, state or business. The site also provides companion resources and information to re-allocate resources and plan for healthier workplaces and communities that are more supportive of physical activity.

Yesterday the New York Sunday Times ran a fascinating piece on the manufacturing of iPhones. The making of 200 million phones is taking place in the far east, mostly in China. When President Obama asked Steve Jobs "why can't that work come home?" Jobs replied: "Those jobs aren't coming back." The article, written by Charles Duhigg and Keith Bradsher, describes the reasons why this work will never come back home (and why we wouldn't want them anyway).

In the months prior to the release of the iPhone, Steve Jobs carried a prototype in his pocket. He discovered that the plastic screen was easily scratched by the keys and loose change that people often have in their pockets. He informed his engineers that this was not acceptable and insisted - at the last minute - that they redesign the phone with a scratch- and break-resistant glass. Corning Glass was able to do this.

Corning (made in America!) shipped the new parts to China, where they arrived around midnight. Supervisors at the assembly plant woke up some 8,000 workers sleeping in company dorms, gave them tea and a biscuit and set them to work in 12 hour shifts installing the glass into bevelled frames. The plant churned out 10,000 phones per day.

It is impossible to envision an American workforce positioned to perform this kind of work under these conditions. We do not house our workers in dorms (except migrant farm workers). We do not suddenly change work schedules to begin at midnight. Even in the Republican dream of a post-union workforce, it is inconceivable that American workers would accept this kind of pressure - and be paid $17 per day or less.

iPhones and Pyramids
Nearly seven years ago we blogged the emerging issue of worker rights in China. While there is a bare-bones structure of rights, these are arbitrarily enforced and easily avoided. China is a single party state, run with ruthless efficiency by the Communist Party. Opposition is not tolerated; dissent is brutally suppressed; and workers are at the mercy of their employers. To enforce rights, you need a constitution and an infrastructure of laws and regulations. And you need lawyers to argue on behalf of workers. China has none of these crucial elements and, truth be told, no real interest in developing them. And that is why everything is made in China: quality is high, working conditions are whatever management wants them to be, and labor costs are low.

While technically not slaves, production workers in China labor under appalling conditions that do not and cannot exist in most western cultures. They may be paid better than the slaves who built the pyramids, but they are paid less - while working harder - than any comparable workforce in developed countries.

So the late Steve Jobs was correct: the jobs involved in assembling essential electronic devices will remain off shore. These jobs are never coming home, unless, of course, the economy collapses totally and our workers are reduced to accepting virtually any working conditions. Which leads to questions beyond the scope of a workers comp blog: what manufacturing jobs will remain domestic? What will happen to the millions of production workers in America who no longer have jobs? As the American middle class declines, how will the economy function? Who will buy the goods that drive the engine of capitalism?

Epilogue
I drove my American assembled Japanese car to the Verizon store yesterday and picked up my black 16 gig iPhone, designed by indisputable geniuses in America and assembled by an underclass in China. It's awesome. I can't imagine life without it.

We're delighted to be hosting Health Wonk Review this month. In looking for a potential theme, we turned to "the Googles" to see if January was noteworthy for any special commemorations beyond Martin Luther King day. Well buckle down because it looks like we will all be very busy. January is apparently train-your-dog month, radon awareness month, "get organized" month, crime-stoppers month, budget month, cervical health awareness month, closet organization month, mentor month, beer month, pet registration month, anti-human trafficking month, tuna month, pork month, and more - we're sure we've missed some and we're exhausted already.

We've decided to go with beer month (as we wrote this last night) and a turn to the classics: January is named after Janus, the ancient Roman god of the doorway. Janus is generally depicted as a two faced god, with one face looking to the past and one to the future. Here on Health Wonk Review, our last issue included some recaps of the prior year, so in this issue, we are looking to the future and what the coming year might hold for healthcare.

Reading the tea leaves
Since our last issue, several of our intrepid wonks have proffered prognostications for the coming year. First up is Joe Paduda at Managed Care Matters who offers his workers' comp predictions, which are expansive enough to encompass not one post, nor two, but but three - and if he is right, it looks like it will be a busy year in the occupational medicine arena.

At The New Health Dialogue Blog, Joe Colucci notes that the countdown to the SCOTUS ruling on the Affordable Care Act has begun, and weighs in with prognostications about how the constitutionality challenges are likely to fare.

At InsureBlog, Bob Vineyard looks ahead at the future of healthcare, finding some things you won't get on the 6 o'clock news.

The devil-some details
While some of our posters are looking at the broad trends, others are looking under the hood. As the saying goes, the devil is in the details.

At Health Affairs Blog, Timothy Jost examines the first set of Supreme Court briefs filed in the challenge to the ACA, including the U.S. government brief defending the constitutionality of the minimum coverage requirement, aka individual mandate.

At Health Care Renewal, Dr. Roy Poses takes a bipartisan look at the presidential candidates and their financial relationships with large health care organizations, wondering whether any of them would be inclined to advocate for health reform measures that might threaten the interests of these organizations. He notes that some of these relationships appear significant enough to be called conflicts of interest in arenas other than the political one, yet none of the candidates has made a point of disclosing these relationships as potential conflicts.

Louise Norris of Colorado Health Insurance Insider examines some of the potential reasons why claims expenses in Colorado's new high risk pool are double the national average. She points out that, "pre-existing condition exclusion riders have all but disappeared in the individual health insurance market in Colorado. Nearly all carriers now use underwriting rate increases instead."

On the eponymously named John Goodman's Health Policy Blog, John examines barriers that physicians face in pricing and packaging their services in a post entitled How Doctors are Trapped.

David Williams of Health Business Blog looks at Medicaid expansion and questions if we will we get our money's worth. He notes that as more diabetics are added to the rolls, their out of pocket costs will fall. But overall costs will rise steeply and it's unclear whether outcomes will improve.

Healthcare Economist Jason Shafrin investigates how Medicare's physician value-based purchasing scheme will work. He notes some of the challenges involved in evaluating physicians for quality and cost.

Brad Wright is looking sharp at his newly designed blog, Wright on Health, where he offers an overview of the Independent Payment Advisory Board, the mechanism created by the Affordable Care Act to deal with growing Medicare spending. He looks at how it works, as well as what it can and cannot do.

Gary Schwitzer looks at senior health care policies from another perspective. He earns his Health News Watchdog blog name as he digs up the truth about a dishonest health care hoax intended to scare seniors which has recently been making the rounds, including airtime on a national radio call-in show.

And for another angle on senior care, at Health AGEnda, Marcus Escobedo looks at the issue of life expectancy and whether it should affect treatment. His post discusses a new evidence-based website for predicting life expectancy among older patients, ePrognosis.org, and the debate surrounding its use.

On the technology front...
Primary care physician Jaan Sidorov believes the digitization of health care information will commoditize primary care. At Disease Management Care Blog, he examines the transport of information and the likelihood that, when it comes to routine medical problems, patients won't need to be seen by a physician in a traditional face-to-face visit.

Also on the healthcare technology front, Dr. Michael Koriwchak has a post a Healthcare Talent Transformation where he takes a closer look at the "enthusiasm gap" between Health IT startup companies and physicians and opines about some of the reasons for barriers to adoption.

Closing thoughts...
At Corporate Wellness Insights, Kat Haselkorn reminds us that wellness can be a good investment with a good ROI, and that ignoring workplace wellness is as risky as gambling because no employee is immune to illness or injury.

Here at Workers Comp Insider, we point you to our piece on How Doctors Die, recounting a thoughtful article by a physician who notes that, "What's unusual about them is not how much treatment they get compared to most Americans, but how little."

Next up: Our next edition of Health Wonk Review will be hosted by Louise Norris at Colorado Long Term Care Insider on February 2!

Falls in Construction - Reroofing

In Spanish: Caidas en la Construccion/Reparacion del Techo

Sprains and Strains in Construction/Pulling Cables

In Spanish: Torceduras y Desgarres en la Construccion/Tendido de Cables

Struck-by Accidents in Construction/Swinging Cranes

In Spanish: Golpes Causados por Accidentes en Construccion/Gruas en Movimiento

Risk Roundup - Political Calculations blog hosts this week's Cavalcade of Risk, replete with a post rating system. Check it out.

Florida repackaged drugs issue redux - Dave DePaolo posts about a new effort to put a price cap on Florida's repackaged drugs. He posits that changing economic and regulatory conditions might create a more favorable climate for passage. He also talks about how "capping the price of drugs has been hotly contested by the Florida Medical Association (FMA) and a company called Automated Healthcare Solutions (AHCS)." AHCS is a firm whose executives have contributed heavily to politicians to prevent such legislation. A Tampa Bay news report talks about how the state's pill mill crackdown was held up by proponents of doc dispensing, including AHCS principals: "The two Miramar workers' compensation doctors have helped pump about $3 million into the political system through a dozen companies in the past year." A story in the Florida Independent covers an earnings report for top lobbyists, noting that, "Among the companies to have spent the most on lobbying is Automated HealthCare Solutions, a group whose co-chairmen have become fixtures on the political scene. According to the Current, Automated HealthCare has posted minimum lobbying expenditures greater than $300,000." For more on why repackaging controls are needed, see Joe Paduda's posts: Drug Dispensing by Docs and Repackagers and the myth of AWP.

The big five - Roberto Ceniceros reports that Top 5 workplace injury causes make up 72% of direct workers comp costs, according to a research report by Liberty Mutual Group. "Overexertion--or injuries caused by lifting, pushing, pulling, holding and carrying--costs businesses $12.5 billion in direct annual expenses and accounts for more than 25% of the national burden." This was followed by falls on the same level, falls to a lower level, bodily reaction, and struck by object.

Violence in Nursing - In When it hurts to help, Victoria Ison reports on workplace violence in nursing. Many might assume most violence is perpetrated by patients or intruders but not so: "Assistant nursing professor Cindy Thomas said the most common form of violence currently seen in health care occurs between nurses. She said violence between physicians and nurses is second, and violence between patients and nurses is actually third most common."

Strange suits - Top 10 Bizarre Workers' Comp Cases for 2011. From an eye-related injury after hitting a bowling ball with a sledge hammer to a fall from a helicopter while attempting to capture a deer with a net - read Thomas Robinson's picks for workers comp lawsuits with strange circumstances. Robinson reminds us that, "one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families."

Brief takes

• New OSHA page targets winter storm-related injuries


• What to expect when you're expecting the Department of Labor


• Protecting Porn Workers Part II: Watch Where You Point That Thing"


• Insurer Sues Google in Alabama Over Unflattering Search Results


• Bans on Smokers in the Workplace Continues


• Supreme Court will review case on FMLA and state immunity


• Lady Gaga's former personal assistant sues pop star for overtime pay


• Behind the [NYC pharmacy] Counter, an Acute Anxiety


• Report Says Mafia Now 'Italy's No.1 Bank' as Economic Crisis Bites


• Bungee jump gone wrong - not work related, but just yikes

We've bringing you something a bit peripheral to our normal topics today, but it deals with the business of medicine. Plus, it is excellent.

How Doctors Die by Ken Murray, MD talks about how doctors face end of life issues. Many might assume that when faced with a terminal condition, physicians would leverage their expertise and access to the max, harnessing all the latest treatments and technologies. But the picture that Murry paints is a very different one. Armed with the knowledge of just how grueling and terrible the "do everything possible" model can be, many doctors choose to forgo chemo, radiation, surgery, and other life-prolonging treatments entirely.

"What's unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently."

Why, if they don't want this treatment themselves, do they inflict it on patients? Murray explores the many often human reasons why family members and physicians make these choices and points to a system that encourages and rewards excessive treatment and unrealistic expectations about what medicine can do. Plus, as a society, we have a cultural bias against accepting death. Perhaps it was ever so - no one want to die. But advertising, a stay-young-forever culture, pharmacology, and the miracles of technology all conspire to make us think we perhaps can live forever. When someone facing a terminal illness chooses acceptance of the natural order, they are often pressured by family and friends for not being a fighter.

The comments in the article are also well worth reading. Other people -- doctors, medical professionals, and "civilians"-- offer their thoughts, opinions, and touching real life experiences with family members, friends, and even their own terminal circumstances.

Healthcare policy - Kick off the new year with a bit of health policy wonkery. Jared Rhoads hosts 2012's first edition of Health Wonk Review at The Center for Objective Health Policy. We'll be hosting the next issue here on this blog later in the month.

OSHA fines double for serious violations - OSHA Law Update has a good overview of statistics recently released by OSHA. While the number of inspections have dropped in 2011, fines for serious violations or workplace safety doubled. The average OSHA penalty per serious violation in 2011 increased to $2,132, more than doubling from 2010's average of $1,053. OSHA head David Michaels points out that this is still too low, "We have to maximize the impact of our penalties because we're trying to not just focus on the employer where we found the [violation], but the whole industry." OSHA conducted 40,648 inspections, down from 40,993 in 2010. The drop was attributed to a change in inspection priorities, with a higher mix of health inspections and recordkeeping compliance, which take longer.

Wyoming - "Wyoming's overall workplace death rate was more than three and a half times the national average in 2010 and has ranked worst in the nation five of the past 10 years." A yearlong study and report to the Governor by epidemiologist Dr. Timothy Ryan points to a lack of workplace safety culture and finds that employers consistently fail to enforce safety rules. (Thanks to Joanne Wojcik for the pointer.

Hello, hard market - By year's end, it looks as though insurers finally had something to toast. Joe Paduda posts that the soft workers comp market is over. He cites a MarketScout report, which indicated rates were up 3% in December, the highest increase among all P&C lines.

Claims adjuster workload norms - At Comp Time, Roberto Ceniceros asks if 12 to 18 minutes per claim file is adequate. He's looking for feedback on "how much time should be devoted per file in order for adjusters to do a really great job."

Michigan, Maryland - WCRI recently issued two new cost-per-claim reports on Maryland and Michigan. Both studies include observations about the impact of recessionary pressures on claim costs. The picture may change going forward in Michigan, where reform legislation was just signed, the state's first overhaul in more than twenty years.

Brief takes

• Inspections of Dairy Farms to Begin
• Tackling Muscle and Joint Pain (PDF) - a useful tool courtesy of kendallburton
• Emory Researchers Use iPhone 4 for Remote Assessment of Stroke
• Interactive safety: What's wrong with this photo?
• Worker fails to prove necessity for inground pool
• Bob's Top 10 Predictions for 2012
• The Ten Most Annoying Management Terms Of 2011

We close with this compelling video, which might provide some inspiration for your new year. It's a great video to share with your work force. (Hat tip to the Renaissance Alliance Consumer Insurance Blog

To usher in the new year, we're posting recaps of 2011 and prognostications for 2012 that we've gathered from some of our regular sources around the web.

PropertyCasualty360
Top 10 Stories of 2011
Catastrophes 2011: The Top 10 -- Revisited
2011's Headlines Set 2012's Course

Risk & Insurance
OSHA announces top workplace violations for FY 2011
POINT: 2012: A Bang-Up Year for Risk Managers
COUNTERPOINT: 2012: Another Challenging Year for Risk Managers

Business Insurance (registration may be required)
The Year in (Insurance) Cartoons
Business Insurance's top stories of 2011

Risk Management Magazine
Year in Risk

Joe Paduda
Predictions for 2011 - how'd I do?

Jon Gelman
(Gelman's) Top 10 Workers' Compensation Blog Posts for 2011

LexisNexis
Larson's Spotlight: Top 10 Cases for 2011 That You Should Know About
The Year in Review: Top 10 Workers' Comp Fraud News Stories

Workers Comp Zone
Top 10 Developments in California Workers' Comp in 2011

OSHA Law Update
Top 5 OSHA Developments to Look Out For In 2012

SafetyNewsAlert.com
Top 10 safety stories of 2011 - reader's choice

Tech Decisions
Top Tech Feature Articles of 2011

HR Daily Advisor
Year in Review

Human Resource Executive
A Look Back: At Employment-Law Issues
A Look Back: At the Workplace

All of us at Lynch Ryan hope you are enjoying the holiday season. As our year end wrap-up, we are revisiting some of our popular posts, as indicated by post clicks. Thanks for your interest and support in 2011, and we'll see you around the bend!

Top 20 posts in 2011
Have you protected your employees from this seasonal peril?

Medical Marijuana: Walmart Wins! (Walmart Loses)

Cool work safety tool from WorkSafeBC - "What's wrong with this photo?"

John T. Dibble's Sympathetic Ear

Dangerous jobs: window washing at extreme heights

Health Wonk Review: the heatwave edition

The wacky world of workers comp

Managing Chronic Pain, Revisited

Health Wonk Review: Stormy Weather

Social media and workers comp

Independent Contractors in Pennsylvania

Experience Modification Alert: NCCI Changing the Rules

Are nurses and health care workers facing more on-the-job violence?

Low clearance: truckers, this one is for you

The "here's a guy doing stupid things" safety photo genre

The Not-So-Hidden Cost of Obesity

Record number of grain bin fatalities in 2010; OSHA cites employers

NCCI suggests a "precarious outlook prevails" for the workers comp market

Medical Marijuana in the Workplace: Dude, Lock Me Out!

Managing Chronic Pain

All time greatest hits
We've been blogging for more than 8 years, but our stat counter has only been tracking for about half that time. In that time, we have recorded 1,356,748 visits. Below, we've posted the all-time favorites over the 4+ years we've been tracking, along with the number of visits to each post. There are no duplicates with the above list. Since about 85% of all visits come from search engines, the list gives you a pretty good window into what types of things people are searching on for worker's comp topics.

26,766 - You're fired! Should you terminate an employee who is on workers compensation?

21,138 - Independent Contractor or Employee?

18,180 - Carpal Tunnel Syndrome: Who Should Pay?

11,100 - The history of workers compensation

7,607 - Can You Terminate an Employee on Workers Comp?

6,607 - Exception to the "going and coming" rule: operating premises

6,309 - The AIG Saga: Joe Cassano's Performance-Based Compensation

5,349 - Cavalcade of Risk #113 and a scary work scenario

5,320 - Pre-existing conditions and second injuries

5,258 - Heart attacks on the job: are they covered by workers compensation?

4,922 - Workers comp costs and benefits - Current state rankings

4,726 - Controversial Canadian workplace safety ads unveiled

4,550 - Workers' compensation reform in a New York minute

3,825 - You think your job is tough?

3,693 - Measuring Success 2

3,671 - Poppy Seeds and Drug Testing: False Positives?

3,596 - Underwriting for Dummies?

3,540 = The Comp Success Story in Massachusetts: Who Pays?

3,484 - The Cost of Volunteers

2,870 - Swine Flu Meets Workers Comp