Archive for June, 2012

Maggie Mahar’s Health Wonk Review & other noteworthy news of the week

Friday, June 8th, 2012

Maggie Mahar has posted the Voices from the Blogosphere edition of Health Wonk Review at healthinsurance.org blog. It’s a robust edition with talk about individual rights, the upcoming SCOTUS decision, the proposed ban on sugary drinks, and more. Maggie is one of the healthcare bloggers that we follow regularly. She’s an author and a financial journalist who has written extensively about the U.S. health care system over her career. Stop by to check out her curated compilation of healthcare policy posts.
Other noteworthy news & views
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Derek Boogaard: A Bully and His Demons

Tuesday, June 5th, 2012

Derek Boogaard was a hockey player. Well, sort of. He didn’t score goals (only 3 in 6 years) and he spent a lot of time in the penalty box (589 minutes). He was an enforcer: at 6’8″ he was a ferocious and much-feared brawler.
As we learn in a New York Times article, he was also addicted to pain medications. While still playing hockey in 2008-2009, he received at least 25 prescriptions for opioids from ten doctors, a total of 600+ pills: eight team doctors of the Wild (his team at the time), an oral surgeon in Minneapolis and a doctor from another NHL team.
In 2010, he was signed by the New York Rangers for $6.5 million, despite his by then well-documented drug problems – he was an active participant in the NHL’s substance abuse program. While playing for the Rangers, a team dentist wrote five prescriptions for hydrocodone; another team doctor wrote 10 prescriptions for Ambien.
Occupation-related Pain
There is not much question that Boogaard suffered from pain. Here is just a small segment of his pain-filled saga, from the final few months of his career: In October 2010, a punch from a Toronto player broke a three-tooth bridge in his mouth. A couple of days later, he hurt his hand while punching a Boston player. In November he had his nose broken by an Edmonton player. In December he suffered a concussion in a fight with an Ottowa player. He never played hockey again.
In the months following his retirement, he exhibited erratic behavior and wild mood swings. He acquired numerous prescriptions from current and former doctors. In May of 2011 he signed himself out of a rehab facility, spent a night drinking with friends, and died of an overdose in his Minneapolis apartment. He was 28 years old.
Privilege Has Its Pain
The article quotes Dr. Jane Ballantyne, a pain expert from the University of Washington: “A single course of opiates might be O.K. for normal people who only get injured once in a blue moon, but when injuries are frequent, it can easily turn into chronic treatment instead of just acute treatement. And athletes are at high risk of developing addiction because of their risk-taking personalities.” She adds: “the tendency is to overtreat” because team doctors want to help athletes return to competition.” [At LynchRyan, we are strong proponents of prompt return to work, but only where there is no risk of re-injury. There is no such thing as modified duty on ice.]
Boogaard was a fan favorite wherever he played. In hockey, fighting is “part of the game.” But his sad saga is primarily a story of brain injury and addiction. As a professional athlete, Boogaard had virtually unlimited access to drugs, through doctors who, for the most part, did not bother to document their treatment plans or monitor their patient.
It should come as no surprise that an autopsy revealed that Boogaard had chronic traumatic encephalopathy C.T.E., a brain disease caused by repeated blows to the head.Thus he is linked in death to the growing number of football players who suffered the same fate, the result of frequent concussions.
Official Response Speak
As a lifelong student of language and rhetoric, I cannot miss an opportunity to quote some of the official responses to Boogaard’s death:
The NHL: “Based on what we know, Derek Boogaard at all times received medical treatment, care and counseling that was deemed appropriate for the specifics of his situation.”
The Minnesota Wild: “The Wild treated Derek’s medical status in accordance with the NHL/NHLPA Substance Abuse and Behavioral Health Program as we do with all our players.”
The NY Rangers: “We are confident that the medical professionals who treated Derek acted in a professional and responsible manner and in accordance with their best medical judgment. They took extraordinary steps to coordinate the medication prescribed for him with the professionals in charge of the NHL-NHLPA Substance Abuse and Behavioral Health Program.”
Not exactly heartfelt or compassionate, just the voices of powerful corporations, protecting their interests, their brands and their proverbial asses. As for Derek Boogaard and his misguided career on ice, RIP for the man who knew no peace.

Risk, mining industry growth, drug repackaging, E&O, SIGS & more news of note

Monday, June 4th, 2012

Risk roundup – Nina Kallen posts the latest Cavalcade of Risk at Insurance Coverage Law in Massachusetts – check it out.
Mining – Joe Paduda talks about the growth of the mining industry, noting that it is up almost 60% over the last ten years, with an increase of 12% since the beginning of 2011 – a growth rate that looks like it will surpass the BLS ten-year projection of 24%. Joe notes that regulators, work comp executives and providers should be on alert since this growth will have a dramatic impact on selected states, citing North Dakota as one example.
Disparity in healthcare costs – Dave DePaolo has an interesting post on the wide disparity in cost for cash paying patients vs insurance. He points to a recent LA Times article that cited numerous real world examples (routine blood work was charged $782 by the hospital, $415 by the insurer, and $95 if paid in cash.) DePaolo asks: “What would fee schedules look like if those in charge of these pricing decisions shared with payers and regulators all of the data that identified each friction point in insurance based reimbursement schedules versus getting paid cash?”
Florida drug repackaging – Do the people who write the biggest checks to politicians determine the cost of workers comp in Florida? That’s a question many keep raising, and it appears so. In the article drug-bill battle is lucrative for lobbyists, legislators, Aaron Deslatte of The Orlando Sentinel talks about how Broward County’s Automated Health Care Solutions has invested nearly $6 million into lobbying to protect the practice of drug repackaging by physicians. Why should this issue be of concern to Florida employers and insurers? Joe Paduda offers a primer on repackaged drugs and the effect on work comp costs.
E&O and workers compWorkers’ compensation is the leading cause of agent in E&O claims, accounting for approximately 10% of all claims annually, according to Curt Pearsall. He notes the majority of claims involve the following issues: Questions involving coverage for sole proprietors, partnerships or single-member LLCs; Dealing with a broker to place coverage for that “tough” risk; Dealing with the state workers’ comp market to place coverage; Ensuring employees in all states are covered; Placing clients in a trust/alternative program; and U.S. Longshoreman and Harbor coverage.
On reforming SIGS – At LexisNexis Workers’ Compensation Law, John Stahl offers a summary and some of the salient points of the International Association of Industrial Accident Boards and Commissions’ (IAIABC) recent report on self-insurance groups (SIGs): Regulatory Challenges Regarding Self-Insured Groups: Failures Prompt New Regulation. He notes that employers liked the low cost of joining an SIG but did not realize the potential liabilities associated with that choice, and that many employers made the false assumption that they were protected by state regulation. The full IAIABC report is available for $45: Self-Insured Groups for Workers’ Compensation: Effective Regulatory Strategies.
CA protects hair care workers – Jon Gelman posts about a groundbreaking settlement in California that protects hair care salon workers. The settlement was between California’s Attorney General and manufacturers of Brazilian Blowout hair smoothing products that contain a cancer-causing chemical. In addition to paying fees and penalties and implementing safeguards for workers, hair care facilities must warn the public about the cancer-causing potential of the chemicals used in the procedure and must cease deceptive advertising.
Poultry workers push back – Citing concerns over worker and public health, poultry workers, safety advocates, and groups ranging from the Southern Poverty Law Center and the National Council of LaRaza, to the American Public Health Association and Nebraska Appleseed all united in opposition to USDA’s proposed ‘modernization” plan that would shift work from inspectors to workers. At The Pump Handle, Celeste Monforton talks about this issue: Public health officials urge USDA to withdraw plan to ‘modernize’ poultry inspection, worker and food safety will suffer.
A Request for Help Bob Wilson calls all UR hands on deck for participation in Health Strategy Associates’ survey. Learn more here: Your Opinion Needed on Critical Utilization Management Survey.
Migration from Mexico – Peter Rousmaniere posts about a recent Pew Hispanic Center Report on Mexican migration, which states that, “The largest wave of immigration in history from a single country to the United States has come to a standstill. After four decades that brought 12 million current immigrants–more than half of whom came illegally–the net migration flow from Mexico to the United States has stopped–and may have reversed.”
Some of the factors cited as contributing to this change include the weakened U.S. job and housing construction markets, heightened border enforcement, a rise in deportations, the growing dangers associated with illegal border crossings, the long-term decline in Mexico’s birth rates and changing economic conditions in Mexico.
it would be funny if it weren’t so true – Cartoonist Jen Sorenson issues An Open Letter To The Supreme Court About Health Insurance.
Death on the Job The Weekly Toll.
More noteworthy news

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