Archive for February, 2014

WCRI’s Annual Conference: I hope to see you there

Friday, February 28th, 2014

The Workers Compensation Research Institute is holding its Annual Issues and Research Conference in Boston at the Park Plaza Hotel on 12 and 13 March. This year, the WCRI dives into the healthcare deep end to try to sort truth from fiction and explain how Obamacare intersects with workers comp. Is it consensual pairing or a train wreck? The long and winding road of Public Law 111-148, the Patient Protection and Affordable Care Act, is littered with the carcasses of the true, the half true and the just plain untrue. People can’t even seem to agree on how many pages are in the Act (is it 906 or more like 2,400?), or how many pages are in the regulations that followed it (10,000 or 40,000?)
And we all remember those “death panels,” too, don’t we?
I doubt that WCRI President Dr. Rick Victor will waste much time on pages or death panels, because there are a lot of substantive issues that need exploring and explaining. This year’s conference, to quote the WCRI, “will have a focus on the impact of national healthcare reform on state workers compensation systems.”
Go here to see the seven different components and the many questions WCRI speakers and panels will try to address. And go here for hotel registration information. WCRI has negotiated a $159 per night room cost. And speaking as a Boston “Homey,” I can tell you that the Park Plaza is a very nice place.
I look forward to high level dialogue and debate. Most of workers comp’s smartest and best informed people will be there. Will you be among them?

Health Wonk Review and Other Noteworthy News

Thursday, February 27th, 2014

Check out the excellent Health Wonk Review, In like a Lion edition posted by David Harlow at HealthBlawg. It’s a robust issue with no shortage of Obamacare updates and opinions, along with other policy issues. Plus, he offers interesting trivia notes between postings – if you’ve ever wondered why February has only 28 days, here’s your chance to find out.
By the way, in addition to being a stellar, long-time healthcare blogger, David is also one of the prime movers behind another blog carnival, Health Care Social Media Review – so if you don’t get your fill of health care from the wonks, be sure to drop by the bi-weekly SMR.
Medical Marijuana – Now that 21 states have legalized medical marijuana and two states – Colorado and Washington – have legalized the possession of small amounts of marijuana for recreational use, Darrell Brown of Sedgwick looks at marijuana and workers’ compensation. He reminds us that the drug it is still illegal in federal law, he looks to some case law on the matter and states Sedgwick’s policy. Plus, he also points us to the related whitepaper, Spotlight: How will medical marijuana laws impact workers’ compensation claims handling? (PDF)
Transparency – At Risk & Insurance, Roberto Ceniceros poses the question, How About a Flat Fee?. He notes: “More employers wanting predictability in the fees they pay workers’ comp third-party administrators are negotiating to pay a single, flat fee for bill-review services, sources tell me. The arrangements follow from criticisms some employers, their brokers and consultants have heaped on TPAs, saying traditional TPA charges for bill-review services obscure the ultimate cost of those services.”
Egregious conduct – At The Pump Handle, Celeste Monforton takes a principled stand: When employers are reckless with workers’ lives, they have no right to remain in business – and we’d have to agree. Part of being in business is being responsible to all your stakeholders. Monforton notes:

“Last week, Labor Secretary Tom Perez announced that OSHA has proposed penalties of $697,700 to Wire Mesh Sales. Eight of the violations were classified as “willful,” and OSHA recommends a $70,000 penalty for each. They relate to the employer’s failure to have an effective procedures in place to ensure that equipment is de-energized and pad-locked off. These “lockout/tagout” violations were found on other pieces of equipment in the Jacksonville plant.

A slew of other violations, more than 20, involve hazards related to electrical systems, respiratory protection, blocked passageways, cranes, and overhead slings. Noise exposures in the plant were extreme and well above the permissible level, repeat violations for the company. And one violation reflects the employer’s utter disrespect for the workforce: There was a “bathroom with a sink that had been clogged for months with maggots swimming in standing water.”

Trucking – Truckers take note: New Study Shows Significant Health Risks for Long-haul Drivers – “A new study from the National Institute of Occupational Safety and Health (NIOSH) shows that long-haul drivers have significant health risks. Obesity tops the list at 70%, this is compared to 31% of other workers who are considered obese. Morbid obesity is also twice as high, 17% versus 7%. Exacerbating the issue is that over half of drivers are cigarette smokers.”
Yet More Healthcare – OK, for those of you who aren’t Obamacare aficianados, avert your eyes as we link to these items – we don’t want to be the cause of any utilization spikes due high blood pressure, we know we have a few readers who are passionate “non-fans.” A recent Insurance Journal talks about a study by the Insurance Research Council: How ACA Healthcare Law Could Affect P/C Insurance Costs and Claims. Meanwhile, we learn that Enrollment Reaches 4 Million and Joe Paduda offers thoughts on Exchange enrollment – the big picture. Wendell Potter discusses a study of the Massachusetts health law, which cited a reduction in financial stress, including personal bankruptcy reduction, fewer delinquencies, and improved credit scores.
Other noteworthy items

Honor Sold, Trust Betrayed: Unbridled Greed in California

Wednesday, February 26th, 2014

“What is here?
Gold? Yellow, glittering, precious gold?”

— Timon of Athens by William Shakespeare
Suppose you’re a doctor in California with a patient who complains that his back hurts a lot. Suppose further that Michael Drobot, the owner of California’s Pacific Health Corporation, will give you $15,000 if you refer your patient to his Pacific Hospital of Long Beach for lumbar fusion surgery, which may or may not be warranted. And what if Drobot’s Pacific Hospital were hundreds of miles away and that other qualified hospitals that wouldn’t pay you a kickback were much closer. What would you do?
It is illegal under both California and Federal law to pay doctors for referring patients to hospitals. Yet, according to Andre Birotte, Jr., U.S. Attorney for the Central District of California, this is precisely what Drobot was doing on a massive scale in California from 2003 through 2008. The kickbacks amounted to between $20 million and $50 million. That was chump change compared to what Drobot netted from the surgeries. On Friday, Birotte announced that Drobot had pleaded guilty to paying the kickbacks in what amounted to a $500 million dollar fraud conspiracy and now faces up to 10 years in prison.
Drobot began building his health care empire in the mid-1990s. He bought a number of hospitals, but Pacific Hospital was his jewel in the crown. It was his “spine center,” and, according to U.S. Attorney Birotte, it is where doctors, who apparently think the Hippocratic Oath a mere suggestion, would refer patients for questionable lumbar fusion surgery at $15,000 per surgery. That is, unless the referral was for a cervical fusion, in which case the kickback was only $10,000. Needless to say, there were more lumbar fusions.
Workers compensation paid for all of this. More than 150 insurance companies were “ripped off,” according to Eric Weirich, Deputy Commissioner of the California Insurance Department’s Enforcement Branch.
The Los Angeles Times has been covering the Michael Drobot saga for the last 6 years. Drobot’s Pacific Health Corp. got itself out of big trouble in 2012 when it agreed to pay $16.5 million dollars to the government to avoid criminal conspiracy charges. From 2003 to 2008 it recruited homeless people, drove them to one of Pacific Health Corp’s hospitals and then charged Medicare and Medicaid for services never performed. The whole thing makes “ambulance chasing” look like a PBS donor acknowledgement.
But that little traipse into the dark side pales in comparison to the spinal fusion scheme.
In 2012, California SB 863 threatened to put more than a little crimp in Michael Drobot’s hose of money. Up until SB 863, Pacific Health Corp was paid highly inflated prices for both the surgeries and the surgical hardware, because it could charge duplicate invoices for the surgical implant hardware. The provisions of SB 863 would have severely limited duplicate payments beginning 1 January 2013. If Dobrot couldn’t collect the duplicate payments he wouldn’t be able to pay the kickbacks to get the patients he needed to keep the scheme going. He desperately wanted those provisions to be mitigated to some degree. To do that, he needed help.
He got it from friends in high places – the California Legislature. It’s a little murky as to method, but prior to final passage, SB 863 was changed to allow half the duplicate payments to continue, status quo, for all of 2013. The authorities have been looking into this, and U.S. Attorney Birotte has begun to reel in the fish.
The day before he indicted Michael Drobot, Birotte indicted state Senator Ron Calderon and his brother, former Assemblyman Tom Calderon, on 24 charges, including bribery and money laundering. Ron Calderon is alleged to have been paid more than $100,000 in bribes by Michael Drobot and in an FBI sting operation that Calderon thought was a film studio. If convicted, he faces up to 400 years in prison. And that’s the blood in the water that California’s media sharks now circle. Here’s an LA Times infographic of the Calderon family’s tree of connections and alleged corruption.
However, as that great TV salesman, Ron Popeil, used to say, “But wait! There’s more!”
An FBI affidavit leaked to, of all places, Al Jazeera America, is making life uncomfortable for at least four other legislators, including Senate President Pro Tem Darrell Steinberg. Look deeply enough at this and one begins to think that Teapot Dome was nothing more than a benign business deal gone bad. (See the full associated Al Jazeera story: State Compensation Insurance Fund’s lawsuit against Michael Drobot)
Notwithstanding all of this, I keep coming back in my mind to those doctors, those chiropractors, those medical professionals who sold their souls and endangered their patients for all that “yellow, glittering, precious gold.” I ask, “Where is the outrage?” At some point, one hopes that U.S. Attorney Birotte turns his eyes to them.

OSHA: No More Falling Workers

Tuesday, February 25th, 2014

In May 2012, we posted about the excellent Frontline – Pro Publica documentary report on on cell tower worker deaths: The high price for fast phones: Cell tower deaths. Since that time, the issue has gotten worse, not better. In 2013, there were 13 cell tower-related fatalities. In the first two months of 2014, there have already been 4 fatalities related to cell towers.
In response to these deaths, The U.S. Department of Labor’s Occupational Safety and Health Administration is collaborating with the National Association of Tower Erectors and other industry stakeholders to ensure that every communication tower employer understands their responsibility to protect workers performing this high-hazard work. Assistant Secretary of Labor for Occupational Safety and Health David Michaels has issued a warning letter to Communication Tower Industry Employers reiterating these responsibilities.
In addition, OSHA has launched resources to focus on protecting cell tower employees in its No More Falling Workers initiative. It has created a new Web page – Communication Towers – targeting the issues surrounding communication tower work.
Education is great in as far as it goes, which isn’t all that far. The problems that plague the industry and the related deaths revolve around the unrelenting deadlines to complete towers to meet demand and the complex network of contractors and subcontractors that allow the tower owner to shrug off responsibility for any deaths.
Travis Crum of the Charleson Gazette echoes the problems found in the Frontline-Pro Publica report in his reporting about three West Virgina tower-related fatalities earlier this month: Company that owns collapsed Clarksburg cell towers had fatalities before

“These incidents seem likely to continue as cell companies push contractors and their employees to meet rising demand for 4G and 4GLTE data networks, said Randy Gray, a former OSHA inspector from Kentucky.”

“Gray said cellphone companies are racing to replace older 3G networks with 4G, or fourth-generation, networks. This rapid expansion places cell tower climbers at risk, Gray said, who now does private consulting on accidents and fatalities at cell tower sites.”

He also explains why it’s so difficult to hold the cell tower owners/networks responsible:

To make matters worse, Gray said, it’s difficult for OSHA to hold companies such as SBA responsible, because there’s a web of contractors and sub-contractors who often shield them from scrutiny.

OSHA investigators must prove several elements before citing a company, Gray said, one of them being knowledge of potential hazards.

“With the owner of the cell tower not being present at the time of the fatality, it’s hard to prove they had knowledge about what the employees were signing off on,” he said. “So these companies start layering themselves between the people who work on the ground, and this layering, in my opinion, protects them from possibly being cited by OSHA or being involved in OSHA inspections.”

So while it’s great that OSHA is warning employers and putting an emphasis on tower worker safety, it will serious accountability to drive the change.
Wireless Estimator tracks U.S. tower-related fatalities
13 Cell Tower Maintenance Workers Died on the Job in 2013
Cell tower worker fatalities continue: More than a dozen deaths since 2012
OSHA Urges Tower Employers to Protect Workers After Recent Spate of Fatalities
Cell Tower Deaths Get OSHA’s Attention
West Virginia Firefighter Killed in Secondary Collapse at Cell Phone Tower Rescue, Two Workers Also Dead

The “Be Mine” Valentine’s Day Edition of Health Wonk Review

Thursday, February 13th, 2014

Steve Anderson has posted a great new “Be Mine” Valentine’s Edition of Health Wonk Review at Blog. His post shows which bloggers are feeling the love for Obamacare and which aren’t, among many other topics. Check it out.
And as long as we’re on the health policy frame of mind, here are a few other things that have caught our eye this week:
New Obamacare Figures from HHS, Gallup Are Encouraging – Jonathon Cohn

Obamacare beats a January enrollment projection
– Sarah Kliff
Why Are So Many Americans Confused About Obamacare? How a Video Produced by CBS’ Washington Bureau Misled Millions -Part 1 – Maggie Mahar
HHS Enrollment Figures Indicate Sign-Ups Even In States Where Officials Have Opposed The Health Law – Kaiser Health News
The Latest Obamacare Numbers: Three Charts and Two Unanswered Questions – Business Week
GOP States Struggling With Medicaid Expansion Issues _ Kaiser Health News
Where the states stand on Medicaid expansion – 4 states are considering expansion

Opioids: the Gateway to Heroin

Wednesday, February 12th, 2014

The surprising overdose death of acclaimed actor Philip Seymour Hoffman has put a spotlight on a national epidemic: prescription drug abuse. In workers’ comp, prescription drugs have been an area of great concern for a number of years; so too in the public health and policy arena. But has the message — and the necessary education — filtered to the general public? It would seem not: According to the CDC, prescription painkiller overdoses nearly quadrupled in the decade from 1999 to 2008.
This past week, the New York Times framed the new reality: Prescription Painkillers Seen as a Gateway to Heroin

“Dr. Jason Jerry, an addiction specialist at the Cleveland Clinic’s Alcohol and Drug Recovery Center, estimates that half of the 200 or so heroin addicts the clinic sees every month started on prescription opiates.

“Often it’s a legitimate prescription, but next thing they know, they’re obtaining the pills illicitly,” Dr. Jerry said.

In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.

In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.”

Oklahoma: One state’s experience
The investigative journalism non-profit Oklahoma Watch recently published a report on the state’s addiction: As Drug Deaths Rise, Millions of Narcotic Prescriptions Filled
According to this report, Once occupying the ignominious position of first in the list of states with prescription drug abuse, Oklahoma is now #8 on the list. In 2012, 844 Oklahomans were killed by overdoses, eclipsing the year’s 708 traffic fatalities. The state has a real-time Prescription Monitoring Program that is reported to be one of the best in the nation, but doctors are not required by law to check the database before prescribing controlled dangerous substances. There was an average of 68 prescriptions per patient.
Oklahoma is also seeing a steep rise in heroin use, echoing the concept and experience that opioids are the gateway drug.

“Hal Vorse, a physician who treats habitual drug users and teaches new doctors about addiction at the University of Oklahoma Health Sciences Center, said he’s seen the phenomenon in his own practice.

“We’re seeing a big surge in heroin, and 85 percent of those people started on prescription opiates,” said Vorse. “The cost of their addiction got so high that they switched to heroin because it’s cheaper.”

Vorse said the price on the street for OxyContin has risen to $1 to $1.50 per milligram. Addicts typically use 200 to 300 milligrams per day, he said. “They find out they can get an equivalent dose of heroin for a third of what it costs for Oxys,” Vorse said.”

On the Workers Comp front
Meanwhile, in workers’ comp’s battle against opioids, Joe Paduda says that Opioid guidelines are about to get a whole lot better with the anticipated upcoming release of guidelines by ACOEM. He’s has a sneak peek and finds them to be “comprehensive, extremely well-researched and well-documented, and desperately needed.”
But he also points out that more progress is needed: Why don’t workers’ comp payers have pharmacists on staff?.

“I’m only aware of three major work comp insurers (Travelers, BWC-Ohio, Washington L&I) that have pharmacists on staff; the North Dakota State Fund does as well.

With pharmacy costs accounting for somewhere around 15% of total medical spend, that seems like a “miss”. Yes, pharmacy costs have been flat in recent years, but the impact of drugs on work comp claim duration and the medical and indemnity expense associated with long-term drug use is quite significant.

The National Conference of State Legislatures offers an overview of state laws
CDC on the Drug Overdose issue
Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008
Prescription Drug Overdose: State Laws

201st Cavalcade of Risk!

Wednesday, February 5th, 2014

Russell Hutchinson, proprieter of the “down under” Chatswood’ moneyblog, is hosting Cavalcade of Risk Number 201. It’s a roundup of some of the usual suspects and a few new-to-us participants, too.
Don’t miss the important advice offering guidance for revising and implementing your organization’s emergency plans in the event of a nuclear detonation!

WCRI: Upheaval in the Market for Health Care – Facts and Myths

Wednesday, February 5th, 2014

Tom Lynch will be attending the 2014 WCRI Annual Issues & Research Conference on March 12-13, 2014 – will you be there? Let us know. He’s looking forward to covering some of the events and sessions on the blog. The theme of the conference is an important one: “Upheaval in the Market for Health Care – Facts and Myths.”
Love it or hate it, we’re undergoing a seismic shift in the nation’s health care system and workers’ comp is along for the ride. We hope to learn more about the way that this is likely to impact workers comp. Some of the issues the conference plans to address include:
What might the market for and the delivery of health care look like in the U.S. in five years?
What are Accountable Care Organizations and how are they developing?
How might workers’ compensation systems be affected . . .

  • Vulnerability to cost shift toward workers’ compensation?
  • Opportunities for cost shifting away from workers’ compensation?
  • Impact of increasing size and concentration of health care providers?
  • Impact of federal government regulation of medical prices?How will increased coverage affect access to care for injured workers?
  • What are the major unintended consequences to watch out for?
  • In which states are the effects likely to be largest?

Of course, there will be a host of noteworthy speakers presenting research and presentations on other topics as well – you can learn more about the event here.