Health Wonk Review, TGIR Edition, plus a News Roundup

September 25th, 2014 by Julie Ferguson

Billy Wynne has posted the “Thank God It’s Recess” edition of Health Wonk Review at Healthcare Lighthouse, a bi-weekly best of the health policy bloggers. Go there now to find out the latest scoop on the Affordable Care Act as the rubber hits the road. Plus, assorted other health policy issues.
In other news:
Happy birthday to us! Worker’s Comp Insider is 11 years old this month. Follow us on Twitter too
National Employers Push for Comp Options
Roberto Ceniceros, Risk & Insurance
“National employers already benefiting by opting out of Texas’ workers’ compensation system are now pushing for “free market alternatives” to traditional state systems across the nation.
They launched a new organization called the Association for Responsible Alternatives to Workers’ Compensation. ARAWC plans to lobby state legislators to allow employers to develop new options for delivering medical and wage replacement benefits to injured workers.
Its members include nationwide companies such as Wal-Mart Stores Inc., Lowe’s Companies Inc. and Sedgwick Claims Management Services Inc.”
Workers’ Comp – Feeding the Heroin Dragon
Risk & Insurance, Jason Beans:
“When you start doing some back-of-the-napkin math, you realize that the workers’ compensation system’s potential contribution to the heroin problem in America is staggering. Bottom line, we need to take ownership – our industry is creating addicts who are creating a massive recurring demand for heroin and other illegal substances.”
Drugs and Drinking on the Job in New Mexico
Joan E. Collier, WCI360
“My home state of Florida has a law on the books that says workers’ compensation benefits can be denied if an employee is found to have been intoxicated on the job at the time of injury. I’ve always thought that was sound public policy, so I was surprised to learn that we are decidedly in the minority on this.”
Clinical Connections: What’s So Special about Specialty Managed Care in Work Comp?
Shelley Boyce, CEO, MedRisk:
“As consolidation limits marketplace choices and as specialization is replaced by generalization, it is critical that buyers remember that expertise and ongoing clinical oversight is more important than ever. Service-specific guidelines, care oversight and outlier identification and management are still the answers to achieving the best patient outcomes. Outcomes, which, in the long-run, will continue to be the right answers for the carriers and payers, for their customers and their injured workers.”
Accountable Care and Workers Compensation: Are They Compatible? (PDF)
Jacob Lazarovic, Chief Medical Officer of Broadspire
“Do these alternative medical models offer opportunities to redesign the prevailing model
of delivery and financing in workers compensation? It would seem that bundled arrangements would be easier to implement than population‐based models, and furthermore they would more closely match the nature of WC events which are inherently episodic, not holistic.
Several barriers to WC application of these models exist. Historically, WC has been a volume‐driven, fee‐for‐service model, and expectations and attitudes would need to be reformed. A pattern of micromanagement of all medical services would need to be altered, by increased delegation to provider entities. And the plethora of state regulations, dealing with reimbursement and direction of care, among others, would need to be overhauled to facilitate these approaches.”
It’s the diagnosis…
Joe Paduda, Managed Care Matters
“If the diagnosis isn’t right, there’s a pretty good chance the treatment won’t be right.
A while back I had an interesting conversation with folks from Best Doctors about this issue, and they provided some interesting statistics about the incidence of misdiagnosis.”
Severe black lung reaches near-record levels
Ken Ward, Coal Tattoo
“There’s a new paper out this morning that has some scary news about the continued resurgence of black lung disease in the Appalachian coalfields. It focuses on progressive massive fibrosis, or PMF, an advanced, debilitating, and lethal form of coal workers’ pneumoconiosis with few treatment options and no cure.”
California is the tail that wags the dog
Dave DePaolo, DePaolo’s Work Comp World
“Injured workers in California received nearly 20% of the $181.4 billion in medical and indemnity benefits paid by state and federal workers’ compensation programs between 2010 and 2012.
In looking at the NASI numbers, the California Workers’ Compensation Institute noted that the $11.5 billion paid in medical and indemnity benefits in California was “by far the highest in the nation, exceeding the combined total of New York, Pennsylvania and Florida, which ranked second, third and fourth among all states.”
Related: Mark Walls, PropertyCasualty360
The current state of California workers’ compensation and a look forward
Insurance Carrier Fraud: Know the Signs
Bill Byington, Missouri Employers Mutual WorkSAFE Center
“When you hear about workers compensation fraud, you usually think about employees and employers filing false claims or falsifying premium. It is important to know that insurance companies can also commit fraud. There are red flags and indicators that policyholders and injured employees need to be aware of when dealing with insurance companies.”
NIOSH Celebrates National Farm Safety and Health Week
September 21-27, 2014, is National Farm Safety and Health Week. The National Institute for Occupational Safety and Health (NIOSH) marks this year’s theme, Safety Counts: Protecting What Matters, by announcing the new Agriculture, Forestry and Fishing directory page.
Meetings & Conferences
Safety National has a new blog called Conference Chronicles
Register for Business Insurance’ 5th annual virtual conference focused on workers comp and safety solutions is scheduled for October 8, a full day of webinars, audience Q&A and networking with peers that can help you better understand and manage the drivers for success in your workers comp and safety programs.
Don’t miss out on a discount if you are planning to attend the National Workers’ Comp & Disability Conference – if you register by tomorrow, you can save $275. You can learn more about the Nov. 19-21 Las Vegas event at the link above, or follow on Twitter at @wcconf or #NWCDConf
News Briefs