Archive for March, 2016

New Health Wonk Review, New Host: ACASignups.net

Thursday, March 24th, 2016

Charles Gaba has posted an all-new Health Wonk Review: ACA Anniversary Edition! at the ACASignups.net blog. It’s an eclectic and robust issue covering an array of topics.

Charles is a new host to HWR and we are delighted with his participation – particularly on this, the 6th anniversary of the Affordable Care Act. Health wonks, policy analysts and the mainstream news media alike all turn to Charles and ACASignups.net to track enrollments in the Affordable Care Act, aka Obamacare. In addition to numbers tracking, his site’s blog is a favored stop. Go there to check out this week’s Heath Wonk Review but also to poke around his site. If it’s not a regular bookmark yet, it should be!

Healthcare providers struggle with violence-related risk management

Wednesday, March 23rd, 2016

There’s no question but that healthcare workers face a growing threat of violence from patients while going about their day-to-day jobs. In a 2015 survey, the International Healthcare Security and Safety Foundation reported a 40% increase in violent crime from 2012 to 2014, with more than 10,000 violent incidents mostly directed at employees. High stress, armed patients and visitors, drug and alcohol intoxication, mental health issues and more all contribute to an increasingly dangerous environment. OSHA reports that:

From 2002 to 2013, the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) was more than four times greater in healthcare than in private industry on average. In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined.

Recently, Susannah Levine reported on the challenge that healthcare facilities face in her Risk & Insurance article, Hospitals Struggle with Security Risks. The article discusses the pros and cons of an armed approach to healthcare security, as well as the insurance implications of various risk management and security measures. Liability insurance may be a determining factor as to whether healthcare facilities opt for armed security or rely on less lethal tools like Tasers and sprays.

“Barry Kramer, senior vice president, Chivaroli & Associates, a health care insurance broker, said that armed security in health care settings is more of a risk management concern than a coverage issue.

“It would be highly unusual for our clients’ liability policies to exclude claims involving security guards, whether or not they’re armed with guns,” he said.

He said many health care risk managers are not equipped to manage exposures associated with licensing and certifying guards or registering the facility’s own firearms.

For facilities that lack the bandwidth to manage, train and track certifications for in-house security staff, Kramer said,third-party vendors, such as local law enforcement or private security companies, can be contracted, since they have firearms experience as well as liability insurance coverage.”

In February, the New York Times discussed various approaches and philosophies that healthcare facilities employ to mitigate risk. The article by Elisabeth Rosenthal – When the Hospital Fires the Bullet – centers on the case of a 26-year-old mental health patient who was shot by police in a Houston hospital. In the course of the article, Roenthal presents various approaches to security:

To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey. That was more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with people who have a mental illness.

Rosenthal contrasts the approach of Boston’s Massachusetts General Hospital, where the strongest weapons its security officers carry is pepper spray to that of the Cleveland Clinic, which has its own fully armed police force and also employs off-duty officers.

Guns in hospitals

Meanwhile, as risk managers struggle with the dilemma of whether to arm or not to arm, patients and visitors are often armed, enabled by state and local gun laws – just one more factor that healthcare facilities are coping with. At of the beginning of the year, Texas law allows for guns in state mental health hospitals. Campus Safety Magazine reports on how Kansas College Hospitals are preparing to allow guns on campus to comply with a new law. Gun laws in health systems vary by state – while a federal law bars guns from schools, there is no such law about firearms in hospitals.

Healthcare Violence Prevention Resources

OSHA: Worker Safety in Hospitals – Caring for our Caregivers

OSHA: Preventing Workplace Violence: A Road Map for Healthcare Facilities

OSHA: Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

Mitigating Workplace Violence at Ambulatory Care Sites

Emergency Department Violence Fact Sheet

Healthcare Crime Survey 2015

Prior related posts

More perils for healthcare workers

Violence in healthcare: 61% of all workplace assaults are committed by healthcare patients

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

Some Final Thoughts Following WCRI’s Annual Conference

Wednesday, March 16th, 2016

 

This year’s conference was an interesting blend of hard data and subjective debate.

On the hard data side we learned the preliminary results of some studies addressing what most in the business consider to be the key issues of the day, and they are all medical (a position with which I do not agree, but, admittedly, I am a minority of one). Some of the studies produced  results that validated what I like to think of as the “Duh!” conclusions. These are conclusions that seem totally logical and predictable, conclusions reached by mere intuition. Trouble is, policy, at least good policy, should be based on verifiable evidence, the kind that these “Duh!” studies produce, and not by intuition.

For example, workers’ compensation pays providers better than group health, in some states way better. So, it is logical and intuitive to believe that providers in those way better states would categorize soft tissue injuries as work-related rather than group health if given the chance. And, what do you know? Preliminary results from one of the studies put “You betcha” to that one.

So, cost shifting happens, and now we have proof, proof that policymakers can cite as they suggest system improvements.

Subjective debate was alive and well in the two Opt-Out panels. There were eight panel presenters, and only one of them, Elizabeth Bailey, from Waffle House, Inc., produced any data. As I wrote during the conference, Ms. Bailey presented data on cost savings Waffle House achieved since Opting-Out of Texas workers’ compensation in 2002. The savings were impressive, indeed, but, as attendees pointed out during the question period, Waffle House has made other workers’ compensation, safety and employee involvement improvements since Opting-Out, so it’s hard to say just how much Opting-Out has contributed to the cost savings. In other words, Waffle House’s cost savings may be nothing more than a painted hook on which Opt-Out enthusiasts want to hang their collective hats. More study is needed. Let’s hope it happens.

And let us not forget Bob Hartwig, the illustrious outgoing President of III, the Insurance Information Institute. Dr. Hartwig, who delivers presentations at Gatling gun speed, spoke on the Sharing Economy, or, as Hilary Clinton calls it, the Gig Economy. His formidable presentation was entertaining, educational and scary all at the same time.

For me, three things are memorable from the presentation:

  1. The Gig economy is bigger than anyone thinks, and is growing swiftly. And, as you might imagine, Millennials are deep into it. This is a movement that has the power to change an economic system.
  2. Hartwig suggested that the days of AI, Artificial Intelligence, taking over America’s jobs are farther in the distance than have been predicted by AI experts. His position is one with which I, respectfully, disagree. I think we’re closer to a cataclysmic shift than he believes. To put a point to that, Gary Anderberg, Senior VP of Analytics for Gallagher Bassett, suggested, no, pronounced, during the question period that all of the WCRI attendees could be replaced given today’s Watson-like technology. That’s heady stuff.
  3. I got to ask the last question of Dr. Hartwig, and it was this: “To what degree do you believe the Gig Economy correlates to the relative stagnation in hourly wages over the last 40 years?” His reply? “Good question. A lot.”

Bob Hartwig now moves to a professorship at the University of South Carolina, and the students in the Finance Department have no idea what is about to hit them. I predict his classes will be over-subscribed from the get-go.

Hope to see you at next year’s WCRI conference, March 2nd and 3rd in Boston.

 

Fresh Health Wonk Review posted at Health Business Blog; WCRI recap

Friday, March 11th, 2016

Grab a coffee and head over to David Williams’ Health Business Blog for this week’s dose of health wonkery:  Health Wonk Review: Tales of the Trump. And while there, don’t miss David’s 11th blog birthday roundup of best posts from the prior year.

Tom Lynch is at WCRI conference yesterday and today – you can see some of his recaps here on the blog. Part 1, Part 2 and Part 3

If you didn’t make it to the conference, no worries. You can follow along with a list of people who are live tweeting the conference.

Other folks blogging the WCRI conference

WCRI: Day One, Part Three: The 2nd Opt-Out Session

Thursday, March 10th, 2016

Bruce Wood, of the American Insurance Association, led off the second Opt-Out session by reminding participants that the 1972 National Commission “considered and rejected employer or employee choice of benefit plans.” So, right away we knew where Mr. Wood was heading. He boarded the Trey Gillespie train and left the station smartly. His conclusions:

  • Opt-Out raises fundamental issues of public policy that policymakers have failed to consider;
  • Opt-Out lacks an organizing principle that reflects acceptable social policy; and,
  • Opt-Out is flawed and should not be enacted.

You know where Mr. Wood stands.

The second presenter was Elizabeth Bailey, VP of Workers’ Compensation & Safety for Waffle House, Inc. Waffle House, headquartered in Georgia,  is in a number of states, Texas being one of them. The company has been a Texas Non-Subscriber (it’s Opted-Out) since 2002, and, according to Ms. Bailey, has enjoyed spectacular results ever since. Such as:

  • Within one year, claims cost per restaurant dropped 57%;
  • Indemnity claims went from 15.03% of total claims to 3.23%;and,
  • Indemnity costs declined 99%

Wow!

Ms. Bailey described how Waffle House has increased its safety and health efforts while providing equivalent benefits as those required by the workers’ compensation statute. The company’s economic results are certainly stellar, but at what cost to employees? We were left wondering. However, as David Deitz pointed out in the question period, Ms. Bailey was the only Opt-out presenter who “presented” any data.

 

The third presenter, Alan Pierce, is a Massachusetts plaintiffs attorney, but that doesn’t begin to describe his standing in the legal community. He is one of the nation’s foremost advocates for injured workers and is the past chair of the Workers’ Compensation Section of the American Bar Association and the Massachusetts Bar Association. As expected, he offered an eloquent precis suggesting that workers’ compensation is not a benefit, but rather an employee right. He, too, cited the 1972 National Commission pointing out that most of its recommendations have never been adopted. Mr. Pierce is always interesting.

The last presented was Oklahoma Insurance Department Chief of Staff James Mills. I was somewhat surprised to hear him defend the Oklahoma Opt-Out statute. Essentially, Attorney Mills said that he was open to any program or law that might have the chance of benefiting both employers and employees and likened the statute, which had 57 legislative authors, to some other ideas that needed time to grow and prosper. Who knows? Maybe that’s what will happen to Opt-Out.

But I wouldn’t hold my breath waiting for that to happen.

WCRI: Day One, Part Two: The 1st Opt-Out Session

Thursday, March 10th, 2016

The afternoon of WCRI’s 2016 Annual Conference was devoted to Opt-Out. The first of two sessions was a Point-Counterpoint exercise. Trey Gillespie of the Property & Casualty Association of America led off. To Mr. Gillespie, with Opt-Out it’s 1910 all over again. He described Opt-Out in Texas and Oklahoma as allowing employers to deliver sub-standard care to injured workers without government oversight. Showing stark contrasts between what is allowed in Opt-Out and required in workers’ compensation, he suggested that employees were at the mercy of employers, which could sometimes be good and sometimes be bad. Opt-Out’s a kind of Employer Personal Responsibility Plan.

Bill Minick, of PartnerSource, followed with a presentation in favor of “Options to Workers’ Compensation.” Minick has been the loudest proponent and most significant advocate for Opt-Out. He and Opt-Out were the subject of a Propublica investigative journalism story late last year. He described Opt-out as a substantial improvement on a failed system and painted a picture of employers being able to provide better care for injured workers at less cost, because regulatory and bureaucratic requirements have been stripped out. Essentially, Minick claims that the workers’ compensation system makes employers go from Massachusetts to Rhode Island by way of Alex Swedlow’s California. He’d rather just drive the 30 miles down Route 95.

My basic problem with Opt-Out, wherever it is, is that some employers with resources and good intentions welcome the chance to design their own injury benefit plans that will provide benefits at least as good as traditional workers’ compensation at significantly less cost. This, in itself, is a good thing. Some large employers in Texas, such as Costco, seem to have done that. Trouble is, not every employer is Costco. As I wrote when I evaluated Opt-Out in 2014, I’m concerned about Kenny’s Citgo, down the street and around the corner, where Kenny and his five hourly workers labor without the benefits of a mandated workers’ compensation plan, because Kenny has Opted-Out. There are more Kenny’s than Costcos.

WCRI – Day One, Part One

Thursday, March 10th, 2016

Day One of the WCRI’s annual conference began with WCRI’s Chairman, Vincent Armentano, of The Travelers Companies, introducing new President and CEO John Ruser. He presented the first session (preliminary finding, subject to change) on the Impact of Fee Schedules on Case Shifting in Workers’ Compensation.

It should come as no surprise that there is substantial variation in fee schedules and prices across the states and that workers’ comp fee schedules and costs continue to be higher than group health costs, in some states significantly higher. Bottom line here: States where workers comp pays higher medical reimbursements have a much greater chance of a soft tissue injury being classified as work-related. Not so much for traumatic injuries, such as fractures. In otherwords, states that have higher reimbursement for workers’ comp than group health have greater incidence of cost shifting to worker’s comp. Follow the money.

Next up, Dr. Bogdan Savych on comparing worker outcomes across fifteen states. Interesting news: Between 9% and 19% (median is 14%) of injured workers “had no substantial return to work” (meaning returning to work for at least 30 days) three years post-injury. These, again, are preliminary findings and subject to change, but 14% is a huge number. This study, based on 6,000 injured worker interviews, raises many questions. For example, what role do differing state workers’ comp benefits play in this. Also, Savych divided the workers into six age cohorts. The older group had more injuries without substantial return to work. What role did their age play in that?

Alex Swedlow, President of the California Workers’ Compensation Institute, delivered a mesmerizing presentation on Independent Medical Review and Dispute Resolution in the state, which, if it were a country, would have the sixth highest GDP in the world. Not surprising, to quote Swedlow, “Size matters.” California’s been trying to control medical costs for decades, and it keeps trying. I can’t begin to cover the totality of  the Swedlow presentation, but here’s one takeaway: Ten percent  of California’s medical providers account for 85% of Independent Medical Review decisions. Again, follow the money.