Archive for May, 2016

It’s A Colorado Rocky Mountain Low

Monday, May 23rd, 2016

Since 2003, when Julie Ferguson and I created Workers’ Comp Insider, we’ve tried to keep bias off the keyboard. Careful objectivity is “a consummation devoutly to be wished.”

For reasons you’ll understand as you read, I want to assure readers that in this post we try to hold to that rule.

Last week, we wrote of actual and metaphorical earthquakes shaking Oklahoma to its core. Today, we write of another metaphorical earthquake, but now it’s Colorado’s turn. It’s a story about a three-car crash involving some well-meaning, but perhaps shortsighted, Coloradans, the state’s leading workers’ compensation insurer and Bernie Sanders. Yup. That guy.

Colorado is a lovely state with wonderful people who just happen to be the fittest in America. Although the obesity rate is 21.3%, it’s the lowest in the nation. Blue sky, clean air, great outdoors, what’s not to love?

In Colorado, the well-meaning, but perhaps shortsighted, people have succeeded in getting on the November ballot Amendment 69 to the Colorado constitution. Amendment 69 creates ColoradoCare, which is universal health care for all Colorado residents, illegal aliens included. Nice idea, you probably think. Good for them, eh?

I wish it were that simple.

The known and unknown unintended consequences of Amendment 69, as well as the profound way it impacts and is impacted by a host of other programs, regulations and laws, both federal and state, are overwhelmingly mind-numbing.

But don’t take my word for it. If you’re up for it, read this cogent, well-written, 38-page, highly detailed legal analysis of Amendment 69 by Gerald Niederman and Jennifer Evans, Attorneys with the Polsinelli law firm. The pair were commissioned by the Colorado Health Foundation to dig deep into the crease of what enacting ColoradoCare will mean for the state, and a lot of it will make your eyes roll. Here’s an image. Imagine for a moment a great big camel. Now imagine two or three hundred of Colorado’s fittest trying to push the south-bound end of the north-bound camel through the very small eye of a teeny-tiny needle and you’ll get the point.

Which brings us to the state’s leading workers’ compensation insurer, Pinnacol Assurance, because one of ColoradoCare’s  provisions (discussed on page 34 of the Niederman Evans analysis) is to take over medical care for all work injuries, medical care that since 1915 has been provided through Colorado’s workers’ compensation statute. As you might imagine, this does not sit well with Pinnacol. Pinnacol has many reasons for not being a fan of Amendment 69, all of which are spelled out in Amendment 69 Would Demolish Colorado’s Stable Workers’ Comp System, by Edie Sohn, Pinnacol’s Vice President of Communication and Public Affairs.

At this point, enter, stage left, Senator Bernie Sanders.

As we all know, Senator Sanders’s proposals are highly idealistic. And his supporters are certainly, shall we say, rather exuberant. Regardless, I doubt if either the Senator or those supporters have ever seen Amendment 69. Still, that didn’t stop him from opining the following:

“Colorado could lead the nation in moving toward a system to ensure better health care for more people at less cost,” Senator Sanders said in a statement to The Colorado Independent.”

Say what? “Less cost?” Hmmm. Even proponents of ColoradoCare say it will cost $25 billion, will double the size of the state budget, will be paid by a 10% tax increase on employers and employees and will make Colorado the highest tax state in the nation.

And what will it do to workers’ compensation? Here’s how Pinnacol’s Edie Sohn describes what she considers to be the coming catastrophe:

Why is Pinnacol concerned about changing the health care system? Under current law, workers’ comp insurance covers the health care needs of injured workers and replaces their lost wages for as long as they are out of work. But ColoradoCare would bring the medical payments of workers’ comp under its umbrella.

The proponents of the amendment say that doing so will save Colorado businesses money because their work comp premiums will go down. Of course, those costs aren’t going away, they’re simply being shifted to the health care system. And any workers’ comp savings will be eroded quickly by lower worker productivity and increased indemnity costs. That’s because ColoradoCare won’t have mechanisms in place to do all the things Pinnacol does: work with employers to keep workers safe and minimize the potential for injury, and work with doctors to help injured workers get back to work in a timely and safe way.

Even allowing for a bit of rhetorical spin, Ms. Sohn makes a compelling case, especially in the area of return to work.

For a somewhat contrarian and intelligent view, you may want to read this blog post from the highly-respected Charles Gaba: COLORADO: OK, Single Payer Fans: Here’s your chance to make it happen. Mr. Gaba points out that he is a “fan” of the single payer concept, but does not believe it has the support to happen on a national scale for quite some time. Rather, he thinks the way to achieve it is through individual states, and, although not endorsing ColoradoCare, he thinks, “It’s more realistic and far better thought out than Bernie’s national plan is.”

One thing on which we can all agree is this: November 2016’s election day will be interesting, indeed. I can only hope it is also peaceful and shows off American democracy in its very best light.




New Health Wonk Review at Boston Health News

Friday, May 20th, 2016

Cambridge, Massachusetts-based health and science journalist Tinker Ready hosts the current edition of Health Wonk Review at her Boston Health News blog: The Health Wonk Review: HIT, LGBT and ACA. Check it out! It’s an eclectic edition covering a cornucopia of health policy topics.

And please join us for a HWR Blab (video conversation / text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/24/2016 at 1:00 pm ET for half an hour. You can watch from here or sign in to Twitter account to log in.

In Oklahoma, The Times, They Are A’Changin’

Tuesday, May 17th, 2016

In Oklahoma, we are now witness to a confluence of events, unintended consequences of perhaps misguided political and business decisions, that are shakin’ the windows and rattlin’ the walls, to paraphrase the great Bob Dylan. And I’m talking actual and metaphorical.

On the actual side, consider this. Prior to 2009, Oklahoma averaged two earthquakes a year of a magnitude greater than 3.0. Last year, there were more than two a day. Cornell University Seismologists studying this say the rise in earthquakes is unprecedented in terms of sheer volume as well as in how fast the number grew. A 60 Minutes investigation revealed that Oklahoma’s biggest industry, Oil and Gas production, is the likely culprit. Why? Because when oil is pumped out of the ground, wastewater comes with it. A lot of wastewater. Billion of gallons of the stuff. So, rather than put the state under water, industry pumps all that wastewater back deep into the ground where it seeps into and around the faults and techtonic plates causing plate shifting which results in all the earthquakes.

A 2015 earthquake study from Stanford University reported:

“Stanford geophysicists have identified the triggering mechanism responsible for the recent spike of earthquakes in parts of Oklahoma – a crucial first step in eventually stopping them,” wrote Ker Than for the Stanford Review.

“In a new study published in the June 19 issue of the journal Science Advances, Stanford Professor Mark Zoback and doctoral student Rall Walsh show that the state’s rising number of earthquakes coincided with dramatic increases in the disposal of salty wastewater into the Arbuckle formation, a 7,000-foot-deep sedimentary formation under Oklahoma.”

As I write this, the U. S. Geological Survey reports a 3.8 magnitude quake hit about 28 miles northeast of Oklahoma City on Sunday. And for good measure, two other slightly less severe quakes struck within eight hours earlier than the 3.8 quake.

On the metaphorical side, a different kind of earthquake, a political one. And by that I mean the abrupt turnaround of Oklahoma’s Governor Mary Fallon and the Republican controlled legislature regarding adopting Obamacare. Seems the state is nearly bankrupt in terms of funding health care. Hospitals and nursing homes face closure. It is a crisis of monumental proportion. But wait – there’s the Obamacare cavalry coming over the crest of the hill! Politicians now realize that federal funding for Medicaid expansion (Governor Fallos says it’s not an “expansion;” it’s a “realignment.”) looks like a pretty good port in the storm. Naturally, critics are lining up to decry the move, but the legislature appears to be coming around to it.

Who knew? Perhaps when next I look out my 3rd story window pigs will be flying by.

News Roundup: 2016 Best Blogs, NCCI State of the Line, Opioids & More

Monday, May 9th, 2016 Best Blog Designees for 2016 – We’re pleased and honored to have been named to the Best Blog Designees for 2016 and a huge part of the honor is the company that we keep: the roster of 22 blogs named to this year’s list are must-reads for our industry. The announcement notes: “They were judged on several criteria. In addition to objective categories such as age of blog, frequency of posting and website traffic, they were also assessed by an independent judging panel for content quality, value and timeliness.” We thank the judges and those who nominated us! Read Bob Wilson to learn more about the process and the judges: Some Final Thoughts on the Best Blogs Experience

‘Transforming’ Workers Compensation Industry Presenting New Challenges, According to NCCI State of the Line

This year’s State of the Line report indicates that the workers compensation Calendar Year 2015 combined ratio for private carriers was 94%. This is a six-point decline when compared with the 2014 combined ratio. Total market net written premium increased by almost 3% to $45.5 billion, driven primarily by an increase in payroll.

Other market indicators and trends highlighted in NCCI’s 2016 State of the Line report include:
–The overall reserve position for private carriers improved in 2015. NCCI estimates the year-end 2015 reserve position to be a $7 billion deficiency—down from $10 billion in 2014. –Estimated reserve redundancy in Accident Year 2015 accounts for much of this reduction.
–Average lost-time claim frequency across NCCI states declined by 3% in 2015.
–In NCCI states, the preliminary 2015 accident year average indemnity cost per lost-time claim increased by 1% relative to the corresponding 2014 value. For medical, the preliminary average cost per lost-time claim decreased by 1% relative to that observed in 2014.
–The workers compensation residual market pool premium volume remained flat between 2014 and 2015, and the average residual market share remained stable at 8%. The latest NCCI data shows that total residual market premium declined in the first quarter of 2016 compared with the first quarter of 2015.

Related: Read Joe Paduda’s report from the NCCI annual conference and his highlights and key take-aways from the 2016 report.

Don’t Stand By
David DePaolo, DePaolo’s Work Comp World

Earlier this year WorkCompCentral published “The Uncompensated Worker: Financial Impact of Work Comp on Households” which reviewed from a very broad perspective the effect an industrial injury has on the prototypical American blue collar worker, “Tim.”

Today we release follow up reports on Kentucky and Florida. Each report compares two different injured workers – one who has a relatively minor work injury and the other a more severe lost time injury. The data used to build these profiles is readily available, the outcomes shocking.

U.S. Health Care Prices Are All Over the Map, New Study Finds
Maggie Fox, NBC News

Why does a knee replacement cost $29,000 in Kansas but $40,000 in next-door Colorado?

Health care prices are all over the map in the U.S., a new study finds. It digs deeply into the crazy pattern of health costs across the U.S. and shows there is very little consistency.

The report from the Health Care Cost Institute (HCCI) finds prices for the same procedures vary by sometimes huge amounts — even within the same state.

Managing Service Providers
Roberto Ceniceros, Risk & Insurance

Uncovering inconsistencies in an insurer’s or third party administrator’s service performance can ultimately strengthen an employer’s partnerships with the organizations managing injured-worker claims.

Advocates of independent reviews maintain that vendor management quality assurance audits conducted by independent reviewers can reveal weaknesses that impact an employer’s workers’ compensation program.

Yet other observers argue that independent quality assurance audits are becoming a thing of the past and their value diminishing.

Still, about 25 percent of self-insured employers and those with large deductibles seek the audits, said Dan Marshall, chief claims officer U.S. at Aon.

“It is only the most sophisticated buyers that want to look under the hood, so to speak, and get a gauge of the performance of claims service providers,” he said.

Because What We Really Need Right Now… Is Another Opioid
Michael Gavin, Evidence Based

A twice-daily, extended release, abuse deterrent formulation of oxycodone, to be exact. And just in time, too. I was becoming concerned that FDA’s recent commitment to take a new approach to the opioid crisis might have actually been genuine. I guess you can’t have too much of a good thing.

The trade name you’ll want to look out for is Xtampza ER. And no, I didn’t misspell it. Wondering how to pronounce it? Your guess is as good as mine. The pharma industry appears to be running low on catchy, hip drug names with the letters “x” and “z” that play well in the market.

‘You Want a Description of Hell?’ OxyContin’s 12-Hour Problem
Harriet Ryan, Lisa Girion, and Scott Glover, The Los Angeles Times

Before OxyContin, doctors had viewed narcotic painkillers as dangerously addictive and primarily reserved their long-term use for cancer patients and the terminally ill. Purdue envisioned a bigger market.

“We do not want to niche OxyContin just for cancer pain,” a marketing executive explained to employees planning the drug’s debut, according to minutes of the 1995 meeting.

The company spent $207 million on the launch, doubling its sales force to 600, according to a court declaration. Sales reps pitched the drug to family doctors and general practitioners to treat common conditions such as back aches and knee pain. Their hook was the convenience of twice-a­-day dosing.

More News of Note

Safety Resources


New Health Wonk Review at Wright on Health

Thursday, May 5th, 2016

Check out the latest & greatest from the web’s noteworthy health policy pundits: Brad Wright has posted Health Wonk Review: Pivoting Towards the General Edition at Wright on Health. We’re 186 days away from the election but his edition is complete with hilarious photos of our next president so you’ll want to check it out.  Lots of good posts, too, from the usual suspects.

Please join the wonkers for a new multimedia experience (video conversation and text chat), Health Wonk Review On Air With HealthBlawg Tuesday, 05/10/2016 at 1 pm ET for half an hour. Watch it live here or click to login via Twitter.

More on the opioid crisis and the fentanyl factor

Wednesday, May 4th, 2016

Here in the state where the world headquarters of Lynch Ryan is housed, we learn the unsettling news that Massachusetts has seen a 190% increase in opioid deaths in five years. Jessica Bartlett of Boston Business Journal notes:

“Despite Gov. Charlie Baker releasing a $27 million plan to address the opioid epidemic in June, opioid deaths have continued to rise, with recent data from the Department of Public Health showing a 12.5 percent increase in estimated deaths in 2015 compared to the year before.

Compared to just five years ago, the estimated 1,526 unintentional opioid-related deaths in 2015 represents a 190 percent increase.”

Things might have been even worse. In 2015, the “opioid antagonist” Naloxone was administered 12,982 times, so we can only guess what the tally might have been without such intervention. It doesn’t look like 2016 will bring much relief: An estimated 400 deaths have have already occurred in the first three months of the year.

Bartlett notes a disturbing trend:

“While the high number of deaths is nothing new, the state has for the first time released the number of deaths with a confirmed presence of fentanyl, a synthetic opioid 50 to 100 times more potent than morphine.

Of the 1,319 confirmed opioid deaths in 2015, 754 of them tested positive for fentanyl.”

Felice J. Freyer and J.D. Capelouto recently reported on this in the Boston Globe: Fentanyl factored in more than half of 2015 OD deaths, state reports

A Massachusetts law criminalizing fentanyl trafficking took effect in February, with sentences of up to 20 years in prison for selling more than 10 grams.

The health department data released Monday provide the most reliable portrait to date of the opioid crisis in 2015, confirming that 1,379 people died from overdoses. A deeper analysis of cases from 2014 raised the number of confirmed fatal overdoses for that year, to 1,282.

The state’s findings do not distinguish between heroin overdoses and those caused by prescription opioids. Health officials are unable to make that distinction because most prescription opioids, as well as heroin, break down into morphine in the bloodstream. But fentanyl, a synthetic drug, turns into a substance that can be detected by a test.

Southern California Public Radio features a story on Why it’s so hard to track the powerful opioid fentanyl. Rebecca Plevin reports:

First, doctors treating overdose victims are mainly looking for the better-known opioids, like Vicodin. And when they check for drugs, standard tests often miss fentanyl. A special lab analysis is often necessary, and doctors – especially in busy ER’s – don’t always think of that. Another problem is that not all hospitals are set up to conduct the special lab analysis.

All of this is complicated by the fact that illegally manufactured fentanyl may be mixed with heroin or counterfeit pills that look like normal prescription medications, so people may not be aware that they’re exposing themselves to the drug.

The rise in fentanyl use has health officials particularly worried, given its tremendous potency. To try to get a handle on the problem, the state has asked all local hospitals to report suspected fentanyl overdoses. State officials have also asked providers to test for fentanyl when ordering drug screening in cases of suspected overdose.

This is a disturbing news in the worsening opioid crisis. A simple search of Google news will show that officials in Ohio, Pennsylvania and other states are seeing surges in fentanyl overdoses.

In his post Opioids, spines, and dead people, Joe Paduda talks about physicians and prescribing, giving context to the issue:

In a related piece, Michael Van Korff ScD andGary Franklin MD MPH summarize the iatrogenic disaster driven by opioid over-prescribing. Over the last fifteen years, almost 200,000 prescription opioid overdose deaths have occurred in the US, with most deaths from medically-prescribed opioids.

Doctors prescribed opioids that killed well over a hundred thousand people.

Today, about 10 million Americans are using doctor-prescribed opioids; somewhere between 10% – 40% may have prescription opioid use disorder – they may well be addicted.

Van Korff and Franklin note that 60% of overdose fatalities were prescribed dosages greater than a 50 mg morphine equivalent.

In days gone by, drug deaths were primarily associated with illicit or street drugs, but today, it’s prescription drugs – and prescriptions are seen as the gateway to street drugs, rather than the reverse.  We now lose more people annually to drug overdoses than by car crashes or firearms.

In 2013, the most recent year for which data is available, 46,471 people in the United States died from drug overdoses, and more than half of those deaths were caused by prescription painkillers and heroin.

That compares with the 35,369 who died in motor vehicle crashes and 33,636 who died from firearms, as tallied by the federal Centers for Disease Control and Prevention.

Combating the public health scourge of prescription drug-related addiction and deaths will require a concerted effort on all fronts: physicians as prescribers; employers and insurers in the workplace; public health, elected officials and law enforcement in our communities. On that front, there have been some promising approaches in moving from a crime to a treatment approach: Connecticut Cops Consider ‘Angel’ Program to Combat Heroin Scourge

Another approach, pioneered in Gloucester, Massachusetts, shows promise and has been attracting increasing attention around the country. In Connecticut, Groton has adopted it and Manchester is considering a similar program.

Launched on June 1, the Gloucester Angel Initiative makes police the point agency in moving addicts directly into treatment. Addicts are allowed to surrender any drugs and needles they have with the understanding that they will not face arrest and that police and community volunteers called “angels” will help them toward recovery.

About 350 admitted addicts have sought help in Gloucester through the program, department spokesman John Guilfoil said on Jan. 8. As a side benefit, crime fueled by addiction, particularly thefts, dropped 33 percent last summer compared with the summer of 2014, Guilfoil said.

Fifty-three police agencies in the country have adopted similar programs, and two to three more join each week through a partnership called the Police Assisted Addiction and Recovery Initiative, Guilfoil said.

Prior related posts: