Archive for March, 2017

The Psychosocial Buzz Is Getting Louder

Friday, March 24th, 2017

“We know the single greatest roadblock to timely work injury recovery and controlling claim costs. And it’s not overpriced care, or doubtful medical provider quality, or even litigation. It is the negative impact of personal expectations, behaviors, and predicaments that can come with the injured worker or can grow out of work injury.

This suite of roadblocks is classified as “psychosocial” issues – issues which claims leaders now rank as the number one barrier to successful claim outcomes according to the Workers’ Compensation Benchmarking Study’s 2016 survey – and they drive up claim costs far more than catastrophic injuries, mostly due to delayed recovery.”

That’s the beginning of a new White Paper authored by friend and colleague Peter Rousmaniere and Rising Medical Solution’s Rachel Fikes. The Paper, How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity, reports on Rising’s 2016 Benchmarking Survey and describes how the workers’ compensation claims management community is ever so slowly coming to realize the leading cause of delayed recovery for America’s injured workers is psychosocial in nature and that efforts to deal with this have, up to now, been woefully inadequate.

Rousmaniere and Fikes point to enlightened employers and insurers who are leading their companies to a greater acceptance of the need for competent, professional intervention to help injured workers overcome mental and emotional barriers delaying their return to employment.

They cite the work of Denise Algire, Director of Risk Initiatives and National Medical Director for Albertson Companies, a grocery chain with more than 285,000 employees. They also report on efforts by The Hartford, Nationwide Insurance and CNA.

All of the progressive actions undertaken by these organizations have one thing in common: the development of an empathic interview methodology devoted to understanding the “whole person” to discover which claims will need more intensive and specialized intervention.

At the Albertson Companies, Ms. Algire espouses the Advocacy-based model of claim management. This model emphasizes building a conversational and trust-based relationship with an injured worker through organic dialogue. She has introduced a modified Linton tool for screening injured workers for psychosocial comorbidities and has contracted with an external telephonic triage firm to conduct initial screenings.

At The Hartford, Medical Director Marco Iglesias reports 10% of claims fall into the psychosocial bucket with at least one psychosocial comorbidity, but they consume 60% of total incurred costs. He says adjusters now ask each injured worker an important question: “When do you expect to return to work?” The Hartford’s analytics indicate any answer longer than ten days is a red flag for the future.

Nationwide Insurance, under the direction of Trecia Sigle, VP of Workers’ Compensation Claims, is building a specialized team to address psychosocial roadblocks. Nationwide’s intake process will consist of a combination of manual scoring and predictive modeling, and then adjusters will refer red-flagged workers to specialists with the “right skill set.”

Pamela Highsmith-Johnson, national director of case management at CNA, says the insurer introduced a “Trusted Advisor” training program for all employees who come into contact with injured workers. CNA’s Knowledge and Learning Group helped develop the training with internal claims and nursing staff.

This White Paper adds to the now undeniable research indicating the psychosocial problem is the biggest one facing the workers’ compensation claims community today. The leading experts agree that empathy, soft talk and the advocacy-based claims model is the method of choice for helping injured workers whose claims carry a psychosocial dimension. The experts cited in the White Paper all agree that adjusters will require extensive and repetitive training to learn the new techniques.

However, all of this is a heavy lift for an adjuster community overburdened and overwhelmed with work, a group for which the average lost time claim load is often north of 150. Even with better training, they can’t do it alone. To really turn the psychosocial tide will require a well-rounded team of claims adjusters, nurses, case managers and external, well-trained clinicians working together with transparent, technologically advanced communication.

The missing links thus far are those well-trained clinicians and the advanced communication. Without these two components, the adjuster community will be sore-pressed to achieve meaningful results.

Wonks weigh in on AHCA prior to today’s vote; more news of note

Thursday, March 23rd, 2017

Today is not only countdown to the House vote when we learn if AHCA passes the first hurdle. The date is significant because it is seven years to the day that President Obama first signed the Affordable Care Act into law, as Louise Norris notes in this week’s hot-off-the-press AHCA: The Aye or Nay? Edition of the Health Wonk Review, posted at Colorado Health Insurance Insider. As you’d expect, many wonks weigh in on ACA/AHCA related matter, but on other health policy issues as well – check it out, Louise always offers a great digest of posts.

Other noteworthy news

The return of Confined Space: It’s with mixed emotions that we welcome the excellent workplace health & safety blog Confined Space back to the blogosphere. It’s a welcome addtion – it’s been on mothballs while author Jordan Barab served as OSHA Deputy Assistant Secretary. It has been a boon for the nation’s workers to have Barab working in a position of influence on their behalf, so we are sorry to see that he is no longer in that post, but we can’t endorse his blog strongly enough – an informed voice and a strong advocate for safe workplaces. We’re fans because we view safe workplaces not only as a moral imperative because they are good for employees, they are good for business too. You can also follow Barab on Twitter @jbarab.

WCRI’s facelift: Just in time for Spring, the Workers Comp Research Institute – more familiarly known as WCRI – has launched a fresh new WCRI website, complete with a a fresh new logo. It’s a much cleaner look with simplified navigtion and designed to be more responsive on any device, including phones. We’re also delighted to see that they’ve added a WCRI Blog, a handy way to keep up on what’s new. You can read more about the new site here: WCRI Launches Redesign of Website with New Logo.

Telemedicine: Joe Paduda says that “Telemedicine will be one of – if not the – most disruptive force in workers’ compensation medical care.” Check out Paduda’s interview with Jonathan Linkous, CEO of the American Telemedicine Association.

NIOSH Coal Workers’ Health Surveillance Program: NIOSH is offering free, confidential health screenings for coal miners in 2017. Screenings will be provided in coal mining regions throughout Alabama, Illinois, Indiana, and Eastern Kentucky. The schedule for Alabama Black Lung Screenings (PDF) has been issued – they begin next week. Watch this site for more information and future screening locations.

More noteworthy news

Chemical Safety Board on budget chopping block

Wednesday, March 22nd, 2017

Photo: Chemical Safety Board

One of President Trump’s key campaign promises was to keep Americans safe, but apparently that promise should come with an asterisk. The news that the Chemical Safety Board is on the budget chopping block contradicts that promise – unless by “safe” we are only talking about threats from sources external to our borders.

The 40-employee Chemical Safety Board (CSB) is the only independent government agency that investigates industrial chemical disasters, issuing reports and safety recommendations to benefit industries throughout the nation. It issues no fines or penalties and makes no rules. Its investigations and reports also identify weaknesses in emergency planning and response that have preventative value not just for workers but also for the communities surrounding potentially hazardous work sites. Its annual budget of around $11 or 12 million is minuscule, particularly when measured against the enormous human and financial toll that a single chemical industrial disaster can inflict.

The Houston Chronicle doesn’t mince any words when talking about the impact of the agency’s demise: ‘Death and destruction’ expected as Trump moves to gut Chemical Safety Board

“A White House proposal to eliminate funding for the U.S. Chemical Safety Board signals a full retreat from two decades of progress against chemical disasters and would, if enacted, put American lives in jeopardy, health and safety experts said.

While little known to the masses, the CSB is to chemical disasters what the much better-funded National Transportation Safety Board is to airline crashes, train derailments and bridge collapses. Without the recommendations that come from these boards, preventable accidents repeat themselves.”

Texas is no stranger to chemical catastrophes. The CSB was instrumental in investigating the 2005 explosion at BP’s Texas City refinery that killed 15 and the 2013 explosion at the West Fertilizer Company that rocked the small town of West, Texas. That incident killed 5, injured more than 250 and damaged 150 buildings.

In Trump Budget Would Eliminate Chemical Safety Board, Jack Kaskey and Jennifer A. Dlouhy of Insurance Journal also highlight the important role that the CSB plays in investigating accidents, and offers several concrete examples of industry recommendations that enhanced safety practices in dangerous industries.

“The CSB makes no rules and issues no penalties, but often identifies dangerous industry practices that are overlooked by enforcement agencies. Its scope of responsibility has included multi-fatality disasters from a 2013 fertilizer distributor in West, Texas, to BP Plc’s Deepwater Horizon drilling rig blowout in 2010.

CSB probes have led to many industry improvements that have saved lives without gaining public notice, said Michael Wright, director of health, safety and environment for the United Steelworkers of America. After a 2012 fire at a Chevron Corp. refinery in Richmond, California, the CSB discovered that the pipe used was subject to corrosion and rupture because of the materials it carried. Though there were no rules against using that kind of pipe, the industry changed its practice because of the CSB, Wright said in a phone interview.”

The CSB issued this statement in response to news of the cuts:

The U.S. Chemical Safety Board (CSB) is disappointed to see the President’s budget proposal to eliminate the agency. The CSB is an independent agency whose sole mission is to investigate accidents in the chemical industry and to make recommendations to prevent future accidents and improve safety. For over 20 years, the CSB has conducted hundreds of investigations of high consequence chemical incidents, such as the Deepwater Horizon and West Fertilizer disasters. Our investigations and recommendations have had an enormous effect on improving public safety. Our recommendations have resulted in banned natural gas blows in Connecticut, an improved fire code in New York City, and increased public safety at oil and gas sites across the State of Mississippi. The CSB has been able to accomplish all of this with a small and limited budget. The American public is safer today as a result of the work of the dedicated and professional staff of the CSB. As this process moves forward, we hope that the important mission of this agency will be preserved.

 

Here are just a few other notable CSB investigations we recall:

Other commentary on the proposed elimination of CSB

 

 

Wonks opine on Republican healthcare plan & more

Thursday, March 9th, 2017

Check out the freshly posted “May You Live in Interesting Times” Edition of Health Wonk Review posted by Peggy Salvatore at Health System Ed Blog. If your head hurts from trying to analyze the new plan, let the wonks lighten your load – some pretty smart people have weighed in.

Of course, while Obamacare past, present and future is the 800 pound gorilla in the room. that’s not the only issue discussed in this weighty issue. Other topics include a tribute to a health care advocate pioneer, a look at our new Secretary of Labor, posts on cancer care, clinical outcome technology, cyber security and medical marijuana.

Navigating extreme height, Chinese workers build cliff walks

Tuesday, March 7th, 2017

China has many incredible cliff walks – some for necessity so that remote villagers can connect with the world beyond and some for tourism so visitors can connect with vistas of natural splendor. Check out this 300m glass bottomed cliff walk that is proving popular with intrepid tourists. Even more terrifying – a death-defying hiking trail some people are willing to undertake all to get a cup of tea.

So much for the trails, what about the workers who construct them? We get a short glimpse in this video of Chinese construction workers building a glass-bottom walkway on Laowang Mountain, Jiangxi, China. The clip says workers are in their 50s and work a 10 hour day, earning between $43 and $58 dollars a day. They build about 65 feet a day. Other than hard hats, they don’t appear to have much in the way of safety equipment.

The workers aren’t the only ones braving these heights – look at the extremes these tiny, brave Chinese kids are willing to go through to get an education!

It wasn’t that long ago that U.S. workers were climbing the cliffs of the skyscrapers to build our cities here in the U.S., and safety equipment wasn’t to be seen. Check out this clip of workers building the Empire State Building – not only did they have no safety equipment, they played catch with red hot iron rivets!

Thankfully, safety standards have come a long way in our country since. Fall protection at 1776 feet: One World Trade Center. Although we’ve come a long way in terms of safety, we haven’t come far enough: The high price for fast phones: Cell tower deaths.

If you are a as fascinated with working at extreme heights as we are, you might enjoy more from our prior posts.

Dangerous Jobs: window washing at extreme heights.

You think your job is tough? Climbing Up The Tallest Antenna Tower 1,768 feet

Safety Nets, Hard-Boiled Hard Hats & The Halfway to Hell Club: Safety Innovations in the Golden Gate Bridge Construction

 

Update On Medical Marijuana

Friday, March 3rd, 2017

Yesterday, while attending WCRI’s Annual Conference in Boston, we wrote about the National Academy of Sciences (NAS) new research results concerning the effectiveness of  medical marijuana (cannabis) in the treatment of chronic pain. The NAS research concluded there is “conclusive support” that cannabis is effective with respect to chronic pain. A number of states are allowing cannabis to be employed in this regard.

However, marijuana is federally illegal in any usage, medical or otherwise.

We learn today from the Boston Globe that a bill was introduced in the US House of Representatives by Virginia Representative Thomas Garrett yesterday to remedy this situation. From the Globe’s story:

A freshman Republican representative from Virginia introduced legislation this week that would end the federal prohibition on marijuana use and allow states to fully set their own course on marijuana policy.

The bill seeks to remove marijuana from the federal Controlled Substances Act and resolve the existing conflict between federal and state laws over medical or recreational use of the drug. It would not legalize the sale and use of marijuana in all 50 states — it would simply allow states to make their own decisions on marijuana policy without the threat of federal interference.

‘‘Virginia is more than capable of handling its own marijuana policy, as are states such as Colorado or California,’’ Representative Thomas Garrett said in a statement. Neither recreational or medical uses of marijuana are allowed in Virginia.

Senator Bernie Sanders introduced a similar bill last year, but no one would co-sponsor it, and it never even got a hearing. Garrett, however, has four co-sponsors already.

We will continue to watch this.

Who Knew? Medical Marijuana Works (at least for chronic pain)

Thursday, March 2nd, 2017

Dean Hashimoto, MD, JD, is a highly-respected researcher and teacher, practicing at Massachusetts’s Partners Health Care (think Harvard and Massachusetts General Hospital) and teaching at Boston College Law School. Today, at WCRI’s Annual Conference, his topic was Medical Marijuana and Workers’ Compensation: Recent Scientific, Legal and Policy Developments.

He led off with the results of a January,2017, scientific report from the National Academies of Sciences, Engineering and Medicine (NAS). The NAS report is a comprehensive, in-depth review of existing evidence regarding the health effects and potentially therapeutic uses of Medical Marijuana (cannabis). The report arrived at nearly 100 research conclusions categorized by the weight of evidence (conclusive, substantial, moderate, limited, no or insufficient).

One of the report’s conclusions that had “conclusive and substantial support” was this: Medical Marijuana is proven to improve chronic pain in adults. There is “moderate” support for the conclusion that Medical Marijuana improves short-term sleep outcomes for both fibromyalgia and chronic pain.

Of course, there are downsides. The report also concludes (DUH!) that Medical Marijuana carries with it an increased risk of motor vehicle crashes. Also, however, there was conclusive, substantial support that taking Medical Marijuana can lead to the development of schizophrenia and other psychoses. Yikes!

The NAS report also investigated whether there was an association between cannabis and occupational injury. The conclusion? There was no conclusion, because the available studies do not permit one to be made with any degree of certainty.

The bottom line? Medical Marijuana presents a potentially therapeutic benefit in the treatment of chronic pain.

Well, that’s not really the bottom line. No, because the larger issue is this: Medical Marijuana is being used in a number of states. Today, along with Dr. Hashimoto, we also heard compelling stories from Paul Sighinolfi, of Maine’s Workers’ Compensation Board, and Paul Tauiello, of the Colorado Division of Workers’ Compensation, describing the successful medical use of cannabis which is generating momentum in both states toward the therapeutic use of cannabis. The trouble is the usage of Marijuana in any form is federally illegal in every state. Seems there is a collision coming, and it may not be pretty.

WCRI: Worker Outcomes And The First Contact: Old News, Still New News

Thursday, March 2nd, 2017

Dr. Bogdan Savych, of WCRI, and Glenn Pransky, MD, from Liberty Mutual’s Disability Research Center, today reported on studies looking at predictors of worker outcomes and the way the initial contact following and injury impacts return to work.

It was in the mid 1980s when my partners and I realized that treating injured workers with dignity and respect and building workplace systems that enabled that would be a good business model. Thus, was Lynch Ryan born. We were right, and over the years became successful selling the model across America. These business systems saved employers a lot of money while providing quality care to injured workers. Frankly, I thought that battle had been won. Au contraire.

Doctors Savych and Pransky (PhD and MD) once again reminded attendees at WCRI’s Annual Conference that we still have a way to go.

Dr. Savych presented three main points (preliminary findings, subject to change):

  • In a 15 state study, 14% of injured workers with at least 7 days lost time never had a “substantial return to work;”
  • “Trust in the workplace” is a major predictor of an injured worker’s likelihood of returning to work;
  • Fear of being fired is a major predictor of an  injured worker’s likelihood of returning to work.

Dr. Pransky, whom I have long admired, presented evidence from several studies from the US, British Columbia and Australia aimed at determining the degree to which both the style and words used in the first encounter following injury influence the final outcome. Guess what? They’re really important.

Much has been written recently about the concept of “perceived injustice” in the course of injury recovery. At this year’s National Workers’ Compensation and Disability Conference, Dr. Marco Iglesias, of The Hartford, discussed this in detail, advocating that adjusters empathically listen to injured workers and, generally, improve their communication skills. That is easier said than done, but surely worth the effort.

 

WCRI – Day One, Session One

Thursday, March 2nd, 2017

Here we are in Boston again for yet another year of swimming the Australian Crawl through the mother of all data dumps from the Workers’ Compensation Research Institute’s annual conference.

WCRI’s first year President, John Ruser, led off the day with a sneak peak at the Institute’s new website, which seems clean and easy to navigate.

Then the fun began. Former Oklahoma Senator Tom Coburn, who happens to be a medical doctor and a Republican, and former Representative Henry Waxman, a California Democrat, looked into their crystal balls to discuss the future, of lack of it, of the Affordable Care Act.

Not surprisingly, the two former legislators had differing opinions, and I’ll bet you can bet what they were.

Coburn opined that we no longer have three equal branches of government, because the congress has ceded its authority to the Executive branch. Waxman bemoaned the lack of bi-partisanship.

John Ruser asked each about “repeal and replace,” opening a ballroom size can of worms. If you’ve been watching Sunday morning television, you know how that went. Predictably, Waxman, the Democrat, and Coburn, the Republican, argued from opposite ends of the spectrum. Each of these intelligent and seemingly reasonable people sincerely believe their position is the right one.

One thing they did agree about was whether the federal government would do anything about workers’ compensation. The answer: No.  That discussion morphed into social security disability, with Senator Coburn saying 27 million people are now on the rolls. This is not true. According to the Social Security Administration, less than 16 million people now receive social security disability benefits.

Coburn and Waxman, two rational people, are not going to agree on what to do about the Affordable Care Act. Not even close, and that is a shame.

Colleague Joe Paduda has an excellent summary of this session here.