Health Wonk Review: the Groundhog Zombie Goes Back to the Future Edition

May 4th, 2017 by Julie Ferguson

 

It’s quite the day to be going to press with a new Health Wonk Review. We were trying to think of  a movie themed metaphor for today’s edition but can’t decide between Back to the Future, Groundhog Day or a zombie flick, so we’re going for a mashup.   Suspense is in the air as we await a vote later today on the revised AHCA. Or at least that’s what the media has been predicting as the bill suddenly sprang back to life late  yesterday after some arm twisting and deal sweetening in the corridors of power. One wonders what the hurry is since the Congressional Budget Office has not had sufficient time to weigh in and a quick vote would seem to violate the pledge of a minimum three-day public review. But maybe avoiding those pesky details are are seen as features not bugs. Our wonks submitted posts from the past week, so most were submitted before yesterday’s frantic hubbub of activity, yet still make trenchant observations about the revised bill. And of course, even though this topic is currently dominating the news, many of our wonks have healthcare observations on topics other than repeal-and-replace so if you are tired of the ongoing legislative goings on, read on.

Joe Paduda has kept an eye on the repeal & replace movement with his series of posts on the ACA deathwatch at Managed Care Matters. In his most recent post, he talks about flaws that plague the current bill and why it is destined to fail: ACA Deathwatch: No, AHCA is not going to pass Congress

At healthinsurance.org blog, Harold Pollack warns us to get ready for the uncomfortable questions with AHCA. Currently, an estimated 27 percent of American adults have been diagnosed with declineable preexisting conditions. Rollback of protections for those with pre-existing conditions means health insurers will again be rummaging through your health history.

Think the $8 billion that the revised AHCA bill earmarks for preexisting conditions solves that problem? Timothy Jost explains why that is unlikely at Health Affairs Blog.

One drum that Roy Poses of Health Care Renewal continues to beat (thankfully) is pointing out how health care organizations are increasingly run by a network of insiders who often put self-interest ahead of patients’ and the public’s health. As we head into today’s vote, he points out another vivid example: How Legislators rigged the repeal of the ACA to keep their own health insurance affordable.

Vincent Grippi points us to a post by Care Centrix CEO John Driscoll at The Homefront blog examining the recent struggle of the American Healthcare Act and highlighting why value-based care is an important part of the solution in his post Coal Mining Isn’t Coming Back and Neither is Fee-for-Service Medicine. It makes great points in light of recent congressional goings on.

Louise Norris of Colorado Health Insurance Insider looks at what’s next in Colorado for health care reform noting that, lately, it’s been a whirlwind. A bill to help out people over 400% of FPL just failed, disappointing many; there is uncertainty about Anthem BCBS staying in the exchange; insurers don’t have an exit clause if Cost Sharing Reduction funding is eliminated; rates will be filed late this year due to market uncertainty, and there is a bill to eliminate the exchange still in progress.

InsureBlog‘s Bob vineyard highlights the financial challenges of actually *paying* for even minor health care in his post Buddy, Can You Spare a Dime?

It’s tough being a cancer patient. New urgent care clinics designed specifically for cancer patients help ease the burden and could be a model for the rest of healthcare. David Williams of Health Business Blog talks about what distinguishes these clinics and wonders why such services aren’t available to all healthcare consumers.

Brad Flansbaum of The Hospital Leader has a challenge to physicians: How often do you ask this (ineffective) question? A recent study calls into question the effectiveness of a widely accepted practice.

Healthcare Economist Jason Shafrin looks at the hedonistic treadmill and asks if it works in reverse when it comes to acclimating to deteriorating health conditions. (Don’t know what the hedonistic treadmill is? We sure didn’t but it is our nomination for concept of the day). He cites an recent study on the topic.

Here at Workers Comp Insider, we recently commemorated Workers Memorial Day, a time remember those who were hurt or killed on the job. In conjunctions with that event, the National Council for Occupational Safety and Health issued The Dirty Dozen, highlighting employers who put workers and communities at risk due to unsafe working conditions.

Next up to bat: May 18, 2017 – Jason Shafrin – Healthcare Economist.

April 28: Workers Memorial Day

April 28th, 2017 by Julie Ferguson

Every April 28 is dedicated to Workers Memorial Day, when working people throughout the world remember those who were hurt or killed on the job. It’s also a time to recommit to and renew the quest for safe workplaces. The following are some resources that list events and offer information that you can use to raise awareness.

Workers’ Memorial Day 2017 Events Also, see OSHA’s event calendar.

More news and events at 28april.org

Facebook

Twitter at #wmd17

The Weekly Toll: Death in the Workplace

Death on the Job: The Toll of Neglect, 2017
This is the 26th year the AFL-CIO has produced an annual report on the state of safety and health protections for America’s workers.

The Dirty Dozen: National COSH Releases Report on Companies That Put Workers at Risk
In his post at Confined Space, Jordan Barab links to the report and says:

“Just in time for Workers Memorial Day, the National Council for Occupational Safety and Health (National COSH) has announced “The Dirty Dozen” employers of 2017, highlighting companies that put workers and communities at risk due to unsafe working conditions. National COSH chooses the “Dirty Dozen” by soliciting nominations from health and safety activists around the country.”

More on the history at Wikipedia: Workers Memorial Day

Fresh Health Wonk Review and other noteworthy news

April 20th, 2017 by Julie Ferguson

It’s Health Wonk Review week and Brad Wright has a fresh, newsy, engaging issue posted over at Wright on Health, the Health Wonk Review: Who’s On First? Edition.

He grapples with health reform, alternative facts, and many other topics. To stay in the know in this dynamic climate, HWR is a great way to stay current on the changing landscape.

 

Here are a few other news items we’ve noted this week: 

In the “in case you missed it” department:

Quick takes

Worker Memorial Day and a voice for the workers

April 19th, 2017 by Julie Ferguson

April 28 is Workers’ Memorial Day, a time when workers and their families, labor unions and safety advocates commemorate workers who were killed on the job: 4,800 fatalities per year, or an average of 13 workers who lose their lives every day. The AFL-CIO dedicated the first Worker Memorial Day in 1970 as a day of remembrance for those who have been killed or suffered injuries/illnesses on the job. It also sheds light on the preventable nature of most workplace incidents with its theme of Remember the dead – Fight for the living.

When it comes to work fatalities, numbers don’t tell the whole story. Jordan Barab of the newly resurfaced Confined Space blog profiles some of these deaths in his Weekly Toll. It’s tough but important reading. Those of us who work in insurance can be focused on dollar and cents and lose touch with the real reason many of us entered the workers’ comp arena. And even the most dedicated number-crunchers among us see the wisdom that the least expensive claims are the ones that never happen.

Jordan’s blog focuses mainly on policy and political issues around worker safety, but he explains why he decided to pick up the grim task of compiling this list:

But ultimately, we’re only fighting the policy and political issues because working people are getting hurt and killed every day in the workplace, and more has to be done to stop the carnage. Today I resume a necessary — if depressing — task that I conducted every couple of weeks in the last version of Confined Space: The Weekly Toll, a list of every worker I could find that was killed in the workplace over the previous week or two. The main reason I started the original version of Confined Space in 2003 was that I realized that while a few workers killed in workplace incidents sometimes receive enormous media attention, most workers die alone and unnoticed by anyone except their immediate families and friends. Something had to be done to ensure that these thousands aren’t dying in vain.

Jordan has been a tireless voice for worker safety throughout his career. He was Deputy Assistant Secretary of Labor at OSHA from 2009 to 2017. Prior to that, he worked for the House Education and Labor Committee, the Chemical Safety Board, the AFL-CIO, OSHA and AFSCME. His Confined Space blog was one of the early blogs that inspired us as we launched Workers Comp Insider. He put his blog on ice while working for OSHA, but he has recently relaunched it and is an important voice in looking to the health and safety of workers – particularly in an administration that has pledged to cut regulations and funding for many programs.

We have talked about and are concerned about the defunding and elimination of the Chemical Safety Board. The administration has also rolled back some important albeit controversial OSHA regulations and it is expected that OSHA will suffer further curtailment. Scott Schneider looks at some of the programs that are at risk and why they are important in OSHA Regulations: The Next Target

The President asked businesses and industries for advice on which regulations should be cut and he received 168 submissions from corporations and industry special interest groups.  Unfortunately, eliminating many of these are likely to have a corrosive effect on worker health and safety. Meanwhile, for the voice and interests of the worker and worker safety, Confined Space is an important read.

Freshly posted Health Wonk Review at InsureBlog

April 7th, 2017 by Julie Ferguson

Start your Friday with your morning beverage of choice and a fresh edition of Heath Wonk Review. Over at InsureBlog, Hank Stern has posted the Health Wonk Review: Pre-Passover edition. In his Twitter promo for this edition, he promises “Everything from horseradish to opioids” – you are probably not going to find too many insurance-related posts quite that eclectic!

In addition to wonks weighing in on RyanCare and the future of the ACA, other topics include opioids, physician burnout, the physician mission, price transparency, “the coding swindle” and more. Check it out!

We bring one post in particular to your attention – a post by HWR regular Brad Wright at his Wright on Health blog. He relates an up-close-and-personal encounter with the health care system, and reflects on his experience in the larger context of healthcare availability and accessibility.  Wonkery is all well and fine, but there is nothing quite like a personal testimonial to make a powerful impact. (Wishing you the best as you recover, Brad!)

 

 

The Psychosocial Buzz Is Getting Louder

March 24th, 2017 by Tom Lynch

“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

March 23rd, 2017 by Julie Ferguson

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

March 22nd, 2017 by Julie Ferguson

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

March 9th, 2017 by Julie Ferguson

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

March 7th, 2017 by Julie Ferguson

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