Fresh Health Wonk Review at medicareresources.org blog – check it out!

February 10th, 2017 by Julie Ferguson

Steve Anderson has posted the latest and greatest Health Wonk Review – the #alternative_facts Edition at medicareresources.org blog.

The Affordable Care Act (aka Obamacare) is not all that’s on our wonks’ minds of late, but it certainly takes up a huge portion of the mind share as evidenced by the plethora of related posts. We are a diverse crew, though, so there are also posts about a variety of other topics: the reaction to/impact of the immigration ban on healthcare industry, best cancer treatments, the process of healthcare M&As, legal liability in the form of class action suits for a data breach. and workers comp. One thing we find: the contributors are all very knowledgeable people – even if a topic is not on your radar, it’s a good way to learn something new.

Two posts we think are particularly worth calling out:

If ACA is repealed, how many will max out on restored lifetime coverage caps?

If ACA is repealed, how many are at risk of losing coverage by U.S. Congressional District? (Data covers 35 states)

Reader Reactions To Our Psychosocial Issues Series

February 7th, 2017 by Tom Lynch

A number of readers wrote to us about last week’s two-part series on psychosocial issues and how they confound claim adjusters and increase costs. A few readers pointed out that we paid scant attention to the “social” in psychosocial. These adjusters and nurses wrote that too often they’d seen and handled claims where life and “societal issues” seemed to get in the way of recovery. Sue Separa, who has overseen workers’ compensation claims for more than 30 years in 40 states and jurisdictions, put it this way:

Employee loses car, loses license, loses driving privileges and can’t get to work, but still needs a source of income;

Employee is having daycare issues and needs to be home, but also needs a source of income;

Employee has a sick relative or child they need to stay with/watch, but still needs a source of income;

Employee is attending school to better themselves, has a heavy school schedule, but still needs a source of income;

Employee has a comorbid or health situation that requires medical care and possibly surgery or absence from work, and has not secured short term disability, or it is not available with the employer; 

Employee has asked for vacation time and it is denied due to no time left, or not eligible, or because someone else is off work at the same time.

And she’s right. Of course these real life situations occur. However, they’re present and happen all the time without injuries, too. They are non-physical, “social” comorbidities; things that can easily impede and delay return to work. Unless, that is, claim adjusters are trained and experienced enough, as Ms. Separa is, to dig a little deeper, find them and address them appropriately.

We also heard from our friend Robert Aurbach who wrote from Down Under to say, while he “applauds” our efforts and thinks “they are valuable,” he suggests “perhaps they don’t go far enough.” Rob believes the “problem is partly the system itself;” we create the harm I cited. As that great American philosopher, Pogo, opined on Earth Day, 1971, “We have met the enemy and he is us.” The system is iatrogenic (system caused).

Rob Aurbach also sent me a paper he authored in late 2015 for the Injury Schemes Seminar, put on bi-annually by the Australian Actuaries Institute. In the Paper (opens in pdf), titled “Better Recovery Through Neuroscience: Addressing Legislative and Regulatory Design, Injury Management and Resilience,” (bit of a mouthful that, but it won the Taylor Fry Award for the Seminar’s best paper) Rob explores Neuroplasticity, a theory dating from the 1800s and recently confirmed by functional Magnetic Resonance Imaging. Neuroplasticity is the process by which our brains continually rewire themselves throughout life due to environment, behavior, thinking and emotions. In short, it’s true; our brains are malleable. Rob writes that when work is disrupted through injury (or, through anything, really) for a long enough period, Neuroplasticity begins rewiring the brain to adapt to the new situation – being out of work. In other words, our brain creates a new “facilitated neural network.” This can happen in as little as 12 weeks, as Rob points out:

Timing is everything. There is a substantial research literature demonstrating that if a worker does not return to work within 12 -16 weeks, the probability of eventual return is reduced to 50% or less.

Rob Aurbach’s paper is a valuable contribution to understanding how easily a claim can deteriorate to the point where an injured person’s life is forever changed, and not for the better. I urge you to read it. It’s well-researched, well-written and profoundly thoughtful. Twenty-seven pages long, the last seven of which are endnotes and references. I found the first half of the text compelling and enlightening. His common sense recommendations that follow are pretty simple, but wickedly difficult to implement: Claim managers and adjusters should intervene early, demonstrate respect for the injured worker, promote early return to work, align incentives that encourage recovery, restrain negativity, listen attentively to the worker’s story, etc. In short, all the things managers, nurses and adjusters like Sue Separa know they should be doing, anyway. Trouble is, for these often overworked professionals, each managing a steamer trunkful of claims, there isn’t a lot of time to devote to Rob’s prescription. The iatrogenic system isn’t built to allow it.

And that’s where behavioral health clinicians and therapists, for the most part underused and undertrained, should be called on to help. Work Comp Psych Net, the New Jersey company I described last week, would be a good place to start.

Workers’ Compensation’s Costly Psychosocial Issues (2)

February 1st, 2017 by Tom Lynch

First, a review.

Yesterday, we described the challenges confronting claims adjusters and injured workers when psychosocial issues are present in a workers’ compensation claim. These issues impede recovery and exacerbate costs. We confidently picked up our saw and walked out on the proverbial limb to suggest this thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory. 

Finally, we listed the serious factors that make finding a solution to this looming crisis tremendously difficult.

But early in 2015 in New Jersey two Neuropsychologists, Mary Ann Kezmarsky and Richard Filippone, had an idea. Over a couple of decades, they’d treated a number of workers’ compensation claimants and had been appalled by what appeared to be the lack of a coherent system to deal with the issues they saw in their patients. They weren’t exactly sure what to do about it – they didn’t know much about workers’ compensation – but they saw it as a business opportunity.

They contacted me, and over the next year we created a company, Work Comp Psych Net (WCPN), and built a systemically organized and integrated specialty network of workers’ compensation clinicians and therapists to treat injured workers in New Jersey who might have behavioral health issues delaying recovery. Here’s how we did it:

  1. Over the last half of 2015, we recruited, credentialled and vetted 44 mental health professionals covering 55 offices throughout New Jersey’s 21 counties. Providers within WCPN’s network include psychologists and neuropsychologists, as well as cognitive rehabilitation and biofeedback specialists. All of the clinicians and therapists gave up a weekend to attend Lynch Ryan training in workers’ compensation. They learned about the New Jersey law, as well as the way workers’ compensation works – how a premium is constructed and  what indemnity and medical benefits are. They now understand experience modification, maximum medical improvement and the law regarding injuries “arising out of and in the course of employment.” Further, they have been educated regarding early return to work and have agreed to work with employers, adjusters and nurses to effectuate modified duty wherever possible.
  2. We built (with difficulty, because it wasn’t easy) the nation’s first electronic Claimant Intake & Referral Portal that allows claims adjusters, nurse case managers and attorneys to refer a claimant instantly. The paperless portal’s referral system is geographically and specialty based, meaning that referrers are assured that claimants will not have to travel far to reach their assigned clinician. In the past, referrals and appointments took weeks, even months, to arrange, but they can now be finalized within minutes. In Beta Testing from May through October, 2016, the longest time from referral to Provider scheduled appointment was 27 minutes.
  3. We built (with even more difficulty) the nation’s first mental health Electronic Health Record system for workers’ compensation. The EHR is set up as a roadmap for all WCPN clinicians to follow, meaning reports have a consistently structured form. The EHR is paperless, HIPPA-compliant and cloud-based. Initial Psychological Evaluations and subsequent treatment reports reach claims adjusters in pdf form within five business days.
  4. Our clinicians are all highly qualified and experienced; they know how to treat workers with mental health issues delaying recovery. But to make the system work we needed to understand the needs of adjusters and defense attorneys who would be referring the injured workers the clinicians would treat. Consequently, we conferred with experienced adjusters and defense attorneys. After doing so we decided that every referral would begin with a thorough Initial Psychological Evaluation (IPE), which, although not technically an IME, would be done at the IME level (we priced the IPE at $450, and, since nobody’s complained, we now think that’s too low, but we’re sticking with it). If the Initial Psychological Evaluation determines the presence of one or more mental health issues which are deemed to be work-related and requiring treatment, the treatment prescribed is initially authorized for up to 12 sessions unless medically justified, extraordinary circumstances are present. Additional treatment requires the approval of the referring party.

We officially launched in November, 2016. Over the intervening three months  we’ve learned two things (among a lot of others): First, our solution works extremely well; referrers have been highly receptive and pleased. They appreciate the ease of referral and the EHR reports.  They appreciate even more the fact that our clinicians and therapists have been trained in workers’ compensation. We’ve signed contracts with insurers and TPAs. Second, this could be a national solution.

So, our solution is working in New Jersey, but every state workers’ compensation system is grappling with how to deal with psychosocial issues that frequently hobble recovery. This may be work comp’s final frontier. Time will tell whether our template and software could help others. Regardless, we will continue to improve our solution at Work Comp Psych Net, as well as report on our outcomes.

It’s taken us nearly two years to get to this point, so if any reader wants to take this issue on in another state, we’d be happy to offer the wisdom (and sometimes folly) of our experience.

 

 

Workers’ Compensation Psychosocial Issues: A Big, Fat, Costly Problem

January 31st, 2017 by Tom Lynch

Workers’ compensation claims adjusters are busier than the Ed Sullivan Plate Spinner. Running around with one or two hundred lost time claims would make anyone dizzy, but at the recent National Workers’ Compensation & Disability Conference (NWCDC) in New Orleans, presenters tossed the frazzled spinners a few more plates to shoot up on the sticks.

The issue? Psychosocial factors delaying claim resolution.

At one well-attended session, Marco Iglesias, Medical Director for The Hartford, and Robert Hall, Corporate Medical Director for Optum, went into great detail about how psychosocial factors rear their heads in the claim process and how they impede recovery.

For example, consider these research statistics based on a study of 75,000 claims:

Time out of work increases 30% for a musculoskeletal claim with one co-morbid complication;

Duration increases 57% if the claim co-morbidity is depression;

According to The Hartford’s Dr. Iglesias, 10% of claims, the ones with all those psychosocial issues, cause 60% of claim costs;

At another presentation, attendees learned that Mental Health, Addiction and Obesity are the three comorbidities causing the greatest cost and time away from work.

Also, according to an AETNA presentation, 97% of depressed patients have a second co-morbid condition.

Research aplenty. Solutions, not so many.

So, perhaps it’s time for a more comprehensive discussion.

To begin that, let me propose a thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory. 

The issue is compounded by the way claim adjusters, supervisors, nurses and defense attorneys view psychological issues. No one wants to ”buy a psych claim,” and many  believe that referring a claimant for behavioral health treatment does nothing more than create a lifetime annuity for a psychologist. Time and again this view has been proven correct.

What to do about that? Ay, there’s the rub. For in that question lies a host of difficulties. These, for instance:

  1. Most mental health professionals do not understand workers’ compensation. They do not realize either its statutory requirements or the concept of maximum medical improvement. They have spent many years being trained to treat the entire person. The players are the patient and the therapist, and it is like sitting on a two-legged stool. They do not fathom that, in workers’ compensation, the stool has five legs, with the other three occupied by the employer, the treating physician and the claim adjuster.
  2. Too often, by the time an adjuster or nurse recognizes that psychosocial issues may be impeding recovery and return to work the claim may have gotten a little long in the tooth; it could be months old, or more.
  3. It can take a claim adjuster weeks, in rare cases, months, to find a psychologist and schedule an appointment. It can also take weeks or months for a report to make it back to the file. Moreover, finding a clinician with even a smattering of workers’ compensation knowledge or experience is often problematic (See 1, above).
  4. Because there is no mental health electronic health record system for workers’ compensation, every report is its own island, sometimes good, sometimes bad.
  5. Everything is paper-based, which wastes claim adjuster time and increases expense.¹
  6. Although psychologists understand the value of work as therapy, many see no reason to help coordinate early return to work with employers, claim adjusters or medical providers

These are deep and difficult considerations. Tomorrow, we’ll describe one possible solution offered by a company in New Jersey, which, in the interests of full disclosure, is a Lynch Ryan clent.

 

¹ Claim adjusters also report that a not insignificant number of these reports are essentially unreadable, because they are handwritten.

 

A Conversation With WCRI’s John Ruser, Ph.D.

January 30th, 2017 by Tom Lynch

As I write this, we are 34 days from this year’s not-to-be-missed Workers’ Compensation Research Institute’s Annual Conference. It all happens at the Westin Copley Place on March 2 and 3 in the greatest city in America. That would be Boston (sorry New York, Chicago, LA and all the rest of you).

This is always one of the top conferences in the nation, jam packed with enough data to satisfy any green-eye-shaded, algorithm loving, analytic modeler.

As you might imagine, this year’s agenda will include a bit of crystal ball gazing with respect to the future of American health care. I discussed that and other conference topics recently with Dr. John Ruser, WCRI’s President and CEO, at the Institute’s Cambridge, MA, offices.

This is Dr. Ruser’s first full year at the WCRI helm. About a year ago he succeeded Dr. Richard Victor, WCRI’s founder and iconic long time leader. Ruser, a perceptive intellectual, realized he had big shoes to fill, so he told me his goal for the first year was “stability.” He wanted a “steady transition.” That’s one goal he can check off as done. No staff left and they all continued to do significant research, much of which will be on display at the upcoming conference in the world’s greatest city.

WCRI’s research can impact policy. For example, in early December, 2016, Massachusetts Governor Charley Baker unveiled the Commonwealth’s new pilot program to help injured workers with opioid addiction. This from the Worcester Telegram:

The two-year pilot program is designed for people with settled workers’ compensation cases who are being treated with opioid medication, but whose insurance company seeks to stop payment for the opioid. Such cases, Gov. Charlie Baker said, can take up to a year to come to a resolution, and all the while the worker is prescribed opioids

 “Injured workers in Massachusetts receive 10 percent more prescriptions for opioids on average than 25 other states that were studied in a two-year study done by the Workers’ Compensation Research Institute (emphasis added), and Massachusetts led the studied states with the percentage of pain medications that were written for Oxycodone and nearly half of all prescriptions stronger than schedule II opioids,” Baker said. “There’s more we can do to help injured workers with settled workers’ compensation claims get appropriate treatment for pain management.”

Going forward, Ruser knows it’s time for him to begin making his mark at WCRI. This former Bureau of Labor Statistics executive wants to “increase WCRI’s reach.” He’s commissioned the building of a new website with the aim of “producing a much better search engine,” which will allow for “easier access to the Institute’s work.” I asked him what that really meant? He said he realizes that the work is scientific in nature, but that doesn’t mean it has to be obscure. He’s looking for plain english with a more “pithy” language style for Abstracts and Research Briefs. Doing so will allow WCRI to reach more stakeholders. A worthy goal, and we wish him luck.

John Ruser emphasized this year’s conference will tend to focus on three main questions:

  • What impact will the 2016 election have on healthcare (ACA, Medicare, etc.), labor and the workforce, and workers’ compensation?
  • Is the workers’ compensation system still fulfilling its mission or does it need revisiting?
  • With opioid use decreasing, what alternatives exist to treat pain?

The conference’s agenda is interesting, for sure, but for my money I’m eager to attend the first and last sessions. The opening session is on “The Impact of the 2016 Election,” and the presenters are former U.S. Representative Henry Waxman and former U.S. Senator Tom Coburn. I think that’s where the crystal ball gazing happens. We all know workers’ compensation is the tiny caboose at the end of the great big health care train. It remains to be seen whether the former Senator and former Representative will get deep into the weeds of what the coming blow up of the Affordable Care Act will do to that little caboose. A year from now we’ll see how prescient Waxman and Coburn have been.

But on to the final session. Last year, at this time, the workers’ compensation industry was rocked by a series of articles by ProPublica’s Michael Grabell and NPR’s Howard Berkes. Grabell lifted some ugly stones and rather unpleasant things crawled out. The industry lashed back. Perhaps the most reasoned comment was from Dr. Victor at the 2016 conference when he said, “Using anecdotes isn’t the best way to analyze an entire national system.”

The last session is at 10:35 AM on Friday morning (don’t leave early). This is the first session’s complement and is likely to get into some of the Grabell/Berkes territory.  “Appraising the “Grand Bargain” in 2017″ has four wonderful presenters, all of whom I admire. Professor Emily Spieler, Northeastern University School of Law, Dr. David Deitz, Principal, David Deitz & Associates, Dr. David Michaels, Former Assistant Secretary of Labor for Occupational Safety and Health (OSHA) and Bruce Wood, of the American Insurance Association are going to take a hard look at workers’ compensation in the here and now. Their comments should bookend nicely with those of Henry Waxman and Tom Coburn.

As we were winding up our talk I asked John Ruser what he hoped would be the biggest takeaway for attendees. “Honestly,” he said, “I want everyone to come out feeling they’ve learned something, something important.” Amen to that.

This year’s conference promises to be well-attended, but if you’re going (and you should be going), you might want to book your hotel now. WCRI has reserved a block of rooms at a special rate of $246 per night. They will go fast. You can register here.

I hope to see you soon in the Milky Way’s greatest city.

Go Pats!

 

Fresh Health Wonk Review posted at Joe’s place

January 27th, 2017 by Julie Ferguson

As we embark on the second week of a new administration, Joe Paduda has posted Health Wonk Review’s Inauguration Edition at Managed Care Matters. Rather unsurprisingly, the Affordable Care Act is much on the minds of the wonks, so there’s quite a few posts dealing with various aspects of repeal and replace.

Related to the topic of this week’s health wonkery, Joe also has a post on his blog about how the demise of the ACA would impact workers comp, specifically. A key quote:

“If ACA is repealed without a simultaneous and credible replacement, we may well see a rise in the number of workers without health insurance. The key issue to track is a cutoff of funding for Medicaid expansion – ACA added about 13 million more employed people to the insured rolls; if they lose coverage they’ll need a different payer to cover their injuries. Bad news for workers’ comp.”

And we’d point you to one other not-to-miss post at Managed Care Matters – Beware of Astroturf, the infuriating story of the American Pain Foundation, an pharma industry sponsored opioid-peddling outfit masquerading as a patient advocacy organization.

OSHA under President Trump: early signs

January 25th, 2017 by Julie Ferguson

We’re still awaiting an appointment to the Department of Labor under the Trump administration, so we don’t expect an Occupational Safety and Health Administration (OSHA) director to be named until after that. Right now, a hearing for the controversial Andrew Puzder as secretary of labor is scheduled for February 2. Part of the controversy related to the fast-food CEO revolves around numerous civil rights suits that his company has logged.

In the National Safety Council’s Safety + Health Tom Musick reports that legal experts are predicting significant changes for worker safety regulation under the new administration in his article OSHA under Trump: A closer look.

Here’s a summary of the article’s key points:

  • Labor-law experts predict that OSHA will move away from an enforcement-based strategy and toward compliance assistance and cooperative programs for employers.
  • OSHA’s funding could decrease, and the way it spends its funds also could change if Trump limits the agency’s enforcement budget.
  • Recent regulations such as the injury and illness recordkeeping rule, the silica rule and the so-called “blacklisting rule” all could be in jeopardy under the Trump administration.

For another take at the crystal ball, Russell Carr has issued two in three-part series of articles on potential changes at EHS Today. Carr comes from the perspective of an owner of an environmental, health and safety consulting business.

In looking at changes that may be in store for OSHA and other regulatory agencies, it’s instructive to look at the broader context of some steps that have been taken early in the new administration.

Hiring freeze

On his first day in office, President Trump issued a hiring freeze on non-military federal employees and, at least for some departments, on grants and contracts.

“President Donald Trump’s hiring freeze will last only as long as it takes his administration to come up with an alternative attrition plan, according to a memorandum released by the White House Monday, and could provide broad exemptions for agency leaders.

Trump said his hiring moratorium would “be applied across the board in the executive branch” and apply to any positions vacant as of Jan. 22. It would bar agencies from creating new positions. Agency heads can exempt positions they deem “necessary to meet national security or public safety responsibilities.”

The hiring freeze is expected to be a precursor to federal job cuts of as much as 20% in some departments and was issued to counter “the dramatic expansion of the federal workforce in recent years.” An article at Government Executive points out that there has been no federal workforce expansion and that “employment by the federal government as share of all US employment is relatively low compared to most of the last 70 years.”

Opponents to the freeze point to several potential unintended consequences: Trump’s Federal Hiring Freeze May Kill Hundreds of Jobs for Nurses, Scientists and Engineers

Unions and veterans groups say the federal hiring freeze would make the government less efficient, and make it harder for the US military personnel to find jobs when they leave the service. (About a third of all federal hires are military veterans, although if they’re working security positions, for example, they may not be affected).

The freeze could also take off the table thousands of well-paying jobs for US citizens with higher education and specific skills.

Federal employees have other reasons to feel pressure, among them the recent reinstatement of the Holman Rule: House Republicans revive obscure rule that allows them to slash the pay of individual federal workers to $1:

The Holman Rule, named after an Indiana congressman who devised it in 1876, empowers any member of Congress to propose amending an appropriations bill to single out a government employee or cut a specific program.

The use of the rule would not be simple; a majority of the House and the Senate would still have to approve any such amendment. At the same time, opponents and supporters agree that the work of 2.1 million civil servants, designed to be insulated from politics, is now vulnerable to the whims of elected officials.

Information lockdown – temporary or a sign of things to come?

There’s always a level of anxiety in the federal workforce when a new administration takes the reins, but one other issue has been causing a level of discomfort among employees. Numerous news reports reveal an information crackdown on staff in various federal agencies, from the the Environmental Protection Agency to Departments of Agriculture, Health & Human Services, and the Interior. In its article Trump clamps down on federal agencies, The Hill reports:

It’s not unusual for incoming administrations to seek control over agency communications, especially at the outset, when Cabinet secretaries aren’t in place.

But experts on the federal workforce say they have never seen a White House take the type of steps Trump’s administration has to curb public communications.

Restrictions are reported to include press releases, photos, tweets, speaking engagements, fact sheets, news feeds, and more. See a related story at Politico: Information lockdown hits Trump’s federal agencies. Hopefully, this will be short-term in nature, but one that we will be watching – by early indicators, it doesn’t seem as though an open “sunlight” approach to communications will be a core value of this administration.  if we were putting money on it, we’d bet that it’s just a matter of time until OSHA’s recordkeeping rule is toast, particularly in light of pending lawsuits challenging the rule and Trump’s recent promise to roll back regulations by somewhere int he order of 70-80%.

See our prior post:  Reading the tea leaves: The Trump administration and OSHA

 

Health Wonk Review: The “words matter” edition

January 12th, 2017 by Julie Ferguson

obamacare

 

Words matter. Right now, for good or bad, as the torch is being passed from one president to new one, one of the key platforms that PEOTUS ran on was eliminating Obamacare. But as the reality of that potential grows closer, social media is abuzz with debates. It would appear that some people didn’t fully understand what they signed up for. Going viral on Facebook, a poster celebrates the demise of Obamacare, patting himself on the back that he had the good sense to go with the Affordable Care Act instead. This person is not alone – witness the Twitter poster who berates Senator Murray: “Why don’t you shut up Murry. Stop Crying. You lost. We won. We are repleaing Obamacare, not the ACA.” We could post more examples, but you get the point. Polls have repeatedly demonstrated that words matter – the healthcare law is viewed much more favorably as the ACA than as Obamacare.  And a number of insureds don’t realize they are one and the same.  We may soon have the dubious privilege of learning how widespread this confusion is.

Wendell Potter also thinks words matter, and opines that poor communication was among the factors that got us to this point of repeal/replace. At healthinsurance.org blog, he says that “lazy, superficial reporting” – and poor communication from the Obama administration and Congressional Democrats – has kept most Americans in the dark about how repeal of Obamacare would affect them. Potter runs down a list of the health coverage problems Americans faced before ACA implementation … as a preview of the problems that the GOP will resurrect if they can repeal the law. Check out Back from the Future. (A sequel we’ll all hate.)

At Managed Care Matters, Joe Paduda tries to clear up some of the miscommunication with a Q&A aimed right at the insured. Joe has been engaged in a series of posts aptly titled ACA Deathwatch. In his most recent post, he tackles what ACA repeal will mean to the consumer in a basic Q&A format. He looks at post-repeal life under replacement plans, tackling issues like what will happen to your cost, will pre-existing conditions be covered, will plans be inclusive of all conditions, etc.

At Health Affairs Blog, Joe Antos and Jim Capretta look at the The Problems with “Repeal and Delay”, warning that the most likely end result of repeal and delay would be less secure insurance for many Americans and procrastination by political leaders. They lay out the possible legislative scenario that this would follow and document the problems:

“To build a functioning marketplace, and to provide a ready path for all Americans to get health insurance, it is necessary to put together a coherent series of policies across Medicaid, employer-sponsored insurance, and the non-group insurance market. A workable plan will necessarily touch on all of these areas, and will be lengthy and politically contentious. That may not be ideal from a political perspective, but the alternative is incoherence and half-measures that will lead to a system that many Americans will view as worse than the ACA status quo.”

At Colorado Health Insurance Insider, Jay Norris offers a street level view of the level of scrutiny that all things ACA have been under in his post Connect for Health Colorado and the OIG Audit Report. Apparently, the Office of Inspector General (OIG) released an audit report (the full report is here) regarding Connect for Health Colorado’s use of federal start-up funding. This funding was provided for state-run exchanges to get their operations up and running in 2013 and 2014. A poorly worded title on the front page of the report, combined with clumsy explanations in the report gave the media and anti-ACA folks a lot to complain about. Jay dissects the details, asking whether at least some of this falls under the much ado about nothing category.

Of course, not everyone is a fan of Obamacare or we wouldn’t be engaged in these political brouhahas in the first place. In a post entitled Flatline at InsureBlog, Patrick Paule “pulls back the curtain on the fiasco known as Open Enrollment v4.0. Disappointing!”

We do have at least a few entries that aren’t focused on the fate of the Affordable Care Act.

At Health Care Renewal Blog, Roy Poses looks at Dr. Tom Price and finds him wanting, in his post Follow the Money: Nominee for Secretary of Health and Human Services Traded Health Care Stocks and Owned Tobacco Stocks While in Congress. For the uninitiated, Roy is a longtime critic and caller-outer of conflicts of interest as they relate to physicians – something that he as a physician himself is fairly passionate about. He finds the current HHS nominee a little too cozy with big pharma, biotech, device companies and health insurers. But that’s just the least of what Dr. Roy finds objectionable … read up so you can be informed and ready for Tom Price’s cabinet hearing schnduled for January 18.

At Health Business Blog, David Williams says that concierge medicine is well-established in primary care, and now it’s coming to the specialties, too. Concierge pioneer Wayne Lipton explains how the “hybrid” model works and how primary care and specialty practices differ: Concierge Cardiology: podcast interview with Wayne Lipton.

At HealthBlawg, David Harlow ponders whether “Big Data” is too big to analyze productively – reasonable minds may differ. David draws some interesting analogies and concludes that computing power has indeed caught up with our data-generation runaway train. See: Of Borges and Big Data, Or: Is Big Data Too Big?

At Heatlh System Ed Blog, Peggy Salvatore finds bright spots for healthcare in the future, noting that no matter how the economy or politics turn, there are a few constants where people can have some control. Technological advances and wellness movements can help improve national health without increasing the cost of healthcare. See Healthcare’s Future: Population Health and Information Technology.

At The Healthcare Guys, Abhinav Shashank says that as eventful as last year was for the healthcare industry, expect a lot of surprises are in 2017, too. He cites the 21st Century Cures Act and MACRA as transformational legislation, and looks at potential trends and issues we are likely to see in the coming year. See: Healthcare 2017: What Does the New Year Have in Store?

At Healthcare Economist, Jason Shafrin brings us a great video short which reviews a recent publication in JAMA that details health care spending: Health Care Spending is Complicated.

Here at Workers Comp Insider, we forgo our own submission (OK, we’ve been goofing off in the new year) in favor of a post from our friends and colleagues at Work Comp Psych Net. We realize that workers comp is just a sliver of the overall healthcare budget, but we find it an important segment, dealing as it does with the health and safety of American workers. One thing that differs in the occupational arena is healthcare treatment is always working to an outcome, ideally a successful recovery and return to work after a work-related injury or illness. Mental health issues are often  impediments to a smooth recoveries because they are so often not factored in at all. Work Comp Psych Net sheds a light on progress in this area in the post Psychosocial Issues And How To Deal With Them.

Soapbox: As bloggers, we all enjoy speaking our mind.  As political discourse grows increasingly heated, we think it’s worth  this short PSA: Support the First Amendment and freedom of the press. Journalism isn’t free.  You can purchase great editorial cartoons like the one we use in this post at cagle.com. We’d also encourage supporting the Committee to Protect Journalists with donations. Journalists die for that freedom we enjoy.

Next issue: Jan. 25, 2017 – Joe Paduda – Managed Care Matters

2016 in Review: Workers Comp, Risk Management & More

January 3rd, 2017 by Julie Ferguson

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2016 was both a hair-on-fire and a pants-on-fire kind of year – so much so that the Oxford Dictionary chose “post truth” as its Word of the Year. In case you’ve been buried in a crypt this year or on a desert island (and who could blame you?) here’s an explanation of how they arrived at that choice. Strangely, “fake news” didn’t even make their list, but you can read the runners up.  You shouldn’t find much in the way of fake news here in our post today – we’re looking at key workers comp, insurance and related stories for 2016 – along with a few predictions  for the upcoming year.

First, a look back at the news of 2016

Business Insurance: Most popular workers compensation and safety stories of 2016

Business Insurance: The BI Top 10 of 2016

Insurance Journal: Top 12 Insurance Trends and News Stories of 2016: Countdown

SHRM: Top 5 Risk Management Articles for 2016

Safety News Alert: Top workers’ comp cases of 2016 Part 1: The issues and Top workers’ comp cases of 2016 Part 2: Unique circumstances

DOL Blog: Top 10 OSHA Citations of 2016: A Starting Point for Workplace Safety

OSHA: Worker Fatalities Reported to Federal and State OSHA

Safety News Alert: Top 10 OSHA stories of 2016

Paduda: 2016 predictions – how’d I do?

EHS Today: America’s Top 10 Safest Companies Awards

WorkCompWire: Leaders Speak: 2016 Year in Review

Workerscompensation.com CA Dept of Industrial Relations Releases 2016 Legislative Digest With Overview of New Laws

Claims Journal’s Top 10 Legal Articles of 2016

Terms + Conditions: Top 10 Posts of 2016

Fierce Healthcare: 5 notable physician practice headlines in 2016

Heath Affairs: The Most-Shared Health Affairs Articles of 2016

Medgadget’s Best Medical Technologies of 2016

Insurance Journal: Top 10 ‘Most Ridiculous’ Lawsuits of 2016: Chamber of Commerce

Human Resource Executive: Top HR Stories of 2016

HR Morning: Top 10 biggest HR stories of 2016

HR Daily Advisor: Top 20 HR Strange But True Stories for 2016, Part 1 and Part 2

III: Insurance Industry Employment Trends: 1990-2016 

Insurance News Net: ‘Rotten Apples’ Kept Authorities Busy In 2016

PropertyCasualty360: 9 fraudsters join the 2016 Insurance Hall of Shame

Looking ahead to 2017

Is it just us or is the world a little too volatile right now for the usual torrent of predictions for the coming year? Here are a few intrepid folks who step out into the abyss:

Paduda: Whither Workers’ Comp in 2017 — Part I and Part II

Risk & Insurance: 2017 Insurance Executives to Watch

Risk & Insurance: Next-Level Solutions for 2017

Occupational Health & Safety Magazine: Looking Ahead to 2017 Automation Trends and Impacts

LinkedIn: The Freelance Economy: Top Trends to Watch in 2017

CBS News: Tech trends to watch in 2017

Bloomberg: The Pessimist’s Guide to 2017

Of general interest

New Yorker: The Five Biggest Business Stories of 2016

USA Today: Trump, turmoil: The top 10 business stories of 2016

Dave Barry’s Year in Review: 2016 — What the … ?

76 of Donald Trump’s many campaign promises

TSA’s Top 10 Most Unusual Finds: 2016 (Video)

The Atlantic: Second Helpings: 2016’s Underappreciated Science, Tech, and Health Stories

Longreads: Best of 2016: Business & Tech Reporting

New York Times: The Year in Pictures

Google: See what was trending in 2016

Twitter #ThisHappened in 2016

 

Health Wonk Review & other news worth noting

December 2nd, 2016 by Julie Ferguson

 

Many folks are still trying to understand the potential impact of the recent election and our health wonks are no exception. Hank Stern hosts this week’s edition at InsureBlog, and in aiming for a palate cleanser, he chooses a soothing theme: Health Wonk Review: Puppies and Kittens edition. Despite the soft veneer, there’s a lot to chew on. Unsurprisingly, the future of the Affordable Care Act aka Obamacare is much on the minds of the wonks. Check it out!

A few other new items that recently caught our attention:

OSHA’s reporting rule is on target – for those who were hoping for an injunction in implementing OSHA’s reporting rule, no luck. A Texas judge denied the injunction. Attorney Matthew C. Cooper has the legal scoop at National Law Review: OSHA Reporting Rule Now In Effect – Injunction Request Denied. Sandy Smith at EHS offers more on what the ruling means where the rubber meets the road: Are You Ready for Recordkeeping? Last Hurdle To Implementation Removed

Undocumented workers – In Business Insurance, Joyce Famakinwa reports on another legal ruling:
Comp benefit cap for undocumented workers struck down:

“A limit on workers compensation benefits for undocumented workers is unconstitutional because it prevents them from being eligible for the same comp benefits afforded to legally employed workers in the state, the Tennessee Supreme Court says.”

Traumatic brain injuries – The Sun-Sentinal reports that Former NFL players file civil suit asking NFL to recognize brain injury disease for workers’ comp:

Retired athletes from South Florida are trying to make the National Football League recognize a traumatic brain disease — linked to repeated head injuries — as an occupational hazard that would be covered by workers’ compensation.
Lawyers for the former NFL players filed a lawsuit Monday in federal court in Fort Lauderdale against the league and NFL teams, including the Miami Dolphins, on behalf of more than 140 retired players who may have chronic traumatic encephalopathy, known as CTE.

Also ee Andrew Simpson’s report in Insurance Journal: NFL Players with CTE Sue to Force Teams to Pay Workers’ Compensation Benefits

Trump’s Cabinet – Joan Lowy and Jonathan Lemire of Insurance Journal look at Elaine Chao’s past record as labor secretary under President George W. Bush and how it might impact her approach as head of transportation in Trump’s Transportation Chief’s Record Signals Slowdown in Safety Regulation:

Among the pressing issues facing the next transportation secretary will be how to boost the nation’s aging infrastructure so that it can accommodate population growth and not become a drag on the economy, modernizing the nation’s air traffic control system, ensuring that new transportation technologies are adopted in a safe manner and responding to a surge in traffic fatalities.

Whether it’s integrating drones into the national airspace, deploying self-driving cars or “some other new technology, she’s not going to be especially inclined to second-guess the industry when they say that this will be safe,” McGarity said.

Healthcare CEOs Opine on the ACA – Harris Meyer of Modern Healthcare reports on a recent survey in CEO Power Panel: No repeal without replace

Healthcare CEOs, Paulus among them, are willing to consider Trump’s healthcare reform ideas. But they have strong concerns about whether his plan would match the ACA’s performance in expanding coverage and slashing the uninsured rate to less than 9%, according to Modern Healthcare’s post-election Power Panel survey, which got responses from 93 of 123 CEOs contacted. Leaders of large hospitals and health systems are disproportionately represented on the panel, but the participants also include CEOs of insurers, suppliers and technology companies, as well as associations representing sectors across the industry.
Beyond the ACA, the CEOs surveyed stressed the need for action to curb the growth of prescription drug prices, with 60% saying that should be a top priority for the new administration and Congress.

Brave new world: Robots Are Growing Tons of Our Food. Here’s the Creepy Part. – Tom Philpott, Mother Jones

“You don’t see self-driving cars taking over American cities yet, but robotic tractors already roar through our corn and soybean farms, helping to plant and spray crops. They also gather huge troves of data, measuring moisture levels in the soil and tracking unruly weeds. Combine that with customized weather forecasts and satellite imagery, and farmers can now make complex decisions like when to harvest—without ever stepping outside.”

Quick takes