Taking Credit When It’s Due (And When It’s Not)

September 20th, 2017 by Tom Lynch

Politicians have proven over and over again to be the most adept people in the known universe at taking credit for good things happening with which they had absolutely no involvement and blaming others for bad things happening with which they were directly connected. Case in point is happening right now in the Hawkeye state of Iowa where workers’ compensation rates for 2018 are going down 8.7%.

About a nanosecond after NCCI announced the rate reduction, Republican Governor Kim Reynolds issued a press release claiming the rate decline to be the “direct result” of workers’ compensation legislative reforms that went into effect in July, which, if you happen to be counting, ended 51 days ago as I write this. Phew. That was quick.

Of course, while the new reforms may reduce costs in the future, they have nothing at all to do with the recently announced rate cut, which, according to NCCI, is predicated on a decrease in claim frequency and actuarial data from 2014 and 2015, which, if you’re still counting, is a full 18 months before the new reforms, to whose sticking post Reynolds has now glued himself.

It will be interesting to see, over time, if the new reforms reduce costs for Iowa’s employers and enhance care for its injured workers. That’ll be a neat trick for which Kim Reynolds can justifiably stand up and take a bow at some date in the future, say around 2019.

Here’s a little ditty to go out on:

It’s a little early for the Reynolds curtain call
But if things don’t work out, who takes the fall?

 

Automation Designed To Keep People Safe Can Produce The Opposite Result Through No Fault Of Its Own

September 18th, 2017 by Tom Lynch

A fascinating article in today’s Daily Alert from the Harvard Business Review describes how our dependence on automation can erode cognitive ability to respond to emergencies.

In “The Tragic Crash of Flight AF447 Shows the Unlikely but Catastrophic Consequences of Automation,” authors Nick Oliver, Thomas Calvard and Kristina Potocnik, professors and researchers at the University of Edinburgh Business School, report on their analysis of the horrific crash of Air France flight 447 in 2009. Their research, recently published in Organizational Science, describes in riveting detail the series of preventable cascading events that led to the deaths of all 228 passengers and crew.

Although the crash of AF447 is a transportation tragedy, it also can serve as a stark reminder that employees who depend on technology, especially technology that controls dangerous work, say self-driving 18-wheel trucks, for example, need a lot of training to take the right steps when technology reacts to emergencies. Without that training, the authors contend, the cognitive ability to take manual control and successfully deal with the emergency is problematic at best.

The authors provide an example:

Imagine having to do some moderately complex arithmetic. Most of us could do this in our heads if we had to, but because we typically rely on technology like calculators and spreadsheets to do this, it might take us a while to call up the relevant mental processes and do it on our own. What if you were asked, without warning, to do this under stressful and time-critical conditions? The risk of error would be considerable.

This was the challenge that the crew of AF447 faced. But they also had to deal with certain “automation surprises,” such as technology behaving in ways that they did not understand or expect.

The point here is the technology offering up the “automation surprises” was doing exactly what it was programmed to do. The technology did not fail; the pilots, all three of them, failed in their response to the “surprises.”

We are now at the beginning of a monumental shift in the way work (and play) is done. The natural gravitational movement of artificial intelligence assuming more and more control in our daily lives is unstoppable. Think of how it has brought tremendous improvements in air safety. To prove that, consider this astounding statistic: In 2016 the accident rate for major jets was just one major accident for every 2.56 million flights. But this bubble of safety can breed terrible complacency. How humanity deals with and prepares for the rude “automation surprises” that will surely come along on the way to the future should be a critical component in the thinking of organizational leaders and safety professionals.

 

News Roundup: Health Wonk Review and news from our bookmark file

September 15th, 2017 by Julie Ferguson

loudspeakers

Health Wonk Review kicks off the fall season with The Neverending Summer of Healthcare Legislation Edition posted by Louise Norris at Colorado Health Insurance Insider. It unfolds against the backdrop of the continuing ACA saga, with not one but two new bills introduced: Senator Sanders’ single-payer bill and Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson’s ACA repeal/replace bill. This issue covers single payer, opioid abuse, drug pricing, hurricane recovery workers, hospice care, medical innovations, the return of hookworm in the US, and more.

Louise has a sterling reputation as an informed commentator on the evolving ACA matters, contributing to a variety of blogs. If the ACA ison your radar, be sure to see her many entries at healthinsurance.org.

Meanwhile, in the midst of the ongoing debate, it is worth noting that 3 years after the Affordable Care Act’s coverage expansion took effect, the uninsured rate fell to a record low of 8.8%, in contrast to 17% in 2009. The number of people without healthcare insurance fell to 28 million, down from 50 million. The number of uninsured fell dramatically from 42 million in 2013 to 28 million today, when the ACA allowed states to expand Medicaid coverage to low-income people.

Other news of note from our bookmark file

Think you’re an informed health wonk? Test your knowledge in this Kaiser Health News Quiz: How Well Are You Paying Attention?

NCCI: Recovering From a Nightmare: Assaulted Employee Returns to Work in 10 Weeks

Joe Paduda: Costs & Benefits of Disasters and Big changes a-coming in workers’ comp.

Roberto Ceniceros at Risk & Insurance: Ergonomic Sense

Jordan Barab: OSHA Covers Up Workplace Fatalities

Jordan Barab: Undercover: Working and Dying as a Temporary Employee

Bob Wilson: God Vacations in Sarasota, or, What I Learned from Hurricane Irma

ESPN: “Who Does This To People?”

Kudos to our friends at Insurance Recovery Group in naming Paul James as new CEO and President. IRG specializes in subrogation, second injury fund, COLA recovery, and cost containment in work comp and other property/casualty disciplines.

Chikita Mann at WorkCompWire: Cultural Competency and the LGBTQ Injured Worker

Ken Ward: Trump nominates former coal exec to run MSHA and Democratic leader calls for scrutiny of Trump’s mine safety nominee

Cal/OSHA’s disappearing funds – where’s the money?

Workers compensation renewal rates remain negative

Gig Economy Workers May See Benefits Relief via Portable Benefits for Gig Economy Workers Act

WCRI Study: Fewer Injured Workers Prescribed Opioids After Kentucky Reforms

Overtime rule scrapped but there’s likely to be a new one

House approves bill to speed autonomous vehicle development

Scanning The Future, Radiologists See Their Jobs At Risk

Medical school debts run $180,000 on average per student

Check out this clip of the world’s first drone equipped with robotic arms

And in more technology developments, the chairless chair

One of America’s Most Dangerous Jobs

September 13th, 2017 by Julie Ferguson

Kicked, pummeled, taken hostage, stabbed and sexually assaulted … would you want a job that included these risks? In One of America’s Most Dangerous Jobs, the Washington Post shines a spotlight on the dangers in the nursing profession, specifically around the violence that they encounter on the job. Citing a recent GAO report on violence in healthcare profession, the article notes that, “the rates of workplace violence in health care and social assistance settings are five to 12 times higher than the estimated rates for workers overall.”

Here’s one excerpt from the article:

“In Massachusetts, Elise’s Law, which is named for the nurse who was attacked in June, is already on the fast track to set state standards for workplace protection. Legislators were working on this months before Wilson was stabbed.

Nurses in Massachusetts were attacked more frequently than police or prison guards. When association members testified about the violence epidemic this spring, they said nurses had been threatened with scissors, pencils or pens, knives, guns, medical equipment and furniture in the past two years alone, according to the Massachusetts Nurses Association.”

OSHA reports that in surveys conducted by various nursing and healthcare groups:

  • 21% of nurses and nursing students reported being physically assaulted and over 50% verbally abused in a 12-month period
  • 12% of emergency department nurses experienced physical violence and 59% experienced verbal abuse during a seven-day period
  • 13% of employees in Veterans Health Administration hospitals reported being assaulted in a year

 

While 26 states have workplace safety standards for health-care facilities, there are no federal standards. Nursing groups say that state efforts have helped increase awareness.

NIOSH worked with various partners – including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. – to develop a free on-line course aimed at training nurses in recognizing and preventing workplace violence. The course has 13 units that take approximately 15 minutes each to complete and includes “resume-where-you-left-off” technology. Learn more about the courses at Free On-line Violence Prevention Training for Nurses and the actual course can be accessed here: Workplace Violence Prevention for Nurses CDC Course No. WB1865

Related

 

 

 

Fresh Health Wonk Review & a summer news roundup

August 17th, 2017 by Julie Ferguson

Fresh Health Wonk Review! Looking for some beach reading? The wonks have you covered. Peggy Salvatore posts The Summer Lull Edition of Health Wonk Review at Health System Ed blog – catch up on what’s been happening in the last few weeks, from autopsies of the ACA repeal to where we go from here and assorted other health topics, the wonks have you covered – check it out.

man reading laptop on a beach

 

More summer reading:

Healthcare reform implications for work comp – Not included in this week’s HWR but a must-read nonetheless, in a two-part series at Managed Care Matters, Joe Paduda breaks down the likely implications for workers comp, Medicaid Expansion and more. Part one is linked above, and here is part 2.

They Got Hurt At Work — Then They Got Deported – Most workers comp laws have upheld workers comp for workers regardless of status: if the employer had the benefit of the labor and the worker is injured, generally comp will pay for those injuries. NPR looks at how that is changing and how some state laws are targeting undocumented workers.

Opt Out is Going to Return, and Why We Should Pay Attention – Think opt out was killed with the OK Supreme Court decision? At Bob’s Cluttered Desk, Bob Wilson talks about why that’s not likely and where the debate is going from here.

WCI 2017 – Miss the recent conference? Here are a few folks who have you covered: WCI has a good conference roundup and Conference Chronicles features good recaps of sessions.

Mourning writer Lizzie Grossman: The Pump Handle readers will miss her – We were sad to learn of Lizzie’s passing, a journalist and blogger who covered important environmental health issues. Her voice will be missed.

Quick Takes

 

In closing, Apparently, robots aren’t quite ready to take our jobs

Medical Care Experts: Where Would We Be Without Them?

August 7th, 2017 by Tom Lynch

If you’ve been following the blog-o-sphere and the LinkedIn-o-sphere, you know that the space is crowded. Lots of workers’ comp practitioners have glommed on to the idea that the way to get ahead is to write and post frequently. Connect with more than 500 others in the profession. Write something, anything, put your name on it and throw it up against the wall to see if anything sticks. Kind of the way Garrison Keillor used to say he changed socks on a book tour.

Every once in a while, something helpful and interesting appears and gains a bit of temporary caché for itself and for its author. Mostly, the topics center on the persistent rise in medical costs and, even more often, on the insidious and often criminal use of opioids, which a regrettable number of alleged doctors, having checked their Hippocratic Oath at the door, are prescribing at a hell-bent-for-leather rate at a hell-bent-for-leather profit. The poor, unfortunate souls for whom these scripts are written are nothing more than high-cost collateral damage.

Consequently, efforts to control workers’ compensation costs are now almost entirely dedicated to reining in costs associated with medical care with a huge emphasis on prescription drugs.

And why not? Injury frequency continues its 13 year, asymptotic approach to zero. While the same can’t be said for injury severity, these are, nonetheless, heady times for insurers. Kind of hard not to make money when the combined ratio is in the 90s.

Regardless of how good things are getting in workers’ comp world, the workplace is still the best place to control and manage the work injuries and costs that are bound to occur despite frequency’s decline and the rise of the robots. But that requires educated employers who understand that they, not the vendors to whom they outsource payment responsibilities, are the hub of the workers’ comp wheel.  Who approach workers’ compensation in a Management 101 kind of way understanding that a systemic, accountable process will reduce costs to a minimum and bolster profits as well as employee morale and productivity.

This means training supervisors in the proper response to work injuries, keeping close communication with injured workers, creating good relationships with treating physicians, bringing injured workers back to work as soon as possible under medical supervision, seeing that injured workers receive full pay while on modified duty, and measuring success every month just as one measures success in every other business enterprise.

These, and other program components, give enlightened employers a distinctive competitive advantage, and the results will speak for themselves.

But not all employers are enlightened; many have lost their way. Why?

Well, could it be we took a system we had made relatively simple for employers to manage (and let’s not forget that it is employers who ultimately pay the bills) and made it progressively more complicated with progressively more vested interests?

Many middle market employers, realizing they have no hope of navigating the haunted house maze medical care has become, have relinquished control to a myriad of vendors, the “experts.” Climbing this Tower of Babel is beyond them.

The question is: Can we do anything about this? Should we? Or, has this ship long ago sailed?

July Health Wonk Review

July 25th, 2017 by Julie Ferguson

Repeal? Replace? Steve Anderson has posted the “Are We There Yet?” Edition of Health Wonk Review at healthinsurance.org blog, a timely edition as a pending vote of one or another of the previous bills is scheduled to come before the Senate today — although no one knows for certain which Trumpcare bill legislators will be voting on – including the legislators themselves. Will it be just for a pure repeal, deferring the hard decisions to some future date? Or the House Bill? Or Senate Bill I, Senate Bill II, a hybrid, or some entirely new animal? Who knew healthcare could be so hard? Stay tuned.

Needless to say, the wonks have opinions on this mess and are not shy about voicing them. Read what some of the best minds in the health policy blogosphere are saying.

 

 

High hazards, gruesome deaths; farm worker safety programs facing cuts

July 19th, 2017 by Julie Ferguson

Farm work is dangerous work. Injuries and fatalities are gruesome – amputations, death by being caught in machinery or rolled over by tractors; drownings in manure pits; suffocation in grain bins. More than 5,000 agricultural workers in the U.S. died on the job between 2003 and 2011, a death rate that OSHA puts at seven times higher than average.

The Idaho Statesman recently featured a troubling but excellent story by Audrey Dutton on two workers who drown in manure pits, a well-known fatality risk in agriculture. While all farm workers face risks – including child workers – the high fatality rate is worsened by the high rates of immigrant workers – both legal and illegal – who may have a poor grasp of English, or who are reluctant to make waves, particularly with the recent ICE crackdowns. These While many farms are good to their workers, there are also many who exploit them.

“We would characterize those employees as vulnerable workers,” said Jordan Barab, who was deputy assistant secretary of OSHA in the Obama administration and now writes Confined Space, a newsletter about worker safety. “Some of them are undocumented, but even those who are documented have come from other countries where, let’s say, the government is not friendly.”

These workers tend to be suspicious of government and unaware that OSHA exists or that they have rights. A complaint can put them at risk of getting fired or deported, Barab said.

“This is a group OSHA has a hard time reaching,” he said.

At Sunrise Organic Dairy in Jerome County, workers did not know about OSHA and were concerned about working near the manure pit the winter Vazquez-Carrera died, according to someone who knew him, who asked not to be identified because of fear of retribution.

In addition to immigrant and non-English speaking workers, children are another vulnerable population at high risk of injury on farms. Small farms – particularly family farms – are unregulated because OSHA cannot inspect farms of 10 or fewer non-family workers, even when fatalities occur. Plus, many of the recordkeeping rules that OSHA was implementing have been rolled back, meaning that many injuries and deaths will continue falling under the radar. These statistics are important for targeting agricultural safety and prevention programs, as well as for targeting enforcement efforts.

OSHA programs are cash-strapped and about to be even more so. Jordan Barab of Confined Space documents how the House budget devastates OSHA and MSHA enforcement. Having served as Deputy Assistant Secretary of Labor at OSHA from 2009 to 2017, he should know.

In addition to enforcement cuts, many prevention programs will be affected – here’s a concrete example: Farm safety funding could be uprooted. The article talks about rollovers, which are the top cause of farm injury and death. But under the president’s proposed budget, one of the key prevention programs – National ROPS (rollover protection system) Rebate Program – would be hurt by budget cuts to the National Institute for Occupational Safety and Health.

In the abstract, cutting regulations and federal budgets can seem like a good idea, but they can have real world health and safety implications. We don’t think worker safety or public health should be on the chopping block. These investments are often a cheap dollar. Measured in either lives or dollars, we earn incalculable savings through the prevention efforts of the Centers for Disease Control, OSHA and NIOSH. Earlier this year, the $11 million Chemical Safety Board was scheduled for elimination, but after much public outcry, the House budget calls for CSB funding to be restored.

 

Related: Agriculture Health & Safety

Lost Both Arms and a Leg: Life and Death for Farmworkers

Walking down the grain … and the fines

Grain Bin Safety

Call to action for teen farmworker safety: Two boys lose legs in OK grain bin auger accident

A survivor’s story: Iowa teen advocates for farm safety after her near-fatal encounter with a power take-off shaft

NIOSH – Agriculture Safety

National Farmers Union – safety videos and practices

Health Wonk Review on AHCA and other health policy matters

June 23rd, 2017 by Julie Ferguson

The secret Senate Republican gang of 12 finally came out from behind closed doors and Joe Paduda is on the case to help analyze the legislation that will have a profound impact on one-sixth of the nation’s economy. Joe’s posted a Double Edition of Health Wonk Review at Managed Care Matters, which includes a great roundup of health policy issues from our usual wonks, as well as a selection of posts and articles related to yesterday’s repeal & replace for the Patient Protection and Affordable Care Act. If you’re trying to make sense out of the AHCA and its potential impact, this post will help. If Republican leaders stick to their aggressive schedule of passing things before the July Fourth holiday, there’s not a lot of time to get up to speed!

Eight Steps To Controlling Workers’ Compensation Costs: Conclusion

June 2nd, 2017 by Tom Lynch

This is part 3 in a 3-part series. Here are parts 1 and 2.

Step 6 – Establish a partnership with your claim service provider

It is not the job of the insurer or third party administrator (TPA) to solve your workers’ compensation problems. That is something you do together. The insurer or TPA administers and manages your company’s claims according to relevant law and brings a diverse array of claims-related services to the table, including utilization reviews, intensive case management for catastrophic injuries and investigation of dubious claims. Your goal should be to develop a close working partnership. On your side, you need to report claims immediately, establish good documentation to serve as the basis for the insurer’s work and work with your adjusters and medical providers to bring injured workers back to work in any medically appropriate capacity as soon as possible.

Together, you and your insurer or TPA should maintain a steady and consistent focus on every open claim. Use all the tools and resources available to return your injured workers to the job; where this is not possible, work diligently to reach agreement on the appropriate way to achieve closure on the case.

Step 7 – Measure and track results

You know the drill – what you measure becomes important.

Be sure to establish clear objectives for what you want to accomplish and communicate them in concrete terms.

Here are three simple, but effective, ways to measure performance. These are measurements that senior management can readily understand and track on a monthly basis (we wrote about the need for simplicity in performance measurement recently here).

First, measure the total costs of losses per full-time-equivalent (FTE) employee (divide the total number of hours worked by 2,000 to get the number of FTEs). Doing so factors out both overtime and part time employment.

Second, measure the cost of losses per hundred dollars of payroll. Compare this to the premium classification rate at the time of the injury to find out if your loss costs are excessive.

Third, measure days lost due to injury per every 200,000 hours worked (equivalent to one hundred employees working 2,000 hours per year). This is the OSHA Severity Rate and is an excellent way to measure lost time.

With this data in hand, ask your insurance broker or carrier what the averages are for these metrics in your industry. They should be able to tell you. Then, benchmark yourself against your industry and yourself.

Track results and report them just as you would track and report production or quality objectives. Moreover, discuss the results with employees. If senior management pays consistent attention to the organization’s loss reduction performance, everyone else will, too.

Another measurement factor focuses on accountability: make support of and participation in your injury management system an ongoing part of performance reviews for management and supervisory staff. Not doing this sends a subtle message – safety and injury management are really not that important at your company.

Step 8 – Define and communicate responsibilities

In a well-coordinated injury management system, everyone knows his or her proper role and responsibilities. Each person must understand how to respond. Injured workers must immediately notify supervisors of any injury. Supervisors must respond in a caring manner and make sure that workers who sustain injuries are escorted quickly from the work site to the right medical provider. Supervisors also are charged with analyzing accidents and taking steps to ensure they don’t happen again. Supervisors should thoroughly document accidents and injuries with the assistance of injured workers. And senior management should follow through by making sure that corrective action identified actually does occur.
It is a truism of business that well-defined responsibilities go a long way toward assuring that objectives are met or exceeded. Workers’ compensation cost control is no different.

We recommend that, among other program documentation, you create a simple brochure that might be called, “What to do when you’re injured on the job.” The brochure should say what employees should do and what management will do. It should describe your Modified Duty Program and accident investigation protocols. It should hammer home the need for every injury to be reported during the shift on which it occurs.

Conclusion

Workers’ compensation is not an insurance problem. It is a management problem. Employers committed to taking control can reduce costs significantly. At the same time, their companies will benefit from improved morale and productivity. Like so many of life’s thorny issues, workers’ compensation can be managed if you only have the will to do it.