Jared Rhoads of The Lucidicus Project hosts this week’s Health Wonk Review, and he dishes up a heaping helping of the blogosphere’s best heath policy posts from the last two weeks. Check it out!
Happy Birthday – to David Williams at Health Business Blog for 6 years of quality healthcare blogging. David is one f the regular Health Wonkers. See his Best of the Blog post for a fine sampling of his work.
More sports-related head trauma tragedy – Earlier this week, my colleague posted about football-related chronic traumatic encephalopathy (CTE). Yesterday, the New York Times featured a story about how hockey brawler Bob Probert also suffered from CTE: “But the legacy of [Bob] Probert, who died last July of heart failure at 45, could soon be rooted as much in his head as his hands.After examining Probert’s brain tissue, researchers at Boston University said this week that they found the same degenerative disease, chronic traumatic encephalopathy, whose presence in more than 20 deceased professional football players has prompted the National Football League to change some rules and policies in an effort to limit dangerous head impacts.”
Bill review – Are you getting what you pay for with medical bill review? At Managed Care Matters, Joe Paduda takes some of the mystery out of the equation in his discussion about what your savings should be from your work comp medical bill review program.
Criminal indictment for Massey mine official – Hughie Elbert Stover, the chief of security for Massey Energy’s Upper Big Branch Mine has been charged with two felonies related to the April 2010 explosion that killed 29 coal miners. He is accused of lying to investigators and destroying records. On his blog, reporter Ken Ward asks if this is just the beginning of indictments.
Don’t mess with Texas – If you ever use the words “workers compensation” and “Texas” in the same sentence, you better think twice. TX law blogger John Gibson has been issued a “cease and desist” order and threatened with further legal action for his TX Workers Comp Law Blog for having the temerity to use the words “workers compensation” and “Texas” in his blog. We can’t get Gibson’s take because his blog appears to be down (www.texasworkerscomplaw.com), but Julius Young posts the scoop on the Texas workers comp language imbroglio at his Oakland Workers Comp Blog. If you don’t see his post – or ours – please blame Texas. Just to be on the safe side, from here on out we may begin referring to Texas as “Exas-Tay.”
Sedgwick acquires SRS – In a major move in the world of third party administrators, Sedgwick completed the purchased of Specialty Risk Services for $278 million. SRS was the claims TPA arm of The Hartford. In his bog on the Hartford Courant, Matthew Sturdevant reports that: “The deal makes Sedgwick CMS the largest independent North American provider of claims administration services. The combined companies will have annualized revenue of about $1 billion as well as almost 8,500 employees.”
Devil’s in the details – Yvonne Guilbert of Complex Care Blog posts two concrete incidents that show how one small detail missed in home care could easily end up costing $50,000 or more.
Safe hiring practices – As the economy ramps up, new hires will increase an employer’s potential for workplace injuries. At MEMIC Safety Blog, Greg LaRochelle says that a new employee is 5x more likely to have a lost-time injury than a more experienced worker, and that 40% of all workers injured on the job have been on the job for less than a year. He posts about hiring practices to help mitigate risk.
Hiring Vets – HR Daily Advisor offers a good roundup of tips and advice for hiring returning veterans. The post includes questions to ask and to avoid during the interview.
Short Takes
AIG results and workers comp
Four steps to evaluate absence policies
Insurance Fraud Hall of Shame 2010
Smiling makes the world go round
7 wellness benefits employees want most
Posts Tagged ‘head trauma’
Health Wonk Review, CTE, bill review, messing with Texas, and more
Thursday, March 3rd, 2011Traumatic brain injuries (TBI): in the workplace and in the field
Thursday, March 11th, 2010The Brain Injury Association reminds us that March is Brain Injury Awareness Month, so it was timely to see that our colleague Peter Rousmaniere has an important piece on brain injury recovery in the current issue of Risk Management magazine: Gray Matters: The Employer’s Role in Brain Injury Recovery. It is important for two reasons: it sheds light and hope on the issue of traumatic brain injuries and the improved prospects for recovery, including return to work; and it serves as an illustration of some important differences between workers compensation and group health
The article notes that each year, 50,000 Americans die of a traumatic brain injury and 235,000 are hospitalized. There really aren’t good statistics to tell us the prevalence of work-related brain injuries. Although there are better statistics available for what Rousmaniere calls “the signature wound of today’s wars,” many think that the estimate of 320,000 war-related traumatic brain injuries may be on the low side.
The good news, as Rousmaniere documents with examples, is that with proper medical care there have been great advances for a type of injury that was once written off as lost cause: “In the past, many adults with work-related traumatic brain injury were simply warehoused. But with advances in treatment and care strategies, including an employer that is ready and willing to help in gradual return to work, many survivors of severe brain injury can regain most of their former way of life.”
Part of the challenge is early identification, rapid response, and aggressive treatment early in the injury, and aggressive recovery goals. Patients who are treated in the workers comp system, where care is often managed and coordinated and where insurers and employers aggressively advocate for recovery and return to work, often have an advantage over those patients treated under group health. With workers compensation, employers/insurers have financial responsibility for the life of a claim and, therefore, more incentive to work towards maximum recovery. Rousmaniere cites a case manager who says, “You have a workers compensation brain injured patient who is in the same hospital room as a nonworkers compensation patient, and the difference in resources is like night and day.”
Rousmaniere cites examples of successes, along with best practices that contributed to those successes – including the important role that the employer can play in maximizing recovery, some of the challenges that occur, and some of the best practices:
As with all successful brain injury recoveries, job coaching is a critical phase that demands employer participation. Rehab counselors often make the trip with the worker back to her or his workplace. Memory failure, a signature feature of brain injury, is sometimes best treated, in part, at the physical site of the employer. So for several months, the vocational specialist helps the worker find ways to organize the day, reinforce memory and work with others. In this way, the patient’s prospects for recovery are greatly improved.
Department of Defense embarks on more aggressive brain injury screening program
Rousmaniere discusses the prevalence of war-related TBI and some of the promising medical advances. He cites the recovery of reporter Bob Woodruff, perhaps one of the cases that we are all most familiar with due to the news coverage. After returning to his job as a reporter, Woodruff became an advocate for our soldiers in the field, developing a ReMIND, a foundation to provide resources and support to injured service members, veterans and their families.
In speaking of his own recovery, Woodruff praised the quality of the care and support that he received, but saw with dismay that such treatment and recovery resources were not always available to service members with similar injuries. He saw the military culture as often stigmatizing or impeding screenings, and treatment options being limited once a vet returned home. That’s why the Department of Defense’s recent policy announcement is such welcome news: head-injury evaluations will be mandatory for all troops who suffer possible concussions. Moving to an incident-based response is a significant change from prior protocol, which depended on service members to self-identify with a complaint. The weakness in this approach is that service members are highly mission-focused and can shrug off complaints that can later prove to be serious problems.
America’s Heroes at Work is a U.S. Department of Labor project that addresses the employment challenges of returning service members living with Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD). The resources and links pages are particularly helpful – and a good resource for employers who are working with either vets or non-vets who are recovering from TBIs.
TBI resources
Brain Injury Association of America
Survivors’ Voice
Traumatic Brain Injury Survival Guide
Brain Injury Resource Center
Concussions: A Softening in the NFL’s School of Hard Knocks
Tuesday, December 1st, 2009Hines Ward is the epitome of the NFL tough guy. As a wide receiver for the Pittsburgh Steelers, he is known for his flamboyant personality and his ability to give and take ferocious hits. He was the most valuable player in Superbowl XL. In his pursuit of athletic excellence, he is a gambler. No, he is not betting on games. He is betting with his own life.
In the course of his football career, Ward has suffered numerous concussions. But he continues playing. He has even lied about his symptoms, so that the doctors would allow him to keep playing.
In this regard, Ward is part of the mainstream culture of professional athletics. Play today, pay (perhaps) tomorrow.
Until recently, the NFL was complicit in allowing players like Ward to gamble away their futures in the interest of the next game. The league’s leading advisor on concussions, Dr. Ira Casson, routinely dismissed every outside study finding links to dementia and other cognitive decline, including three papers published by the University of North Carolina’s Center for the Study of Retired Athletes.
The NFL is in the midst of a major change of policy regarding concussions. Dr. Casson has resigned. The league is requiring teams to have an independent consulting neurologist examine players with concussions. They have finally acknowledged what has been obvious for years: repeated concussions, especially when occuring over a relatively short period of time, can have a devastating effect on the brains of athletes. Well, duh!
Roethlisberger Sits, Ward Frets
Hines Ward came face to face with the new, more cautious NFL this past weekend, when star quarterback Ben Roethlisberger sat out a crucial game against the Baltimore Ravens. He suffered a concussion the prior week, when his head collided with the knee of an opposing player. Even though he practiced with the team all week, Big Ben suffered from recurring headaches toward the end of the week. At the last minute, the coach kept him from the game and substituted a relatively inexperienced quarterback. The Steelers lost.
After the game, Ward said the Steelers players were split 50-50 on whether Roethlisberger should have played. Ward added that, “these games, you don’t get back.”
“I understand what the league is doing,” he said. “I don’t judge another man.”
He went on to say: “We needed him out there. We wanted him out there. This is the biggest game of the year. We lost and we kind of dug ourselves a hole. Me being a competitor, I just wish we would’ve had all our weapons out there. It’s frustrating.”
Paradigm Shift: Sudden or Gradual?
The NFL will never be for sissies. Nonetheless, the policy shift on concussions is long overdue and most welcome. However, it may not be easy to enforce. Players like Ward may soon learn to remain silent on critical symptoms (dizziness, headache). They may avoid talking to the team doctors so they can stay in the game. These old school tough guys might even call out teammates who choose a more cautious route. As the legendary coach Vince Lombardi supposedly said: “Winning isn’t everything. It’s the only thing.”
Well, not quite. There are many things in life that are a lot more important than winning. Just ask one of the many retired NFL players with Parkinson’s or dementia.
In the conventional workplace we tend to fret about people with minor injuries, who may resist returning to work even though it is safe to do so. In professional sports, it’s usually the opposite: athletes will do almost anything to get back into the game, even jeapordize their future health. Just as we could use a little more of a “get me back in the game” attitude from reticent employees, we need to recognize that concussions require time to heal. Toughness is fine in its place, but let’s not be stupid about it. A game is just a game, a job is just a job. Neither is worth a single life.
Promising PTSD and TBI research holds hope for better treating injured veterans
Wednesday, November 11th, 2009On this Veteran’s Day, here’s a salute to all the veterans and active military service members out there. In the shadow of the horrific events at Fort Hood, this day of commemoration takes on a particular poignancy.
Here at Workers Comp Insider, we have a tendency to view things through the lens of dis-ability and the restoration work-ability because that’s the nature of what it is that we do. So we were particularly intrigued to read about new research that is offering hope to unlock some of the secrets of post traumatic stress disorder (PTSD) and traumatic brain injuries (TBI), two of the most frequent and debilitating types of injuries sustained in Afghanistan and Iraq.
Powerful new scanning techniques are allowing doctors to see how the brain changes with such injuries, and doctors are learning that there are many similarities in these injuries, including symptoms like memory and attention problems, anxiety, irritability, depression and insomnia. This leads researchers to believe that the two disorders share brain regions.
“A brain processing system that includes the amygdala — the fear hot spot — becomes overactive. Other regions important for attention and memory, regions that usually moderate our response to fear, are tamped down.
“The good news is this neural signal is not permanent. It can change with treatment,” Hayes says.
Her lab performed MRI scans while patients either tried to suppress their negative memories, or followed PTSD therapy and changed how they thought about their trauma. That fear-processing region quickly cooled down when people followed the PTSD therapy.
It’s work that has implications far beyond the military: About a quarter of a million Americans will develop PTSD at some point in their lives. Anyone can develop it after a terrifying experience, from a car accident or hurricane to rape or child abuse.”
These physical signs that tests are revealing hold the potential to greatly enhance a physician’s ability to accurately diagnose and treat PTSD – an illness that is often unrecognized and untreated. While there is heightened awareness of PTSD, it can be difficult to diagnose and there are limitations for establishing accurate prevalence rates.
Additional Resources on PTSD and TBI
National Center for PTSD – with resources for veterans, the general public, providers, and researchers
Veterans: where to get help for PTSD
Post-Traumatic Stress Disorder (PTSD) – from the National Institute of Mental Health
Post Traumatic Stress Disorder Gateway
Defense and Veterans Brain Injury Defense Center
Traumatic Brain Injury Information Page – from the National Institute of Neurological Disorders and Stroke (NINDS)
Traumatic Brain Injury – from the CDC
