Posts Tagged ‘healthcare’

Co-Morbidities and the Cost of Claims

Wednesday, December 5th, 2012

NCCI Holdings has issued a report on the impact of co-morbidities on workers comp claims. While there are few surprises, the research is able to point toward a handful of specific conditions that are most likely to drive up the cost of a claim: hypertension, drug abuse, chronic pulmonary problems and diabetes. The research also confirms a particular red flag that has frequently been the focus of this blog: the impact of the aging workforce on the costs of workers comp.
The overall scale of the co-morbidity problem is relatively modest: only 6.6 percent of claims involve workers with co-morbid conditions that directly impact their treatment; however, this reflects a nearly a three fold increase between 2000 and 2009. In those claims where co-morbidities are a factor, the cost of medical treatment is double that of less complicated claims. Co-morbidities begin to show up in workers in their mid-30s and rise with age. Workers with co-morbidities are more likely to work in contracting or manufacturing – as opposed to clerical/office and goods and services. Finally, injuries to workers with co-morbidities are more likely to involve lost time, transforming what might normally be a medical-only claim into one involving indemnity.
The majority of claimants with co-morbidity diagnoses are male: 65 percent of all claimants, 73 percent of claims involving drug abuse, 68 percent of claims involving diabetes and 67% of claims involving hypertension. This may also correlate to the fact that men are more likely to be involved in physically demanding jobs, where co-morbidities would have more of an impact on recovery.
American Health
The study notes that illness rates in the general population are increasing, especially in the areas of hypertension, obesity and diabetes. As the incidence rates increase in the general population, the workforce will mirror this growth. While workers with co-morbidities currently comprise only 6.6 percent of injured workers, we should expect to see a steady climb in that percentage over time..Amercian workers reflect American health.
It will be fascinating to track the impact of (virtually) universal healthcare – AKA Obamacare – on workers compensation. For starters, we can hope for earlier diagnosis and treatment of serious health problems. Where workers without health insurance were highly unlikely to undergo treatment for their non-work related conditions, insured workers may receive treatment. Where uninsured workers were only covered by workers comp – and then only for work-related injury and illness – insured workers will have access to preventive care all along. This might help to contain the growth of workers comp costs.
As always, medical treatment under workers comp represents just a miniscule portion (about 3 percent) of total medical costs in America. There is an elephant in the room and it isn’t us. But what happens to that elephant will impact the unique, 100 year old public policy experiment that is workers comp. In this era of data mining, there will be much data to be mined.

Health Wonk Review and assorted news of note

Thursday, April 12th, 2012

Brad Wright of Wright on Health tees up all the health wonkery this week as he hosts Health Wonk Review: A Masterful Edition.
Texas – Texas does things differently and their work comp program is true to course. Employers are not mandated to have workers comp insurance – they can opt out. According to a 2010 survey, 15% of businesses with 500+ employees choose to opt out. And now Walmart is opting out of work comp in Texas. See more on this at PropertyCasualyt360, including a graph of market share for the top 10 insurers comparing 2010 to 2011: Concerns Arise over Texas Workers’ Comp. State System After Walmart Drops Out
Mississippi reform – Mississippi is working on workers comp reform and we note that one provision about “medical proof” establishes a pretty high bar to hurdle for some injuries; for example, a back injury: “It also would require a worker to provide the employer with medical proof that an injury or illness is a direct result of the job if the worker’s claim is contested.”
Dirty Business – Is workers’ comp dirty? Some people seem to think so and Dave DePaolo considers whether there’s more to the frequent use of the term than coincidence. See Work Comp and Dirt – Do They Have to be Synonymous?
Florida drug warsTampa Bay Times says that drugstores are the new focus of painkiller investigations. From the article: “The U.S. Drug Enforcement Administration says that in 2009 no Walgreens retail pharmacies were listed among the DEA’s top 100 Florida purchasers of oxycodone — a key ingredient in OxyContin, Percocet and Percodan. / By 2011, 38 Walgreens made the list. By February, the total reached 53 of the top 100. So says a warrant filed last week in U.S. District Court for the Middle District of Florida. / In Fort Myers, the DEA says one Walgreens pharmacy sold more than 2.1 million oxycodone pills in 2011. That’s more than 22 times the oxycodone sales at the same pharmacy two years earlier.”
Healthcare’s 1%Who are the chronically costly? The costliest 1% of patients consume one-fifth of all health care spending in the U.S., according to federal data. Doug Trapp of amednews digs into the data to profile the most costly patients and where so much of the medical spend goes.
From the courts – Fred Hosier of SafetyNewsAlert has an interesting post about whether workers comp will be on the hook for prescribed drug’s side effects. He cites a case related to a West Palm Beach police officer who has filed for additional workers’ comp benefits for the treatment of his gynecomastia, an excess growth of breast tissue, a side effect of medication he was prescribed to treat a work-related injury. Initially denied, an appeals court has reopened his claim for review by an expert medical advisor.
Occupational Medicine – It’s been a bit since we visited the American College of Occupational and Environmental Medicine (ACOEM) site. ACOEM offers up a few new guides, and a revision of an older guide – Fatigue Risk Management in the Workplace (PDF), Guidance to Prevent Occupational Noise-Induced Hearing Loss and Guidance for the Chronic Use of Opioids.
Affordable Care Act – At Health Care Policy and Marketplace Review, Bob Laszewski looks at what individual health insurance might cost if the court strikes the mandate down and still requires insurers to cover everyone. Hint: a lot.
Briefly….

New study reveals occupational chemical exposure risks for nurses’ reproductive health

Tuesday, March 13th, 2012

Female nurses who have occupational exposure to sterilizing agents and chemotherapy drugs are at least twice as likely to have miscarriages as those who do not have such exposure. Elizabeth Grossman of The Pump Handle offers a summary of a recent study on chemical exposures and nurses’ reproductive health, which was conducted by the National Institute of Occupational Safety and Health, Harvard School of Public Health, and Brigham and Women’s Hospital. The study encompassed more than 7,000 female nurses.
Grossman notes:

Similar effects have been reported before, but this is one of the largest studies ever to look at these exposures, explained Christina Lawson, a reproductive epidemiologist with NIOSH and study author. Because these results reflect adjustment for a number of variables — including age, hours worked, and shift-work — and because the study was designed to avoid overestimation, its findings may be conservative, said Lawson.

While further studies are needed to determine the exact chemical exposures, high on the suspect list are a variety of chemicals used to disinfect medical equipment and surgical instruments, such as formaldehyde and ethylene oxide. In her post, Grossman also talks about the dangers of formaldehyde exposure to beauty salon workers, an issue that was a recent NIOSH Science blog focus: Hair, Formaldehyde, and Industrial Hygiene. Both the Food & Drug Administration and OSHA have issued particular warnings about the Brazilian Blowout, a highly popular hair straightening treatment.

How Doctors Die: It’s Not Like the Rest of Us, But It Should Be

Monday, January 9th, 2012

We’ve bringing you something a bit peripheral to our normal topics today, but it deals with the business of medicine. Plus, it is excellent.
How Doctors Die by Ken Murray, MD talks about how doctors face end of life issues. Many might assume that when faced with a terminal condition, physicians would leverage their expertise and access to the max, harnessing all the latest treatments and technologies. But the picture that Murry paints is a very different one. Armed with the knowledge of just how grueling and terrible the “do everything possible” model can be, many doctors choose to forgo chemo, radiation, surgery, and other life-prolonging treatments entirely.

“What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.”

Some physicians who have participated in or witnessed extraordinary and extreme measures to prolong life – what Murray calls “futile care” – wear “No Code” medallions or tattoos.
Why, if they don’t want this treatment themselves, do they inflict it on patients? Murray explores the many often human reasons why family members and physicians make these choices and points to a system that encourages and rewards excessive treatment and unrealistic expectations about what medicine can do. Plus, as a society, we have a cultural bias against accepting death. Perhaps it was ever so – no one want to die. But advertising, a stay-young-forever culture, pharmacology, and the miracles of technology all conspire to make us think we perhaps can live forever. When someone facing a terminal illness chooses acceptance of the natural order, they are often pressured by family and friends for not being a fighter.
The comments in the article are also well worth reading. Other people — doctors, medical professionals, and “civilians”– offer their thoughts, opinions, and touching real life experiences with family members, friends, and even their own terminal circumstances.

Wide disparity in costs for common medical procedures

Wednesday, July 6th, 2011

All other things being equal, if you had a choice of paying $300 or $1800 for an abdominal CT scan just by going to a clinic or a doctor in a nearby town, would you? It seems like a trick question or a no brainer, but the reality is people are paying the higher cost every day… just because the transparency in health care costs just isn’t there. And this lack of transparency gives rise to a situation where patients can pay as much as 683% more for the exact same medical procedure in the same town.
More and more people will begin to notice the cost differentials as the trend for consumers bearing increased responsibility for healthcare costs continues. Whether through insurance arrangements such as high deductible plans or through assuming a higher proportion of co-pays and other out-of-pocket costs in more traditional plans, more consumers have a direct stake in the cost of healthcare. Yet the average person with a healthcare insurance policy is in the dark about the costs for various procedures and treatments. First, many consumers have been insulated from the cost of anything beyond the price of the insurance policy itself. The unit cost of services and procedures has largely been a matter between the insurer the provider. Secondly, medical care is a highly complex service with little in the way of tools available for comparison shopping. It’s complex enough that even the treating physicians themselves are often in the dark about costs about specific procedures, tests, or medications.
Change:healthcare, a national organization that is trying to establish more transparency in the cost of healthcare, recently released a cost comparison report for several common medical procedures such as MRIs, CT scans, ultrasounds and PET scans. The Q2 2011 Healthcare Transparency Index reports on what they learned about cost variations by examining claims data over the course of a year for 82,000 employees of small businesses. While it’s been widely understood and acknowledged that price might vary greatly depending on what part of the country you are in, this study shows that the price can also vary greatly depending on which side of the street you are on: inter-regional costs fluctuate widely, too.
This wild divergence in pricing is probably less of a surprise to employers, many of whom who have been keeping a close and wary eye on skyrocketing workers’ compensation medical costs. There are no co-pays or cost sharing mechanisms on the workers comp side of the house – the employer underwrites 100% of the associated costs of a compensable injury or illness. Many enlightened employers have been tackling costs on the macro level (outcomes) as well as on the micro level (unit costs) by seeking high-performing physician networks. But even with the buying power and the resources that a large employer can bring to bear, it can still be difficult to get it right when it comes to managing workers’ compensation medical costs.
Whether in work comp coverage or in general health care, many employers have also recognized the role that the individual employee plays in helping to control costs and stem losses – through behaviors both on the job (safety compliance) and off the job (general wellness and healthy behaviors). Wellness and EAP benefits are widespread as a result. In a similar vein with a potential for a win-win outcome, employers should take every opportunity to help employees to become more savvy consumers of health care services.
Here are some consumer healthcare education tools / resources that might be useful in your wellness program:

Single Payer in Vermont: Occ Doc or Not?

Monday, March 21st, 2011

In a move stunning for its contrariness, Vermont is moving toward a single payer health care system. In the course of the debate, the inevitable issue of whether to include workers comp has come up. At this point, a committee will make recommendations on whether to “integrate or align” workers comp with the state’s radical reconfiguration of the health care system. (Further details are available at WorkCompCentral – subscription required.)
The Vermont approach would completely separate indemnity from medical benefits. Employers would continue to pay for the indemnity portion, but are unlikely to have any input into treatment plans. The Insider has pointed out – ad nauseum, some might say – that the relatively miniscule comp system is quite different from the behemoth health delivery system. In the interests of saving the Vermont committee a little time, here are a few of the conundrums confronting anyone trying to merge the two systems:

: Comp is paid solely by employers. Injured workers pay nothing (no co-pays, not deductibles, ever).
: Consumers pay quite a bit for conventional health coverage: a portion of premiums along with co-pays and deductibles for treatment and for medications
: Comp has very narrowly defined eligibility requirements, while conventional health has virtually none
: The goal of comp is to provide medical treatment for injured workers and, if possible, return them to work; if return to work is not possible, comp pays lost wage benefits and injury-related medical bills virtually forever.
: The goal of the conventional health system is to take care of people, regardless of the employment implications
: Comp provides indemnity, temporary or permanent, for those unable to work. No such wage replacements exist in the conventional health system
: Perhaps most important, medical services under comp have an occupational focus, with the explicit goal of returning people to their jobs. In the conventional health system, any occupational focus would be subordinate to the goals of the consumer.

Should Vermont achieve its ambitious goal of universal coverage, the presumption is that everyone would have a primary care physician, who would serve as gatekeeper for all medical services. (Let’s set aside, for a moment, where the Green Mountain state will be able to find these primary care doctors.) In a unified system, injured workers would go to their primary care physicians for work-related injuries. These primary care docs may or may not focus on returning their patients to work. Many people hate their jobs and might welcome a few weeks or months of indemnity-supported leave. The primary care physician might be quite sympathetic to their cause.
This brings us to the great divide between conventional health care and workers comp: conventional health care may or may not embrace the need for return to work. Indeed, if the work is hazardous – as much work is – the doctor may want to discourage his patient from returning to it. The doctor’s goal is to “do no harm” – so why send someone back into harm’s way? If the patient suffers from lower back problems and has a job involving material handling, what is the right thing for the doctor to do?
Who Pays?
In the current system, workers comp pays doctors for eligible medical services. Whether or not they like the comp fee schedules, doctors are acutely aware that comp is paying for the services of a particular individual. Often, treatment is provided by occupational specialists, who bring a unique “return-to-work” focus to the treatment plan. These occ docs are often in communication with employers seeking to return injured workers to productive employment. The occ docs specify the restrictions so that employers can design appropriate modified duty jobs. The employers have a sense of urgency, as they are losing the productivity of the individual who is out of work – and of course, they are paying all of the costs associated with the injury.
Under the proposed Vermont system, all bills will be paid the same way. Comp disappears from the doctor’s view. Employers may have little input into the choice of doctors or specific treatment plans. The role of occupational doctors is unclear, to say the least. Given that primary care physicians generally lack an occupational focus, return to work may become secondary to the comfort and personal inclinations of the patient. As a result, there is a risk of substantial increases in indemnity costs.
When contemplating change on the scale of Vermont’s single payer system, it is tempting to brush aside the implications for something as small as the workers comp system. That would be a big mistake. The system might be small, but the costs to the state’s employers are already substantial and have the potential for going much higher. The comp system plays an unique and long-established role in protecting both workers and employers. As they take steps to transform healthcare in Vermont, lawmakers need to remember that workers comp itself is worthy of their protection.

“The touch of a human hand and tone of voice can do so much in the process we call healing”

Thursday, January 6th, 2011

As long as we’re on the topic of healthcare today, it seems to be an opportune time to share a moving video clip that we bookmarked over the holidays. Marty Ratermann, a Missouri a craftsman and furniture maker, relates his story as a cancer patient at the 2010 Health Literacy Missouri Summit. He was diagnosed with Stage 4 rectal cancer in 2008. After a grueling recovery process, he has been in remission for more than a year. He details how his situation could have been prevented with better communication between him and his doctors.
His story illustrates the difficult path that a person faces navigating the complex healthcare system and making critical choices at a point when he or she is particularly vulnerable. His prescription at the end of the clip is a simple one: take the time and make it a priority to communicate.
I couldn’t help but think of the parallels in the healing process for workers who have experienced a serious injury. Many a claim has spiraled out of control for want of good, clear communication and a simple human-to-human moment of concern. So often, we see workplace injuries that are treated as financial transactions when, in reality, they are fundamentally human events: someone is injured, often through no fault of their own. The complexity of the system a worker may find themselves suddenly thrust into, the unfamiliar insurance jargon, the impersonality – all occurring at a point where the worker may be feeling fear and anxiety about their future physical and financial well being. Our prescription: Less thinking about the injured worker as a claimant and more thinking about them as a person. In our experience, that’s what leads to the best financial outcomes in the long run.

A Patient’s Story from Health Literacy Missouri on Vimeo.

A Question of Language?

Monday, July 19th, 2010

The following guest post was submitted by Gary Anderberg, Phd, the Practice Leader For Outcomes and Analytics at Broadspire.
I was participating in a recent meeting of health, wellness, workers’ compensation and disability professionals. One of the issues on the table was information that the regs defining “Cadillac” plans may loop the cost of wellness programs, disease management and other health related productivity benefits into the total cost of the employer’s health plan for purposes of assessing penalties. If this intelligence is correct and if such provisions become effective, most large employer plans, so defined, will be subject to potentially expensive penalties, thus strongly incenting employers to relegate employee health care to the soon to be created exchanges.
This question stirred up a wide ranging discussion of how to frame the value of health and productivity programs for employers. For the last several years, most of the players in this space have been using the “investment” and “ROI” model, telling employers that they will reap rewards for astute investments in employee health and productivity. As a practical matter, returns on investment have been problematic to quantify. There is broad, intuitive agreement that a healthier workforce is a good thing, but what does it drive to the bottom line?
I suggested a different model — risk management. If trained, knowledgeable, productive employees are indeed a corporate asset — like trucks, buildings, airplanes, equipment, and so forth — then the health and well being of those employees presents a major risk exposure for the corporation in very immediate terms. We know that as the overall well being of a workforce declines, not only do absences of all types go up, but so do opportunity costs and the costs of poor performance and decision making. As absence rates and disability claims climb, more positions are filled by new employees with less experience and training than the absent workers. Mistakes get made, customers do not get the service they expect, and product quality suffers.
I suggested that, properly viewed, health plans, chronic disease programs and all types of effective wellness programs are really risk management tools in much the same way that fleet maintenance is a risk management tool. We assume that companies will maintain their eighteen wheelers and provide safety courses for their drivers, but the health and well being of the person behind the wheel is equally critical to the company’s risk exposure when a truck is on the road.
Every time a company hires a new employee, it takes on a new risk. For every employee on the payroll, from the CEO on down, there is a definite risk cost of employment which is based in large part on that person’s health and well being. So, are health, wellness and productivity programs investments with uncertain returns or are they critical risk management tools which allow the employer an important measure of control over the performance of a key asset — employees? It seems to me that these tools are vital to controlling employment costs and critical parameters of product and service delivery, especially in a world of very lean staffing and just in time management.
To my mind this is not just a question of which metaphor to use. Managing risk is real and the consequences of poor risk management are often dramatic and even tragic. I wonder how many companies would consider handing over the maintenance of their critical manufacturing and distribution equipment to a government program just to save a few bucks. But how many employers may be tempted to do the same thing if the soon to be created healthcare exchanges offer a short term dollar saving?
The words we use to frame decisions can carry massive consequences. If you think about the health and well being of your employees as a risk exposure to be effectively managed to minimize replacement costs and the expense of suboptimal performance and errors, what might you do differently? Think about it.

Health Wonk Review’s Research Edition & a roundup of other news

Thursday, June 24th, 2010

Brad Wright of Wright on Health has an excellent edition of Health Wonk Review, which shines a spotlight on research. Brad notes that, going forward, research will be incredibly important as health reform is implemented and evaluated. He offers a fine research roundup from leading healthcare bloggers – check it out!
Healthcare – According to a Commonwealth Fund report on healthcare, which assessed and compared data from patient and physician surveys in seven countries in 2007, 2008 and 2009, the U.S. scored sixth out of seven countries on quality issues, yet we spent more than double per person than any other surveyed country. See the full report How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update, which includes both a snapshot chart and an interactive comparison tool. Related: Results from the National Scorecard on U.S. Health System Performance, 2008
The importance of timely reporting – In Manucy v. Joe Manucy Racing, The Louisiana Court of Appeal recently ruled that an employee who was injured during horse training was ineligible for benefits because although the injury was immediately apparent, the worker did not file for benefits until about a year and a half after the injury occurred. Louisiana law stipulates a one-year from date of injury filing deadline for injuries that are immediately evident, and two years for injuries that do not develop immediately. In this case, the injury was immediately apparent, requiring ambulance transport and surgery within two months. State law varies on statues of limitations for benefit eligibility, most commonly falling between one and three years from date of injury. Many states offer some exceptions to the statutes – such as starting the clock ticking at date of disability rather than date of injury or allowing exceptions if there is conduct that might be regarded as deceptive on the part of the employer.
Going and coming – As a rule, any injuries that happen to an employee when they are traveling to or from work – ‘going and coming’ – are not compensable, but there are exceptions. Fortney v. AirTran Airways, Inc. deals with one of those exceptions: service/benefit to the employer. In this case, the employee was killed in a plane crash while flying on a reciprocal arrangement with another airline. The Kentucky Supreme Court upheld benefits to the estate of the deceased. At Lexis Nexis Workers’ Comp Community, Roland Legal PLLC summarizes the issues: “Whether an employer uses transportation or transportation expense as an inducement for an employee to accept or continue employment is material to supporting compensability, particularly when the journey is sizeable and when the employer pays all or substantially all of the expense.” See our prior post about common exceptions to the ‘going and coming’ rule.
Medicare – Get your popcorn and follow along as Joe Paduda offers a guide to the status of the Medicare “fix” and looks at various scenarios for how things may play out.
Retroactive Insurance in Georgia – events continue to play out in the wake of the insolvency of Southeastern U.S. Insurance Inc (SEUS) in Georgia (a story in and of itself, and worth a read if you haven’t been following along). After the SEUS demise, many employers were left holding the bag for the open claims of injured workers because they had not paid into the state’s insolvency fund and were therefore ineligible for coverage. New legislation will cover employers retroactively if they pay into the state insolvency fund, but the Georgia’s Insurers Insolvency Pool has filed a challenge to the new law. “The pool is placed in a position of uncertainty as to whether the legislation imposes duties and obligations on the pool retroactively in violation of the Georgia state constitution,” the filing says.
Arizona judge: no raiding the compensation fund – The state of Arizona is considering an appeal to Maricopa County Superior Court Judge Larry Grant’s ruling which found that Governor Brewer and legislators ignored the plain language of the law by trying to use $4.7 million from the State Compensation Fund to help balance the budget. According to the judge “The proceeds held by the special fund are insurance proceeds held in the benefit of employees and employers covered by the Workers’ Compensation Act.”
Safety shorts

Health Reform Roundup

Wednesday, March 24th, 2010

We’ve compiled a variety of resources on the health care reform developments this week:
First stop, see Joe Paduda’s excellent analysis of Health Reform’s implications for workers’ comp, part 1, part 2 and part 3. Joe’s expertise in the inner workings of the medical side of workers comp make this a must-read.
In the National Underwriter, Arthur D. Postal gets insurer reactions to bill passage: Insurers Decry Health Bill for Lack of Cost Restrictions
Insurance Journal looks at the various suits filed by 12 state Attorneys General which challenge the constitutionality of reform: How States Are Responding to Healthcare Reform Law and Republican Attorneys General Pursue Sovereignty Claim Against Health Bill
Law Professor Mark D. Hall, J.D. offers his thoughts on the constitutionality of mandating health insurance at The Health Care Blog.
At the Washington Post, Ezra Klein explains how the exchanges work. Also see How big is the bill, really?
Jaan Sidorov at Disease Care Management Blog Has a multi-part post focusing on What the Health Reform Bill Says About Prevention, part 2
Tinker Ready does a local roundup over at Boston Health News: Health reform: How’s it playing in Mass?
At Healthcare Economist, Jason Shafrin samples the international reaction.
At Gooznews, Merrill Goozner talks about the the reinvention of social progress and notes the Physician Payments Sunshine Act, which requires more transparency about payments that drug and device companies make to doctors.
For employers, Anne Freedman of Human Resource Executive suggests that uncertainty reigns. While most changes for employers won’t be in effect until 2014 to 2018, she outlines some changes that go into effect this year.
Consumer Corner
The New York Times Prescription blog answers reader questions on the Health Care overhaul
At Kaiser Health News, Phil Galewitz offers a Consumers Guide to Health Reform. Kate Steadman and Julie Appleby talk about the immediate effects of the Health Reform Bill.
The Washington Post offers a cost calculator to help consumers learn the impact on their situation: What does the health care bill mean to me?
Specifics about the legislation – from House Speaker Nancy Pelosi’s page
U.S.A. Today looks at how health care overhaul affects taxpayers.