Posts Tagged ‘Maine’

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

Wednesday, August 15th, 2012

When it comes to on-the-job assaults, healthcare workers are on the front lines. Earlier this year, NCCI issued a report on Violence in the Workplace, which showed that homicides and assaults are trending down. Good news, overall, but let’s take a closer look at assaults:

“The decline in the rate of workplace assaults has lagged the steady decline in the rate for all lost work-time injuries and illnesses. This reflects a notable change in the composition of the US workforce and, in particular, the ongoing increase in the share of healthcare workers, who experience remarkably high rates of injuries due to assaults by patients. This is especially common in nursing homes and other long-term care facilities. In fact, 61% of all workplace assaults are committed by healthcare patients. For assaults, coworkers make up just 7%, and someone other than a healthcare patient or coworker comprises 23%. The remainder is unspecified.”

Now, a new research report from Maine offers a close-up snapshot of the issue of workplace violence as it relates to caregivers. The Research and Statistics Unit of the Maine Department of Labor compiled data from First Reports of Injury for 2011 and issued a report on 2011 Violence Against Caregivers in Maine.
The report encompassed about 100,000 workers in healthcare and affiliated professions. Of the nearly 10,000 thousand injuries reported by those workers, 13.4% were related to violent and aggressive acts by patients and care recipients.
Key report findings include:

  • Where incidents occurred – Mental health care settings and other residential care facilities accounted for 52% of all violent/aggressive incidents in 2011. These were followed by nursing care facilities for the elderly and people with disabilities, 18.9%, and general medical and surgical hospitals and services, 16.8%.
  • What types of jobs were involved – Nurses at all levels (including nursing assistants) were involved in 21.27% of the cases; education technicians were involved in 18.6% cases; direct support professionals (personal care, hygiene, life skills, etc) were involved in 9.4% cases; Other occupations with significant numbers of cases included psychiatric technicians, behavioral health technicians and analysts, mental health and social workers and child care and senior child care workers.
  • What types of assaults occurred – The most prevalent type of assault – being hit – accounted for 21.3% of all incidents. Bites were the second highest reports, at 16.6%, of the incidents. Other identifiable assault categories included kicks, 9.45%, and being grabbed, 9.4%.

Due to the high number of bite incidents, a specific section of the report focuses on bite injuries and references information from the Federal Bureau of Prisons’ 2009 Clinical Guidelines regarding viral and bacterial exposures and the potential for infections if the skin is broken. The report also cites NIOSH publications and reports, including common risk factors for violence and a list of potential prevention strategies.
The full report is available in PDF: Maine’s Caregivers, Social Assistance and Disability Rehabilitation Workers Injured by Violence and Aggression in the Workplace in 2011.
(Hat tip to for pointing us to this news item.)

Risk, ADA, OSHA, fraud & other workers comp news notes

Wednesday, April 20th, 2011

Risk roundup – Check out this week’s Cavalcade of Risk.
Americans with Disabilities – This week’s must-read is Dan Reynold’s essay in Risk & Insurance: Disability in the Second Act. He says, “… it’s not that the amended act, which goes into effect on May 24, represents a new game. It’s that the amended act has returned the ADA to its original, intended scope.” The article offers advice for employers to prepare for the changes.
OSHA gets tough on distracted driving – If your employees are texting while driving, the stakes just got higher. Jon Gelman posts about OSHA’s plan to fine employers for distracted driving accidents. This is part of OSHA’s initiative to reduce transportation accidents, the top cause of worker fatalities. Gelman says, “OSHA will investigate motor vehicle accidents, including cell phone records, and will issue citations and fine employers where an accident involved texting while driving. While OSHA has jurisdiction over employers, and not employees, it hopes to encourage all employers to declare motor vehicles a “text free zone.” More information and resources at the OSHA Distracted Driving page.
Fraud – to paraphrase the common horror film trope, “the fraud is coming from inside the house. When people refer to workers comp fraud, more often than not they are talking about employees. But as we’ve noted many times, employer fraud such as misclassification, is also a huge and costly problem. There are other players too – such as doctor mills, dishonest agents, and this week, Roberto Ceniceros points to a fairly egregious example of TPA adjuster fraud.
Limits on comp for PTSD?SafetyNewsAlert talks about legislative efforts to curb permanent workers’ comp coverage for mental distress. A bill that is currently under review in Maine is drawing opposition from first responders. Here’s more on the proposed Maine legislation.
Dangerous technologies – In the new and emerging health risks department, we bring you Facebook Depression. Add this to the many other emerging technology-related maladies: Blackberry Thumb, Cell Phone Elbow, IPod Ear.
News briefs

Cavalcade of Risk #123 and assorted news notes from the blogosphere

Wednesday, January 26th, 2011

Get your biweekly fix of risk: Cavalcade of Risk #123: High-Yield Edition is now posted at The Notwithstanding Blog. There’s an eclectic roundup of posts and you might take the time to visit the host blog too – our blogger is a Canadian med student studying here in the U.S., and posts “tales from medical school, health policy analysis, critiques of the academic medical zeitgeist, and the occasional bonus Canadiana.”
Misclassification in Maine – analysts in the Maine Labor Department estimate that tax losses to the state resulting from misclassification could be as high as $36 million a year. As in many other states, lawmakers had been looking at establishing guidelines and rules for independent contractors. Newly elected Governor Paul LePage abolished the state’s misclassification task force that had been working on this initiative, stating that he would be introducing legislation based on the federal definition.
Union Demographics – Jeffrey Hirsch of Workplace Prof Blog gives us the latest report on union density for 2010: “Overall union density went down from 12.3% to 11.9%; in the private sector, union density went down from 7.2% to 6.9%, and in the public sector, it went from 37.4% to 36.2%.” See more detail at his post.
Vote for Workers’ Comp Notable People – Lexis Nexis announced the finalists in its Workers’ Comp Notable People 2010 – check it out and vote for your favorites. Voters can select two individuals from each of the three categories. The voting period runs from January 23, 2011 through February 4, 2011. Click here to join and vote in the LinkedIn Work Comp Analysis Group.
Food features an in-depth federal report on Injuries, Illnesses, And Fatalities In Food Manufacturing In 2008, which notes that “Workers in food manufacturing are more likely to be fatally injured and experience nonfatal injuries and illnesses than workers in private industry as a whole. Food manufacturing workers are also much more likely to suffer an injury requiring job transfer or restriction than one that requires days away from work.”
Underwriters – After reading an article on disappearing jobs, Jared Wade of Risk Management Monitor considers whether insurance underwriters are an endangered species now that technology can crunch the numbers.
Sign of changing times? – Roberto Ceniceros discusses how some of the large carriers are letting business walk rather than price it too low. With the combined ratio moving up, many industry analysts have stated that underwriting will make the difference between profit and loss and it appears that some insurers are taking heed.
Technology – Some workers comp insurers are adopting self-reporting options for payroll reporting for employers.
Quick takes

Flighty Health Wonk Review and sundry other news blurbs

Thursday, August 5th, 2010

Jaan Sidorov has an air travel themed Health Wonk Review posted over at Disease Management Care Blog, which he calls “frequent flyer miles for your brain.” There’s a roundup of assorted news on the health care policy front ranging from a post on the growth of MinuteClinics to a look at hospital quality surveys. Get your dose of the news from some of the brightest braniacs in the health policy blogosphere.
Here are a few other health-care related news items we noted in our travels: Katharine Van Tassel of HealthLawProfBlog posts the disturbing news revealed via a survey that 36% of responding physicians don’t believe in reporting impaired colleagues. And at Managed Care Matters, Joe Paduda talks about the results of a Kaiser Health Tracking Poll that demonstrates the power of mis-information: “Half of seniors (50%) say the [heathcare reform] law will cut benefits that were previously provided to all people on Medicare, and more than a third (36%) incorrectly believe the law will “allow a government panel to make decisions about end-of-life care for people on Medicare.”
The Weekly Toll – If you haven’t visited in awhile, stop by The Weekly Toll to read about US workers who died on the job this past week. Many seasonal hazards are represented with a high toll of tractor and farming-related fatalities and construction-related deaths in this week’s grim list. And the list does not include the 8 employees of Hartford Distributors who were killed by a coworker.
Whistleblowers – Michael Fox of Jottings By An Employer’s Lawyer tell us that the difference between cloth and leather gloves is just over $1 million in his post about a Maine court’s ruling in favor of a whistleblower who was terminated after making complaints about safety and working conditions. Maine courts aren’t the only ones who are taking a dim view of retaliation against employees who report safety problems: at Today’s Workplace, Mike Hall posts that OSHA takes whistleblowers seriously and has established a website to offer a Whistleblower Protection Program.
Teen workers – Elizabeth Cooney writes about young employees who face injury or even death on the job in an article in the Boston Globe. Teens often are employed in some of the most dangerous jobs and have little in the way of training, as evidenced by the fact that the nonfatal injury rate for 15- to 17-year-olds in the United States was 5.2 per 100 full-time equivalent workers per year, double the rate for adults 25 and older. She discusses research from the state’s Teens at Work initiative, which revealed that of “208 teens under age 18 who had been injured at work from 2003 through 2007, about half said they had no safety training. About 15 percent said there was no supervisor on site when they were hurt. Almost a quarter said they had no work permit.”
Remarkable storyChrissy gets a new face from Work Comp Complex Care: “…her story of recovery is incredible on several levels – for the medical technology involved; for the reminder that dedicated health care professionals have the power to make a huge difference in a patient’s quality of life; and for the grace and attitude of the woman who suffered a devastating, life-changing injury and did not let it defeat her.”
Protecting football players – In Hitless or Witless?, Skip Rozin of discusses new NFL safeguards to protect football players from serious head injuries. Long overdue, and more is needed. The biggest hurdle will be overcoming the culture. As Rozin puts it “One of the biggest obstacles here is the athletes’ code of playing hurt.”
Nursing shifts – A new study from the University of Maryland-Baltimore reveals that long shifts pose health hazards for nurses – and may increase the risk to patients, as well. Study authors said that “the most common problems with an overemphasis on 12-hour shifts are needle-stick injuries, musculoskeletal disorders, drowsy driving, and other health breakdowns related to sleep deprivation.”
Legal briefs – In South Carolina, the court ruled that free living quarters offered as inducement for employment are considered wages. In a case involving horseplay, an Iowa court ruled in favor of a butt-shaking employee on appeal. A Washington court found that a fitness for duty test did not violate the ADA.
OSHA – Dwayne Towles of Advanced Safety Health News Blog warns employers that OSHA is scrutinizing safety incentive programs and may be asking for any written policies or details of any contests or promotions. They are looking for programs that might discourage employees from reporting injuries. Towles offers his thoughts for how to handle matters should OSHA come calling. And while on the topic of OSHA visits, SafetyNewsAlert offers additional suggestions in prepping for an inspection: top 10 dos and don’ts for OSHA inspections from 2 OSHA inspectors.

Fee Schedule in Maine: Interest without the Conflict?

Wednesday, June 23rd, 2010

We return to the beautiful state of Maine, where moose wander the woods looking for whatever interests a moose and where employers self-insured for workers comp look for a fee schedule. The moose are a lot happier than the self-insureds. As we have pointed out in prior blogs, the legislature mandated the creation of a fee schedule for medical services nearly 20 years ago. There is still no fee schedule. So while insurance carriers are free to negotiate with hospitals to determine rates, self-insureds – Bath Iron Works (BIW) the most notable and vocal – are stuck paying the exorbitant “usual and customary” fees.
BIW has sued a number of times to move this process to a conclusion. Most recently, they sued to remove Paul Dionne, chairman of the workers comp board, from heading up the fee schedule committee. Dionne is also board chairman of Central Maine Healthcare Corp., which includes Central Maine Medical Center in Lewiston. While he claims objectivity, Dionne is in an untenable situation: you do not ask a medical provider how much they want to cut their own revenues.
In deference to the “appearance” of a conflict of interest, and perhaps in an acknowledgement that after 20 years, enough is enough, Dionne has recused himself from any further involvement in the fee schedule process.
“It’s a hard decision because this is a very important issue for the workers’ compensation system,” he said. “But I’ve got a lot of confidence in the board members.”
So from here on Dionne will follow the debate from the sidelines: no conflict, but plenty of interest. His confidence in the other board members might give rise to anxiety for BIW. Regardless, this is surely a step in the right direction.
When it comes to the long-mandated, long-absent fee schedule, patience is wearing a bit thin in Maine. The moose may wander where they choose, but self-insureds are caught in a very expensive trap. Too bad they don’t sell fee schedules at L.L. Bean.

Bath Iron Works: “All I want for Christmas is a Fee Schedule”

Monday, December 21st, 2009

It’s hard to think of anyone bullying Bath Iron Works, the General Dynamics subsidiary that builds destroyers for the U.S. Navy. But they are being kicked around like the proverbial 90 pound weakling by the workers comp system in Maine. Two years ago we blogged the inability of Mainers to come up with a viable fee schedule for workers comp medical costs. The legislation authorizing the fee schedule became law in 1992. Now we approach 2010 – nearly 20 years! – and there’s still no fee schedule.
Workers comp insurers are free to negotiate rates for medical services. In effect, they develop their own de facto fee schedules. Bath Iron Works (BIW) is self-insured for comp. They do not have the leverage to negotiate fees. So when a local hospital sent a bill for $107,000 for treatment of two injured workers, BIW filed a lawsuit. They lost: they had to pay the hospital’s “usual and customary” fees – an ironic appelation if there ever was one. The only suckers stuck with paying the full boat (so to speak) are self-insureds and uninsureds.
So how is the fee schedule coming along? And why the inordinate delays?
The rule-making group charged with developing the fee schedule is trying to come up with something acceptable to the medical providers. That’s like asking an employee how much of a pay reduction they would like. How about nothing? In the current draft, total billings of $80 million would fall by about $1 million. In other words, a drop of less than 1 percent. That’s a fee schedule only a medical provider could love!
The Massachusetts Model
Maine officials are worried that low fees would drive doctors away. Paul Dionne, executive director of the Maine Workers’ Compensation Board, says he heard from a group of orthopedic doctors who said if the board made the new base fee too low, “they weren’t going to treat injured workers. They’re private, they can do that.”
That’s not what happens in Massachusetts, which has the lowest fee schedule in the nation. Everyone recognizes that the fee is too low. So insurance carriers and TPAs routinely negotiate a reasonable fee with doctors on an individual basis. For example, the scheduled fee for hand surgery is only $725. The “usual and customary” fee of a skilled surgeon might be $5,000. The insurer and doctor would settle somewhere in the middle, perhaps $3,000 for the service. It sounds frictional and inefficient and to some degree it is, but overall, medical costs remain unusually low in Massachusetts, doctors continue to provide services and injured employees are satisfied with the results. The system is working despite what appear to be severely deflated medical rates.
One unusual and perhaps unintended benefit of the low fee schedule is the leverage it provides against medical providers who refuse to treat with a return-to-work focus. If “Dr. Feelgood” insists on keeping a marginally injured employee out of work, the adjuster can dig in and offer to pay only the deflated fee schedule rates. That will get the doctor’s attention immediately.
Maine used to be part of Massachusetts. If they want to solve this particular problem, they might consider re-joining the Commonwealth, or at least copying Massachusett’s highly successful comp model. Step one involves some tough negotiations – with or without the doctors in the room. Thus far, by trying to please everyone, Maine is punishing some of their most valued employers. Nearly twenty years into a failed process, it’s time to face reality: a fee schedule is a cut in pay. If the doctors are happy, it’s not an effective fee schedule.
Meanwhile, it looks like a bleak Christmas for the mighty folks at Bath Iron Works. There are undoubtedly a lot of nice goodies under their tree, but a fee schedule is not among them.

News roundup: Cavalcade of Risk, comments, lunch breaks, and quick takes

Thursday, June 22nd, 2006

Risk roundup – The second issue of Cavalcade of Risk is posted over at It’s Just Money. LA Money Guy is the host, and he’s assembled an eclectic array of posts ranging from drug caps to hurricane insurance. Check it out!
Comments – Our apologies if you’ve ever left a comment that didn’t get published here. When emptying several thousand spams from our spam trap this past weekend, we were dismayed to find about a dozen legitimate comments from you, our readers, that had been automatically routed to the spam file. Part of the reason we re-designed the site a few months ago was to incorporate a better comment filter – we get hundreds of trash comments each week, some quite vile. We thought things were working out quite nicely, but realize now that it’s been a little more aggressive than we intended. Our sincere apologies – we look forward to and appreciate your comments! We rescued about a dozen comments and rightfully restored them to the posts where they belong. We made further adjustments to the filter and hope that will do it, but we’ll be checking more carefully going forward so that we don’t lose any of your comments.
Lunch breaks – Are your employees covered by workers compensation when they are out of the office on a lunch break? Yes, according to a new ruling by the Maine Supreme Court as reported by Mark Hoffman in Business Insurance. In this case, the employee slipped on icy steps as she entered the building. The insurer contested the case on the basis of the going and coming rule, which holds that employees aren’t usually covered on their routes to and from work. However, courts often award compensation to workers who are injured in company parking lots or other areas in or around the workplace. (See our prior post on Exception to the “going and coming” rule: operating premises.) In this case, there was an additional twist: the employer was renting the office, and part of the rental contract stipulated that the landlord would keep the walkways clear of ice. Regardless, the employee’s injury would still be compensable. If the employer or insurer would like to try to recoup the costs from the third party through subrogation, that’s another matter. (Read the full court decision: Robyn D. Fournier v. Aetna, Inc., et al.)
Meatpacking hellConfined Space brings our attention to a recent series by Bob Herbert in the New York Times reporting on the brutal and dangerous working conditions at Smithfield Packing Company in Tar Heel, North Carolina. Because these are subscription only articles, we’ll link to Jordan’s two posts: Where the workers come last and Walking Into The Pit Of Hell. (See also: Blood, Sweat, and Fear: Workers Rights in U.S. Meat and Poultry Plants). Now the workers are taking their case for safety and basic worker rights the public.
Medical blogs – If you enjoy learning about emerging medical technologies, then Medgadget is the blog for you. There’s always some fascinating matter to be found. And for another interesting blog by a medical professional, check out the always fresh Emergiblog, a blog we found when Kim, a nurse who runs the blog, left a comment in one of our posts. Today, she kicks off the first edition of Change of Shift, a nursing blog carnival.
Quick takes