Posts Tagged ‘pain’

News Roundup: ACA, WC & Profitability, Pain, Opioids & More

Friday, June 26th, 2015

The big news that’s dominated the week is the Supreme Court decision on the Affordable Care Act subsidies. NAIC’s statement on the ACA ruling sums things up well:

“Uncertainty in insurance is not a good thing. The decision allows regulators, consumers and the industry a level of certainty that supports stability for insurance markets in our states. The NAIC will continue to support state insurance departments – as we have done since the passage of the ACA – and ensure consumers are protected, regardless of the type of exchange in any given state. There are still a number of challenging issues facing health insurance consumers across the country, and U.S. insurance regulators are working together through the NAIC to promote stable and competitive markets.”

Here are some related news stories / opinions we found noteworthy

Is Workers Comp Profitable?
If you haven’t yet checked it out, don’t miss Joe Paduda’s three part posting on the profitability (or lack thereof) of workers comp. Part 1: If workers’ comp is so profitable, why is Liberty Mutual de-emphasizing the business? Part 2: Workers’ comp profitability, Part 3: Workers’ comp profitability.
Related: Boston Globe, Liberty Mutual shedding its workers’ comp roots

New Blog
We’d like to welcome a new work comp related blog to our blogroll – Work Comp Psych Net – an eponymous blog from an organization of the same name. Work Comp Psych Net is a New Jersey-based network of behavioral health practitioners who facilitate return to work. They specialize in addressing psychological and mental health obstacles delaying return to work. such as PTSD, traumatic brain injury, chronic pain, adjustment and mood disorders, and the like.

Virginia
Worker Misclassification – What Employers Need to Know in Light of New Enforcement Efforts
D. Earl Baggett, Amanda Weaver | Williams Mullen, JDSupra Business Advisor: “The Virginia Department of Labor and Industry (“DOLI”) has recently announced the implementation of a new Virginia Occupational Safety and Health (“VOSH”) policy directed at preventing the misclassification of workers in VOSH cases. VOSH will be seeking to identify workers who have been misclassified as independent contractors during the course of VOSH inspections and investigations. Misclassification occurs when an employer improperly classifies a worker as an independent contractor when the worker should be classified as an employee. The new policy, which takes effect July 1, 2015, comes on the heels of Governor Terry McAuliffe’s 2014 executive order establishing an inter-agency task force on worker misclassification and payroll fraud in Virginia.”

Pain
Nancy’s super-simple guide to pain, Jennifer Christian: “Nancy Grover’s June 15 column on Work Comp Central is a super simple guide to pain for anyone who isn’t really interested in the latest science of neurophysiology — but who wants a basic understanding of how the science of pain is changing our view about how to treat it.Nancy interviewed me and wrote her column after reading a white paper entitled Red Herrings and Medical Over-Diagnosis Drive Large Loss Workers’ Compensation Claims released by Lockton Companies. I am one of the co-authors, along with Keith Rosenblum, senior risk consultant at Lockton Companies and Dr. David Ross, a Florida neurologist who is CEO of NeuroPAS Global…”

Massachusetts
Massachusetts: Task Force Says Opioid Abuse an Epidemic – Claims J0urnal: “Massachusetts is in the midst of an epidemic of deadly opioid abuse, according to a task force created by Gov. Charlie Baker that said Monday that drug addiction must be considered a medical disease.
The 18-member group released a total of 65 recommendations in the areas of prevention, education, intervention, and treatment and recovery, after holding a series of meetings around the state in recent months.
“Over the past decade, more than 6,600 members of our community have died because of opioids, and behind those deaths are thousands of hospital stays, emergency department visits, and unquantifiable human suffering inflicted upon individuals, families and our communities,” the task force said in an overview of its report.”

Don Blankenship / Massey Energy
New York Times: ‘The People v. the Coal Baron’ – At Coal Tattoo, Ken Ward Jr. dissects the recent NYT story on Don Blakenship, correcting the record on several counts. Ken Ward offers a sterling example of why local journalism is so vital. As the October 1 criminal trial of former Massey Energy CEO Don Blankenship approaches, we expect more national media coverage, but for the definitive source, you can’t do better than Ken Ward and his coverage at the Charleston Gazette.

More Noteworthy News

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Derek Boogaard: A Bully and His Demons

Tuesday, June 5th, 2012

Derek Boogaard was a hockey player. Well, sort of. He didn’t score goals (only 3 in 6 years) and he spent a lot of time in the penalty box (589 minutes). He was an enforcer: at 6’8″ he was a ferocious and much-feared brawler.
As we learn in a New York Times article, he was also addicted to pain medications. While still playing hockey in 2008-2009, he received at least 25 prescriptions for opioids from ten doctors, a total of 600+ pills: eight team doctors of the Wild (his team at the time), an oral surgeon in Minneapolis and a doctor from another NHL team.
In 2010, he was signed by the New York Rangers for $6.5 million, despite his by then well-documented drug problems – he was an active participant in the NHL’s substance abuse program. While playing for the Rangers, a team dentist wrote five prescriptions for hydrocodone; another team doctor wrote 10 prescriptions for Ambien.
Occupation-related Pain
There is not much question that Boogaard suffered from pain. Here is just a small segment of his pain-filled saga, from the final few months of his career: In October 2010, a punch from a Toronto player broke a three-tooth bridge in his mouth. A couple of days later, he hurt his hand while punching a Boston player. In November he had his nose broken by an Edmonton player. In December he suffered a concussion in a fight with an Ottowa player. He never played hockey again.
In the months following his retirement, he exhibited erratic behavior and wild mood swings. He acquired numerous prescriptions from current and former doctors. In May of 2011 he signed himself out of a rehab facility, spent a night drinking with friends, and died of an overdose in his Minneapolis apartment. He was 28 years old.
Privilege Has Its Pain
The article quotes Dr. Jane Ballantyne, a pain expert from the University of Washington: “A single course of opiates might be O.K. for normal people who only get injured once in a blue moon, but when injuries are frequent, it can easily turn into chronic treatment instead of just acute treatement. And athletes are at high risk of developing addiction because of their risk-taking personalities.” She adds: “the tendency is to overtreat” because team doctors want to help athletes return to competition.” [At LynchRyan, we are strong proponents of prompt return to work, but only where there is no risk of re-injury. There is no such thing as modified duty on ice.]
Boogaard was a fan favorite wherever he played. In hockey, fighting is “part of the game.” But his sad saga is primarily a story of brain injury and addiction. As a professional athlete, Boogaard had virtually unlimited access to drugs, through doctors who, for the most part, did not bother to document their treatment plans or monitor their patient.
It should come as no surprise that an autopsy revealed that Boogaard had chronic traumatic encephalopathy C.T.E., a brain disease caused by repeated blows to the head.Thus he is linked in death to the growing number of football players who suffered the same fate, the result of frequent concussions.
Official Response Speak
As a lifelong student of language and rhetoric, I cannot miss an opportunity to quote some of the official responses to Boogaard’s death:
The NHL: “Based on what we know, Derek Boogaard at all times received medical treatment, care and counseling that was deemed appropriate for the specifics of his situation.”
The Minnesota Wild: “The Wild treated Derek’s medical status in accordance with the NHL/NHLPA Substance Abuse and Behavioral Health Program as we do with all our players.”
The NY Rangers: “We are confident that the medical professionals who treated Derek acted in a professional and responsible manner and in accordance with their best medical judgment. They took extraordinary steps to coordinate the medication prescribed for him with the professionals in charge of the NHL-NHLPA Substance Abuse and Behavioral Health Program.”
Not exactly heartfelt or compassionate, just the voices of powerful corporations, protecting their interests, their brands and their proverbial asses. As for Derek Boogaard and his misguided career on ice, RIP for the man who knew no peace.

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Overdosing on Drugs: Compensable in Tennessee, Denied in Ohio

Monday, December 12th, 2011

Today we examine two court cases that trouble the dreams of claims adjusters: workers with severe injuries whose use of pain medication leads to their deaths. In one case, the accidental overdose is deemed compensable; in the other, the claim is denied. The devil, of course, is in the details.
Compensable Death In Tennessee
In November 2008, Charles Kilburn was severely injured in an auto accident while in the course and scope of employment. Fractures to his back and neck resulted in permanent total disability. Following surgeries, he still experienced severe pain. A pain specialist prescribed oxycodone. Fourteen months after the accident, Kilburn died of an accidental overdose. His widow filed for death benefits.
Kilburn’s employer believed that the death was the result of negligence, which would break the chain of causality with the original injury. Kilburn had ignored his doctor’s cautions to limit his intake of oxycontin to a specific maximum dose. The Supreme Court of Tennessee determined that the severe pain experienced by Kilburn might result in diminished faculties, which in turn might lead to taking more medicine than was prescribed. In their view, the chain of causality remained intact at Kilburn’s death and thus his widow was entitled to benefits.
Denial in Ohio
In Parker v Honda of America, the initial circumstances are similar, but the apparent “diminished faculties” lead to a very different result. John Parker suffered a severe back injury at work in 1988. He was prescribed OxyContin in March 1999. He eventually became addicted to the drug, along with cocaine, percocet and heroin. In March of 2006 he was found dead, a syringe in his arm, a spoon with a lethal dose of melted OxyContin at his side. In this case, the Ohio Court of Appeals found that his melting and injecting the drug, combined with his documented abuse of street drugs, broke the chain of causation linking the death to the workplace injury.
The court rejected his widow’s argument that the drug abuse was the result of a “severe disturbance of mind” and thus unintentional. It’s worth noting that if Parker had deliberately overdosed as an explicit act of suicide, the death may have been deemed compensable. But because the overdose was an acccident, workers comp benefits were denied.
The Big (and Not-So-Pretty) Picture
Pain is a constant factor in work-related injuries. The control of pain is a complex and widely misunderstood aspect of claims management. Because we live in a culture that relies heavily on powerful medications to control pain, and because the prescribing of these powerful drugs is neither well managed nor well monitored, we will see more and more cases of drug overdoses wending their way through the workers comp system. Some cases will be compensable, others will not. One thing is certain: the challenges of managing these situations will continue to haunt key players in the comp system: the doctors who prescribe the drugs, the adjusters who authorize bill payment, the families who suffer the consequences of loved ones in severe discomfort, and above all, the injured workers, whose every waking moment is compromised and consumed by a pain that just won’t go away.

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Health Wonk Review & other news notes

Thursday, September 29th, 2011

Best of the healthcare blogosphere – Looking for your biweekly fix of health wonkery? Check out Health Wonk Review: Muppets Edition! – posted by Joe Colucci at The New Health Dialogue blog.
Health Care Costs – The Kaiser Family Foundation’s 2011 Employer Health Benefits Survey revealed that average annual premiums for family health benefits are up 9%, topping $15,000. According to the report, “Premiums increased significantly faster than workers’ wages (2.1 percent) and general inflation (3.2 percent). Since 2001, family premiums have increased 113 percent, compared with 34 percent for workers’ wages and 27 percent for inflation.” It’s pretty jolting, and even more so when you check the graphic depiction of rising costs. You can find additional report documents here.
Drug deaths – Los Angeles Times reports that drug deaths now outnumber traffic fatalities in U.S.. Apparently, we’ve been so busy fighting “the drug war” that we’ve overlooked the creeping and insidious threat of the prescription pain and anxiety drug problem. Deaths related to these drugs now outpace deaths from heroin and cocaine combined.
Mark Walls pointed this article out and he has a discussion going on the LinkedIn Work Comp Analysis Group. He also links to several related resources – here’s a sampling: ACOEM – Comments to State WC Officials on Prescription Opioid Abuse in the U.S.; Joe Paduda – Understanding Opioid Abuse; and Mark Walls – It Starts with the Regulators
Safety tools – The Federal Highway Administration has a portal for Work Zone Safety. It includes some good highway safety tools and resources for you safety program.
Time Capsule – What was work life like in 1943? Check out The Ropes at Disney’s, an employee handbook from 1943. Pop quiz: How many current labor law violations can you spot?
And in another look back at days of yore, Oregon’s Willamette River Bridge Project posts an historic construction photo of the Willamette Bridge, inviting readers to spot the safety hazards. The answers are already posted, so if you want to play along, don’t peek at the comments.

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Managing Chronic Pain, Revisited:

Tuesday, June 21st, 2011

We posted earlier this week on draft guidelines for pain management issued by the Massachusetts Department of Industrial Accidents. While we found much to like in the draft, our colleague Peter Rousmaniere, proprietor of his own blog on immigration issues, finds that the guidelines leave much to be desired. He views them as somewhat of a mincing mini-step in an area where rather big strides are needed.
Here are his thoughts on ways to make pain guidelines more effective:
Workers Comp Insider alerted us on Monday to the publication of draft chronic pain guidelines by Massachusetts DIA.
Medical treatment guidelines are helpful where clinicians, payers and courts desire an authoritative third party to say if and when a treatment is appropriate. But the value of guidelines really strikes home not only in the details but in how they pick their topics. Only so much can be covered proficiently. Guidelines need to focus on pressing matters of protecting lives and husbanding scarce resources. Then even the non-clinician in workers comp can say, “I may not understand all the medical details, but I know that these guidelines speak to my top concerns, and I will respect them and promote them accordingly.”
Perhaps because workers comp chronic pain treatment guidelines tend to avoid some of the most pressing issues for claims payers, they are not as useful as they could be. Perhaps also because claims payers feel free to ignore them, which they regularly do, we don’t see a visible, sustained effort within the claims payer community to improve the management of chronic pain cases.
Something for the Pain
One thing the guidelines have done laudably is to alert their readers to the very important patient safety issue when opioids are prescribed. This is very important: claims payers usually don’t require periodic drug tests for injured workers who have been prescribed opiates and they rarely are trained to respond when a test shows that the patient’s urine has no trace of the prescribed drug.
On balance, the Massachusetts guidelines, like other chronic pain guidelines used in the workers compensation community, are rather narrowly focused to the point where their usefulness is compromised. These various guidelines focus on non-surgical treatment of patients after they reach the stage at which they can be called chronic pain cases, and before they become extended, multi-year dependents on pain medication.The proposed guidelines devote just a few summary paragraphs to a challenge of the highest importance to claims payers: knowing the specific steps physicians can take to help their extended treatment patients improve their pain experience and function.
Predicting Pain
None of the current guidelines invest any time in describing the quite rich and fertile topic of chronic pain prevention among newly injured workers. Prediction and prevention are areas in which only a few occupational medicine doctors and nurses have achieved proficiency. Claims payers should focus on the need to identify chronic pain risk and encourage doctors to intervene as early as possible, when chronic pain risk, having been identified, can be addressed before the downward cycle begins. Unfortunately, you won’t learn about these best practices in these or in other state-promulgated guidelines. (I have proposed that chronic pain predictive models, matured through the wisdom of many, be placed in the public domain and inserted in treatment guidelines.)
Why these gaps? I wonder if the claims community has taken the time to communicate its concerns about chronic pain, so that guideline editors might address them? I imagine that they were back at the office, unaware of guidelines being drafted, and deeply involved in the deep stack of files that welcome them every working day.
Let’s Talk!
An inconvenient truth for workers comp claims payers is the universal endorsement of counseling intervention. Virtually all the chronic pain guidelines share a high regard for the psychological dimension of non-cancer chronic pain, which surfaces in pain perceptions and beliefs, catastrophizing, poor locus of control, and other traits that can be both measured and altered. The guidelines recommend time-limited cognitive behavioral therapy, the kind used to help you, say, overcome your anxiety about elevators, re-injury, or perpetual pain. The Massachusetts guidelines contain within their relatively thin girth a full-throated endorsement of psychological intervention – and that’s a good thing.
Unfortunately, most claims adjusters refuse to recognize the importance of cognitive therapy. They will have none of it and will deny treatment if the word “psychology” is attached to a request for treatment. The adjusters argue that once they allow psychological treatment, the workers comp courts will require them to pay for a lifetime of counseling intervention. I’ve heard this argument a lot. I wonder if the claims community and treatment guideline editors have ever had an extended discussion about psychological services and how to frame the issue to be most useful in a workers comp setting.
While the proposed pain guidelines leave a lot to be desired, I believe that an effective strategy for controlling chronic pain risk is within reach. Pain management is an essential element of any cost reduction strategy. If states can begin to draft chronic pain treatment guidelines that are more prescriptive, more specific and more focused on prediction and prevention, we would take a giant step toward bringing the costs of many large comp claims under control.
Submitted by Peter Rousmaniere

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Managing Chronic Pain

Monday, June 20th, 2011

In the world of workers comp, chronic pain is a major cost driver. When pain persists beyond expected healing times, the prognosis is grim: injured workers suffering from prolonged pain often drift into anxiety and depression and may even become addicted to powerful pain medications. In the downward spiral of relentless pain, it becomes increasingly difficult to separate physical and psychological issues. The prospect of return to work disappears, the injured worker’s life disintegrates and the cost of the claim goes through the roof.
The claims adjusters who are responsible for managing chronic pain injuries usually resist any recommendations for psychological counseling; they avoid such interventions because treatment – whether individual or group therapy – cannot and should not be limited to what is “work related.” Pain subsumes the worker’s entire life. Yet counseling is often an essential part of what is needed: injured workers talking through their many difficulties and sharing their experience with others.
So is it possible to develop a chronic pain program that limits financial exposures, narrows the treatment options and sets reasonable time frames for completing the treatment cycle? And can pain management encompass at least some focused counseling?
A Guide for the Perplexed?
Massachusetts has taken a shot. The state’s Department of Industrial Accidents(DIA) Health Care Services Board has issued draft guidelines (PDF) for managing chronic pain. Under the leadership of Dean Hashimoto, who holds both medical and legal degrees, the draft protocol tiptoes through a minefield populated with poppy plants, doctors with prescription pads and long needles, chiropractors, acupuncturists, counselors and biofeed back practitioners – not to mention the ever-present drug salespeople. The draft guidelines could well serve as a Guide for the Perplexed.
Beginning with the caveat that 10 percent of all chronic pain cases will fall outside of the protocol, Hashimoto’s task force tries to set parameters for all types of treatment: the number and type of diagnostic and therapeutic injections permissible; the goal-oriented use of mental health counseling, with specified durations (6 to 12 months); “very limited” use of opioid analgesics, with referral to pain specialists, if needed, and including a detailed list of specific actions designed to avoid addiction.
A Work in Progress
The DIA is soliciting comments on these guidelines. Alas, they are unlikely to hear from the relatively small portion of stakeholders who are profiting from the current chaos: the pill-happy doctors, the attorneys who discourage injured workers from returning to work, the physical therapists and chiropractors who believe that treatment, once begun, should go on forever, and the pharma sales folk who encourage use of the most powerful opiates for what is usually short-term pain.
The draft guidelines are comprehensive and reasonable. As the final guidelines will not and cannot have the force of law, they will not eliminate the abuse that currently exists. But if they help motivated treatment practitioners to offer more effective services, and if they open the door to at least some counseling for injured workers, the guidelines will surely save both lives and careers. That in itself will validate the admirable and essential work of Hashimoto’s board.

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A Hand for Dr. Woolley

Tuesday, January 4th, 2011

For nearly 15 years, beginning in 1990, Bradley Clark was a baggage handler for United Airlines. He started at age 33, and by the time he was unable to perform the work, he was nearly 50. Ten years in, he began experiencing pain in his thumb joints. In 2004 he banged his hand against a cart and was diagnosed with bilateral carpal tunnel, for which he had surgery. Unfortunately, the surgery did not stop the pain. (NOTE to claims adjusters: This is yet another example of unnecessary surgery, based upon the wrong diagnosis.)
With pain continuing after the surgery, Clark sought treatment from a hand specialist. He treated with Dr. Charles T. Woolley, who performed surgical fusions on both thumbs. Coverage of this surgery was denied, as a succession of five physicians concluded that Clark’s problem was osteoarthritis, which is hereditary and unrelated to work. The opinions included an IME performed by two doctors, who concurred with the other doctors that the condition was not work related.
Slam dunk for the employer, right?
Making the Case
In his choice of a hand surgeon, Bradley Clark stumbled upon a stubborn and determined physician, one more than willing to disagree with his colleagues. Dr. Woolley diagnosed bilateral trapeziometacarpal joint arthritis and insisted that it was work related. Among his impressively detailed findings:
– Clark was too young to develop osteoarthritis, as he was only 43 years old when the pain first developed.
– He found no genetic pre-disposition to developing osteoarthritis, as none of the other joints in Clark’s hands, such as his fingers, revealed osteoarthritis. There was no osteoarthritis in any other part of his body.
– Osteoarthritis in the thumbs is typically seen in women, in particular post-menopausal women. Clark rather obviously did not fall within this category.
– Clark performed significant lifting for 16 years, which required repetitive pinching of his thumbs. This kind of grabbing/pinching activity places significant loading on the thumbs and ultimately leads to a wear and tear of the thumb joints. Wear and tear over time led to instability of his joints causing the osteoarthritis. His TMC or thumb joints became unstable over time because of the repetitive grabbing/pinching use. Over time with continued use, his cartilage in his thumbs wore off due to the repetitive friction from the pinching/grabbing.
– Contusions/strains, such as the work injury he sustained in November 2004, also contributed to the osteoarthritis, because they cause damage to the cartilage which leads to instability of the ligament. Jamming one’s thumb also contributes to the development of osteoarthritis because it damages the ligament causing instability and then osteoarthritis.
– The thumb basal joint (where the thumb meets the wrist) is exposed to very high stresses with grabbing activities and the forces felt at the tip of the thumb are multiplied twelve times in their effect on the thumb base, thus predisposing this joint to wear and tear. Clark’s work activities as a ramp serviceman are the exact kind of activities to cause wear and tear to the thumb joint because of the grabbing involved; this wear and tear led directly to the osteoarthritis in his thumbs.
Deep Knowledge
While there were five doctors lined up against him, Woolley was the only hand specialist among them. The duelling docs bolstered their differing cases through articles in medical journals. The Oregon Court of Appeals was faced with a choice: side with the majority or side with the expert.
Ultimately, Dr. Woolley’s opinion prevailed. His compelling testimony, combined with his intimate knowledge of hands, won the day. So let’s have a little hand for Dr. Woolley, who could have taken the easy way out and deferred to his colleagues, but instead fought the good fight for a hard-working man who could no longer do his job.
(For the record, we duly note that Clark retired from his job long before the onerous baggage fees went into effect, at which time many of us lost a bit of sympathy for these harried and ultimately blameless workers.)

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Cavalcade of Risk #100 (!) and other news of note

Wednesday, March 10th, 2010

Is the 100th time the charm? Cavalcade of Risk celebrates its centesimal issue today – that’s a lot of risk coverage! Our host for this landmark issue is Russell Hutchinson of moneyblog – tip of the hat to him for a good issue. And kudos to Cavalcade founder and visionary, Hank Stern of InsureBlog.
Chronic Pain – a few weeks ago, we brought you one approach to chronic pain management. In Risk and Insurance, Peter Rousmaniere discusses the CT Workers’ Compensation Trust approach to chronic pain. This self-insurance pool of 390 healthcare employers introduced a a five-pronged program in 2009, which Rousmaniere outlines. He challenges readers to “consider how many of the five you or your vendors apply.”
Uncovered in Georgia – a loophole left 88 injured workers without workers’ comp coverage on the recent failure of Atlanta-based workers’ compensation insurer Southeastern U.S. Insurance (SEUS) Inc. Normally, the state’s insolvency pool would serve as a safety net for failed insurers, but up until a law change in 2008, captive insurers were not covered by this pool. While SEUS had converted from captive to become a traditional insurer, 88 workers claims predated the conversion and are responsible for their According to the article, “Eight of those workers have catastrophic injuries and will need lifetime care. One has medical needs exceeding $45,000 a month.”

“Twelve other firms that operated under rules that exempted the failed company’s clients from drawing from an insolvency pool still do business in the state. And while they all now pay into that pool, 10 have claims predating the 2008 change in the law that required them to do so.
If any fail, workers with active pre-2008 claims could find themselves in a similar bind. State insurance regulators say they don’t know how many people ultimately could fall in that category. But they say they don’t think any of the 12 companies is in danger of failing.”

Mad as a hatter – On the recent release of Tim Burton’s Alice in Wonderland, the CDC reminds us that the phrase “mad as a hatter” originated from on-the-job mercury poisoning. To shape felt hats, hat makers used a solution of mercuric nitrate and, as a result, often suffered from agitation, tremors, slurred speech and other neurological symptoms – thus, “mad as a hatter.” Hat manufacturers used mercury until 1941. Mercury is still used in many industries and the CDC article has some interesting statistics, as well as a page devoted to recommendations, reports, and other resources for preventing hazardous exposures to mercury on the job.
Fatal Injury mapping – via Occupational Health & Safety, we learn that OSHA has introduced a new fatal injury mapping module, which “…allows users to create customized, color-coded maps of injury-related death rates throughout the United States. It defines injury-related deaths according to intent (e.g., unintentional, homicide, suicide) and mechanism of injury (e.g., motor-vehicle traffic, fall, fire or burn, poisoning, cut).” CDC’s Fatal Injury Mapping Module. Other data and statistics are also available from CDC’s WISQARSTM (Web-based Injury Statistics Query and Reporting System), an interactive database system that provides customized reports of injury-related data.
NY crane deaths followup – Liz Borowski of The Pump Handle offers and update on the 2008 crane NY crane disasters. The owner of the city’s largest construction crane company is expected to be indicted for manslaughter in the death of two workers in one of the incidents. She also updates status on OSHA’s crane & derrick rule.
Legislator, heal thyself – More than 70% of congressional offices violate OSHA safety standards – but the good news is that violations have dropped. “The number of Occupational Safety and Health Administration (OSHA) violations found in each office has significantly decreased over the years as well — from an average of about 8.15 violations per office in 2007 to an average of 1.75 hazards in each office this year.” (via Advanced Safety and Health)
March is workplace eye wellness month – Reliable Plant offers some tips on eye and face protection. Other resources: OSHA Eye and Face Protection; NIOSH: Eye Safety; National Safety Council: Protecting Your Eyes from Injury; Healthy Vision 2010: Occupational Eye Injuries
Briefs

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Chronic pain management in workers’ comp

Friday, February 26th, 2010

Recently, I attended the 2010 Health and Productivity Forum jointly sponsored by the Integrated Benefits Institute (IBI) and the National Business Coalition on Health (NBCH) in San Antonio. I had been invited to participate in a panel discussion by Gary Anderberg, of Broadspire, who, as I have written previously, is one of the smartest people I’m fortunate to know.
With me on the panel were Dan Shaughnessy, Director of Disability Programs, Textron, Inc., and Mike Machanich, Chief Executive Officer, Workers’ Comp Solutions. Gary’s charge to us was to discuss the effect of national health care reform on workers’ compensation. Thanks a bunch, Gary. But we had a stimulating discussion as we opened that colossal can of worms. I’ll write more about this in another post. One of the issues our panel tossed around was chronic pain. We’ve written about chronic pain many times over the last few years. Here are links to a couple of the relevant posts:Workers Comp Drugs: Paying too much…For the Wrong Medicines!; The Pain Conundrum.
Our concern is that the treatment of chronic pain often involves what is to us a highly problematic overutilization of narcotics. So, I was a bit surprised to learn of Broadspire’s well thought out and relatively holistic approach to treating this debilitating and often times life-changing medical condition. With that in mind, I invited Broadspire’s medical team to submit a guest blog post for the Insider. Our one requirement was that it be informative to our readers, but not a self-serving advertisement for Broadspire. The company accepted our invitation, and what follows is Broadspire’s approach to the treatment of chronic pain. I’d be remiss if I didn’t add that Broadspire is not a client of Lynch Ryan’s and our publication of this guest blog post does not constitute an endorsement of the company’s products or services.
Chronic Pain Management Matters
Candy Raphan RN, BSN, ARNP, MAOM and Dr Jacob Lazarovic, MD, FAAFP, Broadspire
In 2006, The Center for Disease Control and Prevention (CDC) released its 30th annual report on the health status of America, “Health, United States, 2006” which found that the overall health of the nation seemed to be improving or holding steady, but highlighted one particular condition as needing further attention: pain.
Pain is a common and troubling condition around the world. In a 2005 European study, it was estimated that 20% of the world’s population deals with some form of chronic pain. In Europe, chronic pain accounts for over 30 billion euros in lost productivity. In 2002, an American study found common pain conditions caused 13% of workers to experience a loss of productivity over a two-week period. The estimated cost to corporate America was $61.2 billion dollars that year. In fact, pain has been such a prominent health care issue that the 106th U.S. Congress passed Title VI, Sec. 1603, of H.R. 3244, declaring the period between January 1, 2001 and December 31, 2010 the “Decade of Pain Control and Research.”
Solutions
Conventional treatment of chronic pain is time-consuming and often very expensive, particularly for those claims that continue without resolution over the course of several years. For this reason, it is important that employers and payers understand the dynamics and drivers of the costs associated with chronic pain. By employing a focused, multi-disciplinary clinical approach very costly segments can be targeted. It is then possible to effectively manage chronic pain from the overall costs associated with medical care and treatment as well as loss of a productive workforce.
Using evidence-based medicine to create a plan of action for those individuals with inadequately managed chronic pain promotes optimum results. Medical management programs can provide information and resources to the claimant’s current treating doctors, clinics and hospitals. These types of consultations with providers help achieve the following objectives:

  • Safe, rational and effective management of the chronic pain population
  • Maximized functionality and return to work
  • Management of medical costs
  • Focused and designated processes/people to reduce internal duplication of effort
  • Documented and measurable results and ROI metrics

How It Works
Broadspire’s Chronic Pain Program, for example, uses a defined and rigorous process. After an initial eligibility assessment, a team of specialty physicians and nurses reviews the medical and psychosocial aspects of each case. The team establishes a list set of customized strategies in the form of recommendations to ultimately achieve the goals and objectives for each case. The team then monitors the impact of interventions during subsequent meetings and follows the case through to timely resolution.
The key to the program is the expertise clinical and claim professionals bring to each claim. A highly experienced staff performs the data analysis, oversight and management of the process. An expert panel of specialized pain physicians (anesthesiologists, physiatrists, orthopedists, and psychologists or psychiatrists) provides guidance. Other contracted resources such as selected, accredited pain management facilities and urine drug monitoring labs help ensure that patients are compliant with prescribed regimens.
A Chronic Pain Program has the power to make a sizable difference. With proven methods, resources, and expertise it can provide the support and control to help employees beat pain back and return to productivity.

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A new prescription for back pain

Wednesday, February 11th, 2004

I have long suspected that the way this country treats back pain for work-related injuries is not only ineffective, it’s actually destructive. I have seen countless back claims degenerate into permanent and total disability following surgery. We are now beginning to see data that bears this out. In an article with profound implications for employers, insurers and workers with lower back pain, New York Times (free registration required) reporter Gina Kolata demonstrates the futility and the ineffectiveness of our current approach to back pain. The data calls for a transformation of the treatment paradigm itself.
Here’s the way it works now: A worker suffers a lower back strain. He’s in a lot of pain. He goes for an MRI, which reveals a herniated disc. The insurer assumes that the herniation is work related, the condition is compensable and treatment begins. Perhaps surgery is performed. However, a number of studies have suggested that in 85% of the cases it is impossible to say why a person’s back hurts. Beyond that, many studies have found that abnormal disks are usually inherited, with no links to occupation, sports injuries, or weak muscles. So the use of the MRI to confirm compensability is indeed questionable.

Then there is the issue of treatment. Studies confirm that there is little evidence that aggressive treatment is in any way helpful to the patient. One doctor quoted in the article says, “Maybe you are better off not going to a doctor.” Under the current system, if the employee is lucky, neither the treatment nor the surgery will permanently disable him and, eventually, he will return to work. The irony is that in most cases, doing nothing at all would be equally or even more effective than treating the injury with conventional medicine!

So what is the new treatment paradigm? In the view of Dr. James N. Weinstein, a professor of orthopedics and editor in chief of Spine, we should teach people to live with pain, to put aside the fear that any motion will aggravate their injury. This is a concept that many Americans have trouble accepting. If we experience pain, we seek an immediate cure. For back injuries, this approach just doesn’t work. We have to learn that “hurt doesn’t mean harm.” There will be pain for a while. During the natural recovery process, treatment should focus on “functional restoration:” That means working on training, strength, flexibility and endurance. And let’s not forget to offer the needed counseling that addresses fears of reinjury, anxiety, and depression.

Which brings me back to the employer’s best tool for fostering an active (but not necessarily pain free) recovery: Modified duty. Once we recognize that the vast majority of back injuries resolve themselves in a few months, with little or no treatment required, the need for proactive employers to help injured employees through the process – and the pain – becomes paramount. By providing modified duty, we give injured employees a reason for getting up in the morning and a place to go. We give them meaningful tasks, which help take their minds off the pain. Above all, we help them maintain their identities as productive workers. This is by far the most effective and the least expensive approach to lower back injuries. As with so many other workers compensation issues, proactive management is the best solution.

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Posted in Best Practices, Disability, Medical Issues | 5 Comments »