Posts Tagged ‘physicians’

« Older Entries

Lessons from Ernest Shackleton’s Medical Kit

Tuesday, October 2nd, 2012
“Men wanted for hazardous journey. Low wages, bitter cold, long hours of complete darkness. Safe return doubtful. Honour and recognition in event of success.”

That is the ad that was allegedly posted to attract crew to Sir Ernest Shackelton’s Arctic Expedition on the Nimrod in 1907-09. There’s been a lot written about this adventure to one of the then-most remote corners of the earth. It is still among the most remote wilderness locations today – contemporary workers who agree to stint at Antarctic bases have to prepare for a long haul since some locations only afford a two to three month window when bases are reachable.
A few years ago, when Gavin Francis accepted the position as a medical doctor ‘wintering’ at Halley Base, a profoundly isolated research station on the Caird Coast of Antarctica, he had to plan accordingly since the base is unreachable for ten months of the year. He’s written a pretty fascinating article in Granta magazine comparing the preparations he took in terms of supplying a medical kit with the list of supplies in Shackleton’s Medical Kit.

“In the well-stocked polar section of the little base library I unearthed the packing list for Shackleton’s medical kit – the drugs and dressings he took on the sledge trips of his Nimrod Expedition of 1907, the one that turned back only ninety-seven miles from the South Pole. It added up to a weight of about three kilos, less than a sixth of the modern kit, and to my technomedical mind read more like a witch’s grimoire than the best medical advice of just a century ago.”

It’s a pretty fascinating read, one that we think might tickle the fancy of occupational physicians. We enjoyed the author’s observations about how the practice of medicine has changed, particularly in regards to the challenges of caring for a workforce in a remote location.
Chances are, no matter how remote your workplace, planning for employee health and safety program doesn’t have quite the same extremes in parameters. But one thing remains true: advance planning can still mean the difference between life and death; knowing how to respond quickly can be the difference between a relatively minor event and a life-changing tragedy.
What’s the status of your workplace first aid kit?
In Fundamentals of a Workplace First-Aid Program (PDF), OSHA suggests:

“Employers should make an effort to obtain estimates of EMS response times for all permanent and temporary locations and for all times of the day and night at which they have workers on duty, and they should use that information when planning their first-aid program. When developing a workplace first-aid program, consultation
with the local fire and rescue service or emergency medical professionals may be helpful for response time information and other program issues.”

The booklet outlines OSHA Requirements, recommended First-Aid Supplies, including Automated External Defibrillators, guidance on First-Aid Courses and Elements of a First-Aid Training Program. In addition to evaluating their own organization’s risk factors, employers should be aware of any state laws governing workplace first aid.
ANSI/ISEA Z308.1-2009 is the current minimum performance requirements for first aid kits and their supplies that are intended for use in various work environments. You can purchase these through the American National Standards Institute (ANSI) or the International Safety Equipment Association (ISEA). If you want to save a few dollars, you may be able to find a free copy, such as the one we found minimum contents list from the Minnesota Department of Labor and Industry.
Automated external defibrillators (AEDs) programs are an increasingly common component in a workplace health and safety program to address sudden cardiac arrest. These programs require some medical guidance and training to put in place.
Arguably, one of the most parts of your emergency planning should be to prepare your employees and your supervisors about what to do in the case of a medical emergency. Put your policies and protocols writing and communicate them to your employees frequently. Don’t forget to include solitary and remote workers in your emergency planning.

Tags: , , ,
Posted in Business, History, Medical Issues | No Comments »

Florida is getting tough on the pill mills

Thursday, September 8th, 2011

Florida doctors bought 89% of all the Oxycodone sold to practitioners nationwide last year and thousands of outside visitors flocked to the state to buy drugs at the 1,000+ pain clinics. But armed with new legislation, the state is cracking down hard by shutting down pill mills and suspending the licenses of about 80 physicians who were high-volume prescribers. And physicians are now generally barred from dispensing narcotics from their offices. In October, things will get even tougher as a new prescription drug monitoring system will be implemented.
Lizette Alvarez reports on on the Florida pill mill crackdown in The New York Times, stating that “As a result, doctors’ purchases of Oxycodone, which reached 32.2 million doses in the first six months of 2010, fell by 97 percent in the same period this year.” This article has some eye-opening observations about the scope of the prescription drug problem: “Last year, seven people died in Florida each day from prescription drug overdoses, a nearly 8 percent increase from 2009. This is far more than the number who died from illegal drugs, and the figure is not expected to drop much this year.”
You can read more about how authorities are going after medical licenses of over-prescribers in a Miami Herald article by Audra Burch. This article discusses some egregious abuses, including a physician who dispenses from the back of a car and an office with long lines waiting outside and many cars with out-of-state license plates in the parking lot.
Related Resources
The issue of physician dispensing is one that our colleague Joe Paduda has covered extensively. See:
Physician dispensing – Exactly how much more does it cost?
Why Florida’s work comp costs are heading up
Florida’s dispensing legislation clarified
The issue of transparency related to a physician’s relationship with pharmaceutical companies is one that ProPublica has been taking on in their Dollars for Doctors campaign. See:
Patients Deserve to Know What Drug Companies Pay Their Doctor
Piercing the Veil, More Drug Companies Reveal Payments to Doctors
For more about Prescription Monitoring Programs, see:
Alliance of States with Prescription Monitoring Programs – The Alliance was formed in 1990 to provide a forum for the exchange of information and ideas among state and federal agencies on prescription monitoring programs. Since then, it has grown to be a valuable resource to all those concerned with combating the increase in prescription drug abuse, misuse and diversion. Currently, 48 states and one territory either have operating Prescription Monitoring Programs, or have passed legislation to implement them.

Tags: , , , , ,
Posted in health care, Medical Issues, State News | Comments Off on Florida is getting tough on the pill mills

Required reading: how to find the best docs

Friday, September 24th, 2010

The folks at American College of Occupational and Environmental Medicine (ACOEM) know something about doctors. They also know quite a bit about workplace injuries in that most of the members are physicians actively practicing in the field, in one capacity or another. That’s why we sat up and took notice when we saw their recent publication, A Guide to High-Value Physician Services in Workers’ Compensation – How to find the best available care for your injured workers. ACOEM joined forces with the International Association of Industrial Accident Boards and Commissions (IAIABC) to produce the 11-page “best practice” summary, which includes the best thinking and contributions from a diverse group of workers’ compensation system stakeholders in a meeting convened by ACOEM and the IAIABC last April. You can see the list of participants on page 11 – a group of heavy hitters that includes a geographical and industrial sampling. It’s great to see a think tank of employers and insurers sitting down at table with policymakers and physicians to come to some agreement about best practices. The only thing we might suggest for improvement would be to add a representative from labor at any future convocations.
The stated purpose of the document is to provide specific guidance and resources to all stakeholders in the workers comp system – from injured workers and employers to insurers and TPAs – to help identify the best physicians for care of both everyday, uncomplicated injuries, as well as for specialized medical services addressing catastrophic injury or administrative tasks required by the workers’ compensation process.
It identifies ways to find physicians who:

  • Are willing to accept patients covered by workers’ compensation insurance
  • Employ best practices in providing high quality and compassionate medical care
  • Respect and fulfill the extra responsibilities that the workers compensation system creates
  • Produce better overall outcomes at comparatively better total cost over the course of an injury or illness. (High-quality care produces better outcomes for workers and better value for payers.)

The Guide offers both a “High value” checklist and a step-by-step process for identifying physicians, verifying credentials, working with, and measuring performance. We put this one on our “required reading” list. And for adjunct reading, we also recommend ACOEM’s Preventing Needless Work Disability by Helping People Stay Employed.

Tags: , , , ,
Posted in Best Practices, health care, Medical Issues, Tools & Resources | Comments Off on Required reading: how to find the best docs

Health Wonk Review: the biweekly smorgasbord of the best fare in the health care policy blogs

Thursday, May 14th, 2009

smorgasbord.jpg Welcome to Health Wonk Review, our bi-weekly smorgasbord of the best that the policy wonks have dished out on some of the most noteworthy healthcare blogs over the prior fortnight. We have an extensive sampling of tasty and nutritious treats, with lots of brain food among the fare – so without further ado, we offer this week’s buffet.

  • The love fest at the White House with health care providers generated great headlines, but, where’s the beef? Merrill Goozner at GoozNews points out that the promises made by the trade associations and physicians held not a few ironies: Just Don’t Ask CBO To Score It.
  • To say that Joe Paduda of Managed Care Matters is skeptical about said love fest is an understatement. He is shocked and blown away that the politicians in Washington actually believe the health care-insurance industry’s self regulation will reduce the nation’s health care costs.
  • Will the consortium of private sector stakeholders be able to cut $2 trillion in healthcare costs as they claim? Jason Shafrin of Healthcare Economist casts a critical eye on this in his post Letter to Obama: We’re gonna save $2 trillion .
  • When it comes to financing health care reform, Anthony Wright of Health Access WeBlog suggests that policymakers take a two birds with one stone approach by seeking options that not only raise funds but also help the health system.
  • Are hospitals really taking a hit from the current health care system? That’s a question posed by InsureBlog’s Henry Stern, who deconstructs the latest survey results from the American Hospital Association in his post, Economy Tanks; Hospitals, Patients Hardest Hit.
  • Brady Augustine of MedicaidFrontPage posts about Wellcare being taken to the woodshed for the sins of its prior executives who lived high on the hog while shortchanging vulnerable citizens. He discusses lessons learned, offering his thoughts on how to avoid such a scenario in the future.
  • How Hard Can It Be To Coordinate Care? Rich Elmore of Health Technology News interviews Dr. Mai Pham, who turned up some startling results in a study of the number of physicians and practices that are linked to a primary care provider for coordination of care.
  • Jeffrey Seguritan looks at a study of Medicare’s unplanned hospital readmissions at nuts for healthcare, noting that readmissions seem to indicate low quality of hospital care and drive health spending. He suggests that hospitals should be incentivized to cut readmissions, but current
    policy proposals should be wary of system-gaming and should consider illness severity.
  • Yikes. David Harlow of HealthBlawg posts about the Virginia prescription record security breach, in which millions of prescription records were lifted from a state government website and replaced with a $10m ransom note. He suggests that organizations that hold electronic protected health information should use this incident as a learning experience for planning and executing programs yo increase data security, as well as preparing for communications both to prevent breaches and to respond to any breaches that do occur.
  • Roy M. Poses of Health Care Renewal has frequently tackled the topic of conflicts of interest in health care, offering examples of published defenses based on logical fallacies. Most examples were written by people who had their own ties to health care corporations and appeared mainly in the op-ed pages of newspapers, but in his post Attacking “Crusaders” Against Conflicts of Interest with Logical Fallacies, he offers an example in a scholarly journal, published as an anonymous editorial. He says we can expect to see more accusations of witch-hunting, prudery, moralism, lack of realism, and the like leveled against those who oppose such lucrative financial
    relationships.
  • Louise of Colorado Health Insurance Insider posts about how Reid is absent in Sick Around America, apparently fallout with Frontline after last year’s acclaimed Sick Around the World. Louise offers the scoop on the controversy.
  • At Disease Management Care Blog, Jaan Sidorov examines the ugly politics that emerged around the issue of using gender in health insurance underwriting in his post Snatching Humiliation From the Jaws of Compromise.
  • President Obama recently spoke about his grandmother’s death and the questions it raises about end of life care in an interview published in the New York Times Magazine. Joanne Kenen of New Health Dialogue discusses Obama’s Grandmother and the National Conversation on Healthcare, adding her own patient-centric questions that need to be part of the dialogue.
  • Jocelyn Guyer of Say Ahhh! tells us that there was mostly good news for children in the Senate Finance Committee’s Health Reform Proposal.
  • Glenn Laffel of Pizaazz discusses a particularly vexing clinical and policy problem involving a defective defibrillator produced by Medtronic, that is currently in the bodies of a quarter of a million people. Leaving the failing device in place may kill patients, but removing it may do the same.
  • Pop goes the health care bubble? At the Health Care Blog, George Lundberg looks at Enron, the dot.com era, and the real estate-financial collapse, all recent examples of growth and expectations far exceeding substance, and makes the case that the health care bubble will be soon to follow.
  • David Williams of Health Business Blog asks why employees should be penalized for smoking or being overweight but not for having unprotected sex with multiple partners in his post on the ethical considerations of financial penalties for unhealthy behaviors.
  • Eric Turkewitz of New York Personal Injury Law Blog notes that doctors still top our the pay charts, but complain about malpractice premiums anyway. He cites a survey which states that out of the ten top paying jobs, nine go to medical professionals.
  • Tinker Ready of Boston Health News posts about a new Partners/Harvard HIT blog on clinical informatics. Incidentally, Tinker will host the next issue of Health Wonk Review.
  • In his post Even more ‘Fierce’, Neil Versel of Healthcare IT Blog discusses a new publication FierceEMR, which includes one of his articles about live video links from ambulances to a trauma center in Tucson, Arizona.
  • Although the influenza A (H1N1) or swine flu outbreak is gradually falling out of U.S. news headlines, Kara Rogers of Britannica Blog notes that the full extent of the outbreak may not be known for some time because other countries are only now experiencing their first cases or are experiencing an increase in confirmed cases as their backlogs of samples are tested.
  • Is our food policy behind the current swine flu pandemic? Eric Michael Johnson discusses how we can best promote national health by changing how our food production policies at The Primate Diaries.
  • And here at Workers Comp Insider, we’ve noted that there’s a new OSHA sheriff in town. Long-time worker safety advocate and former safety blogger extraordinaire Jordan Barab is serving as Acting OSHA Administrator.

Tags: , , , , ,
Posted in News roundups | Comments Off on Health Wonk Review: the biweekly smorgasbord of the best fare in the health care policy blogs

Taking the cookie-cutter to workers’ comp medical networks – Why that doesn’t work

Thursday, August 28th, 2008

Yesterday, at Managed Care Matters, our good friend Joe Paduda published an excellent “how-to primer” for starting a workers’ compensation medical network. Essentially, Joe’s advice for would-be network creators is:

  • Bring the right physicians into the network – board-certified occupational health specialists, for example, as well as primary care and specialist physicians who understand workers’ compensation;
  • Exclude physicians who don’t know anything about the subject;
  • Pay the physicians a reasonable rate; and,
  • Support the network physicians by sending them patients.

If the network is formed in that way it should be of gold standard caliber. But that’s easier said than done.
We’re all familiar with the super-large networks that include anyone with a medical degree – as long as “anyone” agrees to see network patients for a discounted fee, which the network can then tout as “savings” for employers regardless of the quality of care. Most of these networks and the doctors in them came from the group health arena where modified duty, transitional duty, early return to work, the buzzwords of workers’ compensation professionals, are foreign concepts. And why should that be surprising? After all, workers’ compensation is only one, tiny room in the American health care house that Jack built.
What workers’ compensation professionals sometimes forget is that most doctors, whether in or out of these networks, went to medical school because they wanted to devote their lives to healing the sick, not to becoming some company’s external medical personnel director. Many, perhaps most, physicians in networks that have physician directories the size of New York City’s phone book understand “injuries,” but not workers’ compensation, and that is not their fault. It is ours. We have not educated them sufficiently regarding workers’ compensation, nor have we cohesively partnered with them to help injured workers transition at the right pace back to full duty, which, in my 25-year Lynch Ryan experience, is where injured workers really want to be.
Consider this. Most doctors have small practices that turn them into small business owners. I’ve never met one who liked that, the business end of medicine. Most are not technologically facile, and workers’ compensation injuries comprise a minor share of their “business.” Their responsibility focuses totally on their patients and what’s wrong with them. They don’t see a real need to be overly interested in the workplace; in fact, they most often don’t even know what or where that is. On the assembly line that has become American health care, where insurers force physicians to cycle through patients in fifteen minute intervals, who has time to probe deeply about the workplace and what goes on there? When some claims adjuster or nurse case manager wants to pin them down about physical restrictions or a date when their patient can return to work, they err on the side of humongous caution in order, in their minds, to “do no harm.” This leaves workers’ compensation professionals and employers befuddled, scratching their heads and wondering what is wrong with the doctor. They think, “Why can’t the doctor see what’s really going on here?” They don’t understand the doctors and the doctors don’t understand them.
That’s the scenario in which workers’ compensation professionals very often find themselves. At Lynch Ryan, the only way we have ever found to deal with it successfully is one doctor at a time, sitting face to face and finding common ground. Occupational health specialist or not, an educated physician is a powerful weapon for good in the little world of workers’ compensation.
In my next post I’ll describe the step-by-step process my colleagues and I went through to build the first workers’ compensation medical network in Massachusetts once upon a time. Here’s a teaser: It was a thing of beauty, profoundly successful for everyone involved, and would not be legal today.

Tags: , , , ,
Posted in Best Practices, Medical Issues | Comments Off on Taking the cookie-cutter to workers’ comp medical networks – Why that doesn’t work

Health Wonk Review: the party’s at our place this week

Thursday, August 9th, 2007

Kudos to some of our Health Wonk Review “usual suspects” who were included in Managed Care’s July story on health care blogs. Author Alan Adler, MD, who is the Medical Director, Independence Blue Cross, offers a brief intro into what blogs are and a sampling of various health care blogs. I think he did a great job explaining blogs. For example, how true is this:

If you’ve only heard of blogs from the consumer press, you might think they consist entirely of blather about pop culture and outrageous fulminations from the political far left and far right, but the fact is, there are many serious, well written blogs, and the major health care issues of the day are discussed on blogs — before, and more extensively, than they are or could ever be discussed in academic articles.

We’re glad to see some of the HWR crew cited. In the four years since we began blogging, we’ve really seen health care grow to be an exciting and thriving blog sector, and as Adler points out, there’s something for everyone.
OK, on to this week’s issue of Health Wonk Review. When I agreed to host in August, I thought I would have things easy, with just a few skinny posts here and there. Not so – lots of submissions rolled in, so settle down for a big fat issue and a good long read.
First up to bat, Dr. Roy M. Poses of Health Care Renewal blogs about another death in a gene therapy trial. In this case, the death occurred in an early phase trial of gene therapy for arthritis. The story includes troubling allegations of irregularities in the trial and odd connections between this trial and the infamous trial of gene therapy in the late 1990s, which also led to a patient death. Roy notes that despite the the story raising many intriguing questions and providing few answers, it has garnered little attention in the mainstream media.
Bob Laszewski of Health Care Policy and Marketplace Review asks why President Bush is suddenly so willing to veto spending bills. He notes that the President threatened to veto a highly popular bipartisan deal to reauthorize the State Children’s Health Insurance Plan (SCHIP), along with just about every other spending bill the Democrats have offered, including those with substantial Republican support. In the first six years he didn’t veto a single spending bill. What’s going on here? Bob has some ideas.
Jason Shafrin of Healthcare Economist discusses a study which appeared in the August issue of JAMA demonstrating that violence is a vicious cycle. The study included interviews with more than 2500 adults in northern Uganda to examine how exposure to war crimes affects views about peaceful negotiations.
What’s the secret to reforming health care? Dr. Brian Klepper from The Doctor Weighs In suggests that the answer lies in the private business sector, a group that must come together with common purpose to drive reform. And in assembling this coalition, he has a prescription for success: Don’t invite anyone from health care.
David Williams of Health Business Blog is apparently better natured than we are. He managed to get a laugh out of news reports that MA premiums were being held down by the health reform law since his own premium is going up 26.3%! I guess it’s laugh or cry. That was bad news for him to come home to. David has been on the road to see hospitals in Singapore, and kept a seven-part record of his travels at Singapore Medical Tourism Diary.
At HealthBlawg, David Harlow informs us that the Centers for Medicare & Medicaid Services (CMS) is slouching towards pay for performance (P4P). He notes that while private-sector payors and CMS demonstration projects have begun P4P work in earnest, CMS is still in the pay-for-reporting phase of development, but is broadening the scope of this program.
Joe Paduda of Managed Care Matters tells us that when Medicare sneezes, the rest of the health care sector catches a cold. (Or some might even suggest pneumonia, Joe). He offers a quick guide to the primary impending Medicare changes.
Shock! Horror! Matthew Holt of The Health Care Blog disagrees with Uwe Reinhardt. Well, sort of. This week, he tackles the prickly subject of physician compensation.
Cheesy Insurance? What do swiss cheese, NFL teams, and insurance have in common? InsureBlog’s Bob Vineyard thinks that Wisconsin’s latest effort toward “universal health care” may get sacked before the first play, mainly because it’s full of holes.
Adam J. Fein of Drug Channels raises some heretical questions about the AMP war, including why we need the “Saving our Community Pharmacies Act of 2007” (H.R. 3140), which was proposed last week by Reps. Nancy Boyda (D-KS) and Jo Ann Emerson (R-MO). He cites economic data showing that the rhetoric about patient welfare has been overblown by the pharmacy lobby. He may also raise the hackles of the drug lobby in questioning whether the U.S. may actually have too many retail pharmacies.
According to Jay Norris at Colorado Health Insurance Insider, things aren’t looking too favorably for the “independence” of the independent commission established by newly elected Colorado Gov. Bill Ritter, which had the laudable goal of drawing up a plan for the future of health care in Colorado. It turns out that despite good intentions, the commission is now being run by bigwigs in the insurance industry.
Rita Schwab of MSSPNexus blogs about court decisions that signal a new era for hospital liability. Both Putnam General Hospital in WV and Silver Cross Hospital in IL have both been on the losing side of lawsuits involving negligent or sub-standard credentialing practices.Increasingly, malpractice attorneys are looking, not just at the physician’s skills, but also at the credentialing process in the hospital that granted the physician access to the facility.
In his post about why New York medical malpractice insurance jumped 14%, Eric Turkewitz of New York Personal Injury Law Blog suggests that “lousy government policy on the insurance end has caused a ‘crisis’ that affects health care.”
Michael F. Cannon of Cato@Liberty has a conversation with one of the WTC rescue workers who appeared in Sicko. If you’ve seen the film, you know that Michael Moore took 3 rescue workers to Cuba for health care that they couldn’t get here. Michael wrote an op-ed in a NY paper, and one of the workers posted a comment. Read the exchange.
Dmitriy Kruglyak of Trusted.MD looks at People Powered vs. Consumer Directed Healthcare and discusses what he sees as the very real differences between the two. The post offers his assessment of what is really wrong with Consumer-Directed Healthcare and how he thinks the private sector can fix things without turning everything over to the government.
Here at the Workers Comp Insider homestead, my colleague Jon Coppelman discusses the impending problems that are likely with the Homeland Security’s scheme to get tough on illegal immigration. Employers will be required to fire workers who have Social Security numbers that come up false.
The next issue of Health Wonk Review is just two weeks away. It will be hosted by Daniel Goldberg at Medical Humanities Blog. Keep up with the schedule and the archives at Health Wonk Review.

Tags: , , , , , ,
Posted in News roundups | 3 Comments »

News Roundup” Cavalcade of Risk, networks, docs & drugs, scandal watch & more

Friday, May 11th, 2007

Carnival time – Cavalcade of Risk #25 is posted at Getting Green. Among other fine entries, we note there are two posts about data security. In one case, the Transportion Security Office lost the records of 100,000 workers – great, that speaks well to their ability to protect us! And in another item, we learn that Chase is careless in disposing of sensitive client materials – and they are obviously not the only ones. Not good. Is your agent, insurer or TPA properly disposing of any claim-related data and records for your organization? You may want to add this item to things you check for in renewals or RFPs.
WC networks – Joe Paduda has some thoughts on the future of workers compensation networks. After meeting with several network executives at the recent RIMS meeting, he sees a definite continuation of the trend away from the national broad-based, discount-oriented networks to regional hybrid networks. Not sure what a Hybrid network is? Joe offers a good explanation in his post. His expert analysis on these matters is worth your attention.
Docs & Drugs – Those free drug samples that physicians hand out may not be such a good idea after all, or so says a recent article in the New York Times. Critics see these as just another example of the close ties between physicians and drug companies, and say that ” … they may actually drive up the cost of health care in the long run, because the drugs being promoted are the most expensive brand-name medications.” We’ve talked about docs and drugs a few times before. (Thanks to HealthLawProf Blog for the pointer to the article)
Scandal watch – We’ve written quite a bit about the Ohio Bureau of Workers Compensation Coingate scandal. Today we learn that the BWC’s former CFO faces 5 years in prison. His sentence was reduced based on cooperation with authorities, so there is the potential for further shoes to drop. There have been 16 public officials and money managers convicted of various offenses thus far. In other state news, trouble is brewing in the North Dakota workers comp system too.
Geek safety – 25 Free health Tips for Computer nerds This blog may focus on work-related risks, but play can be dangerous too – In 2005, a 28-year-old South Korean man who played computer games for straight 50 hours died of heart failure. Pass this article on to your IT folks and the bloggers in your life. Via Ergonomics In the News
Notes from the Blogosphere – Congratulations to Michael Fitzgibbon at Thoughts from a Management Lawyer ob his 4-year Blogiversary. Michael is a Toronto-base attorney and professor who keeps us informed about the employment-related goings on in our neighbor to the North. And speaking of Canadian bloggers, we told you that rawblogXport had announced the blog was winding down, but we are happy to note that items are still being posted daily.

Tags: , , , , ,
Posted in News roundups | Comments Off on News Roundup” Cavalcade of Risk, networks, docs & drugs, scandal watch & more

How Long should a Disability Last?

Thursday, December 8th, 2005

One of the most important questions confronting disability managers is how long a disability should last. During Lynch Ryan’s 20+ years in the business, we have seen the loss of a finger tip turn into a permanent total disability, while the loss of three fingers resulted in only a month of lost time. One employee injures his back and is gone forever; another with a more serious back strain is back to work on modified duty within a week. What accounts for the differences? How many days of disability are medically necessary?
What are Disability Duration Guidelines?
If you study a lot of injuries, over a long period of time, you can develop a strong sense of how long a disability should last, ranging from no time lost to years and years of disability. The data can encompass many diagnoses and can take into account the occupation of the individual (sedentary to physically demanding) as well as co-morbidities (health problems that may impact the speed of recovery). The data can reveal optimum results (minimal time away from work), average and mean durations (the middle of the bell curve) and the outlyers on the wrong side (many months of what is often medically unnecessary disability). This type of data should be very useful for claims adjusters, nurse case managers, sophisticated employers and insurers in general for setting goals in returning disabled individuals to fully productive lives. There are a number of these data bases available; the Reed Group has one that is both comprehensive and user-friendly.
Like managed care, disability duration guidelines are a hot topic, one of the new buzz words in the world of cost control. A lot of people are now using these guidelines – but are they using them effectively? I doubt it. Our esteemed colleague, Dr. Jennifer Christian, head of Webility MD, has done a great job of listing the uses and misuses of disability duration guidelines in one of her “Ask Dr. J” columns, available here in PDF format.
What not to do!
Jennifer notes that people often simply match the guideline numbers with the current length of disability for a given situation. The adjuster tends to feel that there is no need to do anything until the mid-point has been reached. And of course, the red flags really start blowing in the wind once the claim approaches the maximum durations. As happens all too often in the world of insurance, this approach results in too little being done too late. You are shutting the barn door long after the horse has wandered into the field.
Aligning Incentives
Jennifer suggests that people focus on the optimal side of the distribution. Adjusters should set a goal of beating the best: returning disabled people to work faster than is normally expected for the given disability. In doing this, you ensure that the proper resources are directed with a laser-like focus on the situation. In Lynch Ryan’s experience, you have to treat every disability with a sense of urgency from day one. Too many things can and often do go wrong if you sit back and wait for a situation to resolve itself.
Jennifer acknowledges that the “worst case” number might be useful for setting reserves, but absolutely not for setting the agenda. She suggests that adjusters be rewarded for taking risks early on – for drawing upon the full range of options before the claim drifts toward long-term duration. With this strategy, you are likely to find yourself spending a little more in the short run and much less in the long run.
Jennifer’s column contains a lot of interesting detail. It’s well thought out and very comprehensive. If you are interested not just in using disability guidelines, but in using them well, this would be a good place to begin.

Tags: , ,
Posted in Best Practices, Disability | Comments Off on How Long should a Disability Last?

Google New Hires!

Monday, June 20th, 2005

If you were to Google the name “Dr. Jayant Patel,” you would find over 20,000 references going back a number of years. The more recent entries are undoubtedly the most alarming. “Dr. Death” has been implicated in the demise of 87 patients at a municipal hospital in Bundaberg, Australia. He has become infamous for not washing his hands between surgeries, for failing to use anesthesia during surgery and perhaps most famously, for performing a colostomy backwards (I’m not sure what that would look like, and I don’t really want to know). If you do take a few moments to google his name, you would be more diligent in researching the doctor than were his previous employer and the executive recruitment firm that brought him to Australia. Therein lies our tale.
Bundaberg is a farming community on the eastern coast of Australia, just south of the Great Barrier Reef. They are famous for “Bundy Rum” — an alcoholic beverage that presumably bears no relationship to the star of the dubious sitcom, “Married with Children.” The local municipal hospital was delighted to find a former professor of surgery at the State University of New York who was willing to relocate to Australia. Unfortunately, his tenure down under was not unlike his work in Oregon and New York. He had been suspended in New York and his license had been revoked in Oregon, where he had once worked for Kaiser Permanente.
Whistleblower Blown Off
One of the striking aspects of the story as presented in the New York Times (registration required) involves the head nurse at the hospital, Toni Ellen Hoffman. She continuously raised her concerns about Dr. Patel’s performance with hospital administrators, only to be told that she had a “personality problem.” After a particularly shocking incident, where a 9 year old girl watched her father die through Patel’s neglect, the nurse requested an inquiry. The administration’s response? They named Patel as the employee of the month!
Finally, as the result of a legislative inquiry, Dr. Patel’s name was published in a paper. An enterprising reporter Googled the name and the scandal finally exploded. Dr. Patel fled the country, returning to Oregon where he lives in a mansion and appears to be unenthusiastic about returning to Australia, where he could face charges of homicide.
Management Lessons
We often talk about the potential negligence involved in hiring and entrusting incompetent or dangerous people to carry out their responsibilities. Here we certainly have a case of negligence in hiring: the hospital in Bundaberg was so excited to find a credentialed foreigner willing to join their staff, they did not look beyond the documents he presented about himself. As we have seen, a simple Google search would have exposed Patel as both incompetent and dangerous.
In addition, Patel carried letters of reference from several of his Oregon colleagues. These letters were provided after his termination for cause; the doctors who wrote them are likely to find themselves involved in the many lawsuits that are going to come out of this situation, under the legal concept of “negligent reference.” Then again, perhaps the colleague who described Patel as “above average” has a very low opinion of the average doctor!
Beyond these examples of negligence, hospital administrators really messed up when they failed to respond to the alarms raised by a trusted member of the staff. The administration went into a denial mode that will severely compound their negligence in hiring: it’s bad enough to drop the ball on reference checking, but far more serious to ignore the evidence right in front of your eyes. The lawyers will have a field day.
Some are calling Patel a psychopath. Others think he is simply incompetent. The bottom line is that he did not belong in any operating room, anywhere in the world, including one in a relatively remote town on the shores of Australia. With the advent of the internet, the HR folks in Australia had access to the same data available in New York City. So here’s our advice: google new hires. It doesn’t cost anything, it only takes a few moments, and it might save you a whole lot of pain, suffering and trouble.

Tags: , , , , ,
Posted in Business | Comments Off on Google New Hires!

A Few Thoughts on Comp Medical Networks

Tuesday, May 24th, 2005

Workers comp is about injuries and injuries require medical attention. Our colleague Joe Paduda blogs the problem of finding good medical care under the comp system. Back in the 90’s, there seemed to be a proliferation of occupation medical practices: from hospital based occ clinics to the “doc in a box” walk-in clinics, there were a lot of options for treating injured workers. These options have diminished dramatically over the past few years. Why? It’s pretty simple: a combination of not enough volume (injury rates are declining) and suppressed rates of reimbursement (rate schedules for medical services under comp tend to be low). In addition, you need to consider the context: total health care in this country costs $1.4 trillion, while the comp portion of this is only $30 billion. Comp, in other words, is chump change in comparison to medical care in general.
Paduda’s blog shows that the prevalent trend is away from networks specializing in work related injury and toward bringing injured workers into conventional health networks — in other words, family practices. This is far from an ideal situation. Occupational medicine brings a unique and essential focus to work injury: the goal is always to keep people as productive as possible; to help them heal faster by returning them to work as soon as possible, often through the prudent use of temporary modified duty. I’m not sure that traditional family practices view injuries the same way. Family doctors are perhaps more sensitive to the pressures and issues outside of work. I suspect they are more inclined to give the injured work time away from work, especially when they know that any lost wages will be covered by indemnity payments. They are not used to communicating directly with their patient’s employer. Indeed, if the patient doesn’t like his or her job, the doctor may be inclined to separate the goal of getting the patient better from returning him or her to work.
Paduda highlights one exception to this trend: the recently announced merging of The Hartford’s workers comp business with Aetna’s workers comp specialty network, which is available in Pennsylvania, New Jersey, Connecticut, Texas and Virginia. Aetna’s network includes 130,000 physicians, hospitals and other health care providers. Aetna, along with Corvel, HealthFirst, Concentra and Focus, and a few others, continue to offer occupational services for injured workers.
Preferred Provider Networks that Really Work
I have long been intrigued with the issue of medical care in the workers comp system. I’m not sure that anyone has got it quite right. In the ideal system, doctors explicitly buy into the notion that a rapid return to work is the optimum result. They are committed to a “sports medicine” approach. They limit office visits and therapy to what is truly needed. They prescribe the necessary medications, but are careful to use generics where appropriate (even though the patient doesn’t really care, because there is no co-pay). These doctors are able to resist the raucous pitch of drug companies to experiment with off-line use of branded medications. And they communicate readily with their patients, the employer and the insurance carrier.
In exchange for all this good work, occupational doctors should be paid reasonable rates — which in many states means paying well above scheduled rates. Too often, the established rates (and the rates within many of the formal medical provider networks) are ferociously suppressed, which can lead doctors to make up the difference by over-utilization; in other words, suppressed rates do not necessarily produce lower costs. In addition to paying occ docs above rate schedules, they should also be reimbursed for certain key activities that usually are provided for free — such as filling out return-to-work status reports. If you don’t pay for such reports, the message to the doctor is that the reports are not important. In the comp system, there is no more important communication than the doctor’s take on medically necessary restrictions — what the employee can and cannot do.
We recommend that employers with any significant volume of injuries develop a relationship with their local providers, whether or not they are in a formal provider network. Make sure that the provider understands your commitment to modified duty. And let your carrier or TPA know that you are not interested in saving a few pennies by forcing your medical provider into a punitive rate schedule. Rather, you want to pay a little extra, in order to secure the level and quality of service that ensures success in workers comp cost control.

Tags: , , ,
Posted in Medical Issues | 1 Comment »

« Older Entries