Posts Tagged ‘prescription drugs’

Medical Care Experts: Where Would We Be Without Them?

Monday, August 7th, 2017

If you’ve been following the blog-o-sphere and the LinkedIn-o-sphere, you know that the space is crowded. Lots of workers’ comp practitioners have glommed on to the idea that the way to get ahead is to write and post frequently. Connect with more than 500 others in the profession. Write something, anything, put your name on it and throw it up against the wall to see if anything sticks. Kind of the way Garrison Keillor used to say he changed socks on a book tour.

Every once in a while, something helpful and interesting appears and gains a bit of temporary caché for itself and for its author. Mostly, the topics center on the persistent rise in medical costs and, even more often, on the insidious and often criminal use of opioids, which a regrettable number of alleged doctors, having checked their Hippocratic Oath at the door, are prescribing at a hell-bent-for-leather rate at a hell-bent-for-leather profit. The poor, unfortunate souls for whom these scripts are written are nothing more than high-cost collateral damage.

Consequently, efforts to control workers’ compensation costs are now almost entirely dedicated to reining in costs associated with medical care with a huge emphasis on prescription drugs.

And why not? Injury frequency continues its 13 year, asymptotic approach to zero. While the same can’t be said for injury severity, these are, nonetheless, heady times for insurers. Kind of hard not to make money when the combined ratio is in the 90s.

Regardless of how good things are getting in workers’ comp world, the workplace is still the best place to control and manage the work injuries and costs that are bound to occur despite frequency’s decline and the rise of the robots. But that requires educated employers who understand that they, not the vendors to whom they outsource payment responsibilities, are the hub of the workers’ comp wheel.  Who approach workers’ compensation in a Management 101 kind of way understanding that a systemic, accountable process will reduce costs to a minimum and bolster profits as well as employee morale and productivity.

This means training supervisors in the proper response to work injuries, keeping close communication with injured workers, creating good relationships with treating physicians, bringing injured workers back to work as soon as possible under medical supervision, seeing that injured workers receive full pay while on modified duty, and measuring success every month just as one measures success in every other business enterprise.

These, and other program components, give enlightened employers a distinctive competitive advantage, and the results will speak for themselves.

But not all employers are enlightened; many have lost their way. Why?

Well, could it be we took a system we had made relatively simple for employers to manage (and let’s not forget that it is employers who ultimately pay the bills) and made it progressively more complicated with progressively more vested interests?

Many middle market employers, realizing they have no hope of navigating the haunted house maze medical care has become, have relinquished control to a myriad of vendors, the “experts.” Climbing this Tower of Babel is beyond them.

The question is: Can we do anything about this? Should we? Or, has this ship long ago sailed?

Reactions To “Pharma’s Nine Words”

Monday, May 15th, 2017

We received a lot of thoughtful feedback to last week’s post on drug company Direct To Consumer (DTC) television advertising. I thought I’d share a couple that are representative of the whole.

This from a doctor in Florida:

You have acutely illustrated the challenge that allopathic physicians now battle with every day. In short, big Pharma has found a way to circumnavigate the drug salesperson and physician and go directly to the end consumer
Every physician feels significant pressure to satisfy their patients even when the request for certain pharmaceuticals is unreasonable; if the patient walks out of your office empty-handed chances are they won’t come back, so at the very least most patients have some prescription in hand upon their exit.

And this from a C-Suite Chief of Marketing:

I must confess upfront that I was one of those “DTC advertisers” in the early 2000s, having worked with Eli Lilly, Boehringer Ingelheim and Pfizer to name a few former clients.

Over the years I’ve read conflicting studies on DTC’s effectiveness and impact.  This said, there is typically a relationship between the largest category spender and market share.

You may also be interested in a dated survey from the FDA on the subject.  While there are definitely some “pro’s” associated with these efforts, including but not limited to patient empowerment (more prepared for doctor’s appointment, asking thoughtful questions, generally being more involved in one’s health, and better conversations about one’s condition and possible treatments). But there are also some “con’s,” including but not limited to:  overpromises/over statements of a drug’s potential benefits (and a corresponding downplay of possible side effects); pressure on physician’s part to prescribe a patient-requested drug, among others.  (But let’s not forget that there were physicians who were also in pharma’s pockets long before DTC, prescribing certain drugs based on lucrative relationships with companies.  Certainly not all of them… but unfortunately there were – and likely still are – some “bad apples.”)

It will be interesting to see how this debate evolves as baby boomers age.  Let’s hope that the patient is the ultimate winner here!

We can all agree with that last bit about hoping the “patient is the ultimate winner.”

We welcome responsible, thoughtful comments from our readers.

 

 

Pharma’s Nine Words

Thursday, May 11th, 2017

Any idea what the nine most frequently spoken words on US television are? How about:

My doctor said…

Tell your doctor…

Ask your doctor…

These words come at the beginning, “My doctor said,” the middle, “Tell your doctor,” and the end, “Ask your doctor,” of Direct To Consumer (DTC) television advertising with which Big Pharma bombards Americans every day. This is especially true during the morning network shows between 7:00 and 9:00 AM, the evening news hours and the occasionally funny prime time sitcoms that follow. The ads also feature a swell story with great looking actors and sweet music that plays as someone doing a voiceover tells us all about the 25, or so, ways the drug being pushed can kill us.

DTC ads come in many forms, but in 2015  69% of them were television ads with about a third of those coming from Pfizer. These ads have been allowed since the mid-1980s, but gained momentum in 1997 when the FDA relaxed the rules regarding television. Since then, it’s been Katy bar the door.

According to Pharmacy and Therapeutics (P&T), a peer reviewed journal for managed care and hospital formulary management:

The average American television viewer watches as many as nine drug ads a day, totaling 16 hours per year, which far exceeds the amount of time the average individual spends with a primary care physician.5,23,27

Since beginning the recovery from the Great Recession, television DTC has seen staggering growth:

 

 

According to Kantar Media, 72% of the commercial breaks in the CBS Evening News now have at least one pharmaceutical ad in them. These ads have a specific demographic target: Baby Boomers. Until 2012, they were mainly aimed at conditions such as dry eyes, erectile dysfunction, smoking cessation, chronic pain, constipation, heartburn, allergies and cholesterol. But in the last five years, they’ve made a deep dive into cancer, rheumatoid arthritis, and other illnesses to seniors. And, a reflection of our time, Opioid Induced Constipation hit the field during the 2015 Super Bowl. I can still hear the collective national gasp from that one.

Kantar Media reports Pharma spent $6.4 billion on DTC in 2016, with television garnering more than two-thirds of the spend. Since 2012, television spending is up 62%. During that time, the number of drug companies annually spending more than $50 million and the number spending more than $100 million has doubled. For example, last year, makers of Viagra and Cialis spent a combined $306 million convincing older (and increasingly younger) men that without those magic little pills their once prodigious sexual prowess, rapidly approaching Wooly Mammoth-like extinction, will never rise again, literally (but watch out for that 4-hour thing).

And when a new drug hits the market, first year spending can be breathtaking. Consider Opdivo, which debuted in 2015. The drug treats a certain kind of end-stage lung cancer (non-small cell lung cancer), which has a US patient population of less than 200,000. Yet Bristol-Myers Squibb, Opdivo’s maker, spent $93 million marketing it in its first year.

All this money begs an obvious question: Does it work? Well, even Pharma’s not sure, saying ROI is only one measure of a brand’s marketing success. Who is sure? The American Medical Association, which, in 2015, saying it was a colossal waste of money, called for an “outright ban” on Direct To Consumer advertising. The AMA also said doctors felt pressured by vulnerable patients who were looking for relief from one thing or another and that older drugs often work just as well, or even better, than the newer high-priced brands. Of course, it is preposterous to think we’ll ever return to to good old days of the 1980s before DTC advertising became more than a gleam in a marketer’s eye. The drug lobby is nearly omnipotent and there is the  little matter of commercial free speech. Moreover, drug makers claim they are providing valuable information with which consumers can make informed choices. Yet, according to the World Health Organization, “DTC is used to drive choice, not to inform it.”

America is one of only two countries in the world that allow Direct To Consumer drug advertising, the other being New Zealand, a country with a population of less than 4 million. The medical community doesn’t like it there, either.

Pharma has long had a wish to bring DTC to the European Union. That’s not going to be happening, however, as last year 22 of the 27 members rejected the idea.

The P&T white paper, mentioned above is presents an excellent analysis of DTC advertising, and ProCon.org has a nifty for-and-against page regarding DTC advertising. They’re both worth a look.

More on the opioid crisis and the fentanyl factor

Wednesday, May 4th, 2016

Here in the state where the world headquarters of Lynch Ryan is housed, we learn the unsettling news that Massachusetts has seen a 190% increase in opioid deaths in five years. Jessica Bartlett of Boston Business Journal notes:

“Despite Gov. Charlie Baker releasing a $27 million plan to address the opioid epidemic in June, opioid deaths have continued to rise, with recent data from the Department of Public Health showing a 12.5 percent increase in estimated deaths in 2015 compared to the year before.

Compared to just five years ago, the estimated 1,526 unintentional opioid-related deaths in 2015 represents a 190 percent increase.”

Things might have been even worse. In 2015, the “opioid antagonist” Naloxone was administered 12,982 times, so we can only guess what the tally might have been without such intervention. It doesn’t look like 2016 will bring much relief: An estimated 400 deaths have have already occurred in the first three months of the year.

Bartlett notes a disturbing trend:

“While the high number of deaths is nothing new, the state has for the first time released the number of deaths with a confirmed presence of fentanyl, a synthetic opioid 50 to 100 times more potent than morphine.

Of the 1,319 confirmed opioid deaths in 2015, 754 of them tested positive for fentanyl.”

Felice J. Freyer and J.D. Capelouto recently reported on this in the Boston Globe: Fentanyl factored in more than half of 2015 OD deaths, state reports

A Massachusetts law criminalizing fentanyl trafficking took effect in February, with sentences of up to 20 years in prison for selling more than 10 grams.

The health department data released Monday provide the most reliable portrait to date of the opioid crisis in 2015, confirming that 1,379 people died from overdoses. A deeper analysis of cases from 2014 raised the number of confirmed fatal overdoses for that year, to 1,282.

The state’s findings do not distinguish between heroin overdoses and those caused by prescription opioids. Health officials are unable to make that distinction because most prescription opioids, as well as heroin, break down into morphine in the bloodstream. But fentanyl, a synthetic drug, turns into a substance that can be detected by a test.

Southern California Public Radio features a story on Why it’s so hard to track the powerful opioid fentanyl. Rebecca Plevin reports:

First, doctors treating overdose victims are mainly looking for the better-known opioids, like Vicodin. And when they check for drugs, standard tests often miss fentanyl. A special lab analysis is often necessary, and doctors – especially in busy ER’s – don’t always think of that. Another problem is that not all hospitals are set up to conduct the special lab analysis.

All of this is complicated by the fact that illegally manufactured fentanyl may be mixed with heroin or counterfeit pills that look like normal prescription medications, so people may not be aware that they’re exposing themselves to the drug.

The rise in fentanyl use has health officials particularly worried, given its tremendous potency. To try to get a handle on the problem, the state has asked all local hospitals to report suspected fentanyl overdoses. State officials have also asked providers to test for fentanyl when ordering drug screening in cases of suspected overdose.

This is a disturbing news in the worsening opioid crisis. A simple search of Google news will show that officials in Ohio, Pennsylvania and other states are seeing surges in fentanyl overdoses.

In his post Opioids, spines, and dead people, Joe Paduda talks about physicians and prescribing, giving context to the issue:

In a related piece, Michael Van Korff ScD andGary Franklin MD MPH summarize the iatrogenic disaster driven by opioid over-prescribing. Over the last fifteen years, almost 200,000 prescription opioid overdose deaths have occurred in the US, with most deaths from medically-prescribed opioids.

Doctors prescribed opioids that killed well over a hundred thousand people.

Today, about 10 million Americans are using doctor-prescribed opioids; somewhere between 10% – 40% may have prescription opioid use disorder – they may well be addicted.

Van Korff and Franklin note that 60% of overdose fatalities were prescribed dosages greater than a 50 mg morphine equivalent.

In days gone by, drug deaths were primarily associated with illicit or street drugs, but today, it’s prescription drugs – and prescriptions are seen as the gateway to street drugs, rather than the reverse.  We now lose more people annually to drug overdoses than by car crashes or firearms.

In 2013, the most recent year for which data is available, 46,471 people in the United States died from drug overdoses, and more than half of those deaths were caused by prescription painkillers and heroin.

That compares with the 35,369 who died in motor vehicle crashes and 33,636 who died from firearms, as tallied by the federal Centers for Disease Control and Prevention.

Combating the public health scourge of prescription drug-related addiction and deaths will require a concerted effort on all fronts: physicians as prescribers; employers and insurers in the workplace; public health, elected officials and law enforcement in our communities. On that front, there have been some promising approaches in moving from a crime to a treatment approach: Connecticut Cops Consider ‘Angel’ Program to Combat Heroin Scourge

Another approach, pioneered in Gloucester, Massachusetts, shows promise and has been attracting increasing attention around the country. In Connecticut, Groton has adopted it and Manchester is considering a similar program.

Launched on June 1, the Gloucester Angel Initiative makes police the point agency in moving addicts directly into treatment. Addicts are allowed to surrender any drugs and needles they have with the understanding that they will not face arrest and that police and community volunteers called “angels” will help them toward recovery.

About 350 admitted addicts have sought help in Gloucester through the program, department spokesman John Guilfoil said on Jan. 8. As a side benefit, crime fueled by addiction, particularly thefts, dropped 33 percent last summer compared with the summer of 2014, Guilfoil said.

Fifty-three police agencies in the country have adopted similar programs, and two to three more join each week through a partnership called the Police Assisted Addiction and Recovery Initiative, Guilfoil said.

Prior related posts:

 

Studies: Opioid epidemic grows; Is obesity a smoking gun in rise of prescription drugs?

Wednesday, January 13th, 2016

You may have taken hope from studies that pointed to a decrease or leveling of the rate of deaths related to opioid and prescription drug use in 2012-2013. If so, the Centers for Disease Control wasted no time this year in throwing some cold water on those hopes.

On January 1, via the Morbidity and Mortality Weekly Report (MMWR), the CDC issued new data on Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014.

                      Age-adjusted rate of drug overdose deaths and drug overdose deaths involving opioids: US 2000–2014

mmwr opioid trends

Here are some of the key findings:

  • During 2014, a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014.
  • Rates of opioid overdose deaths also increased significantly, from 7.9 per 100,000 in 2013 to 9.0 per 100,000 in 2014, a 14% increase.
  • In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes
  • The 2014 data demonstrate that the United States’ opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.
  • From 2000 to 2014 nearly half a million persons in the United States have died from drug overdoses.
  • The rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin).

The 2013-2014 increase was geographically pervasive. In 2014, the five states with the highest rates of drug overdose deaths were:

  • West Virginia (35.5 deaths per 100,000)
  • New Mexico (27.3)
  • New Hampshire (26.2)
  • Kentucky (24.7)
  • Ohio (24.6).

States with statistically significant increases in the rate of drug overdose deaths from 2013 to 2014 included Alabama, Georgia, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Pennsylvania, and Virginia.

For more analysis of the data, see Kim Krisberg’s story at The Pump Handle.

Obesity: A Smoking Gun?

Is obesity a contributing factor to the opioid epidemic? That’s certainly an avenue worth further investigation. Recent research shows more evidence of the increase in prescription drug use and study authors suggest an obesity connection.

In November, researchers at Harvard’s T.H. Chan School of Public Health issued a report which was published in in JAMA, the journal of the American Medical Association: Trends in Prescription Drug Use Among Adults in the United States From 1999-2012

NPR’s Alison Kodjak reports on the study in Americans Are Using More Prescription Drugs; Is Obesity To Blame?

Two of the key findings:

  • 59% of adults used a prescription drug in a 30-day period, up from 50% a decade earlier.
  • The share of people taking more than five prescription drugs in a month doubled to 15%.

Lead author Elizabeth Kantor said that:

” … the rise in prescription drug use may have to do with the rise in obesity, since many of the most widely prescribed drugs treat obesity-related conditions such as diabetes, high blood pressure, and high cholesterol. The study found, for example, that the share of people using cholesterol-lowering agents, mostly statins, jumped from 7% to 17%.”

 

Related opioid reading matter:

Opioids: the Gateway to Heroin

Wednesday, February 12th, 2014

The surprising overdose death of acclaimed actor Philip Seymour Hoffman has put a spotlight on a national epidemic: prescription drug abuse. In workers’ comp, prescription drugs have been an area of great concern for a number of years; so too in the public health and policy arena. But has the message — and the necessary education — filtered to the general public? It would seem not: According to the CDC, prescription painkiller overdoses nearly quadrupled in the decade from 1999 to 2008.
This past week, the New York Times framed the new reality: Prescription Painkillers Seen as a Gateway to Heroin

“Dr. Jason Jerry, an addiction specialist at the Cleveland Clinic’s Alcohol and Drug Recovery Center, estimates that half of the 200 or so heroin addicts the clinic sees every month started on prescription opiates.

“Often it’s a legitimate prescription, but next thing they know, they’re obtaining the pills illicitly,” Dr. Jerry said.

In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.

In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.”

drug-1
Oklahoma: One state’s experience
The investigative journalism non-profit Oklahoma Watch recently published a report on the state’s addiction: As Drug Deaths Rise, Millions of Narcotic Prescriptions Filled
According to this report, Once occupying the ignominious position of first in the list of states with prescription drug abuse, Oklahoma is now #8 on the list. In 2012, 844 Oklahomans were killed by overdoses, eclipsing the year’s 708 traffic fatalities. The state has a real-time Prescription Monitoring Program that is reported to be one of the best in the nation, but doctors are not required by law to check the database before prescribing controlled dangerous substances. There was an average of 68 prescriptions per patient.
Oklahoma is also seeing a steep rise in heroin use, echoing the concept and experience that opioids are the gateway drug.

“Hal Vorse, a physician who treats habitual drug users and teaches new doctors about addiction at the University of Oklahoma Health Sciences Center, said he’s seen the phenomenon in his own practice.

“We’re seeing a big surge in heroin, and 85 percent of those people started on prescription opiates,” said Vorse. “The cost of their addiction got so high that they switched to heroin because it’s cheaper.”

Vorse said the price on the street for OxyContin has risen to $1 to $1.50 per milligram. Addicts typically use 200 to 300 milligrams per day, he said. “They find out they can get an equivalent dose of heroin for a third of what it costs for Oxys,” Vorse said.”

On the Workers Comp front
Meanwhile, in workers’ comp’s battle against opioids, Joe Paduda says that Opioid guidelines are about to get a whole lot better with the anticipated upcoming release of guidelines by ACOEM. He’s has a sneak peek and finds them to be “comprehensive, extremely well-researched and well-documented, and desperately needed.”
But he also points out that more progress is needed: Why don’t workers’ comp payers have pharmacists on staff?.

“I’m only aware of three major work comp insurers (Travelers, BWC-Ohio, Washington L&I) that have pharmacists on staff; the North Dakota State Fund does as well.

With pharmacy costs accounting for somewhere around 15% of total medical spend, that seems like a “miss”. Yes, pharmacy costs have been flat in recent years, but the impact of drugs on work comp claim duration and the medical and indemnity expense associated with long-term drug use is quite significant.

by-state
Resources:
The National Conference of State Legislatures offers an overview of state laws
CDC on the Drug Overdose issue
Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008
Prescription Drug Overdose: State Laws

Doggone fraudster of the month

Tuesday, July 17th, 2012

Fraud of any flavor is to be decried, but somehow it bothers us just that much more when the perpetrator is a physician. Call us sentimentalists, but we like to think of the Hippocratic oath as more than just a quaint mythic tradition. You know, the “do no harm” thing. But with the proliferation of prescription pain pill abuse, addiction, and deaths, it’s inevitable that some physicians are involved. We happened to spy a recent news story about the bust of a California pill mill.
Police had complaints that Dr. Rolando Lodevico Atiga of Glendora was essentially selling prescriptions for strong painkillers, such as oxycodone and Vicodin. Atiga was already on probation from prior charges related to fraudulent activity. Undercover agents went to obtain proof by trying to obtain fraudulent prescriptions. At one point, Atiga asked the officer for proof that she suffered from pain. How conscientious!

“This undercover officer obtained X-rays of her dog, brought these X-rays into the office, showed the doctor,” Staab said. “He looked at these X-rays, immediately said that pain medicine for her would be warranted and for $400 immediately issued a prescription for hydrocodone. Either Sparky the dog really, really badly needs Percocet or this doctor is a petty drug dealer masquerading as a physician,” Staab said.”

Now the dog x-ray angle of this story is pretty humorous, but there is nothing whatsoever that is funny about the underlying issue. Propelled by an increase in prescription narcotic overdoses, drug deaths now outnumber traffic fatalities in U.S.. When you think about druglords and pushers, doctors are probably not the image that comes to mind … but as the prescription drug problem worsens, that may change.

Health Wonks, drug epidemic, ACA mandate, exploding hog farms & more

Thursday, February 16th, 2012

Health Wonk Review – Jason Shafrin has posted the Health Wonk Review: More than Birth Control Pills edition at Healthcare Economist. And there is indeed much more than birth control in this issue: politics, health care reform, the Affordable Care Act, and a grab bag of other timely topics. Check it out!
CDC calls prescription drug problem “epidemic” – The CDC weighs in on the prescription drug abuse problem, calling it “epidemic” and “the fastest growing drug problem in the United States.” Risk & Insurance offers a concise summary. And on the same theme is a story about how New Jersey has implemented a Prescription Drug Monitoring Program. “In unveiling the program last month, state officials related that one patient obtained more than 2,500 doses of oxycodone and methadone in a four-week period. The patient presented what are now believed to be forged prescriptions to three pharmacies on 14 separate occasions, spread out his visits among the pharmacies, and paid sometimes with cash and sometimes by insurance.”
Affordable Care Act: What if… – What if the Supreme Court overturns the mandate? At Managed Care Matters, Joe Paduda looks at what the repeal of the mandate would mean for workers comp.
Marijuana & impairment Roberto Ceniceros recently discussed the issue of marijuana use and impairment. He cites a recent Louisiana appeals-court ruling that upheld benefits for an injured worker who showed positive in a post-injury test for consumption of marijuana and a prescription drug.
Emerging Risks: Exploding Hog Farms – Hog farmers take note: the Minnesota Daily covers reports of a mysterious foam that has caused Midwest swine barns to unexpectedly explode. The foam can build up to heights of four feet on manure pits. “The foam traps gases like methane and when a spark ignites it causes an explosion. About a half dozen barns in the Midwest have exploded since the foam was discovered in 2009. / In mid-September 2011, a barn in Iowa was added to the growing number of barns taken down by the foam. In the explosion, 1,500 pigs were lost, and one worker was injured.”
Contractors in conflict zones – At Risk Management Monitor, Jared Wade discusses contractor deaths in Afghanistan as reported in a recent New York Times article. He notes that, “In 2011, for the first time, there were more civilian contractors working for U.S. companies that died in Afghanistan than there were U.S. soldiers.” He follows up with excerpts and links to a prior Risk Management story on working in the world’s most dangerous locations
Economy & Insurance – Global financial woes will not derail the economy, according to Robert Hartwig, President and Economist at the Insurance Information Institute, who has been a reliable forecaster and source of information on both the overall economy and the impact on the insurance industry. He sees opportunities for insurers beyond waiting for rate increases. Read more in Chad Hemenway’s story at Propertycasualty360: Hartwig: U.S. Insurers Should Look at ‘New Trajectory of Growth’
Aging & Construction Work – The Center for Construction Research and Training analyzed 100,000 workers comp construction industry claims for the
state of Colorado to understand the relationship between the claimant
age and costs by the causes and natures of injuries and illnesses. Consistent with other aging studies, the report says “Older construction workers filed a small percentage of the total workers’ compensation claims; however, when they did file a claim the associated costs were greater.” Review the key findings: The Role of Age on the Cause, Type, Nature and Cost of Construction Injuries (PDF)
News briefs

Risk roundup, student athletes, pharma report, misclassification, war of the giants & more

Wednesday, September 21st, 2011

Cavalcade of Risk – The Terrorism, CyberWar, Floods, Bad Mortgages, Robberies, Investment Losses and Disease Edition of Cavalcade of Risk is hot off the press and posted by Jaan Sidorov at Disease Management Care Blog. Check it out!
Tribute to Workers – A few weeks ago, we made a 9/11 memorial post, which focused heavily on the event, the aftermath, and the losses. More recently, we came upon an excellent New York Times feature that focuses on portraits and stories of workers who are rebuilding the World Trade Center, the largest construction project in the United States. It’s a positive testament to the future, to resilience, and to some great American workers. The rebuilding effort has employed 3,200 workers. NYT features more about the WTC rebuilding project.
Student Athletes? – Jared Wade posts about how the NCAA Has Used the Term “Student-Athlete” to Avoid Paying Workers Comp Liabilities – part of a longer article that The Atlantic featured on college sports. Wade notes that, “For our purposes, however, the most interesting excerpt chronicles the how and the why of the NCAA’s creation and widespread promotion of the term “student-athlete.” According to Branch, the main reason that former NCAA head Walter Byers, in his own words, “crafted the term student-athlete” and soon made sure it was “embedded in all NCAA rules and interpretations” was because it was an excellent defense against being held liable for workers compensation benefits that those injured in athletic competition could seek.”
Prescription Drugs – NCCI has issued Workers Compensation Prescription Drug Study: 2011 UPDATE (PDF), a 31 page report. The key findings:
*The indicated Rx share of total medical is 19%; this is slightly higher than the estimate given in our 2010 update
*OxyContin climbs from the number 3 WC drug in Service Year 2008 to number 1 in Service Year 2009
*Hydrocodone-Acetaminophen drops from the top WC drug in Service Year 2008 to number 3 in Service Year 2009
*Recent overall cost increases are driven more by utilization increases than by price increases
*Physician dispensing continues to increase in Service Year 2009 in almost every state
*Increased physician dispensing is associated with increased drug costs per claim *Per-claim Rx costs vary significantly by state
At Managed Care Matters, Joe Paduda offers his educated observations on the pharmacy study.
Agricultural worker protections – Laura Walter of EHS Today writes about A Disposable Work Force: Farm Worker Advocates Push for Agricultural Worker Protections. Her article focuses on a new report published by the advocacy organization Farmworker Justice which criticizes the H-2A temporary guest work visa program. The report claims that it makes agricultural workers vulnerable to poor working conditions. Farm worker advocates argue that to improve these conditions, foreign agricultural workers should be able to seek legal immigration status.
Battle of the giants – In catching up on a backlog of blog reading, we find a post from Roberto Ceniceros’ Comp Time of great interest. It focuses on the battle of the giants chronicling the ongoing dispute between two workers’ comp behemoths, AIG and Liberty Mutual. The dispute is being fought in court, and now in the court of public opinion via dueling websites.
Hunt for misclassification is getting muscle – The Department of Labor and the IRS will be teaming up with other federal agencies and the labor departments of 11 states to share information that will help to track down employers that misclassify workers. For more on this, see Jon Gelman’s post, US Dept of Labor Moves Aggressively on Misclassification of Employees and Dave DePaolo’s post One Way to ID Scofflaw Employers: IRS Co Op
Social Media – The more we use Twitter, the more we like it – we’ve certainly come across some great users and learned about some great pointers and links to breaking news. One Twitter user we’ve found particularly helpful is Kyle Thill posting for @ToyotaEquipment, a forklift dealership from Minneapolis. With 15,000+ followers, he must be doing something right! Safety is one of the ongoing themes of his posts, so if that’s of interest to you, he’s a good Twitter user to follow. He also issues The #Safety Daily Update, which is a curated “newspaper” of web-related safety matters. It’s worth checking out.
Signs of life for the elusive hard market – At Terms + Conditions, Claire Wilkinson talks about an uptick in commercial insurance prices as reported by Tower Watson’s latest commercial lines pricing survey.
Administrative note – We’ve shut down comments due to an unbelievable flood of comment spam. We’re sorry about that – but we don’t have the time to deal with it. If we come up with any new magical solutions to curtail it (we’ve tried many) we may reinstate comments at a later time.

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.