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WCRI’s Annual Conference: The Curtain’s About To Rise

Monday, March 19th, 2018

This week will see most of the nation’s workers’ compensation cognescenti at the Workers’ Compensation Research Institute’s annual conference in beautiful downtown Brahmin Boston, the home of the bean and the cod, where the Lowells speak only to Cabots, and the Cabots speak only to God.

This is WCRI’s 34th annual conference, and it sports an agenda that should satisfy even the geekiest of data geeks.

To me, two things stand out. First, if you’re coming to my home town expecting not to hear much about drugs, I submit you’ve been living on another planet. Three of the eight total sessions address drugs: two on opioids, one on Medical Marijuana.

Dr. Terrence Welsh, Chief Medical Officer at the Ohio Bureau of Workers’ Compensation, will detail Ohio’s successful program aimed at reducing opioid dependence among injured workers.

In 2011, the Ohio Bureau of Workers’ Compensation (OBWC) found that more than 8,000 injured workers were opioid-dependent for taking the equivalent of at least 60 mg a day of morphine for 60 or more days. By the end of 2017, that number was reduced to 3,315, which meant 4,714 fewer injured workers were at risk for opioid addiction, overdose, and death than in 2011.

After years of thumb-twiddling, other states have made great strides in combating opioid dependence in workers’ compensation, California and Washington State to name just two. But because workers’ compensation is state-based, there’s no national workers’ compensation solution; every state is on its own. Most are actively engaged in building programs to reverse the deadly trend, but workers’ compensation is only the tiny caboose on the back end of the great big American health care train(wreck). Nationally, the health care industry doesn’t seem to be having as much success as workers’ compensation’s committed leaders.

Evidence: U.S. life expectancy at birth dropped in 2015 for the first time since 1993 during the AIDS epidemic. The years 2015 and 2016 saw the first consecutive two-year drop in life expectancy at birth since 1962/63 (generally attributed to an epidemic of flu).  The two-year drop in American’s life expectancy is primarily due to drug deaths. In 2015, the nation suffered 52,400 drug overdose deaths. That’s more people than were killed in car crashes in any year since 1973. In 2016, the total rose to 63,600, more than were killed during the entire Vietnam conflict, which lasted more than a decade. Drug deaths for 2017 appear to be even higher, although, because drug deaths take a long time to certify, the Centers for Disease Control and Prevention will not be able to calculate final numbers for 2017 until December. No other country in the OECD has seen a drop in life expectancy in recent history.

Although it is obviously appropriate that medical issues make up the preponderance of this year’s WCRI sessions, the Keynote Address, to be given by Dr. Erica Groshen, former head of the U.S. Bureau of Labor Statistics, is of great interest to me. In her presentation, “Future Labor Force Trends and the Impact of Technology,” Dr. Groshen will address and analyze current labor market trends and provide official statistics leading to her views on the future of work. Because I have written about America’s pathetic, more-than-four-decade lack of hourly wage growth, I’ll be keenly interested in her remarks. Here are some questions I’d like her to answer:

January, 2018, saw the first substantial monthly hourly wage growth (2.9% from a year earlier) since 1974. This was not repeated in February (0.1% gain in wages, offset by 0.2% growth in the Consumer Price Index)
  • Does Dr. Groshen see any correlation between stagnant hourly wage growth and workers’ compensation’s declining injury frequency and loss costs?
  • If this is a current unknown, should WCRI study it? If not WCRI, then who?
  • Between 1948 and 1973 there was a one to one correlation between productivity and wages. However, since 1973, productivity has risen nearly 75%; wages about 9%. How does Dr. Groshen see this playing out in the next decade?

Two final thoughts about the upcoming conference. I know time is limited, but I wish WCRI had allotted one session to Artificial Intelligence and Machine Learning and their impact now and in the immediate future on workers and workers’ compensation. Artificial Intelligence (AI) continues to gain significant momentum throughout industry.  The workers’ compensation industry is ever so slowly increasing the bandwidth of its AI capability, but it still seems to lag far behind other industries in embracing much that AI has to offer.

Speaking of AI, IBM Q, the creator of Watson, put a 5 cubit quantum computer prototype in the cloud in 2016 and two months ago unveiled a 20 cubit quantum computer available to its clients and a prototype 50 cubit quantum computer. Unlike  current computers, which perform operations sequentially, quantum computers perform many operations simultaneously. An operation which currently can take days, or even weeks, will be done on a quantum computer in minutes, or even seconds.

I would love to see the massive brain power at WCRI turn its attention to this fascinating area and its potential impact on the labor force and workers’ compensation.

See you in Boston.

 

 

 

 

 

 

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A Conversation With WCRI’s John Ruser, Ph.D.

Monday, January 30th, 2017

As I write this, we are 34 days from this year’s not-to-be-missed Workers’ Compensation Research Institute’s Annual Conference. It all happens at the Westin Copley Place on March 2 and 3 in the greatest city in America. That would be Boston (sorry New York, Chicago, LA and all the rest of you).

This is always one of the top conferences in the nation, jam packed with enough data to satisfy any green-eye-shaded, algorithm loving, analytic modeler.

As you might imagine, this year’s agenda will include a bit of crystal ball gazing with respect to the future of American health care. I discussed that and other conference topics recently with Dr. John Ruser, WCRI’s President and CEO, at the Institute’s Cambridge, MA, offices.

This is Dr. Ruser’s first full year at the WCRI helm. About a year ago he succeeded Dr. Richard Victor, WCRI’s founder and iconic long time leader. Ruser, a perceptive intellectual, realized he had big shoes to fill, so he told me his goal for the first year was “stability.” He wanted a “steady transition.” That’s one goal he can check off as done. No staff left and they all continued to do significant research, much of which will be on display at the upcoming conference in the world’s greatest city.

WCRI’s research can impact policy. For example, in early December, 2016, Massachusetts Governor Charley Baker unveiled the Commonwealth’s new pilot program to help injured workers with opioid addiction. This from the Worcester Telegram:

The two-year pilot program is designed for people with settled workers’ compensation cases who are being treated with opioid medication, but whose insurance company seeks to stop payment for the opioid. Such cases, Gov. Charlie Baker said, can take up to a year to come to a resolution, and all the while the worker is prescribed opioids

 “Injured workers in Massachusetts receive 10 percent more prescriptions for opioids on average than 25 other states that were studied in a two-year study done by the Workers’ Compensation Research Institute (emphasis added), and Massachusetts led the studied states with the percentage of pain medications that were written for Oxycodone and nearly half of all prescriptions stronger than schedule II opioids,” Baker said. “There’s more we can do to help injured workers with settled workers’ compensation claims get appropriate treatment for pain management.”

Going forward, Ruser knows it’s time for him to begin making his mark at WCRI. This former Bureau of Labor Statistics executive wants to “increase WCRI’s reach.” He’s commissioned the building of a new website with the aim of “producing a much better search engine,” which will allow for “easier access to the Institute’s work.” I asked him what that really meant? He said he realizes that the work is scientific in nature, but that doesn’t mean it has to be obscure. He’s looking for plain english with a more “pithy” language style for Abstracts and Research Briefs. Doing so will allow WCRI to reach more stakeholders. A worthy goal, and we wish him luck.

John Ruser emphasized this year’s conference will tend to focus on three main questions:

  • What impact will the 2016 election have on healthcare (ACA, Medicare, etc.), labor and the workforce, and workers’ compensation?
  • Is the workers’ compensation system still fulfilling its mission or does it need revisiting?
  • With opioid use decreasing, what alternatives exist to treat pain?

The conference’s agenda is interesting, for sure, but for my money I’m eager to attend the first and last sessions. The opening session is on “The Impact of the 2016 Election,” and the presenters are former U.S. Representative Henry Waxman and former U.S. Senator Tom Coburn. I think that’s where the crystal ball gazing happens. We all know workers’ compensation is the tiny caboose at the end of the great big health care train. It remains to be seen whether the former Senator and former Representative will get deep into the weeds of what the coming blow up of the Affordable Care Act will do to that little caboose. A year from now we’ll see how prescient Waxman and Coburn have been.

But on to the final session. Last year, at this time, the workers’ compensation industry was rocked by a series of articles by ProPublica’s Michael Grabell and NPR’s Howard Berkes. Grabell lifted some ugly stones and rather unpleasant things crawled out. The industry lashed back. Perhaps the most reasoned comment was from Dr. Victor at the 2016 conference when he said, “Using anecdotes isn’t the best way to analyze an entire national system.”

The last session is at 10:35 AM on Friday morning (don’t leave early). This is the first session’s complement and is likely to get into some of the Grabell/Berkes territory.  “Appraising the “Grand Bargain” in 2017″ has four wonderful presenters, all of whom I admire. Professor Emily Spieler, Northeastern University School of Law, Dr. David Deitz, Principal, David Deitz & Associates, Dr. David Michaels, Former Assistant Secretary of Labor for Occupational Safety and Health (OSHA) and Bruce Wood, of the American Insurance Association are going to take a hard look at workers’ compensation in the here and now. Their comments should bookend nicely with those of Henry Waxman and Tom Coburn.

As we were winding up our talk I asked John Ruser what he hoped would be the biggest takeaway for attendees. “Honestly,” he said, “I want everyone to come out feeling they’ve learned something, something important.” Amen to that.

This year’s conference promises to be well-attended, but if you’re going (and you should be going), you might want to book your hotel now. WCRI has reserved a block of rooms at a special rate of $246 per night. They will go fast. You can register here.

I hope to see you soon in the Milky Way’s greatest city.

Go Pats!

 

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Fresh Health Wonk Review posted at Health Business Blog; WCRI recap

Friday, March 11th, 2016

Grab a coffee and head over to David Williams’ Health Business Blog for this week’s dose of health wonkery:  Health Wonk Review: Tales of the Trump. And while there, don’t miss David’s 11th blog birthday roundup of best posts from the prior year.

Tom Lynch is at WCRI conference yesterday and today – you can see some of his recaps here on the blog. Part 1, Part 2 and Part 3

If you didn’t make it to the conference, no worries. You can follow along with a list of people who are live tweeting the conference.

Other folks blogging the WCRI conference

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WCRI – Day One, Part One

Thursday, March 10th, 2016

Day One of the WCRI’s annual conference began with WCRI’s Chairman, Vincent Armentano, of The Travelers Companies, introducing new President and CEO John Ruser. He presented the first session (preliminary finding, subject to change) on the Impact of Fee Schedules on Case Shifting in Workers’ Compensation.

It should come as no surprise that there is substantial variation in fee schedules and prices across the states and that workers’ comp fee schedules and costs continue to be higher than group health costs, in some states significantly higher. Bottom line here: States where workers comp pays higher medical reimbursements have a much greater chance of a soft tissue injury being classified as work-related. Not so much for traumatic injuries, such as fractures. In otherwords, states that have higher reimbursement for workers’ comp than group health have greater incidence of cost shifting to worker’s comp. Follow the money.

Next up, Dr. Bogdan Savych on comparing worker outcomes across fifteen states. Interesting news: Between 9% and 19% (median is 14%) of injured workers “had no substantial return to work” (meaning returning to work for at least 30 days) three years post-injury. These, again, are preliminary findings and subject to change, but 14% is a huge number. This study, based on 6,000 injured worker interviews, raises many questions. For example, what role do differing state workers’ comp benefits play in this. Also, Savych divided the workers into six age cohorts. The older group had more injuries without substantial return to work. What role did their age play in that?

Alex Swedlow, President of the California Workers’ Compensation Institute, delivered a mesmerizing presentation on Independent Medical Review and Dispute Resolution in the state, which, if it were a country, would have the sixth highest GDP in the world. Not surprising, to quote Swedlow, “Size matters.” California’s been trying to control medical costs for decades, and it keeps trying. I can’t begin to cover the totality of  the Swedlow presentation, but here’s one takeaway: Ten percent  of California’s medical providers account for 85% of Independent Medical Review decisions. Again, follow the money.

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WCRI’s Annual Conference: Two Days of Research Data. What Could Be Better?

Monday, February 15th, 2016

The Workers’ Compensation Research Institute, located in the heart of Geek Heaven, Cambridge, Massachusetts, begins its 32nd Annual Issues and Research Conference in less than a month, 23 days to be precise. The conference is always interesting and often highly informative. Looking at the Agenda, this year’s effort seems to hit on both marks.

The theme is Understanding Today to Prepare for Tomorrow, which I guess could be anyone’s daily Mantra, but is exactly what the WCRI has been doing since its founding in 1983.

A lot has happened in the workers’ comp world since then. Perhaps the most astonishing development is the tremendous rise in medical costs. In the mid-1980s, medical costs comprised about 44% of total loss cost dollars, while indemnity payments took the lion’s share of 56%. Today, we see something entirely different, with medical costs taking up around 60% of the total. How times have changed!

However, comparing medical to indemnity costs is a bit like the old apples and oranges cliché. By that I mean that medical costs, despite fee schedules, have been able to go on there own little rocket ride to the moon in most states. Indemnity payment increases, on the other hand, are everywhere limited and tied in some way to the rise in the average weekly wage in the various states. And since 1973, average hourly wages, measured in constant 1984 dollars, have increased by a paltry 4%. This is one of the reasons why, despite a continuing decrease in injury frequency, a concomitant increase in severity doesn’t move the indemnity needle.

WCRI’s conference will dive into workers’ comp’s thorny issues with both feet. The session entitled Impact of Fee Schedules on Case-Shifting in Workers’ Compensation promises to be interesting, indeed. The relationship of case-shifting to the ACA has been something that many have opined about, but now I presume we’ll see some solid data.

Another session that looks as if it will present both interest and fireworks is the Opt-Out Panel. Actually, there are two Op-Out Panels. WCRI is devoting nearly three hours to the subject. Seat belts should be fastened.

I’m looking forward to this year’s conference. It’s happening  March 10-11 at the Westin Copley Place Hotel. Hope to see you there.

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WCRI: Day One

Thursday, March 5th, 2015

Two major issues were discussed this morning on the first day of WCRI’s annual conference: cost shifting from group health to workers’ comp and physician dispensing.
Dr. Richard Victor, the 31-year WCRI CEO who’ll be retiring in 2015, hung the cost shifting issue firmly around the neck of capitated group health insurance plans. His reasoning went this way:

    • Capitated plans have been steadily decreasing in number since the turn of the century.
    • A capitated plan pays doctors a set amount for each patient in the plan assigned to them.
    • Workers’ comp is fee for service and pays more than capitated plans.
    • A major goal of the ACA is to establish Accountable Care Oranizations, which pay by capitation.
    • Therefore, there will be a reversal in the decline of capitated plans and they will steadily increase in the future.
    • Consequently, there will be a heightened incentive for doctors and patients to shift some claims from group health to workers’ comp, especially soft tissue injuries, which are harder to attribute to a specific cause.

The second presentation, one that was a bit more dense, looked at physician dispensing, specifically in the 18 states that have changed their rules governing reimbursement.
The physician dispensing panel was moderated by WCRI’s Dr. Vennela Thumula, and consisted of her, Alex Swedlow, President of the California Workers’ Compensation Institute, Dongchun Wang, of WCRI, and myMatrixx’s Artemis Emslie.
With the exception of Dr. Swedlow’s presentation, I have the following takeaways from this panel:

      • The state reforms lowered costs.
      • But physicians continued to dispense, because, even with the lower reimbursements to them, they were still getting paid significantly more than pharmacies were paid for the same drugs.
      • The lower costs may not be sustainable, because Pharma has figured out that it can retake the low ground by changing the strength of drugs. Vicodin is an example.

Regarding Alex Swedlow’s presentation – I felt like I was drinking from a firehose. Try as I might, I couldn’t keep up with all of the data he was dishing out. I know it was really good, but I felt like the Ed Sullivan Plate Spinner trying to keep all the plates on their sticks while being handed yet more sticks and plates. What my feeble brin came away with was this: California workers’ comp is a many headed hydra, and Alex and his colleagues can’t keep up with all the heads. They’re fighting the good fight, and the research produced by the CWRI is awesome, indeed, but there are forces at work in the Golden State that are formidable and relentless.

Gary Orren, Ph.D., of Harvard’s Kennedy School of Government, gave the last session of the morning. It was titled, Persuasion: The Science and Art of Effective Influence. Dr. Orren built his talk around Joshua Chamberlain’s heroic contribution at the Battle of Gettysburg. Chamberlain’s actions at the battle of Little Round Top were critical to the Union winning the battle of Gettysburg and, ultimately, the war. One could argue that if his Maine troops didn’t succeed at Little Round Top there would be no United States today.

As a history buff, I found this to be great stuff, but I have no idea what it had to do with workers’ compensation.

In the afternoon sessions, NCCI’s Barry Lipton presented data on the Price Impact of WC Fee Schedules and WCRI’s Dr. Rebecca Yang on the Perverse Effects of Low Fee Schedules. For Liptpon’s preasentation, I had returned to the firehose. He offered yet more data showing that workers comp costs routinely exceed those of group health and Medicare.

I take a bit of an issue with Yang’s presentation, which suggested that low fee schedules lead to problems with access to care – what doctor wants to treat someone if payment is really low?

Well, I suggest that WCRI take a hard look at Massachusetts, the state with the lowest fee schedule in the nation, where medical loss costs are 36% of total loss costs and where there is no problem with access to care. Just a suggestion.

I look forward to tomorrow’s sessions. Now, it’s on to a good dinner, followed by the Boston Symphony Orchestra’s performance of Szymanowski’s opera, King Roger.
Couldn’t be better.

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WCRI, Inside Baseball in California, Patient Records in New Jersey and Who’s Managing What Care

Thursday, February 26th, 2015

The WCRI Annual Issues and Research Conference gets underway a week from today in Boston. The conference and Lynch Ryan are each in their 31st year, but, truth to tell, the first WCRI conference could have been held in a telephone booth (not The Tardis).

We wrote about this conference a couple of weeks ago, so no need to cover old ground. However, it is worthwhile to mention how valuable the conference has become. It’s a serious event attended by serious professionals. Sorry- not much partying. Las Vegas it aint. And this year its style is even more cramped what with more than eight feet of snow hanging around. But the walkway around the Charles is cleared, so you can bring your running shoes. I, on the other hand, coffee in hand, will be happy to wave goodbye to you as you head out the hotel door for that morning run. The older I get the more I subscribe to Winston Churhill’s view of exercise: he said he got enough of it carrying the coffins of his athletic friends.

Unfortunately, we just learned that the WCRI has “reluctantly” decided to cancel its Opt Out session, because “at least one of the presenters felt that the time allotted for the session was too short for the objectives to be well-met.” This is truly unfortunate given the momentum the Opt Out movement is gaining nationally. You would have thought the presenters could have raised this issue a lot earlier. Nonetheless, I’m sure there will be much opt out discussion among attendees outside of the sessions. WCRI is offering to refund registration money for those who choose to “opt out” of Boston due to the cancellation. Regardless, I hope to see you in Boston.

Inside Baseball In California
When looking for something a bit out of the ordinary, California workers’ comp never disappoints. Work Comp Central’s Greg Jones reports this morning that:

A Southern California applicants’ law firm claims in court filings that Knox Ricksen “hacked” the computer network of a vendor it uses to sign up new clients to gain access to an estimated 2,000 confidential and privileged documents.

In the suit, the plainiffs’ law firm, Reyes & Barsoum, says it has a vendor, HQ Sign-up Services Inc., whose job it is to “sign up” customers for the firm. The suit alleges that the defense law firm Knox Ricksen hacked HQ Sign-up, gaining access to claimant information which HQ Sign-up would forward to lawyers at Reyes & Barsoum. This would give Knox Ricksenan unfair and illegal advantage in the legal proceedings. People, I did not title this Inside Baseball for nothing!

This little dust-up shines a light on the dog-eat-dog adjuducative business that is California workers’ comp. It’s not pretty and it never has been. I wonder what opt out legislation would do for California?

Patient Records In New Jersey
Now we balance the cesspool into which California’s workers’ comp courtroom wars sometimes descend with workers’ comp law as it should be practiced. John Geaney, a man for whom I have great respect, is an executive committee member and shareholder with New Jersey’s Capehart Scatchard. John began publishing a client newsletter in 2001. A few years ago it morphed into a blog, which Lexis Nexus awards as one the nation’s Top 25 workers’ comp blogs. John’s blog should be required reading for all workers’ comp professionals in New Jersey. For that matter, it’s instructive wherever you are.
Today’s blog post concerns the right of injured workers to have access to their medical files. In my experience, there are some claims adjusters that resist this. However, doing so can worsen the situation and alienate the injured worker. Transparency is good for everyone. This blog post is well worth reading.

Who’s Managing What Care
In his Quick Tips blog post of today, Barry Thompson takes no prisoners as he derides what has become of “Managed Care,” which Barry has renamed “Manipulated Cost.” His is a tale told in anger, and he asks, “Where’s the outrage?” Good question. In the early 1990s, I gave a presentation at NCCI’s Annual Issues Conference and titled the presentation Managed Care: Who Manages, Who Cares? ‘Twas ever thus. It seems that the question is still begging for an answer.

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The WCRI Annual Conference: May The Weather Gods Cooperate

Thursday, February 12th, 2015

As Bostonians try to dig out from the most snow ever recorded in a 30-day period in Boston, we look forward to the WCRI’s upcoming Annual Conference at the Westin Copley Place Hotel on Thursday and Friday, March 5th and 6th.

More about the snow a little later, but first the conference.

This year, the conference theme’s title is Resilience or Renovation. However, we won’t get the resilience and renovation until Friday, Day Two. Day One is devoted to updates on all things medical, starting with Dr. Richard Victor, the Institute’s Executive Director, discussing the impact of the ACA on case shifting, which promises to be interesting, indeed. From there we move on to physician dispensing and the perverse effects of low fee schedules.

When the boat docks at Resilience and Renovation on Day Two, we begin with a session titled Resilience: Lessons From Two Decades of Reforms. The panel will discuss reforms in Texas, Pennsylvania, Oregon and Florida. While I am sure this discussion will be stimulating, as well as engaging, I find it curious that conference planners skipped over the greatest reform in the history of workers compensation. It happened in 1992 right where conference attendees will be sitting – the Commonwealth of Massachusetts.

“Renovation” is a good way to describe a couple of late morning sessions on Day Two, one on Opt Out and the other on challenges to the constitutionality of workers comp. You might think that a bit wonky, but I think attendees will find it thought provoking. It’s interesting that the Opt Out session will focus on the Texas perspective, not the Oklahoman. You may recall that the Texas Opt Out provision has what I consider to be flaws of the first order. Those flaws were corrected when Oklahoma adopted its version of Opt out.

All in all, the conference is an excellent opportunity for workers comp professionals to stay in front of the research curve and to connect with some of the leading lights in the field. I hope to see you there.
Now, the weather. Here’s a Fenway Park snow sellout. Seats full of snow fans.


Speaking for all Bostonians, I think we’ve had enough. Really. Monday night, during our third major snowstorm within a week and a half, Boston Mayor Marty Walsh announced there would be no public transportation the following day. None. A gazillion people ride what we affectionately refer to as “The T” to get to work every day in and around Boston. Not Tuesday. Shortly after that, standing in front of the TV cameras, Governor 5-weeks-in-office Charley Baker said the 100-year-old MBTA’s performance is “not acceptable.” I guess the bloom is off his rose. We have entered the “find a scapegoat” phase.

Yesterday, the first head rolled – Dr. Beverly Scott, the T’s General Manager. She won’t be the only one.
The rest of us will be fine, but, my God, I’m looking at more than five feet of snow outside my door, and it’s not a drift! And Boston has nothing on Worcester, just 35 miles to the west where nearly 100 inches, that’s more than eight feet, have already fallen at about the halfway point of the snow season. Mother Nature has now gifted Worcester with more snow than any other city in America. Take that, Fargo! You,too, Buffalo! When this stuff melts (please, God, make it melt) we’ll probably have a new lake to rival Michigan in Central Massachusetts. Oh, and our friendly local meteorologists, never happier than when they’re forecasting impending doom, now predict that beginning tonight we’ll descend into the coldest weather of the year. High temps will be in the single digits. Human digits will freeze and fall off. And Saturday night through Sunday there’s a foot more of the fluffy white stuff headed our way just in time for Valentine’s Day. The Lord just keeps showering us with his tender mercies.

But here’s the good news: Spring training is right around the corner. Pitchers and catchers report in three days. By the time the WCRI Conference rolls around Fenway South will be in full bloom. And here in Boston the sun will be shining, the snow will be gone, temperatures will be balmy and the T will be running on time.

And pigs will be seen flying in formation outside the windows of the Westin Copley Place Hotel.

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WCRI’s Annual Conference: I hope to see you there

Friday, February 28th, 2014

The Workers Compensation Research Institute is holding its Annual Issues and Research Conference in Boston at the Park Plaza Hotel on 12 and 13 March. This year, the WCRI dives into the healthcare deep end to try to sort truth from fiction and explain how Obamacare intersects with workers comp. Is it consensual pairing or a train wreck? The long and winding road of Public Law 111-148, the Patient Protection and Affordable Care Act, is littered with the carcasses of the true, the half true and the just plain untrue. People can’t even seem to agree on how many pages are in the Act (is it 906 or more like 2,400?), or how many pages are in the regulations that followed it (10,000 or 40,000?)
And we all remember those “death panels,” too, don’t we?
I doubt that WCRI President Dr. Rick Victor will waste much time on pages or death panels, because there are a lot of substantive issues that need exploring and explaining. This year’s conference, to quote the WCRI, “will have a focus on the impact of national healthcare reform on state workers compensation systems.”
Go here to see the seven different components and the many questions WCRI speakers and panels will try to address. And go here for hotel registration information. WCRI has negotiated a $159 per night room cost. And speaking as a Boston “Homey,” I can tell you that the Park Plaza is a very nice place.
I look forward to high level dialogue and debate. Most of workers comp’s smartest and best informed people will be there. Will you be among them?

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WCRI Conference: Shifting Paradigms in Workers Comp

Monday, November 21st, 2011

I spent two very productive days last week at the Workers Comp Research Institute (WCRI) conference in Boston. WCRI plays a unique role in the comp system. Their annual conference, devoid of the usual hucksterism, focuses on the fundamental paradigms of insurance and poses the toughest questions. Some of the answers provided by conference speakers (most of whom are not from WCRI) are both radical and surprising. I find myself relentlessly jotting down notes from topic to topic.
Here are ten paradigm-shifting propositions that I have extracted from my time at the conference. A number of these propositions address the issue of opiate use, perhaps, along with back surgery, the most important cost drivers in the treatment of workplace injuries.
[VERY IMPORTANT DISCLAIMER: These are my interpretations and should not be attributed in any way to WCRI]:
1. Pain is hard to objectify, expensive to treat, and absolutely the wrong focus for treating workplace injuries. Treatment should focus instead on behavioural approaches to pain and the relentless encouraging of maximum feasible physical activity.
2. The comp system, a wonderful success story celebrating its 100th anniversary, is poorly designed to confront the problems in today’s fractured and highly unstable economy.
3. Monopolistic systems for comp (only 4 remain) have unique leverage to solve intractible problems such the cost of drugs in the comp system. Washington state has solved the pharma problem through the aggressive use of generic drugs, the limiting of opiate prescriptions and the imposition of a favorable fee schedule. Alas, these solutions are unlikely to work in states with competitive systems.
4. Most prescriptions for opiates in the comp system are unnecessary, ill-advised and poorly managed. [See below.]
5. Virtually all injured workers prescribed opiates should be evaluated for dependency issues prior to beginning an opiate regimen, drug tested prior to receiving opiates and throughout the course of treatment. Without these pre-conditions, opiate use is full of uncertainty and fraught with danger. (Dr. Janet Pearl has a compelling and well-structured approach to the use of opioids in treatment.)
6. Opiates should come with a written contract and a User’s Manual. Workers should be tested on their knowledge of the benefits and the risks.
7. Most doctors who prescribe opiates have no idea what they are doing, no idea how to manage opiate-based treatment and no clue about the potential for harm. Medical schools simply do not address these issues.
8. Back pain is virtually universal, the inevitable result of aging, and generally is unrelated to workplace trauma. (You might want to read that again for full effect.) To be sure, this is a controversial assertion and involves a complete paradigm shift. Nonetheless, the idea is well worth scrutiny by all parties involved: doctors, payers, injured workers and their families. Conference speaker Dr. James Rainville asserts, among other things, that exercise is the best treatment for back pain.
9. Medical fee schedules lower costs, except when they don’t (e.g.Connecticut, where the schedule appears to be set too high).
10. There is an enormous disconnect between the workers losing their jobs in this recession and the severely limited number of jobs projected for creation over the coming decade. This bodes poorly for the 25 million injured or unemployed workers with obsolete skills who are struggling to return to productive employment.
I recognize that these ideas require much more in the way of detail and documentation. I offer them as a Monday morning stimulant. Consider this posting as a micro-conference on some of the major issues facing the time-worn workers compensation system. I hope it’s a list worth a few moments of your time, as you sip your coffee and prepare for the holiday-shortened week ahead.
Special thanks to Andrew Kenneally, WCRI’s able communications director, for recognizing that bloggers have a role to play in disseminating information about workers comp research and who invited me to attend the conference. I would also acknowledge Dr. Richard Victor, whose penetrating insights animate the entire WCRI world and whose conference-concluding talk (“The Elephant in the Room”) made it well worth the time to stay to the end (see # 10 above).

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