Archive for the ‘Misc.’ Category

The Pledge, AstraZenica’s Hiccup, An Important WCRI Study, And An Homage To Bourbon!

Wednesday, September 9th, 2020

Having put The Insider on pause for a few weeks to have some fun researching pandemics in earlier times (they were awful) and to improving my tennis game (it’s pretty good), we now dive back into the blogging fray. Today, we get a running start.

The Pledge

At a press conference on 24 August, President Trump and FDA Commissioner Stephen Hahn trumpeted (pun very much intended) the FDA’s Emergency Use Authorization (EUA) of blood plasma to treat COVID-19 patients.  The Trump/Hahn announcement came less than a week after officials at the National Institutes of Health (NIH) had put a hold on releasing the EUA, saying randomized trials were needed before such an action could occur. The President disagreed, saying, “There are people in the FDA and actually in your larger department [HHS] that can see things being held up and wouldn’t mind so much — its my opinion, a very strong opinion — and that’s for political reasons. We are being very strong and we are being very forthright, and we have some incredible answers, and we’re not going to be held up.”

In yet another example of Olympian Hyperbole, a disease to which Mr. Trump seems to be terminally infected, he also called the EUA a “truly historic announcement,” which puts it alongside something like the Emancipation Proclamation.

Like most of Trump’s hyperbolic pronouncements, the blood plasma EUA created quite the controversy, especially when the FDA released the comments of one of its own scientists tasked with reviewing the appropriateness of the same blood plasma EUA. That scientist— displaying far less enthusiasm than Trump and Hahn, and whose name was redacted from a memo released by the agency — wrote that the data:

 “…support the conclusion that [convalescent plasma] to treat hospitalized patients with COVID-19 meets the ‘may be effective’ criteria for issuance of an EUA. Adequate and well-controlled randomized trials remain nonetheless necessary for a definitive demonstration of … efficacy and to determine the optimal product attributes and the appropriate patient populations for its use.”

After the 24 August press conference, it took about 1.5 nanoseconds for Joe Biden and many media pundits to accuse Trump and Hahn of politicizing the EUA to influence the coming election.

Which brings us to The Pledge.

On 8 September, wanting to get out of firing range, the CEOs of all the leading Western developers of COVID-19 vaccines vowed to only file for FDA approval after demonstrating safety and efficacy in their Phase 3 trials. Their Pledge and descriptions of all nine trials can be found here.

The Pledge also promises all the developers will share some, but not all, of their data to propel their vaccines to the finish line. However, although every CEO wants their vaccine to be the first approved, not one of them wants to get there only for the world  to discover they’ve cut corners and now endanger humanity. These are people who want to go down in history for the right reason.

Mr. Trump will push, prod and kick these vaccine developers to get one of their efforts approved before 3 November. But I have a 95% confidence level none of them will buckle under that pressure. I sure hope I’m right.

AstraZenica’s Hiccup

In an example of the caution just described, yesterday AstraZenica announced  it was putting its Phase 3 vaccine trial on hold, due to a suspected serious adverse reaction in a participant in the United Kingdom.

This is not an uncommon happening in vaccine development, but it does show how fraught with uncertainties these trials can be. It proves that AZ’s data and safety monitoring group is doing its job, and that’s what is supposed to happen. I previously wrote about all the leading COVID-19 vaccine candidates, as well as ChAdOx1, the one being tested by AstraZenica in partnership with the University of Oxford’s Jenner Institute.

It is entirely possible we will experience more bumps in the road before one of the developers wins FDA approval.

An Important, New WCRI Study Is Released

Low back pain (LBP) is something that has afflicted humanity since Homo Sapiens decided to stand straight and walk upright. And it’s been the bane of claims adjusters since Otto von Bismarck, Germany’s Iron Chancellor, created the first workers’ compensation program in the 1880s.

Back injuries are the leading cause of all musculoskeletal claims, which are the leading cause of all workers’ compensation claims, and have been since it seems forever. If you’ve ever looked at a workers’ compensation loss run for any hospital in America, you’ll know what I mean.

One of the myriad treatment modalities for these claims is physical therapy (PT). However, it’s always been a bit of a crap shoot as to when to prescribe PT for a patient beset by a work injury resulting in low back pain.

Now, the Workers’ Compensation Research Institute (WCRI) has produced a study that convincingly puts the matter to rest. The study’s conclusion: the earlier PT is begun, the better.

The study, The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation?, is based on a review of  nearly 26,000 LBP-only claims with more than seven days of lost time from 27 states, with injuries from 1 October 2015, through 31 March 2017, and detailed medical transactions up through 31 March 2018.

One of the many reasons this study is important is that PT can sometimes be the last resort, not the first, in many cases being recommended only after opioids and other invasive procedures have been tried.

The WCRI study found:

  • Later timing of PT initiation is associated with longer temporary disability (TD) duration. On average, the number of TD weeks per claim was 58 percent longer for those with PT initiated more than 30 days post-injury and 24 percent longer for those with PT starting 15 to 30 days post-injury, compared with claims with PT within 3 days post-injury.
  • Workers whose PT treatment started more than 30 days post-injury were 46 and 47 percent more likely to receive opioid prescriptions and MRI, respectively, compared with those who had PT treatment initiated within 3 days of injury. The differences between PT after 30 days post-injury and PT within 3 days post-injury were 29 percent for pain management injections and 89 percent for low back surgeries.
  • The average payment for all medical services received during the first year of treatment was lower for workers with early PT compared with those with late PT. For example, the average medical cost per claim for workers who had PT more than 30 days post-injury was 24 percent higher than for those who had PT within 3 days post-injury.
  • Among claims with PT treatment starting more than 30 days post-injury, the percentage with attorney involvement was considerably higher (27 percent compared with 13–15 percent among those in the early PT groups) and workers received initial medical care much later (on average 18 days compared with 2–3 days in the early PT groups).

If you’re a claims adjuster wary of incurring the cost of sending injured workers with resultant low back pain to PT, this study should make you press the “Reset” button in your mind.

And, finally, an homage to bourbon (which is also good for low back pain)

In the constant sea of terrible, divisive, set-your-hair-on-fire news, we now row to a bipartisan safe harbor: Bourbon.

In the halls of Congress, bipartisanship seems to have gone the way of the Woolly Mammoth. But, reader, that is not the case in the case of Bourbon! That’s because on 2 August 2007, Congress ratified a bill designating September as National Bourbon Heritage Month. More notable, however, is that it passed unanimously. Thus, history shows that amid the countless issues and places and opinions that divide us, nothing unites Americans like bourbon.

And that aint all. A 1964 act declared bourbon “America’s Native Spirit,” making it the only spirit distinctive to the United States, if you don’t count the “spirits” the QAnon folks are worried about.

So, although I can’t stand the stuff, on this first day after 2020’s Labor Day as we all get sucked along the giant tube of political rigarmarole, you might want to consider the nationally endorsed benefits of America’s Native Spirit. Things will still be dire, the President will continue his hyperbolic rants, many of your fellow Americans will continue to “choose liberty” over masks, but you? You’ll hardly notice any of it.

 

 

It Bears Repeating: We Have Been Here Before

Friday, June 19th, 2020

In the summer of 1918, during the first wave of the Spanish Flu pandemic, American troops were at war in Europe’s killing fields. That was when Philadelphia officials decided they would hold a massive parade for the ages to promote Liberty Loans – government bonds issued to pay for the war. The City Of Brotherly Love organized an extraordinary spectacle: marching bands, women’s auxiliaries, Boy Scouts, soldiers and floats showcasing the latest innovation in warfare – floating biplanes built in Philadelphia’s Navy Yard.

That Philadelphia’s medical community thought this a very bad idea didn’t matter. That the nation was awash with flu had to be put aside in order to support the war effort. The flu could wait.

When two miles of parade marchers took their first steps on the morning of 28 September, some 200,000 people jammed Broad Street, cheering wildly.

The Spanish Flu had been circulating in America for six months at the time of the parade, and the flu, like COVID-19, loved a crowd. The flu couldn’t, and wouldn’t, wait.

Within 72 hours of the parade, every bed in Philadelphia’s 31 hospitals was filled. In the week ending 5 October, nearly 2,600 people in Philadelphia had died from the flu or its complications. A week later, that number rose to more than 4,500, with 200,000 more sick. With many of the city’s health professionals pressed into military service, Philadelphia was unprepared for this deluge of death.

City leaders closed Philadelphia, locked it down. But it was too late. Morgues and undertakers could not keep pace. Grieving families had to bury their own dead. Casket prices skyrocketed. And a rumor started to spread – The Germans did it.

History continually repeats itself. Tomorrow night we have a potential case in point when 19,000 followers of the Cult of Donald Trump will gather in the BOK Center in Tulsa Oklahoma. That the city’s medical officials have unanimously declared this a very bad idea doesn’t seem to matter. That the nation is awash with COVID-19 has to be put aside in order to support the election effort. COVID-19 can wait.

Campaign officials say they’ll take peoples’ temperatures as they enter and pass out face masks and hand sanitizer. But they won’t insist any be used and they won’t enforce social distancing. Can you, in your most far out imagination, visualize the camera shot of Donald  Trump at his podium with his amped-up ardent followers behind him, each six feet apart and all wearing masks?

Since 17 June, two days ago, Tulsa’s COVID-19 cases have risen 42%, going from 259 to 450. At one time, New York City had 450 cases.

As we have seen, this is not the first time in the midst of a pandemic people have been irresponsible and downright wacky.

Both President Trump and Vice President Pence have lately taken to declaring victory over the virus. You’d be hard pressed to find a single medical expert who agrees. We can only hope that somehow Trump’s medical experiment tomorrow night will not turn a very bad idea into a tragic one.

And Now For Something Completely New And Different: May Day!

Friday, May 1st, 2020

“When the pandemic is over, our society will need to stop and think about who is essential and why should the delivery truck driver earn a tiny fraction of what is paid to the Executive Vice President for Interactive Synergy & Proactive Metrics?” ― Garrison Keillor

Boy, do we need a break. This dystopian, abnormal new normal is wearing us down.  Yesterday’s little broo-ha-ha in the Michigan Capital with wackadoodle white gunslingers roaming the gallery illustrates the point.

So, today we’ll take a break from all things COVID and bring you a touch of history. Stay with me, now.

First, a plug. For many years, Garrison Keillor has published The Writer’s Almanac, a refreshing and informative daily dollop of history and poetry that somehow finds its way to the inbox every morning. If you’re not a subscriber (it’s free), you will thank me if you become one. Today’s Writer’s Almanac told the story of May Day, all the way back to the 3rd century BC. Everyone thinks they know all about May Day, but maybe everyone should give that a rethink, especially when everyone reads about the Puritans’ views on the subject.

Here, from The Writer’s Almanac, is the story of May Day.

Today is May Day. Even though spring officially begins in March, today is the day that celebrates the height of spring, a day of spring festivities and celebrations. It is also a day to honor laborers.

Like many of our modern holidays, May Day has its roots in ancient, pagan celebrations.

Beginning in the third century B.C. in Rome, the festival Floralia, for the goddess Flora, was held in the days around May Day, April 28th to May 3rd. Flora was a goddess of flowers and fertility, and the festival was held to please her so that she protected flowers and other blossoming plants. There was a circus and theater performances, there were prostitutes and naked dancers, and a sacrifice to the goddess. Deer and goats were let loose to symbolize fertility, and beans and lupines were scattered for the same reason. Romans usually wore white tunics, but during Floralia, they got to wear bright colors.

In the Celtic British Isles, May Day was celebrated as the festival of Beltane, or Bealtaine or Bealtuinn — Bel was the Celtic god of light, and taine or tuinne meant fire. It was the summer half of the year — a time when the sun set later, when the earth and animals were fertile. Beltane lasted from sundown the night before to sundown on the first of May. On the eve of Beltane, people lit bonfires to Bel to call back the sun. People jumped over the fires to purify themselves, and they blessed their animals by taking them between bonfires before leading them to their summer pastures the next day. It was a day to walk around the property lines and assess your land for the summer season, to mend fences. Women washed their faces with the spring dew so that they would stay beautiful, and there was dancing, tournaments, parades, feasting, and general revelry. There were lots of flowers — men walked around the fires with rowan branches to keep evil spirits at bay, and May trees, or Maypoles, were set up covered in rowan or hawthorn flowers as a blessing. People danced around the Maypole, seen to be a phallic symbol to promote fertility, and villages would compete with each other to see who could produce the tallest maypole. Young couples went off into the forest to spend the night together and came back the next day with flowers to spread through the village. A young woman was crowned May Queen, and she would ride naked on horseback through the village.

Many of these celebrations continued as late as the 17th century — the Puritans were not too pleased, especially since so many young women went off into the woods and came back pregnant. Maypoles were made illegal in 1644.

Since the Puritans discouraged May Day, it was never a major holiday in America. In the late 19th century, May Day was chosen as the date for International Workers’ Day by the Socialists and Communists of the Second International to commemorate those who were hanged after the Haymarket Square riot, which occurred in Chicago in early May of 1886.

A Puzzlement Before The WCRI’s Annual Conference

Tuesday, March 3rd, 2020

Thoughts and questions before heading to the Workers’ Compensation Research Institute’s (WCRI) annual conference this week in Boston.

Despite the erstwhile efforts of certain folks to put a big lid on scientific data and bury it all deep in the ground, the U.S. Bureau of Labor Statistics (BLS) continues to publish interesting and compellingly thought-provoking work. Take the paradox of union membership and earnings, for example.

Beginning of the paradox: Non-union wage and salary workers earn only 81% of what union members earn. Union workers in 2019 earned an average of $1,095 per week, as opposed to $892 for non-union workers, a difference of $203 per week, which, if you’re doing the math, is $10,556 per year.

The difference in earnings for men and women is stark: Men in unions earn an average of $1,147 per week, which contrasts with non-union earnings of $986. The difference here is $161 per week, or $8,372 per year. Unionized women, on the other hand, earn less than the men, but way more than non-unionized women: $1,018 versus $792, a difference of $226 per week, or $11,752 per year.

Clearly, union members earn significantly more than non-union workers.

So, will somebody tell me why union membership has been declining for decades? Every year, God bless ’em, the brainiacs at the BLS tell us by just how much, which is the second part of the paradox.  In January, 2020, BLS published data for 2019, which showed the union membership rate for wage and salary workers to be 10.3%, down 0.2% from 2018. Of course, our workforce is made up of both private and public sector workers, and here the public sector saves the day. The union membership rate of public-sector workers, at 33.6% is more than five times higher than the 6.2% rate for private-sector workers.

Some say the reason for declining union membership is the hefty annual dues union members have to pay. Well, the most any worker will pay in dues to the International Brotherhood of Electrical Workers for 2020 is $492; for the United Auto Workers, it’s $843.84. It doesn’t seem as if sky-high dues can be the answer.

I don’t know whether WCRI, or anyone else for that matter, has studied whether there is a statistically significant difference in workers’ compensation injuries and costs between union and non-union wage and salary workers. Might be interesting to find out whether the 10.3%, in addition to earning more, has better workers’ compensation performance

Hope to see you in Boston

After Catching Bus, Dog Still Doesn’t Know What To Do. But The Bus Just Got Bigger!

Tuesday, March 26th, 2019

In February, 2018, a Texas-led coalition of 20 states sued the federal government claiming the Affordable Care Act is unconstitutional in its entirety. The states argued that after Congress in December 2017 gutted one of its major provisions, a financial penalty for not having health insurance, known as the “individual mandate,” the rest of the law became unconstitutional.

In June, 2018, the US Department of Justice announced it would not defend the suit, which prompted a counter-coalition of states, led by California, to step in to defend the law. In the Brief, the Trump Administration, while refusing to defend, had agreed the individual mandate was unconstitutional, but argued this only invalidated the ACA’s preexisting condition protections and not the remainder of the ACA. This was ironic, indeed, because the part of the ACA with the most public popularity is the part protecting preexisting conditions. Attorney General Jeff Sessions pointed out he had made the not-to-defend decision after conferring with the President.

In December, Judge Reed O’Connor, of the 5th Circuit Court, ruled in favor of the Texas coalition and declared the entire Affordable Care Act unconstitutional. Very few legal scholars, make that nearly none, thought Judge O’Connor’s ruling would stand. Many died-in-the-wool conservatives, make that nearly all, thought the same. We wrote about this in a “Dog Catches The Bus. Now What?” post.

Last night, the Department of Justice sent a two-sentence letter to the U. S. Court of Appeals for the Fifth Circuit saying the DOJ now supports Judge O’Connor’s ruling that the entire ACA be struck down. Further, it will shortly file a Brief endorsing the decision. Here’s the letter:

The Department of Justice has determined that the district court’s judgment
should be affirmed. Because the United States is not urging that any portion of the
district court’s judgment be reversed, the government intends to file a brief on the
appellees’ schedule.

So, in two sentences, the DOJ went from everything in the ACA, except the preexisting conditions part, is constitutional, to everything is unconstitutional.

Reaction in Republican circles has not exactly been one of untold delight. In fact, so far, it’s been as quiet as midnight in Death Valley. So, what was William Barr thinking and why did his minions send the midnight missive?

Here’s a thought. Since most of the heavy money is on Judge O’Connor’s ruling being overturned somewhere along Appellate Way, could the DOJ have sent its billet doux with the intention of showing its ultra-conservative allies that it’s with them all the way, while all the while realizing it will never have to put the ACA toothpaste back in the tube? Think about it.

After all, you have to admit it’s easier to think about that than about what will happen if O’Connor’s ruling becomes the law of the land.

We’re goin’ right straight back to 2010
And start the healthcare war all over again!

God help us.

Robots In The Manufacturing Sector – We’re Lagging Behind

Thursday, March 14th, 2019

In 2013, Oxford professors Carl Frey and Michael Osborne published what became a highly read, highly cited and highly criticized study suggesting that machines could replace 47% of America’s jobs over the following 25 years. This landed like a stink bomb on the robotic revolution.

The study, which examined more than 700 US occupations, found that jobs in transportation, logistics, and administrative and office work were at “high risk” for automation. “We identified several key bottlenecks currently preventing occupations being automated,” said Dr. Osborne when the study was released. “As big data helps to overcome these obstacles, a great number of jobs will be put at risk.”

Following the study, academics and pundits jumped into the middle of the debate to argue its conclusions. In 2015, Forrester Research’s J. P. Gownder authored The Future Of Jobs, 2025: Working Side By Side With Robots and updated it two years later in 2017. Gownder concludes that, yes, AI will replace many jobs, but it will also create many jobs. He suggests a net job loss of perhaps 9.1 million, or about 7% of the workforce. Seven percent isn’t 47%, but 9.1 million jobs are a lot of jobs. And a lot of people who could be swept away by the rise of the robots.

So, clearly, the robots are coming. And, just as clearly, there is now, and will continue to be, human collateral damage. We should do everything in our power to help the millions of people the robots will displace. It would be outrageously stupid, and immoral as well, not to do that.

But if you believe development and adoption of robots is essential to keep the country competitive and prosperous, then you should be concerned, because other countries are outpacing us. By long shot.

A new report from the Information Technology & Innovation Foundation (ITIF) finds the US ranks 7th in the world in the rate of robot adoption in the manufacturing sector.

When controlling for worker pay, the situation is even more bleak. In that case, we’re 17th in the world.

The report relies on International Federation of Robots data for industrial robot adoption rates but adjusted the rankings to control for differences in manufacturing worker pay. The decision to use robots usually weighs the cost savings that can be achieved when a robot can perform a task instead of a human worker, and those cost savings are positively related to the worker compensation levels. Higher wages lead to faster payback, making more robots a more economical investment.

On a compensation-adjusted basis, the report found that southeast Asian nations significantly outperform the rest of the world in robot adoption, with South Korea, Singapore, Thailand, China, and Taiwan the top five nations, in that order. Moreover, China’s rate of robot adoption is so high, fueled by massive government subsidies, that if China and South Korea’s respective growth rates continue, by 2026 China will lead the world with the highest number of industrial robots as a share of industrial workers, when controlling for compensation levels.

Robert Atkinson, ITIF’s President, has some sensible suggestions for how we can catch up. Policy makers should listen to him.

A Message To Our Readers

Saturday, January 19th, 2019

Image result for graphic of oops!

 

Due to a technical error (mine!), yesterday’s blog post was transmitted incorrectly. The post was meant to detail how lower wage workers pay more for employer provided health insurance than higher wage workers. We will publish the corrected post on Monday.

Thanks to the many readers who alerted us to the problem.

Tom Lynch

It Is Time

Monday, November 5th, 2018

This is not a piece about insurance or health care. It won’t make the cut for Health Wonk Review and it will probably cost us readers (Well, 15 years has been a pretty good run). What this piece is is one that addresses the health of our nation.

Today, the Bureau of Labor Statistics (BLS) released a chart showing gains in productivity and hourly wages from Q3 2017 to Q3 2018. It looks remarkably similar to the chart BLS released at the end of Q2. Impressive Productivity and Output gains in both quarters. And, if you didn’t know better, you’d think Hourly Compensation is rising pretty well, too.

However, look to the far right of both charts to see the change in Real Hourly Wages, which are wages after inflation is factored in. The Trump administration and most of the press have trumpeted (pun intended) the nominal wage increase of 2.8% for Nonfarm Business and 2.2% for Manufacturing in Q3, 3.2% and 2.5%, respectively, in Q2, without saying a thing about the negligible, and in some cases decreasing, Real Wages.

Real Wages for Nonfarm Business during this one-year period (Q3 to Q3) are up a measly 0.1%, after rising an anemic 0.5% in Q2; Manufacturing Real Wages in Q3 are actually down 0.4% after being down 0.2% in Q2. And this is not a new phenomenon. In the 40 years since 1979, Real Wages for hourly and non-supervisory workers have increased by a total of only 4.5%. During that same period, the CPI has risen 247.7%.

These are not “alternative facts.”

Since the day Donald Trump and his cronies got the keys to the kingdom, Real Wages per week have risen from $349 to $351 in constant 1982-1984 dollars. Two bucks! For the mathematically inclined among you, that’s an increase of 0.005%. During the same period, the Dow Jones average has grown 20.9%, and that counts the recent decline. I like the stock market as well as the next guy, but barely one-third of families in the bottom 50% of earners own stocks, according to the Federal Reserve. The fact is, lower-income Americans don’t have extra money to put into stocks, and a third of workers don’t have access to a 401(k) or another retirement plan, according to Pew.

The facts make clear that since Republicans took control of everything, the economic gains  have gone to the top earners. Folks in the middle and lower end have, to a large degree, been left by the wayside. Inequality reigns supreme. It is beyond baffling that these people who continue to get the smelly end of the stick resolutely remain, seemingly unperturbed, in the center of Mr. Trump’s base. Look at the enthused, smiling faces at his rallies. Sociologists have written about this, but I have yet to see anything that explains it fully.

Regardless, tomorrow is Election Day. Many of us have already voted. Many more will exercise the option tomorrow. Predictions call for a large turnout, large being defined, God help us, as perhaps a little more than half. I’m now in my eighth decade, and I cannot recall a more consequential election.

Many Americans (as well as some of my friends) are highly satisfied with the tax law changes, the rise in the stock market and the new makeup of the Supreme Court. In exchange for those they allow, without condemnation, the bullying behavior, the constant hyperbole, the ad hominem attacks and the non-stop lying.

It is time for the better angels of our nature to rise to the challenge. It is time to demand decency, and it is time to reject the abject vulgarity that oozes from the awesome edifice where John Adams, Thomas Jefferson and Abraham Lincoln once lived and guided the nation. It is time to raise up America to its true potential. It is time for America to become once again the world’s beacon of hope. Maybe tomorrow America will say, “It is time.” To quote John Milton, “Hope springs eternal.”

Perhaps it is fitting to end this non-insurance piece with the words John Adams wrote to his wife Abigail at the end of his first day residing in the yet-to-be-completed new White House in 1800. Franklin Roosevelt had the words engraved onto the mantel of the White House State Dining Room in 1945. Adams wrote, “May none but honest and wise men ever rule under this roof.” I wonder if the current occupant has ever seen those words.

Summertime reading: Fresh Health Wonk Review & news on our radar

Thursday, July 12th, 2018

Catch up with he latest news and thinking on health care policy issues – Peggy Salvatore has a fresh Health Wonk Review July 2018: Summer’s Coming Around Again edition posted at Health System Ed blog. Topics range from opioids and Purdue Pharma to high deductible plans and the cost of end-of-life care – grab a coffee and check it out!

A few other recent news items on our radar:

NCCI has issued a new a new Insights report on Post-Traumatic Stress Disorder in Workers Compensation. Several states are currently exploring the issue of PTSD injury compensation – it comes up frequently for police, firefighters and other first responders.
Speaking of trauma, if PTSD is on your radar, the New York Times reviews various books on how people recover from trauma, including one by Elizabeth Smart. See Adversity Needn’t Thwart or Define You. Here’s How to Cope.

Work comp drug costs have dropped by over a billion dollars over the last eight years, largely driven by sharply lower opioid utilization. Learn more about this in the 15th annual Survey of Prescription Drug Management in Workers’ Comp via Joe Paduda, CompPharma.

A new Lockton study says that nearly 70% of denied workers’ comp claims are converted and those claims can cost up to 50% more.

Top causes of high-dollar workers’ comp claims. Safety National recently completed a review of its largest workers’ comp claims and uncovered certain trends employers should be aware of.

WCRI Study Compares Hospital Outpatient Payments Across 35 States

Florida’ Supreme Court in Workers’ Compensation – David Langham

12 fast-rising technologies to get ready for

Trump’s trade war has started. Who’s been helped and who’s been hurt?

The U.S. labor shortage is reaching a critical point

Dispatches From the Front Lines of the Battle For Workplace Safety: Short Stuff – Jordan Barab

Cyber-Risk Costs Resist Overall Trend – Businesses’ total cost of risk declined in 2017, but cyber insurance rose 33%.

Cancer prevalence among flight attendants compared to the general population

Who Will Be Sued When A Robot Causes Harm?

Bezos, Buffett, Dimon Name Dr. Atul Gawande CEO of New Healthcare Company

One Man and a Hand Truck

Fentanyls and the Safety of First Responders: Science and Recommendations

It’s The Zip Code, Stupid! Update

Thursday, May 10th, 2018

At the end of February 2018, we wrote about a May 2017 study in JAMA Internal Medicine that concluded that where one lives is a bigger factor in health care outcomes than actual health care. This from our February post:

Geography is the biggest X-Factor in today’s American Hellzapoppin version of health care. The study analyzed every US county using data from deidentified death records from the National Center for Health Statistics (NCHS), and population counts from the US Census Bureau, NCHS, and the Human Mortality Databas and found striking differences in life expectancy. The gap between counties from lowest to highest life expectancy at birth was 20.1 years.

And, surpirse, surprise, it turns out if you live in a wealthy county with excellent access to high level health care, like Summit County, Colorado (life expectancy: 86.83), you’re likely to live about 15 years longer than if you live, say, in Humphries County, Mississippi, where life expectancy at birth is 71.9 years.  So, yes, Zip Code matters.

The concept of  zip code influence seems to be gaining traction. Today, from AIS Health Daily, we learn  a number of Blues Plans are planning on targeting the “where you live” problem with innovative strategies. Here is the AIS Daily release:

Blues Plans Work to Combat “ZIP Code Effect”
The Blue Cross and Blue Shield Association (BCBSA) recently launched the Blue Cross Blue Shield Institute, a subsidiary of BCBSA created to address social and environmental issues, as evidence mounts that health outcomes may be affected as much or more by social determinants of health as they are by actual medical care.
The Blue Cross Blue Shield Institute says it will address what it calls the “ZIP code effect,” which encompasses transportation, pharmacy, nutrition and fitness deserts in specific neighborhoods. It is partnering with Lyft, Inc., CVS Health Corp. and Walgreens Boots Alliance to address transportation and pharmacy deserts. The institute says it plans to deal with fitness and nutrition deserts in 2019.
Meanwhile, Highmark Inc. will launch a transportation initiative this summer to provide rides for members with chronic health conditions who live in a transportation desert. The service will begin in Pittsburgh as a pilot.
On April 17, Highmark’s Allegheny Health Network opened its Health Food Center, which acts as a “food pharmacy” where patients who lack access to food can receive nutritious food items, education on disease-specific diets and additional services for other social challenges they may face.
Other Blues plans also are addressing social determinants of health. For instance, Blue Cross and Blue Shield of North Carolina intends to invest part of its savings from the Tax Cuts and Jobs Act of 2017 into community health programs.
At Independence Blue Cross, the Independence Blue Cross Foundation’s Blue Safety Net Program offers “mobilized services” to medically underserved communities. The IBC Foundation sponsors the Philadelphia Eagles Youth Partnership’s Eagles Eye Mobile to conduct free vision screenings and eye exams and provide prescription glasses to under-insured and uninsured children.
We salute the Blues for recognizing the problem and trying to do something productive about it.
Final thought: If you do not subscribe to AIS Health Daily, you should.