Thursday catch-up

Sorry folks – it’s been a very busy few days with client meetings and project deliverables. When you’re a one-person operation, it’s just not possible to keep up with posting when client stuff needs doing!

So, here’s a quick review of things you may have missed.

Debates are over…(sounds of cheering, clapping, and general relief)

And thank goodness for that.  By any objective measure, Clinton will be our next president, and the Senate may well flip to Democratic control albeit without the 60 votes necessary to avoid filibusters.

That being the case, it looks like we finally may see some much-needed fixes to ACA.  I’ll dig into these in detail next week, but for now, expect:

  • extension of the federal 100% funding for Medicaid expansion for states who haven’t expanded yet
  • remove the “family glitch”
  • perhaps offer near seniors (that’s me!) the option to buy in to Medicare.

More to come…

Customer service and taking care of employees

My two-part series on customer service got a lot of attention; a very recent story on WalMart’s decision to increase labor costs (!) speaks to much of the same.  The ginormous retailer was having problems with poor store results, unkempt aisles, shoddy appearance of displays and the like.  The solution (or at least a big part of it); pay workers more, and they’ll do a better job. While it is too early to measure results, initial reports are encouraging…

For a company that long relied on low labor costs to deliver low prices, this is a tectonic shift.

The state of the work comp industry

Oregon does a great job reporting on premium rates nationally – thanks to Mike Manley for sharing with me.  Mike  wants to “call attention to…states’ index rates expressed as a percent of median.”, not to changes from previous studies.  Listen to Mike!

Good info from NCCI on macro-factors that will affect the workers comp world: highlights from new Communications Director Dean Dimke are:

  • Employment growth to slow to 2% or less this year and in 2017.
  • Average weekly wages are forecast to increase by 2.2% this year and by 4.2% next year.
  • In 2015, workers compensation medical severity declined for NCCI states, but medical inflation—measuring the price component of that equation—increased by 2.6%.
    Low interest rates continue to constrain investment income in the P/C industry.

For those looking for a lot more detail, WCRI just released its CompScope(TM) reports on work comp medical benchmarks for 17 states.  Great weekend reading!

Break’s over – I got to get back to work!

Pain and pain meds are keeping men out of the workforce

The opioid industry’s insidious tentacles are choking the life out of individuals, families, and communities. Now we learn that nearly 44 percent of men aged 24-54 who aren’t in the workforce are on pain meds.

2/3rds of those men are taking prescription pain killers. Yet many are still in pain – a finding that surprises no one remotely familiar with opioids’ poor record with chronic pain.

Only about 2 percent of these men received work comp benefits in the prior year; it is certainly possible that many more were injured at work, settled their claim, reached maximum medical improvement, or otherwise are no longer receiving WC benefits. Fully a quarter are receiving Social Security disability income.

This is a critically important issue for all of us. Research by Alan Krueger PhD of Princeton University gives us much-needed clarity on why labor force participation is near a 40-year low; it’s about

  • poor health status; 43 percent of  men aged 24-54 not in the workforce report their health as fair or poor
  • 34% of these men report at least one functional disability
  • as a group, these workers report “feeling pain during about half of their time.”
  • average pain rating is 88 percent higher for these men than men who are employed

Of course, Dr Krueger’s research is not just about opioids, but it’s abundantly clear that opioids aren’t helping these men deal with their pain, and pain is keeping many out of the workforce.

This comes on the heels of reports that the death rate for middle-aged whites has been increasing of late – and at least part of the problem is, once again, opioids

What does this mean to you?

STOP approving opioids for chronic pain unless nothing else works. 


Part 2 – Serving workers’ comp patients and payers – what works and why

Yesterday’s post on the problems inherent in outsourcing/offshoring/automating customer service made the case that customer service functions must be handled internally.

Today, we’ll dig into a case study – the lesson being it’s not about your company’s metrics, cost structure, or “efficiency”, it’s ALL about your customer.

MedRisk is a physical medicine management company serving the workers’ comp industry. (MR has been an HSA consulting client for over 15 years) For years, it had the niche almost to itself, focusing its sales and service attention on corporate buyers. Along came Align Networks, a start-up that concentrated on the desk-level user, delivering stellar service to each and every adjuster and case manager.  Align was quite successful, eventually becoming the largest vendor in the PM management space.

A misstep by MedRisk helped Align.  Some years ago, MedRisk chose to outsource key functions, including some aspects of IT, billing, and outbound call center functions including patient scheduling. This did not go well, and the resulting dissatisfaction among desk-level users led some customers to switch from MedRisk to Align.

Confronted with the loss of business, MedRisk got back to basics.  The lesson was apparent; a dramatic change in customer service was critical. That involved a major shift in understanding about the central importance of the desk-level customer, the provider and the patient, and a recognition that those customers required, above all, personalized service.

Service isn’t about a couple codes on a bill, or the timing of a patient visit, or A/R days outstanding.   I spoke with MedRisk COO Michelle Buckman about this.

When we’re talking to a provider about our contract or a bill or treatment, it isn’t about crunching numbers on the issue, it’s about the overall relationship – we need to be the liaison, to understand it isn’t about that specific issue or problem, but the entire relationship. Anyone who calls in here, we need them to feel and know that the person on the end of the phone understands where they are coming from and is there to solve their problem…they weren’t getting that before.

We recruited US-based college grads who wanted careers in health care, looking to help people; we did NOT look for folks with call center experience.  That training isn’t necessarily helpful as it can be tied to ending calls quickly – that’s not what patients want to hear or how they want to be treated, and adjusters may need to have more time.

In fact, some metrics used by call centers are counter-productive; MedRisk found it’s much more important for staff to spend time on the phone to get a feel for what’s happening with the patient, the provider, the adjuster, to make sure questions are fully answered, issues identified and understood, then to get off that call and on to the next one. Buckman:

Our people are Patient Advocates. That is their title; their job is not just about setting an appointment, but guiding [patients] through the work comp process. Many [patients] don’t know anything about work comp or functional capacity evaluations, so we educate them…every number is a person who couldn’t pick up their child, or go to work; there is a person, a story, a need behind each one of these calls…

[The Patient Advocate] handles each patient end to end, monitors duration and type of care, in contact with the provider regarding progress. If there’s an issue, the Advocate engages one of MedRisk’s US-based PTs to evaluate the issue, [depending on the issue, resolution may include] perhaps peer to peer to discuss utilization and guidelines…if there is an issue, we get all stakeholders together to figure out how to get things back on track.

Getting there took a huge amount of effort and focus and disciplined execution to bring all customer-facing functions back inside the company. In turn, that required major investment in IT, because those customer service folks had to have the information and the tools necessary to quickly diagnose issues, answer questions, and resolve problems.

In-house IT was beyond necessary, it was mission-critical.  Again, Michelle Buckman:

customers want customized workflows, when IT was outsourced, the [outsourcing vendor’s] folks didn’t get our industry or what we wanted to deliver to customers…One size doesn’t fit all, different customers have different protocols – [I] can walk down the hall and talk to developers [so we can] build what that customer needs…doing it internally is phenomenal, developers understand this is not just coding but actually what they are trying to accomplish [with that coding]

MedRisk now numbers 125 Patient Advocates among its 700+ employees. That’s more than common metrics deem necessary, but “over-staffing” means customers aren’t waiting in a queue, stuck on hold, or rushed off the phone. The company pays those Advocates above call center wages, and invests in them. It hires locally, delegates a lot of responsibility to Advocates, looks to Advocates for system, IT, process, and service improvement ideas, and measures “tangible intangibles”, five core values that make up 35% of performance assessment. Treating staff well does produce some striking metrics;

  • the 4 key staff that began the transition from outsource to internalized customer service are still at MedRisk
  • 78% of patients are scheduled within 4 hours of initial notice
  • calls are answered in less than 10 seconds
  • the “regrettable turnover rate” for the Patient Advocate staff, which is simply losing the people MedRisk wanted to keep – is 9 percent (compared to industry averages far more than twice that)
  • average case duration – the length of time a patient is in PT – declined 15 percent after the Customer Advocacy Program went into effect.

More to the point, investor people, is the financial result.  MedRisk’s revenues and profitability have increased dramatically over the last few years, that growth driven in large part by very happy desk-level customers.

To be fair, this growth has been helped of late by their major competitor’s decision to outsource and offshore key customer-facing functions.

What does this mean for you?

For vendors, serving your customers like your cable company does isn’t a recipe for success.

For payers, do you want your front-line staff to deal with a cable company service model? 


Serving workers’ comp patients and payers – what works and why

After several years of intense activity and billions of dollars invested in the work comp service industry by a score of private equity investors, it’s time to take a step back and figure out what’s worked, and why.

And what hasn’t. Namely outsourcing and offshoring customer-facing tasks…


(this is the first in a several-part series)

This isn’t about what’s worked for investors, but rather what works in work comp – better service, fewer screw-ups, improved patient care, lower cost.

For those not steeped in workers’ comp, a bit of background is critical.  Vendors winning a big national contract may just be getting a “license to hunt”; the executive’s signature on the contract is just the start of the real heavy lifting. Success is about the wholesale sale and the retail sale.

To translate a contract into revenue, vendors need to understand how REAL decision makers – the front-line folks – work, what they want and don’t want, like and don’t like, how they are evaluated, assessed, and bonused, what’s important to their bosses, how their IT systems and applications and security works and interfaces/doesn’t interface with the vendor’s systems/apps/security. Sure, every vendor thinks about this and works at it, but not many do it well.

More to the point, every encounter with an adjuster, case manager, or patient is critical to the outcome of the claim. An angry or upset patient will call an attorney, a satisfied patient will not.

With that as a basis, let’s talk about what happens when investors who don’t understand this buy work comp service companies.

With its strong focus on growth and debt service and cost cutting, the new owner employs a strategy that’s worked really well in other industries; reduce costs thru automation, off-shoring, and out-sourcing.

Their thinking is that many of these tasks can be handled faster/cheaper if a computer does them.  If a computer can’t, then someone in Asia, South Asia, or Central America can.  After a consulting company does an analysis of workflows, operations, and systems, the vendor’s US operations are shut down, work is outsourced, and the owners watch the profits leap.

Except, they don’t.  Leap, that is.

That’s because you can’t automate or outsource customer service.

Customer service is delivered in every encounter with every current or potential customer. It requires a boatload of pre-work:

  • developing your products and services to increase the chance for success and reduce the opportunity for screw-ups;
  • building IT systems that deliver the necessary information to those who can act on it when they need it in a form they can understand;
  • hiring, paying, and motivating workers with service at top-of-mind; and
  • training, re-training, and educating workers so they are confident and capable.

Then, it’s about execution.

  • ensuring your customers can understand what your people are saying and vice-versa;
  • empowering your people to address and resolve every issue for anyone who calls, emails, tweets, or instagrams;
  • connecting those customer-facing people with management and staff so the lessons they learn, complaints they here, and opportunities they identify can be used to improve your core products and services;
  • quickly and with minimal red tape.

We’ve all had frustrating customer service encounters with poorly-prepared customer service reps that don’t seem to grasp an issue, can’t address a specific problem but seem to think they can, or are difficult to understand.  This is NOT a slam at those reps, but rather at the companies that employ them.  Putting a person in a position where they don’t have the tools to do the job is a management failure.call_center_cartoon-1

The front-line, desk-level work comp professional has no time to deal with “customer service” that isn’t.  Claims adjusters and case managers need their issue resolved now. Not after lengthy conversations, multiple voice mails and transfers and back-and-forth emails, now.

That’s because their “customers” – workers comp patients and their employers – are anything but standardized.  State regulations, employer requirements, patient needs and wants, physician/provider policies, and the adjuster/case manager’s individual work style make for for complex and constantly-evolving workflows.

Simply put, while much of this can be standardized, documented, and scripted, some cannot – and it’s those encounters that spell success or failure for vendors.

The problem facing investors is this: automating, outsourcing and offshoring customer-facing activities has been wildly financially successful in many other industries.  

Not so much in workers’ comp, where every encounter with an adjuster or patient is critical to the outcome of the claim.

Some have learned that lesson, but many have not, and that’s the subject of tomorrow’s post.



Pre-election pundit ponderings!

With just a couple Health Wonk Review publication dates between now and the election, we decided to jump into this with both feet.  Which is decidedly different from anything we’re hearing from the Presidential candidates, and pretty much everyone running for elective office.

Not that a little silence wouldn’t be welcome right about now, especially in those hotly-contested toss-up states (we’re talking about FL OH PA NC AZ NV…)

First up is a fact-filled briefing on why insurers are leaving the Exchanges from the keyboard of Louise Norris.  Louise notes that, despite losses in the individual market/Exchanges, insurers are doing fine.  That’s because only 6 percent of Americans get their insurance via individual plans in 2014.

InsureBlog’s got a view on the Exchanges, courtesy of Mike Feehan.   Mike opines: “The collapse of most Obamacare exchanges has captured the attention of the media in recent months” While I’d encourage Mike to not get his shovel ready just yet, in his view private exchanges may – emphasize may – work, but it’s too early to tell.

(HWR Hero Hank Stern is participating in the Strides Against Breast Cancer event next week; you can help him out here.) is wondering if the GOP  would get behind a Medicare expansion that focused on Medicare Advantage plans offered by commercial insurers, these plans are favorites of the Republican establishment.

All you need to know on “Clinton & Trump on workplace issues“, a service provided by the talented and ever-entertaining Julie Ferguson.  Parental leave? Health reform? Drug pricing? Zika?  It’s all there!

Brad Wright offers a trenchant piece on the actual results of ACA to date; Brad notes that most of the folks who gained coverage got it via Medicaid, with significant increases even in non-Medicaid expansion states.  About a third of the growth in coverage came from private insurance bought on the Exchanges.  Not only did Brad report on the data, he got additional insights from one of the study’s principal authors…

Peggy Salvatore is peering into the future of health insurance, and what she sees is pretty darn intriguing.  Peggy’s review of the “demonetization” of health insurance and potential use of real-time data capture and analysis by “health insurers” makes for compelling reading.  Lest you think it too far-fetched, a decade ago you couldn’t read this on your phone…

A BIG issue this election has been pharma costs, with the EpiPen the proverbial poster child.  David Williams thinks that there’s been a bit too much grandstanding and hyperbole here; check out his perspective at Health Business Blog here.

Acronym soup! My contribution is a primer on physician reimbursement changes from CMS. MACRA. MIPS, APM, RBRVS, SGR, along with a discussion of implications for workers’ comp is ready for viewing.

Our good friends at Health Affairs provide welcome insight into maternity care, and why less is more; less care = better outcomes for moms and babies.  That being the case, why is “more” so common? Some thoughts on that, too.

Meanwhile on the hospital front, things aren’t as rosy – unless rosy describes the color of the ink on the financial reports.

Assumptions About Your Hospital Remaining In The Black Are Wrong. And You Better Listen To Who Is Saying So.

Insight into how private equity’s involvement can end up in a heads-they-win, tails-you-lose result comes from Roy Poses MD.  The most persistent and insightful “investigative blogger” I know, Roy’s decade-long focus on the often ugly intersection of capitalism and health care makes for disturbingly necessary reading.  Today he takes on Cerberus’ involvement with Steward Health.  His reporting will NOT make you feel good about our “system”.

There’s a new blog in the blog-o-sphere; GoodNewsWorkComp is up and running, It’s the place for industry folk to meet, greet, and share their stories.  Read Ronnie’s Story for a perspective you won’t get from the “work comp is evil” set.

Meanwhile, Jaan Sidorov is pondering why Apple and insurance companies are working to put Apple watches on members’ wrists. Hint – it’s kinda-sorta big brother, but there’s a win in it for you!

Thanks for reading this far, clicking thru, and sharing with friends, family, and frenemies.

Takeaways from DOL’s State Workers’ Compensation Report

After discussing yesterday’s meeting at the Dept. of Labor with several colleagues and reviewing notes, here are my key takeaways.

  • lots of talk about benefit adequacy
  • lots of concern about work comp not covering real costs of disability
  • much reminiscing about the National Commission of 1972
  • evident concern about states reducing benefits to work com patients
  • very little substantive discussion about the three key issues in comp:
    • medical care and the quality thereof
    • secondary disability and the causes thereof
    • the rapidly evolving labor world and implications for work comp

With the exception of Washington L&I’s Gary Franklin MD MPH, speakers’ views were from 30,000 feet, from high atop an academic mountain that offers little insight into what actually happens – and why – in the workers’ comp world.  Outside of Dr Franklin, no one currently actively involved in workers’ comp spoke. 

Several times there were statements that seemed more appropriate for a faculty lounge conversation than a “bully pulpit” event…

  • Dr John Burton noted that NASI’s figures on employer costs don’t line up with BLS’ numbers, and doesn’t know why. (Seems to be an important topic to get right before going before a national audience to discuss costs v benefits of the WC system)
  • Emily Spieler’s description of work comp claimants as “existing in a Kafka-esque” system, alarmingly complex (no argument there) and stigmatizing (a broad over-generalization)
  • A VERY brief chat about the Gig Economy, and a LOT of talk about a 1972 Commission report focused on an economy that disappeared decades ago.

Much of the discussion centered around or addressed concerns that occupationally-caused disability costs are often paid by workers, taxpayers, and social safety nets – in other words, employers and insurers are getting a free ride because benefits for lost wages are wholly inadequate.  As a result, workers are forced into poverty, relying on Social Security Disability Income, food stamps, and other mechanisms to survive when workers’ comp wage replacement or settlement benefits are inadequate.

That may well be true, and as I’ve noted before, fair wage replacement should be table stakes in work comp.

That said, the panel ignored the real problem – why is that person “disabled”?

There was little context, little depth, little attempt to dig into that very real  issue. What causes disability?  Secretary Perez and others noted the critical importance of preventing accidents and illnesses, but said NOTHING about preventing secondary and unnecessary disability.

It’s almost as if the speakers buy into the “if you get hurt, you are disabled” trope.

To be fair, I very much doubt they do.  But no one spoke meaningfully about what causes disability, the primary cost driver in the system.  Glenn Pransky MD PhD should have been on the panel; his absence was an unfortunate and glaring oversight. As the nation’s leading authority on disability in workers’ compensation, Glenn absolutely should have been involved (disclosure, I consider Glenn a friend and colleague).

Equally unfortunate was the absence of any substantive consideration of the role of medical care in the work comp system.   In the very few minutes Franklin had, he focused on an otherwise-ignored topic – the primary importance of medical care to workers comp patients and the system as a whole.  

Perhaps most notable were Dr Franklin’s statements about the generally poor quality of medical care delivered to work comp patients; paraphrasing here, he said “workers’ comp medical care is about the worst in the country”, citing rampant overuse of opioids and lumbar fusion as two examples.  Dr Franklin also noted a disappointing lack of medical leadership in many payer organizations.

Does your TPA or insurer have a full-time Medical Director who sets medical policy?

Most striking was his statement that work comp patients in Washington were dying due to opioids, a system-inflicted tragedy L&I attacked immediately – and successfully. There was no follow-up, no discussion of lessons learned, not even an acknowledgement that this is horrific, a catastrophe caused by lousy medical care that is absolutely happening in the other 49 states.

Nope, the panel talked about the need for a new Commission, more research, more study.

We do NOT need any more academic studies to prove lousy medical care is disabling and killing workers. Enabled by weak state laws and regulations that don’t require care is driven by evidence-based medical guidelines enforced by strong utilization review, crappy medical providers and crappy medical care are harming patients, extending disability, addicting patients every day.

There’s no question wage adequacy is an important topic that must be addressed, and done so fairly and intelligently.

There’s also no question that the world has changed dramatically since the first National Commission in the early 1970s, and one can’t evaluate today’s work comp system – nor build one that will work for the next fifty years – by doing the same things we did in 1972.

What does this mean for you?

If you don’t tell your story, others will make up stories about you.

Live blogging on the DOL’s State Workers’ Compensation Forum

Geek alert!

For work comp wonks, in this post I’m reporting on what transpired at this morning’s meeting at DOL on Work comp; a summary and perspective will be the subject of a post tomorrow.

OSHA’s Director led off this morning’s presentation at the Department of Labor with a quick summary of the history of work comp, noting the death rate for WC declined from 37 per day to 12 per day over the last 40+ years despite a doubling of the number of people employed.

(note the statements below are paraphrased, some may not be entirely accurate due to lack of transcript available at the time of posting)

The written report is here for download. 

He also stated many injuries are NOT reported, saying workers’ comp is the ONLY element of the social net without federal oversight.  

Key paraphrased quotes:

  • Costs are shifted away from employers, and to workers, their families, and other social insurance programs.
  • The race to the bottom for workers comp among states has continued.
  • Potential policy initiatives are here.

NASI CEO Bill Arnone’s comments included:

  • workers’ compensation is a social insurance system that “needs work”
  • today’s work place is very different from 1908…
  • 3 million injuries and illnesses reported in 2014 – 1/3 represented time away from work
  • lack of uniform reporting of state experience
  • goal of workers comp- adequate wage replacement and medical care at reasonable cost – balance adequacy and affordability

Social Security’s Commissioner Carolyn Colvin was up next; notable statements follow:

  • 9 million disabled workers receive income from Social Security – plus 2 million of their dependents; averaging under $1,200 per month
  • for 1/3 of these workers, SS Disability Income (DI) income is their ONLY income.
  • if the full cost of workers injuries aren’t covered by workers comp, someone else is paying for those costs
  • recent changes in some states’ work comp laws may be shifting costs to SS DI and Medicare

The Commissioner was quite clear that Social Security is very interested in worker disability as shifting of expense to SS DI increases Social Security’s ultimate cost.

Secretary of Labor Tom Perez then took the podium.  Perez gave a detailed and passionate review of the formative years of workers’ compensation.  The Secretary noted that today, just as 80 years ago, state workers’ comp systems vary widely, AND, the Feds have “leverage” at the federal level for other social insurance programs including unemployment insurance.

Perez linked today’s work comp systems with those that led to the National Commission in the last century, starting with Texas opt-out as problematic due to low benefits. The Secretary also said:

  • you’ve got to win the geographic lottery to be taken care of due to differences among states
  • taxpayers are unfairly subsidizing a workers’ comp system that is not doing enough
  • DOL doesn’t have statutory authority to protect workers but we do have the bully pulpit.

A panel discussion began; speakers included John Burton, PhD, Professor Emeritus at Rutgers and former Chair of the Commission; Gary Franklin MD, Medical Director of Washington’s State WC Fund L&I; Christopher McLaren PhD of NASI, Emily Spieler, Professor and Labor Attorney, former Commissioner of WC in West Virginia.

Burton was asked for his views…at which time the broadcast went down for a few minutes. When we were reconnected, Burton provided a background of the Commission’s work, suggesting the standards represented a “floor” for benefits and other aspects of workers comp, and the decline in benefits was largely driven by state’s unfounded fear that employers would leave for more friendly locales.

Burton does not believe there is any chance federal standards will be enacted over the next 20 years, and can’t be developed because the world has changed so much.  Burton believes there is a “race to the bottom” once again, and this has resulted in states reducing benefits.

In a later segment, Burton noted there is a discrepancy between the NASI data and the Bureau of Labor Statistics’ data on employers’ workers’ comp costs; BLS data indicates employer costs are not going up, in contrast to NASI’s findings.

He also panned the AMA Disability Rating Guidelines, claiming among other things that they are completely non-evidence based, and suggesting the Institute of Medicine come up with a disability rating guide…I wholeheartedly disagree w Burton’s assertions about and denigration of the Guides.

Dr McLaren hit the highlights of the new NASI work comp report – copy here. Later, he noted that costs are going up now due in large part to the ongoing recovery from the Great Recession; costs tend to go up before the benefits paid catches up to the new workers’ new injuries. 

Dr Spieler was asked to identify the key problems in state workers’ comp systems. She agreed with John Burton that a major problem is states seeking to compete with other states, and:

  • many injured workers don’t apply for benefits and therefore don’t appear in NASI or other reports
  • some apply for benefits but don’t get them due to payer contesting the claim due to requirement that workplace was major contributing cause to the impairment.
  • are cash benefits adequate – there have been cutbacks in length of time patients can receive benefits, citing Oklahoma
  • patients exist in a “Kafka-esque” system, alarmingly complex and stigmatizing.
  • there’ve been statutory efforts to “cut back” on medical benefits
  • the goal of replacing 2/3 of pre-injury wages was and should remain a goal.
  • Oklahoma opt-out was mentioned multiple times

Gary Franklin MD PhD spoke about medical care in the system (note – Gary is a  friend and colleague)

Gary noted that unlike some states, Washington is in a race to the top.  He also said many payers don’t even have senior medical staff to help guide policy. For those who know Dr Franklin, it will come as no surprise that he used the term “evidence-based” multiple times in referring to formularies, lumbar fusion and other surgery, and disability.

A lot of the contribution to long term disability is due to baad medical care; workers’ comp medical care is among the worst medical care in the country,  Gary cited 32 deaths of workers comp patients who had low back sprains, got opioids, and were dying due to their prescriptions.  WA focuses on preventing disability three ways:

  • develop validated methods, tools, and instruments that docs can use to identify patients at risk for extended disability
  • using evidence based methods to develop treatment guidelines to prevent them from being injured
  • develop delivery systems to reorganize care to allow better care for injured workers, the Centers for Occupational health and Education – 50% of patients are going thru these Centers, which have helped reduce preventable disability by over a third.

Net – paying much more attention to technology assessments, evidence-based clinical guidelines, and preventable disability are all helping workers avoid bad care and prevent extended disability.  Gary talked about the horrible effects of lumbar fusion surgery and opioids – “a huge percentage of injured workers that are now on SSDI are on opioids, and that started in the workers comp system.”

The discussion went on from there, with a discussion of illnesses and how the system doesn’t adequately address occupational injuries, DOL’s views on work comp and the Gig economy, and the need for more research on occ injuries and illnesses sustained by Gig economy workers.

The issue of misclassification, and how states handle independent contractors, problems in the construction industry with labor cheating was raised by Burton – valid points all.

Just-released DOL report on State Workers’ Compensation

Key language -from the just-released report is below… I’ll be live-tweeting at @Paduda and live-blogging here during the broadcast from the Dept of Labor this morning.

Policy areas that deserve exploration include [emphasis added]:

• Whether to increase the federal role in oversight of workers’ compensation programs, including the appointment of a new National Commission and the establishment of standards that would trigger increased federal oversight if workers’ compensation programs fail to meet those standards.

• How to strengthen the linkage of workers’ compensation with injury and illness prevention, including by facilitating data sharing among state compensation systems, insurance carriers, state and federal Occupational Safety and Health Administration (OSHA), and state health departments.

• Whether to develop programs that adhere to evidence-based standards that would assist employers, injured workers, and insurers in addressing the long-term management of workers’ disabilities to improve injured workers’ likelihood of continuing their productive working lives.

• Whether to update the coordination of SSDI and Medicare benefits with workers’ compensation, in order to ensure, to the extent possible, that costs associated with work-caused injuries and illnesses are not transferred to social insurance programs.

Workers’ comp: anecdote v data

A comment by David Deitz MD on last week’s post is well worth your read.  Referring to ProPublica, Dr Deitz said:

describing the use of guidelines and other evidence-based tools as a cut in benefits is not just misleading, it gets to the root of one of the central problems with much WC care

As Dr Deitz notes, what PP doesn’t grasp is this; evidence-based guidelines promote better medical care, and when work comp patients get sub-standard care, everyone suffers. .

Not just a few patients highlighted in a couple of headline-grabbing stories, but thousands victimized by lousy medical treatment. Today, many states do not allow or support the use of evidence-based clinical guidelines (which PP describes as a “cut in benefits”), and as a result many patients get crappy medical care.

Want evidence?

Data and the analysis thereof identifies these issues.

Outcomes data such as return to work, disability duration, functionality, sustained re-employment, re-injury rates differentiates good medical care, and providers who deliver that care, from providers who don’t.

Alerts based on potentially problematic treatment such as prescription of opioids without trauma or surgery, high incidence of surgery for patients with soft-tissue injury diagnoses, physical therapy scripts for patients without musculoskeletal injuries are based on data collection and analysis.

Dull stuff, huh?

Anecdotes are easy to grasp, get lots of attention, generate excitement, start politicians squawking. Data is, well, boring. Thinking based on data requires focus, concentration, effort, and a desire to understand.  Anecdote is quick, easy, and triggers emotions that often lead to simplistic and misguided conclusions.

That’s the briefest explanation I could come up with as to why work comp reform efforts are far too often sidetracked by issues/stories that, while concerning or even troubling, do NOT represent what happens the vast majority of the time.

What does this mean for you?

Make decisions based on data, not on anecdote.