Monthly Archives: September 2014

Options for Workers’ Comp Getting National Attention

Richard’s Note:

All those who read my previous post, Letting Problems Fester, learned that my father was admitted to the hospital the day before I wrote the post. I would like to take this opportunity to thank those of you who sent me condolences, as my father passed away on September 14th. The medical care he received while in the hospital was certainly not a factor in his passing, as one of his doctor’s knows my brother, and the other doctors did whatever they could to help my father. The fact remains that when you leave problems to fester, they eventually catch up to you. That is the case with the workers’ comp industry, as the following post will discuss.

Today’s Health Wonk Review on Workers’ Comp Insider, posted an article from Roberto Ceniceros called, National Employers Push for Comp Options. The article appeared last week in Risk & Insurance.com.

Ceniceros wrote that national employers are benefiting by opting out of the Texas workers’ comp system, and are pushing for “free market alternatives” to traditional state workers’ comp systems.

These employers have launched a new organization called the Association for Responsible Alternatives to Workers’ Compensation (ARAWC), and plan to lobby state legislators to allow employers to develop new options for delivering medical and wage replacement benefits to injured workers.

Some of the members of this organization are: Wal-Mart, Lowe’s and Sedgwick Claims Management Services Inc. They are frustrated with being forced into “entrenched” workers’ comp systems that prevent them from adopting practices that could benefit them and their employees, according to Richard Evans, executive director of Austin-based ARAWC.

I have written before about opt-out programs in Texas and in Oklahoma, and my all of my articles have made the point that medical travel can be beneficial to employers, especially in dealing with the high cost of surgeries under workers’ comp.

Mr. Evans has expressed many of the things I have been saying when he stated in Roberto’s article that traditional state systems, influenced by various interests, make it impossible to adopt medical delivery practices that can lower costs and speed employee return to work. State administrative burdens, for example, he adds, discourage the best doctors from treating workers’ comp cases.

One of the other issues Evans echoes from my previous posts, is that “Workers’ comp is slow to change,”…“There are a lot of stakeholders involved and it’s hard to make those changes.”

It is worth noting that two of the members of ARAWC (pronounced a-rock) have already explored medical travel for their group health plans, albeit as far as domestic medical travel is concerned, and not international or cross-border medical travel.

If ARAWC is successful in lobbying state legislators to allow employers to seek alternatives to traditional workers’ comp, it would be in ARAWC’s interest to also consider medical travel, in both its domestic and international aspects.

This is what I have said all along. There needs to be movement on the part of employers, large ones such as Wal-Mart and Lowes, and smaller ones as well, such as HSM in North Carolina, and all other employers around the country to seek free market alternatives to high cost workers’ comp medical benefits. Medical travel is a free market alternative because it takes advantage of one of economics’ chief rules: goods and services will go to those markets that can provide them at lower cost at the same or better quality than what is currently available in the local market.

Those who pooh-pooh this are not only wrong; they are flying in the face of those like Mr. Evans and his organization and their members who are seeking to escape the padded cell.

Health Care Across US-Mexico Border: A Two-Way Street

The following article appeared on Friday in the Medical Tourism Association’s (MTA) online magazine, Medical Tourism Magazine.

Those of you who have been following my blog for some time now, know that the MTA copyrighted my White Paper without my written permission. However, because this article deals with a subject that I have already written about in the past, I thought it would be a dereliction of my responsibility as a blogger to not post this to my blog and to deprive my readers of the information it contained.

Here is the link to the article.

http://www.medicaltourismmag.com/blog/2014/09/ask-patient-medical-tourism-consumers-know-health-worth-price/

The US workforce is increasingly Latino and will be for the foreseeable future, especially in CA, AZ, NM and TX, not to mention other states like CO and NV.

To allow cross-border health care and not cross-border workers’ comp medical care is quite frankly, wrong and short-sighted. There should be no difference between getting knee surgeries in Houston and knee surgeries in Tijuana and Baja. 

Letting Problems Fester

 

Yesterday, my father was admitted to a local hospital reluctantly by his primary care physician, and on the wishes of my younger brother, who is also a physician. His doctor wanted to put him in a hospice; my brother had the good sense to convince the primary to admit him to the hospital.

My father has been ignoring a very a serious problem with his legs that has left them inflamed, infected and with open wounds and leaking. And despite pleadings and arguments with him from me, my brother, his doctor, and a home health agency we are using to take care of my mother, he has resisted going to the hospital, or even taking responsibility for the state of his health.

For a few years now, he has been treated for this condition by a dermatologist, who has wrapped his legs with bandages and put Calamine lotion on it. They have prescribed compression stockings for him to wear, but he has only worn them whenever he asked an aide to put them on for him.

But because of the leakage and bleeding, the aides and the agency have told him that they cannot do anything for him until his legs are treated.

I have told him that a dermatologist is not the right doctor to treat this problem, but he has insisted on going back there time and again because of the attention they paid to him in the past, especially one young woman who no longer works there who he was infatuated with.

I might add that this doctor was one of doctors in a database the New York Times published online of physicians who received a majority of the payouts from Medicare in 2012.

Hopefully, now that he is in the hospital, he will get the proper treatment and his legs will improve.

The reason I am telling you this is that the workers’ compensation system has so many “health problems” that are being ignored or treated with ineffective and useless treatments.

Sort of like what is wrong with my father…plenty of open wounds and sores, and other underlying issues that is being treated by the wrong kind of doctor.

These problems, as I have discussed in the past, such as the fraud and abuse of injured workers, the opioid abuse problem, general health care plans charged less for the same surgeries under workers’ comp, and so many other issues, have either been ignored, or are being mistreated because some in the workers’ comp industry are infatuated with the service they are receiving from their service providers and cannot understand that these companies are not interested in solving these problems, only prolonging them because they profit from it.

Also, they are pursuing “treatments” that are ineffective and only make the problems worse, as in the case of my father and his dermatologist.

But unlike my father who finally allowed his doctor to admit him to the hospital, the workers’ comp industry is refusing to seek proper treatment.

“Aged statutes and old case law” is one excuse they offer. Another is because doctors and lawyers are milking and gaming the system and they won’t or can’t do anything about this. And finally, they refuse to seek treatment because they are under the delusion that everything they have tried so far, or will try in the future to address these problems will work, if they only keep doing so.

But we have already seen that some states are allowing employers to opt-out of the system. In one state, a judge has ruled that that state’s system unconstitutional. Joe Paduda has been writing on his blog about private equity firms buying up Third Party Administrator companies and workers’ comp service providers in an effort to consolidate the workers’ comp claims process from right after the first report of injury to the management of the claim, to the management of the pharmacy benefits, and all other services.

As this vertical integration proceeds, it is likely that costs will go up, profits will flow to the top, meaning to the private equity firms and their investor clients, and services provided may not be adequate to treat the injured worker because of the demand for greater efficiency in the process and for ever more profits to be squeezed out of the system.

So, do we see if the “patient” still refuses to get the help it desperately needs, or does it go on pretending that there is nothing wrong, and dies a slow death.

I am glad my father finally agreed to get help. I am still waiting for the workers’ comp industry to do the same. It needs to go to the “hospital” not a hospice.