Monthly Archives: February 2016

Zika to Cost Latin America and Caribbean $3.5B

Three weeks ago, I wrote a piece about how the Zika virus may affect medical travel to Latin America and the Caribbean.

Today, Business Insurance.com (article unavailable online due to error) reported that the World Bank warned that the spread of the Zika virus across Latin America and the Caribbean is expected to cost those regions about $3.5 billion in forgone economic output.

A full article can be found here.

According to the article, the World Bank is offering $150 million in financing to those countries combating the disease.

This money is nearly three times the the amount of money requested by the United Nations’ health arm on Wednesday.

However, officials at the World Health Organization said that they needed $56 million to help prevent the spread of the virus.

The officials also said that the short-term funding request would be used to speed up research, vaccine development and diagnostics of the relatively unknown virus, and would last until June.

Advertisements

What’s At Stake for Workers Should the GOP Win in November

LynchRyan published today an excellent article in WorkersCompInsider.com about what life was like for American workers in 1915.

The article, by Julie Ferguson, discusses a report published by the Monthly Labor Review, to commemorate their centennial.

The report chronicles the news of the day for 1915, and discusses the demographics of the day, as well as providing a portrait of daily life in the US of 1915.

Then the report describes some not so pleasant and mundane issues, such as workplace injuries whereby a woman lost her arm and continued to work because back then there was no workers’ comp laws, and as the follow excerpt says, she either could lose her job or assume the risk. Here is the excerpt:

Theodore Roosevelt, arguing in favor of workers’ compensation (then known as workmen’s compensation) laws in 1913, offered the story of an injured worker that summed up the legal recourse available for workplace injuries at the time. A woman’s arm was ripped off by the uncovered gears of a grinding machine. She had complained earlier to her employer that state law required the gears be covered. Her employer responded that she could either do her job or leave. Under the prevailing common-law rules of negligence, because she continued working she had assumed the risk of the dangerous condition and was not entitled to compensation for her injury.

Unfortunately, many Americans are convinced that the best days this country ever had was before Theodore Roosevelt became President. Grover Norquist, the author of the anti-tax pledge GOP Senators, Congressmen and other officials took some years back, said that he wanted to take the country back before Roosevelt, before the “Socialists” took over.

The Koch Brothers and men like Art Pope in NC believe in the right of businesses to do anything they want, and have been responsible for advocating such things as opt-out legislation and even attacks on the exclusive remedy clause of workers’ comp laws.

Yet, as I wrote the other day in “Trends and Issues In Workers’ Comp 2016“, the Koch Brothers drew up a bill defending exclusive remedy so that businesses would be spared the prospect of tort liability.

But I suspect that there are many others who do not share the Koch Brothers view of exclusive remedy, and do seek to overturn it so that we go back to the bad old days of 1915.

One other excerpt from the report discusses workplace safety, and what steps were taken back then to address them. Pay close attention to the name, Frances Perkins, not only was she the first woman cabinet member (FDR), she was also the first Secretary of Labor, as the excerpt states.

Although working in mines was notoriously dangerous, mill work could also be quite hazardous. BLS reported about 23,000 industrial deaths in 1913 among a workforce of 38 million, equivalent to a rate of 61 deaths per 100,000 workers. In contrast, the most recent data on overall occupational fatalities show a rate of 3.3 deaths per 100,000 workers. Regarding on-the-job safety, Green notes, “There was virtually no regulation, no insurance, and no company fear of a lawsuit when someone was injured or killed.” Frances Perkins, who went on to become the first Secretary of Labor (1933–45), lobbied for better working conditions and hours in 1910 as head of the New York Consumers League. After witnessing the 1911 Triangle Shirtwaist Factory fire, which caused the death of 146 mainly young, immigrant female garment workers in New York’s Greenwich Village, Perkins left her job to become the head of the Committee on Public Safety, where she became an even stronger advocate for workplace safety. From 1911 to 1913, the New York State legislature passed 60 new safety laws recommended by the committee. Workplaces have become safer, and technology has been used in place of workers for some especially dangerous tasks.

So lest you think that the Donald will make America great again, that Cruz can be trusted, that Marco is the real deal, or whatever the hell his slogan is, none of them care about the American worker, none of them care what happens to them and none of them will be able to stop their fellow Republicans from carrying out Norquist’s commandment to take the country back.

Unfortunately, it is not 1915 they want to go back to, but before 1901, the year that “Socialist” Roosevelt became president. They want to repeal the 20th century. That’s what’s at stake.

 

Trends and Issues in Workers’ Comp for 2016

From the ‘What’s happening now in workers’ comp’ department comes two articles written earlier this month by Jacquelyn Connelly in Independent Agent magazine.

The first, written on February 1, talks about new health care trends driving change for workers’ comp. The second, written a week later, deals with the top three regulatory issues to watch for in workers’ comp in 2016.

Let’s start with the first article.

As Ms. Connelly writes, medical now represents on average, 60% of the benefit dollar paid to injured workers, according to Peter Burton, senior division executive for state relations at NCCI (National Council on Compensation Insurance).

Burton said that, “if you went back 25 years ago, it would have been about 40%,” and he went on to say that, “medical is the largest component in most states of the benefit given to injured workers. If you looked at the amount of legislative pricing requested of NCCI during last year, the majority of the requests were medical-related.”

In my White Paper, I cited that “medical costs in 2008 were 58% of all total claims.”

One explanation Ms. Connelly gives is rising and shifting medical costs.  According to Donna Urben, vice president and workers’ compensation product manager at Erie Insurance, “the rise in medical costs, we’ve all seen it on typical health plans and we’ve also seen it on workers’ comp.” She goes further to say that, “what helps with the control of the increase in medical costs are those states that actually are able to direct medical care.”

Some state workers’ comp laws state that injured workers must go to panel physician established by the employer for a timeframe that is mandated by state guidelines, according to Ms. Urben.

If the injured workers receives medical care that fits the injury,” says Ms. Urben, “that ultimately gets them back to pre-injury status and enables them to return to work more quickly,”…”this explains why in some states that permit direction of care, employers are able to see a reduction in the claim cost on the medical claims side, versus those states that don’t permit direction of care, employers see a greater volatility in the medical costs from a workers’ compensation claim.

Another reason given by Ms. Connelly for the rise of medical costs is the duration of treatment.

Medical costs could also transform under the ACA, says Yvonne Hobson, vice president of corporate underwriting at Amerisure, and could cause some cost-shifting in workers’ comp insurance, by authorizing the use of capitation models that designate a set amount for each enrolled plan member, regardless of whether they take medical during that time.

This is not the first time we have seen this issue of cost-shifting and the ACA come up, as I and others have written about it last year.

Hobson explains that, “there are some injuries, such as soft tissue injures or back or knee or shoulder pain, where the cause of the injury isn’t readily apparent if it happened on the job or outside of work.” There is some discretion on the part of the doctors, Ms. Hobson states, when determining if the injury is work-related or not.

On the other hand, Matt Lyon, of Foremost Insurance Group, cited some predictions that the ACA could reduce the frequency of “Monday morning claims”, where someone gets hurt on the weekend, they don’t have health insurance, and come into work on Monday and file a workers’ comp claim, Ms. Connelly writes.

Mr. Lyon noted that some preliminary studies suggest a slight correlation between the ACA and a decline in fraudulent comp claims.

Ms. Hobson concurs, and stated that, “the challenge with cost-shifting is that the research and the data on it is new, so only time is going to be able to tell us how it’s going to ultimately be impacting workers’ compensation costs.

The final trend, Ms. Connelly mentions is the misuse and abuse of opioids and medical marijuana. I have discussed the opioid abuse issue before, so I will not go into that here, and the other trend is medical marijuana, as well as recreational use.

States such as Alaska, Colorado, Oregon and Washington have allowed recreational use, and 23 states and Washington, D.C. have legalized medical marijuana.

In her second article, Ms. Connelly identifies three regulatory issues. These issues are:

  1. Opt-out laws. Currently, as I have written about, opt-out is only in Texas and Oklahoma, but it was reported recently that the legislation in Tennessee has not passed this year, and maybe voted on again next year. Other states proposed for this legislation are Arkansas, North and South Carolina and West Virginia. The group behind the writing of this legislation is called “A-rock” (ARAWC).
  2. Reform efforts. Peter Burton, cited by Ms. Connelly in the last article, said that insurance agents need to be wary of the “attack on the exclusive remedy”. I have also written about this; yet, my research for this article has found that the ALEC (American Legislative Exchange Council), a right-wing, non-profit organization partly funded by the Castor and Pollux of right-wing, libertarianism, the Koch Brothers has drawn up a bill defending exclusive remedy, which I find puzzling, because I would have thought that they would want to let workers try to sue their employers, which is what happened before the enactment of workers’ comp laws.
  3. Independent contractor classification. The Department of Labor’s Administrator’s interpretation sought to classify most independent contractors as employees.

What does this mean?

For workers’ comp, it means that there are challenges ahead that the industry needs to be aware of, but it also means that business as usual will no longer suffice, nor will doing the same things over and over again, and expecting different results.

As we have seen in Ms. Connelly’s first article, medical costs are rising for workers’ comp claims. She does not mention whether or not this includes expensive surgeries, or is just confined to the immediate treatment of the injury and the subsequent process of returning the injured worker to their pre-injury state.

Some employers have seen reductions in medical costs, but overall, the medical costs keep rising, as evidenced by my White Paper that stated that in 2008, the percentage was 58%. Two percentage points in seven years.

Obviously, something or some things are not working. But as long as the industry ignores alternatives, as long as some people suggest that judges won’t order surgery out of the country (do doctors order executions, I wonder?), as long as these same individuals believe that no injured workers (especially Latino workers) will want to or will accept going abroad for surgery, and as long as the “old men” of the industry cling to xenophobia, racism and American Exceptionalism, holding back the workers’ compensation industry from joining the globalization of health care, comp included, then nothing will change, and costs will continue to rise.

Lastly, it is state laws themselves that need to be changed, modified or outright discarded so that employers across the country can realize huge cost savings in their medical claim costs, when their employees need surgery.

To say this will never happen is like saying Man will never fly, go to the Moon, or any of a thousand other “impossible” things we humans have accomplished. Are you saying that going to the Moon or flying is easier than going to another country to get surgery? Or are you just being xenophobic, racist, and delusional that American health care is the best?

You decide, but while you do, the meter is running on medical costs, and the other issues, such as opt-out, reform and job classification are making workers’ comp challenging now and for the future. But it does not have to be that way.

Ten Facts About Medical Travel

Maria Maldonado has put together a list of ten facts about medical travel that people in the workers’ comp world should know about.

While it is true that there have been serious medical issues abroad, the same medical errors can and do occur right here at home. One particular one that stuck in my mind some years ago was a patient at a hospital in Tampa who had the wrong body part removed.

Also, there may be some who question whether the JCI’s accreditation is sufficient enough to justify patients going abroad, but absent any other reputable institutions, the JCI will have to suffice as a starting point or floor to which any such future institutions will have to better.

Here is the link to Maria’s post:

https://www.linkedin.com/pulse/10-things-you-should-know-medical-tourism-maria-maldonado?trk=hb_ntf_MEGAPHONE_ARTICLE_POST

OSHA To Weigh In On Interim Guidelines for Zika this Spring

Continuing the discussion from my previous posts on the Zika virus, “Will Zika Impact Medical Travel to Latin America?” and “Insurers’ Have Zika on Radar“, Gloria Gonzalez, of Business Insurance.com, has written today that OSHA (Occupational Safety and Health Administration) is aiming to publish interim guidelines on protecting workers from occupation exposure to the virus this spring.

OSHA is the US government’s health and safety watchdog responsible for overseeing workplace accidents and safety.

As I mentioned previously in “Insurers’ Have Zika on Radar”, US insurance companies are monitoring the virus and are educating their members, but have not determined what it will cost the payer community.

OSHA’s involvement signals that the Zika virus is not only a concern in general health care, but for workers’ compensation as well.

In a report this evening on CBS News, there was no evidence that mosquitoes in the US are carrying the virus, but health officials expect that in the Southern US, there will be a spreading of the virus to the domestic mosquito population.

So like the CDC, OSHA is taking the spread of the virus seriously. David Michaels, the assistant secretary of Labor for occupational safety and health, was reported in Gonzalez’ article as saying the following at a meeting of the Federal Advisory Council on Occupational Safety and Health today in Washington:

Coming soon to a federal office near you is the Zika virus, and we’re quite concerned about it.”

Mr. Michaels also added that “there’s growing concern across the federal government. We’ve heard from a bunch of agencies about the Zika virus. We’re developing interim guidelines for protecting workers for you all to see, both for your workers who go overseas [workers’ comp and medical travel is a stupid and ridiculous idea, and a non-starter, eh, Mr. Wilson?] , but also we’re seeing the first cases in the United States, and we have to be prepared for that as well.”

Mr. Michaels also said that agency officials are reviewing a preliminary draft and soliciting feedback from other federal agencies, but that they hope to publish the guidance this spring.

He mentioned that similar guidance was published last year in response to the Ebola outbreak, with requirements and recommendations for protecting workers whose work activities are conducted in environments known or reasonably suspected to be contaminated with the virus.

In an alert published by Ben Huggett of the law firm, Littler, Mendelson P.C., back in late January, under the OSHA Act, employees may refuse to work only where there is an objectively “reasonable belief that there is imminent death or serious injury”.

An employee refusing to work without an objective belief may result in disciplinary action, but Huggett advised employers to take extreme care to avoid such adverse actions due to a refusal to work caused by concerns about Zika.

What does this mean for workers’comp?

It represents another exposure for loss should a worker contract he virus and pass it on to a pregnant woman, who then delivers a microcephaly baby. Or, the infected individual could pass it on to a sexual partner, or to a mosquito, if they are bitten, further spreading the disease.

But it also give us an opportunity to explore the feasibility of implementing medical travel into workers’ comp, because most assuredly, they would most likely be treated where they were infected, and not back in the US. Having a worker treated in a local hospital, say in Brazil, that also caters to medical travel, would prove that medical care in Latin America is not dangerous or primitive.

Such views of the world of medicine outside our shores are no longer valid, and given the ability of diseases to spread rapidly around the world, such views are outdated, no longer apply in a globalized world. It is essential that governments at all levels, and the business community as well, remove all barriers and obstacles to providing the best medical care available, no matter where that happens to be.

To do otherwise is foolish.

 

Low-Income Uninsured Declines Due to ACA Expansion: Kentucky

Richard’s Note: This is my 250th post, although not all of them were written by me, and some of them are just infograms; nevertheless, this is an important milestone. It shows that with dogged determination, in the face of heavy odds and criticism, one can persevere and be insightful at the same time. My only wish is that more people would read this blog, and that it would be taken more seriously. One does not need a title to be taken seriously. Just ask Donald Trump.

As reported today in Health Affairs, Kentucky, which was one of two Southern states to expand Medicaid in 2013, saw a sharp decline in the percentage of uninsured from 35 percent at the end of 2013 to 11 percent in late 2014.

This decline was part of a study that was completed before the new Kentucky governor, Matt Bevins, a Tea Party lackey, announced that he would discontinue the expansion.

The study used data from the Behavioral Risk Factor Surveillance System, an annual survey conducted by the Centers for Disease Control and Prevention. Residents of Missouri, Tennessee, and Virginia, three neighboring states not expanding Medicaid eligibility, served as study controls.

Some of the other study findings revealed declines in the number of people with unmet medical needs and lacking a regular source of health care.

But now that the new governor has discontinued the expansion, it is quite probable that rates of uninsurance will once again climb, as those who gained insurance under the ACA, will more than likely have it taken away from them.

What this means for the health care system in Kentucky, and in the other states that expanded Medicaid, should their states elect more Matt Bevins, is that people who one did not have insurance, will find themselves back in the same position before the ACA.

As I wrote back in May of last year, in my article, “Failure to Expand Medicaid Could Lead to Cost-Shift to Work Comp“, states such as Florida (my state), Texas (naturally), Virginia (legislature said no, governor wants it), Wisconsin (Scott (I hate unions) Walker, and others, are likely to see such cost-shifting.

Adding Kentucky to that mix will only make matters worse. Why the health care industry in general, and the workers’ comp industry in particular, does not explore ALL possible options to providing health care to low-income and injured workers, is beyond me.

But to leave out one particular option because some judge won’t order it (do doctors order executions?), or because some people think that medical care outside the three mile limit of the US is sub-standard, or because they like the status quo and are fooling themselves into believing that some new program or scheme will fix the problem?

And to tell your industry that those “ideas” are new trends without even trying that one particular option, cannot be called “outfront ideas”. It is just more of the same.

Readers of this blog know what that option is…it is part of the reason this blog exists, and why it will continue to exist. We must open our health care options to every conceivable possibility, no matter how far fetched or “out there” it is. It is a law of economics if you can find a product or service at lower cost, and at equal or better quality somewhere else, you will buy it. That seems to work for everything else, but health care.

 

 

 

Insurers’ Have Zika on Radar

As a follow-up to my last post on the Zika virus and what the medical travel industry should be doing about it, I want to direct you to what Shelby Livingston wrote last week in Business Insurance.

She said that American health care insurers are closely monitoring the virus, educating their members, but have not yet figured out what it will cost payers.

A spokesperson for Aetna said, “We are in contact with the Centers for Disease Control, U.S. federal agencies, state and local health departments, health care providers and others so that we can provide timely, relevant and accurate information from the CDC to our members and customers. Additionally, we have distributed health information from the CDC to our disease management and case management teams to help support our members.

The statement also said, that it is premature to predict health care costs associated with the Zika virus.

Anthem posted a message on Twitter, Livingston reported, cautioning travelers to the Caribbean to heed the CDC’s warnings; UnitedHealth Group has published updates on its website, but did not respond to her requests for comment on how they are responding to the virus, or whether they are projecting costs associated with the virus.

As I noted in my post last week, this virus may have a chilling effect on your business and the health of your patients. It is advisable to monitor what the US insurers say and do going forward.