Monthly Archives: March 2016

Opt-Out A Boon to Employers, Not So Injured Workers

Employers opting out of workers’ comp in Texas are reducing costs, but more study is needed on how non-subscription affects injured workers, according to Stephanie Goldberg of Business Insurance.

Ms. Goldberg reports that a study released last week by Alison D. Morantz of Stanford Law School, found that the overall cost per claim is about 49% lower in the non-subscription environment, which is largely due to declines in medical and wage replacement costs.

The study also found, she writes, that despite no significant decline in frequency of claims, that more serious claims involving replacement of lost wages are about 33% less common among non-subscribing employers.

For the study, Ms. Goldberg adds, Ms. Morantz recruited 15 large multistate companies that operate homogenous facilities nationwide, and compared outcomes in traditional workers’ comp versus opt-out for each company from 1998 to 2010.

The study found also that the frequency of nontraumatic injuries declined about 47% with opt-out coverage.

It could be that nonsubscribers are better at screening out nontraumatic claims under one of the many exclusions that private plans typically contain,” said Ms. Morantz.

Meanwhile, Ms. Goldberg wrote, a nontraumatic injury that is covered may be denied if it is not reported by the end of the employee’s shift, or within 24 hours.

Thirteen of the fifteen employers in the study have “good cause” provisions that allow a claims administrator to determine if there was a good reason the claim was made late.

Finally, Ms. Morantz said that, “the biggest unanswered question is how these plans affect the welfare of workers.

As I reported yesterday in two posts, “Texas State House Seeks to Change Rules for Workers’ Comp” and “Workers’ Comp Opt-Out Goes Under US Microscope“, there are a lot of unanswered questions surrounding the effect opt-out will have on the injured worker.

Those who support opt-out expansion really don’t care about injured workers; they care about saving money for employers (i.e., profits that go back to the investors or to the top executives). They are also diametrically opposed to giving workers any benefits, and would prefer that workers’ comp had never existed, along with unemployment insurance and health insurance.

Those who see through the smoke and mirrors of opt-out know what the world was like before workers’ comp laws, and they don’t want to go back to those days, and whether or not they really are concerned with the welfare of workers, or just say they do, I am afraid that they may not be able to stop this move on the part of opt-out proponents.

But federal oversight would be welcomed to prevent going back to the bad old days before Triangle, which happened 105 years ago tomorrow. Marty McFly went back to the future, these guys in opt-out want to go back to the past.

 

 

Workers’ Comp Opt-Out Goes Under US Microscope

Laws that allow employers in Texas and Oklahoma to opt out of the states’ workers comp systems could be subject to federal oversight, according to an article today in Business Insurance.com,  amid concerns about their effect on injured workers’ access to benefits and care and potential discrimination against employees who report workplace injuries and illnesses.

The article by Gloria Gonzalez, stated that last October, several Congressmen  wrote to the U.S. Department of Labor asking for a report on how it would re-institute oversight of state workers comp systems.

The department annually tracked states’ compliance with recommended federal standards from 1972 to 2004, following an investigation by ProPublica Inc. and National Public Radio into state workers comp programs, the article reported. (Both ProPublica and NPR reports were previously cited by myself and others in earlier posts)

Ms. Gonzalez wrote that the letter also asked whether the department needed additional authority to protect injured workers’ rights and prevent cost shifting to taxpayers via programs such as Social Security.

Chris Mandel, senior vice president of strategic solutions at Sedgwick Claims Management Services Inc. in Nashville, was quoted as asking, “Is that a prelude to federalization?”

His question came Tuesday at the Business Insurance Rick Management Summit, and his reply to his own question was, “Who knows?  But let’s just say they’re not happy with what they see.”

What does this mean to you?

It means Uncle Sam is watching, and he does not like what he sees going on with the expansion of opt-out legislation. Some of us already don’t like it and have not drunk the kool-aid just yet.

Let’s hope for the sake of injured workers that the feds do take a look under the microscope at the promises of opt-out and they find bacteria that can bring down the entire system, leaving injured workers where their great-grandfathers were before workers’ comp existed…out in the cold and out of luck if they got hurt.

Texas State House Seeks to Change Rules for Workers’ Comp

As reported this morning by Elena Mejia in the Houston Chronicle, members of a Texas State House committee are calling for major reforms to that state’s workers’ compensation program that would change coverage rules that now leave thousands of workers uninsured.

Yesterday, the House Committee on Business and Industry questioned state Insurance Department officials at length about employers who are now failing to provide coverage and continuing complaints about the state’s designated-doctor program.

Texas was the first and only state to allow employers to opt-out of the statutory workers’ comp system until Oklahoma passed legislation, that has since been ruled unconstitutional by the Oklahoma Workers’ Compensation Commission.

Testimony given before the committee indicated that participation by physicians in the Designated Doctor Program, in which state-approved doctors examine injured workers to decide claims in disputed cases, has dropped precipitously.

According to Stephen Norwood of the Texas Orthopedic Association, participation is down 67 percent, mostly because the state does not reimburse physicians enough for expenses to travel to remote locations.

Mr. Norwood stated that, “All this time away and expense often unexpectedly to remote locations doesn’t make it feasible for physicians to participate,”… “If you allowed proper specialists to evaluate several workers during same travel, you increase access of workers to more appropriate exams and more efficiency to physicians.”

This testimony caught my eye, as generally, I don’t write specifically about one state, but take an overall, big picture view of the issues surrounding workers’ comp and discuss how medical travel can be implemented to relieve those issues.

This would be a perfect scenario for such implementation, so that injured workers in remote parts of Texas can get their treatment in Mexico that may be less expensive to travel to, rather than to have physicians to take the time and expense to travel to those remote locations.

But I suspect that that solution will elude the Texas legislators like so many other issues have eluded them, such as allowing women the right to have abortions, or the right of all workers to be covered under a mandatory state workers’ comp system that is fair to both injured workers and their employers.

But that would be asking too much of them. Sort of like asking the village idiot from Texas to not think about going to war in two countries at the same time.

 

Trouble Ahead for Workers’ Comp

The Denver Business Journal today published an article by Steve Doss, VP of Commercial Lines at CCIG.

Here are the key takeaways from Conning, a Connecticut-based investment management company for the insurance industry:

  • Accident frequency has increased. A stronger U.S. economy has meant more inexperienced workers have joined the workforce, so high-hazard occupations like transportation and construction have seen increases in work-related injuries since 2012. For example, non-fatal work-related construction injuries jumped 9.5 percent from 2012 to 2013. Also, as older employees work longer, the number of accidents among those 65 and older rose 18.5 percent from 2012 to 2013.
  • Accident severity is rising. The Bureau of Labor Statistics reports that construction fatalities rose 5.6 percent from 2013 to 2015, and manufacturing fatalities rose 9.3 percent from 2013 to 2014. In addition, hospital and drug costs – the biggest expenses associated with workers’ compensation claims – are rising faster than inflation.
  • Evidence of cost-shifting. The Affordable Care Act may be driving physicians and hospitals to “leak” group health cases into the workers’ compensation system, where they can charge more for the same services than under a group health contract, according to Conning.

For those of you not familiar with workers’ compensation, and those of you who are, what each of the bullet points mean, in simple terms is this:

  • More accidents,
  • Degree of accident injury increasing and,
  • Cost-shifting is occurring.

Isn’t time to stop and realize that whatever programs are implemented, whatever analytical or predictive modeling techniques are utilized, whatever the so-called “experts” say is the cause of this or that problem, whatever so-called “reform” or work comp alternative is attempted, wouldn’t it be prudent to think outside the box, and outside the borders of your limited minds?

Schopenhauer said the following:

“Every man takes the limits of his field of vision for the limits of the world”

Those of you who will not listen to other ideas, no matter how far-fetched they may be, have limited your field of vision and taken them as the limit of the world. The world is globalizing, health care included.

Aerospace technology will very soon allow us to travel to any part of the world in under four hours. Don’t believe me? Ask Boeing why they are running commercials that tout that very same possibility.

Those who cite judges as saying no to medical travel must ask yourselves this question: Do doctors sentence people to death? (By that I mean execution, not natural death from disease or incompetence)

Those who say the laws won’t allow it, should know that laws can be changed, and laws written in the era of the horse and buggy should not dictate to the post-modern, jet-age, and soon-to-be sub-orbital space plane age. Would you like to live under the laws of Caesar or Charlemagne?

And finally, those who say the injured workers won’t go abroad to get better medical care, have you ever asked them, or are you just putting your words in their mouths?

Methinks you all doth protest a bit too much for the sake of injured workers and myself. Look in the mirror and ask yourselves why workers’ comp is failing. The answer is staring right back at you.

New York Docs Refuse to Accept Injured Workers

In a video report on New York TV station WNBC-TV, an injured worker was referred to a list of ophthalmologists in Brooklyn by the New York Workers’ Compensation Board (WCB), and all doctors on the list refused to accept workers’ compensation, even though the state’s online database said they did.

The reporter, Chris Glorioso, contacted every doctor on the list and was told the same thing that the injured worker, George Akturk, was told, and even one doctor told Glorioso that they used to accept workers’ comp twenty years ago.

According to the report, the results showed that the state’s list of authorized practitioners was severely outdated.

Although each doctor was listed as a workers’ comp participant, Glorioso discovered,  two-thirds of the offices reported they do not participate in the program.

He also found that thirteen doctors’ offices reported they do accept workers’ comp, but most of them do not perform the kind of retinal surgery prescribed for Akturk.

 Dr Michael Lax, director of the SUNY Upstate Occupational Health Clinic, said the real reason doctors are dropping out of the system is that insurance companies and state regulators increasingly control medical decisions.

In 2010, New York adopted medical treatment guidelines that restrict the medical discretion of specialists.

This is another example of how so-called workers’ comp ‘reforms’ are directed not towards improving the lives of the injured workers, but to save money for the carriers, and that regulators are more interested in restricting medical care than treating the injured worker and getting them back to work faster.

Here is the link to the report and accompanying video:

http://www.nbcnewyork.com/investigations/NY-Refers-Injured-Workers-to-Docs-that-Dont-Accept-Workers-Comp-372153352.html

Five Reasons I Believe in Medical Travel for Workers’ Comp

Throughout the past three years, I have written much about why I believe medical travel should be implemented into workers’ comp, and have often used various issues in both health care and workers’ comp to drive home my message.

Yet, lost in all of the text and the sentiment behind it, is the real reasons I believe in medical travel for workers’ comp. This article will explore these reasons.

First, it has been shown by myself and others, that surgical costs for common workers’ comp injuries are less expensive in many medical travel facilities in Latin America than what is the average cost for those same surgeries in the US. And we also know, that the domestic costs can vary wildly even within the same city, let alone the same state, or in a neighboring state.

Second, medical care in these medical travel facilities are equal to, or better than the care received domestically, and many of the physicians were trained in the US or in Europe, so the medical care is up to Western standards, and may even exceed them in certain treatments and with regard to certain disease modalities. Employers would thus get back employees who are ready, willing and able to work after recuperating in pleasant surroundings.

Third, medical travel for workers’ comp will allow the middle and working class to gain a better understanding and appreciation of foreign cultures and people, especially in this political campaign cycle where one leading candidate is disparaging our southern neighbors and those from the Middle East, as well as many others. While my idea for medical travel is limited to the Western Hemisphere, nonetheless, having such a better understanding and appreciation for our Latin neighbors will lead to less demonizing of people from Latin American countries.

Fourth, it will allow workers to see the world that belongs to all of us, not just to the rich and wealthy. Allowing medical travel in workers’ comp will make it easier for better people to people contact, which will improve the views foreigners have of Americans, and vice versa, and will lead to the fifth reason:

Fifth, taking a step towards world peace, because as new technology makes air travel faster from the US to other regions, the more people will be able to travel abroad and see those parts that are too far away and too expensive for the average working person. This will bring the world closer together than any social media applications can ever do. And that is a good thing.

As I have said before, it will not be easy, and will take a lot of work, especially to change outdated laws, regulations, rules and statutes written nearly a hundred years ago, but if enough people work at it, it is possible that such change can and will happen. We just need the will to make it so.

Health care delivery varies a LOT – and there’s your opportunity

So, medicine is a science right? If it is, then the delivery of care should be consistent across the country for patients with identical conditions, right. Absolutely not. That’s the quick takeaway from a terrific panel this morning at WCRI; … Continue reading →

Source: Health care delivery varies a LOT – and there’s your opportunity

Joe Paduda, blogging from the Workers’ Compensation Research Institute’s (WCRI) annual conference in Boston, has shined a light on where medical travel providers can prove that their lower cost, high quality medical care can produce better outcomes for both patients (injured workers) and their employers.

If what Joe says about a huge variation in medical care delivery across geography – why medical care for identical conditions for the same type of patient varies greatly from place to place is pervasive, fascinating, and, more to the point, driver of low quality and high cost care is true, then it would provide an opportunity for international medical providers to stress in their marketing that they do not have different kinds of treatment for the same type of patient, no matter where the medical care is received.

The rest of his article should give international medical providers a better understanding of how to attract not only patients (injured workers), but their employers and insurance companies.

Proving that, for example, disc replacement provides a better outcome than spinal fusion and is lower cost in your facility outside the US, will go a long way to convince both patients and employers and payers of the efficacy of medical travel.

Knowing that there is such a wide discrepancy in delivery of care across the US for the same type of patient and is responsible for lower quality and higher cost is a strength the medical travel industry can exploit.

What do you think?