Tag Archives: Injury Management

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.

 

 

Understanding Medical Tourism’s Role in Early Intervention in Workers’ Compensation

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Early intervention strategies in workers’ compensation cases are key to improving workers’ compensation results, as my LinkedIn connection, Paul Binsfield writes today in his article, Early Intervention Strategies in Workers’ Compensation in PropertyCasualty360.com. Paul is CEO of Company Nurse, a firm specializing in injury management for workers’ compensation.

In his article, he writes that In a tough economy, employers require effective and innovative ways to improve workers’ compensation results. Many program managers are updating their approach and leveraging early intervention such as prompt reporting, nurse triage, proactive claims management, and integrated return-to-work (RTW) coordination to improve performance. These strategies are designed to manage work-related injuries right from the start and bring about best possible outcomes.

He lays out five key areas employers need to focus on to insure better outcomes for their injured workers. These areas do not necessarily relate to how those wishing to implement medical tourism into workers’ compensation would be involved, but it gives one the background of what the employer has already done before the medical tourism option is considered.

The five key areas are:

  • Improving the Reporting Process
  • Quality Medical Care
  • Pre-Injury Foundation for Success
  • Post-Injury Program Improvements
  • Injury Triage as Backbone to Future Success

If medical tourism is to be successful in being implemented into workers’ compensation, a knowledge, understanding and appreciation of the process laid out by Paul and others in the workers’ compensation arena, is essential for those wishing to seek out employers and insurance carriers as partners in this venture. In much the same way that salespersons know, understand and appreciate the manufacturing process of the products they sell, so too should medical tourism facilitators and the personnel at medical tourism destinations.

By doing so, the entire process from first report of injury to initial treatment and final medical tourism care, if that occurs, would be a seamless flow from beginning to end with all interested parties working together to get the patient the best care possible and back to work as soon as medically possible. In this way, medical tourism could be seen as the end stage of the entire workers’ compensation process and the cost savings realized could be used to incentivize the employee to chose the medical tourism option, and in turn, be re-directed back to making improvements in the five key areas above.