Tag Archives: Opioids

Big Insurer to Put Dispensing Docs on Notice

An article in Healthcare Finance yesterday reported that Aetna has put more than 900 opioid prescribing physicians on notice that they fall with the 1 percent of top opioid prescribers.

Here is the link to the article:

http://www.healthcarefinancenews.com/news/aetna-puts-more-900-physicians-notice-they-fall-within-top-1-percent-opioid-prescribers

What does this mean for workers’ comp?

It means that other insurers need to do the same for the physicians who prescribe opioids for injured workers, but as Joe Paduda recently reported, the drug spend is going down.

But he also said this, earlier this week,  “Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.”

This was for privately insured people, he continued.

“The dollar cost of the drug itself is the least of the cost issues; dependency is strongly associated with much higher utilization of drug testing, overdose treatment, office visits and (my assumption) higher usage of other drugs intended to address side effects of opioids.”

So just because Aetna is watching does not mean that the problem is going to go away any time soon.

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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.

 

 

Opioid Abuse in Workers’ Compensation: What the Medical Tourism Industry Needs to Know

opioid abuseopioid abuse

One workers’ compensation topic that I have avoided discussing so far, given that the tagline of my blog is about implementing medical tourism into workers’ compensation, is the issue of opioid abuse in workers’ compensation.

Many articles and blog postings have been written describing the problem and the ways in which insurance companies, third party administrators, claims management firms, pharmacy benefit management firms, brokers, claims and risk managers, state and federal government agencies, and other interested parties are trying to get a handle on this problem.

It is a very complex and complicated issue, and one that has many in the workers’ compensation industry concerned because it drives up medical costs for claims, adds to the number of claims filed not only due to an injury, but to the abuse and addiction it engenders. It also impairs workers who then get injured again due to the effects of the medication, and it lowers productivity and prolongs the time employees take to return to work.

Business Insurance issued a White Paper on the subject last year entitled, Opioid Abuse & Workers’ Comp. In the paper, the authors describe the growing use of opioids that create abuse issues, the multiple factors causing the persistent problem, the rise of employer costs as abuse widens, the mix of strategies being used to combat this problem, and how to track selected metrics that are being used to support the goals workers comp managers establish to reduce abuse.

It so happens that some of the individuals who are quoted in the paper are people I know from other blogs, such as Joe Paduda, or are one of my LinkedIn connections, or I knew when I did my summer internship at the Third Party Administrator, Broadspire’s Sunrise, Florida office as part of my MHA degree program requirements in 2011.

One of the projects that I worked on while at Broadspire dealt with the dispensing of drugs by physicians, which is another important problem in workers’ compensation, and is related to opioid abuse, since most of the drugs prescribed in workers’ comp are the Schedule drugs being abused the most in the US. What I found was that the most serious problem of prescribing drugs was in California, and was not confined to physicians alone, but to pharmacies as well. Florida was the other state that had the most drugs prescribed by pharmacies or physicians. Time did not allow me to look at the other states of the country.

While not wanting to get too deep into the subject, I believe that it is important for those in the medical tourism industry to be cognizant and aware of the problem. Those who would like to pursue implementation of medical tourism into the workers’ compensation system in the US should realize that such a problem exists, so that in the future, if a self-insured employer or commercially insured employer should send one of their injured workers abroad for medical treatment of a work-related injury, the facilitator and the staff of the hospital where treatment is provided, knows that abuse of pain medication is a rampant problem among US workers’ compensation claimants.

This is even more incumbent upon those who, as I mentioned in my last post, What Role Can Medical Tourism Play in Physical Therapy and Rehabilitation for Workers’ Compensation?, might want to get into the area of physical therapy and rehabilitation, since the goal of rehab and therapy is to get the patient back to work faster, and one of the side effects of abuse is prolonged disability.

This is a serious issue for the workers’ compensation industry at the present time, and before medical tourism can be properly implemented, it is advisable that it is taken just as seriously in the medical tourism industry as well.