Tag Archives: OSHA

Medical malpractice at Pilgrim’s Pride…the poultry company?

It sounds like malpractice to me. That’s what I’ve been thinking ever since learning how the injuries sustained by poultry workers are treated (and not treated) at the company nursing stations.

Source: Medical malpractice at Pilgrim’s Pride…the poultry company?

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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.

 

Workers’ Comp at a Crossroads: Where Does it Go from Here?

Two roads diverged in a wood, and I— 
I took the one less traveled by, 
And that has made all the difference.

Robert Frost

Robert Frost’s poem, “The Road Less Traveled” is symbolic of where the workers’ comp industry stands today as it enters its second hundred years, as I intend to point out in this article, and especially in light of recent reports that indicate that the system is failing, and failing miserably to adapt to changes in the workforce, in technology, and to deal with an ever globalizing world.

You might say that workers’ comp is a Mac in an ever increasing Wintel world. In other words, workers’ comp has a closed architecture, whereas general health care has an open architecture, and like all modern electronic devices with an open architecture, it can change its parts and add new features with not that much difficulty.

But workers’ comp cannot, or will not open itself to other parts, and that is why it is failing.

To begin with, I wrote an article last week entitled, “Hospital Outpatient Costs Still Rising Says New Study”, in which I mentioned a study by the Workers’ Compensation Research Institute (WCRI). This report was one of the topics discussed this morning at their annual conference in Boston. The WCRI report stated that hospital outpatient costs are still rising, and that:

  • States with percent-of-charge-based fee regulations or no fee schedules had the highest payments to hospitals for outpatient surgical episodes for knee and shoulder surgeries. In particular, states with no hospital outpatient fee schedules had 60 to 141 percent higher hospital outpatient payments per episode compared with the typical state with fixed-amount fee schedules.
  • There was tremendous variation in the rates of change in hospital payments per surgical episode across states. From 2006 to 2013, South Carolina saw a reduction of 31 percent in this metric while in Alabama the average hospital payment per surgical episode grew by 81 percent. States with percent-of-charge-based fee regulations or no fee schedules had more rapid growth in hospital outpatient payments per episode than states with other regulatory approaches. In particular, most percent-of-charge-based fee regulation states that did not have updates to the reimbursable percentage of charges experienced growth in hospital payments per surgical episode that was 157–286 percent faster than the median of states with fixed-amount fee schedules.
  • States with cost-to-charge ratio fee regulations had similar levels and growth rates in hospital outpatient payments per episode to states with fixed-amount fee schedules. Hospital outpatient payments per episode in states with cost-to-charge ratio regulations grew 10–25 percent from 2006 to 2013.

The second half of that article discussed a report written by Peter Roumaniere, “Seismic Shifts: An Essential Guide for Practitioners and CEO’s in Workers’ Comp“. Peter’s report examined how technology and demographics will impact workers’ comp from the present day through 2022. One of the factors Peter identified was the shift from a manufacturing to service economy. By the 1960’s, the service sector began to eclipse manufacturing, and employment in services climbed from 55% to 85% of total employment.

He illustrated how jobs as a share of the national employment in three occupation groups from 1950 to 2005 declined. These occupations are: hand craft production; transport, construction, mining and farming; and machine operators and assemblers. He also said that manufacturing employment was much safer, and as an example, stated that in 1994, for every ten work injuries in manufacturing requiring one day’s lost time, there were eight such injuries in the service sector. In 2012, for every two manufacturing lost-time injuries, there were ten service sector injuries

Peter provides four most likely reason for the decline in injuries and claims in workers’ comp:

  1. Workers may be reporting and claiming less out of intimidation or unhappiness with the benefit package which has shrunk in past decades.
  2. Employment sector shifts
  3. Employers are devoting more attention to work safety
  4. Employers are pushing down lost-time claims by stay-at-work arrangements, or expediting return-to work.

The report goes on to discuss how the workers’ comp industry is shrinking and the opportunities for growth that practitioners need to be aware of, but that are out of the scope of this discussion.

Next, a post earlier this week by David De Paolo prompted me to write another article, this one entitled, “STOP THE MADNESS”, in which I decried the disgusting way that employers, their insurance companies and third party administrators are treating injured workers, in this case, a man named Glenn Johnson, who along with his wife, was arrested for allegedly filing a fraudulent workers’ comp claim, but the charges were dropped and the case never went to trial.

Mr. Johnson is not the only aggrieved injured worker in this country. There are many thousands of men and women who are treated inhumanely and unfairly by employers, insurers, and the rest of the workers’ comp system.

As a follow-up to his first post, David wrote a second post the next day in which he suggested, and rightly so, that if employers could be allowed to opt-out of the workers’ comp system, so should employees such as Glenn Johnson and his wife, so they can get the satisfaction of justice they deserve. I heartily agree, and said so in my post, ”Let Our (Working) People Go”.

Then came another report, this time by the Association of American Medical Colleges, in an article by Healthcare Finance News.com, that said that by 2025, there would be a shortage of doctors around 90,000, of which 12,500 to 31,000 would be primary care physicians, and between 28,000 to 63,700 would be non-primary care physicians.

But the really devastating reports, at least as far as workers’ comp is concerned, that came out this week and on the same day, was one report by ProPublica called “The Demolition of Workers’ Compensation” and another by the Occupational Health and Safety Administration (OSHA) called “Adding Inequality to Injury: THE COSTS OF FAILING TO PROTECT WORKERS ON THE JOB”.

Both David and Joe Paduda commented about these reports in their respective blogs today. David’s article is called “Cost of Being Society” and in it he said that both reports came to the same conclusion: workers’ comp… fails in its basic state mission too often, and consequently is pushing the cost of taking care of injured workers onto government benefit systems, ergo costing the general tax paying public to take up the slack.

He cites the OSHA report as saying: “Changes in state based workers’ compensation insurance programs have made it increasingly difficult for injured workers to receive full benefits (including adequate wage replacement payments and coverage for medical expenses) to which they are entitled. Employers now provide only a small percentage (about 20%) of the overall financial cost of workplace injuries and illnesses through workers’ compensation. This cost-shift has forced injured workers, their families and taxpayers to subsidize the vast majority of lost income and medical care costs generated by these conditions.”

It is David’s opinion that these reports are evidence that not only have the times changed, but that more change is necessary, and on a grander scale. Joe’s article is called “ProPublica’s demolition of workers’ comp”, and offers a critique of the report.

David De Paolo’s posts this week, and the two reports about the demolition of workers’ comp and the cost of failing to protect workers, are not mere coincidences of publication. They are a warning sign that something terrible is happening in this country.

As I mentioned in a comment in response to the ProPublica report, we are witnessing the recrudescence of 19th century capitalism, where if a worker got hurt, he lost his job, had to rely on charity from friends, neighbors, family, the church, while the owner of the business went right on making a profit. Too many Americans have been duped by slick politicians and ideologues to believe that workers have no rights, so why should they get benefits when they get hurt through no fault of their own.

So that brings us back to Robert Frost and the poem, “The Road Less Traveled”.

For that is exactly where workers’ comp, and coincidently, my writing about workers’ comp and medical tourism are, on a road less traveled. In the case of workers’ comp, it is at a crossroads as to which road to take, and I have already decided, as Frost points out, to travel the road less traveled, because I wanted to blaze a trail where no one else had been.

Workers’ comp, on the other hand, wants to go down the same old road it have been going down now for nearly a century, and expecting that the woods would be different. So while much of the industry is bundled up in snowy, cold Boston, trudging down that same old road, I am choosing another path, and that has made all the difference, because my mind is open to new possibilities, while theirs is closed, xenophobic, and rife with American Exceptionalism.

I am sure they are learning a lot about the state of workers comp while they are talking among themselves and fiddling while Rome burns, but if they were smart, they would admit that the road more traveled on is fraught with serious problems that only gets more and more serious each and every day.

All is not lost, however. There is still time for them to see a better way, to choose the road less traveled on, and one way to do that is to open the system’s architecture and let in new ideas and new possibilities, especially with medical travel.

In the nearly two and a half years that I have been writing this blog, and in the four years since I first wrote my paper on implementing medical tourism into workers’ comp, I have met dozens of men and women, highly educated and highly intelligent from all over the world, Europe, Africa, Asia, the Caribbean, Central America, South America and other parts of North America, and none of those outside of Europe or the Americas are witch doctors with bones in their noses. These people are ready, willing and able to provide high quality health care to anyone who needs it, and at a reasonable cost. They want our business, and are not concerned about whether it comes from general health care or workers’ comp.

And yet, the very idea of globalizing workers’ compensation is dismissed, is ridiculed, and shunted to the sideline. Well, I am not about to be shunted to the sideline or dismissed, or told to stop writing, as one Okie said earlier this week. I am going to keep on writing and advocating for change, not because I want to, but because I have to. The stakes for all workers, injured or not, is too great. Globalization is a two-way street. Jobs can go abroad, and so should the workers, injured or not.

It’s up to you…take the road less traveled on, or take the road that isn’t less traveled. And that makes all the difference.

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I am willing to work with any broker, carrier, or employer who is looking to save money, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with and follow me on LinkedIn and my blog. Share this article, or leave a comment below.

No April Fool’s Joke ― ACA to Federalize Work Comp

At first, when I read Joe Paduda’s post this morning on my smartphone, I thought it had to be some kind of April Fool’s joke.

But when I clicked on the links Joe provided in his article, I found out he wasn’t joking. His brilliant article, Obamacare exchanges to be used for work comp enrollment, caught me and a few commenters by surprise.

It caught me by surprise because back in the summer of 2011, I took an online elective course on the PPACA as part of my MHA degree program. The term paper I wrote, PPACA: The End of Workers’ Compensation?, mentioned that:

“In 1972, the National Commission on State Workmen’s Compensation Laws issued a report that took the position that it would be unwise and unnecessary for any national health insurance program to assume medical costs of workers’ compensation. The Commission stated that to fold workers’ compensation medical costs into a national health insurance program would be inconsistent with the central tenet of workers’ compensation and that the costs of work-related injuries and diseases should be allocated to the responsible source.”

I went on to write in my paper that in the 1990’s, the Clinton Administration favored the merging of the medical component of workers’ compensation into a federal health care system as part of their health reform proposals. The Administration backed off of this proposal after strong opposition from business owners who said it would not produce any real savings, would have pre-empted state “choice of provider” laws and empower employees to select providers from any federally approved health plan.

Yet, I found that any talk of federalizing workers’ compensation was speculative, since one bill introduced into the House of Representatives was stalled in committee, and when the PPACA was being drafted, the issue of workers’ compensation was not a minor focus of the legislation, and as I quoted:

“there is no language in the law that would directly and explicitly affect workers’ compensation. From the beginning of bill-drafting in both the House and Senate, it was clear that workers’ compensation was not an area that should get mixed into the reform process”.

Well, from reading Joe’s article this morning, it would seem that the Obama Administration has picked where the Clinton Administration left off, and even went further because they ignored the report of the National Commission on State Workmen’s Compensation Laws, and went ahead with a plan to federalize part of the workers’ compensation system.

According to Joe, the reason why the small employer mandate has been delayed is because the “Feds are incorporating a national “single payer” work comp program” that is not ready to be introduced.

This program is called POWER (Protecting Our Workers and Ensuring Reemployment). It is to be administered by the Office of Workers’ Compensation Programs.

Without going into any great detail about the program, here are the key takeaways from Joe’s article:

  • POWER was not part of the original healthcare reform bill; it was initiate as part of a Presidential directive (boy, this is really going to get the Tea Party angry) shortly after PPACA was passed and signed into law. ( July 19, 2010)
  • Detailed in the POWER initiative, the program will measure employers; performance across eight metrics, with those employers failing to demonstrate improvement targeted for additional Federal oversight (another thing that will launch the Tea Party into orbit)
  • Implementation date is June 1st; small employers (26-99 employees) will be required to sign up as their current workers’ comp policies expire
  • Employers WILL be allowed to “opt out”
  • POWER will utilize OSHA reporting system to cross-index claims reporting
  • Employers will avoid reporting claims to reduce the risk of the dreaded “additional Federal oversight.”
  • The federal fee schedule will likely be used for medical treatment, and
  • OSHA will have to revamp their reporting process

It is Joe’s opinion that now that the health exchange “glitches” are mostly fixed, the workers’ comp program will move very quickly, and it will be much less complicated, as there will be a single payer, a single payment system, and universal benefits and coverage specifications.

What does this mean for medical tourism and workers’ compensation?

My guess is that depends on how you view a federal role in workers’ compensation in the first place. Some may like that idea and some may hate it. It could be a boon for medical tourism because now there will be federal coverage for workers’ compensation for employers with less than 100 employees, and as many people have already commented on social media and in medical tourism forums, the ACA may bring more patients to medical tourism destinations.

But it could also be a hindrance because we don’t know how flexible federal workers’ comp rules and regulations are regarding the location of treating physicians, the licensing of physicians, liability and malpractice laws, and whether federal law recognizes the right of choice of physician to the employee or his employer.

In addition, the federal fee schedule for medical procedures may or may not be lower than the fee schedules in states that have fee schedules, or lower in those states that do not have fee schedules. If the federal fee schedule is lower, the question then becomes, can medical tourism physicians and facilities quote lower costs than even the federal fee schedule? (airfare and accommodations included in the cost of going abroad).

Finally, medical tourism facilitators, providers and facilities will have to adhere to OSHA rules under the POWER program. Will facilitators and providers and facilities be able to comply with and understand OSHA rules? That and the other points I mentioned is what will ultimately determine if this program will be a boon for medical tourism. I really don’t know. Only time will tell. It’s up to the medical tourism industry to decide if it is worth going after.

Happy April Fool’s Day everyone! It really was a joke on Joe’s part! 🙂