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News - 2019

Google This in 40 Years

Jan
10

In writing these newsletters, I’m always looking for current, relevant, and credible materials. More often than not, I focus on the rising cost of healthcare and our successful efforts to bend the cost curve through managed care, utilization review, provider networks, pharmacy networks, etc.

I recently found an article from the Congressional Budget Office on the issue of controlling healthcare costs. Unfortunately, it was published in 1979! The government has struggled with this for over forty years! To quote Dr. Phil, “How’s that workin’ for ya?”

The new year is bringing new challenges. In the first 2 days of 2019, over 30 drug companies filed price increases (they say don’t worry, everybody gets a discount; so why file for an increase?). Kentucky has a newly adopted workers’ comp pharmaceutical formulary to help control usage. Will you use it?

Hospital costs are continuing to rise as inpatient customers decline, outpatient customers increase, and newly purchased physician practices are not as lucrative as predicted. Fortunately, our state has also adopted treatment guidelines based on The Official Disability Guidelines (ODG). Will you use them? Will you double-down on quality utilization review to control admissions and fairly apply these guidelines?

They’re coming for you. It’s not time to go it alone. Hopefully no one reads my headline on Google in 2059.   Call us. We can do better.


William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Reefer Madness — From Down Under

Dec
18

…and I’m not talking about the Great Barrier Reef.

 

There was a recent study published in The Lancet Public Health and Pain Medicine News with the following headline:

 

“Medical Marijuana May Not Have Pain Benefits Previously Predicted”

 

This was a four-year study of over 1,500 participants recruited through community pharmacies across Australia. These individuals suffered from chronic non-cancer pain and were being treated with opioids. Approximately ¼ of them were also using cannabis for relief.

 

The study concluded as follows:

 

“Cannabis use was common in people with chronic non-cancer pain who had been prescribed opioids, but we found no evidence that cannabis use improved patient outcomes. People who used cannabis had greater pain and lower self-efficacy in managing pain, and there was no evidence that cannabis use reduced pain severity or interference or exerted an opioid-sparing effect. As cannabis use for medicinal purposes increases globally, it is important that large well designed clinical trials, which include people with complex comorbidities, are conducted to determine the efficacy of cannabis for chronic non-cancer pain.”

 

I’m also linking to a pro and con medical marijuana case vignette published in The New England Journal of Medicine. While not a clinical study, it presents interesting anecdotal approaches to whether to prescribe or discourage medical marijuana.

 

Here’s my conclusions:

 

  • Medical marijuana is coming to your jurisdiction;
  • More widespread and well-designed clinical studies are critical;
  • Anecdotal stories are important, but following the science will help you do better.

 

Call us. We can do better.

 

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Pill Popping Protocols

Dec
11

 

We are learning that the fight to contain opioids is multifaceted. There are many tentacles and cutting one off doesn’t mean the others have gone away. One major tentacle that persists in the opioid crisis is, believe it or not, your local health care provider and your hospital.

Emma Passé, writing in the October 3, 2018 issue of USA Today, recounts her battle against her doctors and the hospital staff when she refused to allow them to treat her pre and post-surgical pain with opioids. Leading up to her surgery she repeatedly told them “no opioids” and every time they fought her, assuring her that the new generation of opioids was safe.

Emma correctly identified pain as being something she could live with when the alternative was to suffer the side effects of various drugs. She was fully aware she might be uncomfortable for a little while – but preferred that over an opioid. At every turn the medical staff attempted to persuade her otherwise, even making arrangements to send her home with 40 codeine tablets. This, when she wanted none.

Hospitals are dangerous places for a number of reasons. Surgeries are dangerous and are the site of many injuries. Opioids are deadly. Know that the hospital and the medical staff can be relentless in encouraging the use of opioids.

Good utilization review can be invaluable in keeping claimants out of the hospital.

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Shocked to Their Senses

Dec
04

I’m linking to an Associated Press article by Mitch Weiss and Holbrook Mohr that recently ran in The Courier-Journal. The story highlights the safety, expense and efficacy of spinal cord stimulators.

 

We have a long and successful history of evaluating and approving these medical devices on an extremely limited basis. As you read the article, you will get the CliffsNotes version regarding these invasive procedures.

 

They are expensive. They are dangerous. They have little supporting evidence.

 

Believe it or not, many years ago we encountered payors who approved spinal cord stimulators as they thought they were just TENS units.

 

These medical requests should always be subject to aggressive Utilization Review by highly credentialed clinicians.

 

Don’t have your bank account overstimulated.

 

 

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

That’s One Small Step For Kentucky…

Oct
30

 

Actually, it’s a pretty big step.

 

The most recent session of the General Assembly gave a very big task to Department of Workers’ Claims Commissioner Robert Swisher. Legislators instructed the Commissioner to develop treatment guidelines and a drug formulary before the end of the year. Many of us thought that to be nearly impossible, but we wished him well.

 

To our surprise and delight, the DWC has now adopted both treatment guidelines and a drug formulary!  This is truly big news.

 

In the weeks and months ahead, you are going to be hearing and learning a lot about both of these  In this note, I want to hit on the big picture.

 

Some folks ask why this is needed. Don’t physicians treat similar injuries in a similar fashion? And the answer would be NO. Many are unfamiliar with treating based upon principles of evidenced-based medicine. Treatment guidelines, as developed by ODG (Official Disability Guidelines) and adopted by the state, make the latest evidence-based medicine available to anyone who would be treating a workers’ compensation claimant. This standardizes treatment throughout the state, minimizes cost fluctuations, and most importantly, gives injured workers the best possible care.

 

As we have learned over the last several years, the best care produces the best outcomes and results in lower medical costs.

 

I’ve run out of space.  More will follow on the drug formulary. But congratulations to the Commissioner, his staff, and the volunteers who gave of their time and experience to make this possible.

 

Call us. We can do better.

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

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