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News - 2018

Well Begun Is Half Done

Jun
21

 

“Well begun is half done.”

~ Mary Poppins

 

I must confess, I never thought we would be quoting Mary Poppins in our workers’ comp newsletter. However, it seems the California State Insurance Fund has adopted this nanny’s sage advice in their successful efforts to reduce opioid abuse.

 

I am linking to an Insurance Journal article by Don Jergler regarding California’s efforts to reduce opioid scripts. They are “well begun” as follows:

  • Early limits on initial prescriptions;
  • Early peer-to-peer education/intervention;
  • Early consideration of alternative treatments.

 

The results? A 60% reduction over the last four years. Maybe “well begun” can be more than half done.

 

In workers’ comp, early is the emphasis if you want to do better and improve outcomes.

 

We have been early to these seemingly intractable issues for years.

 

Well begun does better.

 

Call us. We can do better.

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

Greed Is Not Good

Jun
13

Greed is not good. Sorry, Gordon Gekko.

 

If you happen to be home watching TV in the middle of a week day, you will be inundated with phone numbers to call for help with your medical claim, car wreck, and of course the dreaded workers’ comp injury. These catchy 1-800 numbers are not law firms or physicians. Rather, they are high pressure boiler rooms that will direct you to a very accommodating medical/legal professional. It’s at this juncture that the referral/finder fees start to churn.

 

I’m linking to a press release from the Riverside County, California District Attorney about a typical scheme that resulted in unnecessary, ineffective and expensive treatments. In a nutshell, the con job went like this:

 

  • Injured workers contacted a benevolent-sounding scheduling company;
  • The schedulers referred claimants to their preferred physicians;
  • The physicians had quotas to fill for medical equipment, imaging and other procedures, and these quotas could only be met from referring to entities owned by the schedulers;
  • Miss your quotas and the referrals would dry up;
  • Make your quotas and the kickbacks would flow.

 

There is nothing new in this flim flam. We have seen it for decades.

 

We know what works to fix this.

 

It starts with controlling your provider network.

 

It ends with comprehensive, evidence-based Utilization Review and treatment guidelines.

 

Fundamentals > The Con.

Call us. We can do better.

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

See No Evil, Hear No Evil

May
30

Unless you are a government news aficionado, you may have missed the latest article by Jennifer Haberkorn and Brianna Ehley in Politico, headlined “Opioid distributors blame pharmacies, docs for crisis.”

 

The major opioid distributors recently testified before the House Energy and Commerce Oversight and Investigations Panel regarding this crisis. At least four of the five executives generally denied their responsibility for this painkiller abuse. Their excuses included:

  • Blaming prior management;
  • Poor technology;
  • Lack of expertise to override clinical decisions;
  • The dog ate my homework.

 

The blame-shifting fell on deaf ears, as the panel’s chairman told the stories of a West Virginia town with 400 people who received 9 million opioid pills over two years, and how the pharmacy in a town of 1,800 people got 17 million opioid pills in a decade.

 

Hey Big Pharma, just call me, we have the expertise to confront inappropriate clinical decisions.

 

I’m linking to an article in The Business Journals that highlights the proactive steps Walmart pharmacies are taking to address painkiller abuse.

 

The first step in wanting to do better is wanting to do better.
Call us. We can do better.

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

Transcend Dental Medication

May
09

Did you hear about the patient who refused pain meds from his dentist? He wanted to transcend dental medication.

 

Lately we have been managing more and more dental injury claims. These include coding unique procedures to fee schedules, reviewing cosmetic procedures for appropriateness and/or relatedness, and highlighting the risks of opioid prescriptions issued by dentists and oral surgeons.

 

The New York Times recently reported on a study by The Journal of the American Dental Association regarding the effectiveness of over-the-counter pain medication versus opioids. I’m pleased to report the dentists are adapting the science we have seen in other medical disciplines.

 

Simply put, when considering opioids for dental procedure pain control, “the most effective pain relief with the fewest side effects comes from a combination of 400mg of ibuprofen with 1,000mg of acetaminophen.”

 

The American Dental Association is doing better.

 

Call us. We can do better.

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

Russian Roulette or Breakfast in Bed?

Apr
24

Evidently both scenarios can be dangerous.
Betsy McCaughey, writing in The New York Post, summarizes a Columbia University research project about the dangers lurking in inpatient beds. Contrary to what hospitals claim, these beds are full of germs…and they are not being properly cleaned!

 

Patients are six times as likely to get staph or strep if a bed was previously used by a patient with a dangerous infection. The American Journal of Infection Control purports that half of hospital mattresses may have drug-resistant bacteria on them.

 

Health professor Edmond Hooker from Xavier University explains that hospitals are ignoring the risk in the rush to turn over rooms for patients coming out of the OR and ER.

 

What should you do to do better? The CDC is urging more aggressive and high tech cleaning methods to disinfect entire rooms.

 

OMCA continues to urge aggressive UR to minimize admissions to completely eliminate these exposures before they can take hold.

 

Does your UR vendor protect you and your claimants from inappropriate procedures, or do they merely rubber stamp the breakfast in bed menu?

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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