News from Medical Cost Containment 2012
A Billion Here, A Billion There
Feb
17
What costs more than ALL cancers, ALL diabetes and ALL strokes? The answer is occupational injuries and illnesses. According to a study authored by J. Paul Leigh, a researcher for University of California Davis, $250 Billion per year is spent on workplace injuries/illnesses. His study published in Milbank Quarterly: A Multidisciplinary Journal of Population Health and Healthy Policy reviewed more than 40 data sets that track both direct and indirect costs (e.g. lost productivity) associated with injury/illness in the workplace.
Cancers, $31Billion;
Diabetes,$ 76Billion;
Strokes, $187 Billion;
Occupational $ One quarter trillion.
Every day for 25 years, OMCA has worked to reduce the costs of occupational injuries/illnesses. In over 100,000 cases, we’ve had many successes, gained much knowledge, accumulated significant professional resources and would be pleased to help you with your program, your caseload or your catastrophic claims.
Call us. We can do better
READ ENTIRE ARTICLE >“How We Do Harm”
Feb
07
Perhaps the most important book written in the continual struggle to control medical costs in America is entitled “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America”. It was written by Otis Webb Brawley, MD who, among other things, is Chief Medical and Scientific Officer for the American Cancer Society.
In addition to being an oncologist, Dr. Brawley is also an epidemiologists (he studies large groups of stuff like sick patients). His analyses, observations and conclusions are important to everyone who has a stake in medical costs, whether it be the insurance carrier, self-funded employer or individual patient. His punchline, which I will continue to expound on in future blogs, is
Proponents of science as a foundation for health care have not come together to form a grassroots movement, and until this happens, all of us will have to live with a system based on pseudoscience, greed, myths, lies, fraud, and looking the other way. (emphasis added)
The foundation of all we do at OMCA is based upon the premise that evidence-based medical care is the best and most cost-effective medical care. BUY THIS BOOK. Then call us. We can do better.
William V. Faris, JD
READ ENTIRE ARTICLE >To Err is Human…and Deadly!
Feb
02
A few years ago a seminal report was published by the Institute of Medicine. It concluded that medical errors caused 100,000 patient deaths per year. 90% of those deaths were due to procedural failures at medical institutions.
We all know that being an in-patient in a hospital can be dangerous. Competent, thorough utilization review will decrease the number of patients who are admitted, lowering the risk to your group health members and workers’ compensation claimants. In turn, your programs spend less money.
OMCA is accredited by URAC for both Health AND Workers’ Compensation Utilization Management. We use nationally recognized standards and undergo rigorous auditing to insure the quality of our review process.
Call us. We can do better.
The Myth of “It will all work out”.
Feb
01
ACT 1 – Managing medical costs often comes under fire from a variety of groups. Libertarians say we should all be responsible for our own decisions, some ( a lot) physicians resent any intrusion of case management, utilization review and the like and even a few insurance carriers say “it’s our money – we’ll spend it anyway we like”.
ACT 2 – The Florida Agency for Health Care Administration reports for 2006-2010 a 288% increase in babies who are born addicted to prescription painkillers.
ACT 3 – So how’s that personal responsibility, leave us alone, it’s my money thing working for you?
ACT 4 – At OMCA, responsible, aggressive utilization management is our passion. Call us. We can do better.
READ ENTIRE ARTICLE >Is Care More No More?
Jan
27
The Care More Pain Clinic…ahh, yes…where to begin? Recently Dr. Richard Albert, a physician at the Care More Pain Clinic in Paintsville, Kentucky pleaded guilty to the federal charge of conspiring to illegally prescribe some 50,000 Percocet. Albert was estimated to have prescribed more than 100,000 pills per month. Problem solved? Not so fast.
On January 25, 2012, a task force of local, state and federal law enforcement descended on the Care More Clinic once again. They executed a federal search warrant and expect to present their findings to a federal grand jury shortly. In the process of conducting the raid, they arrested 29 people outside the clinic on a variety of charges. The mayor called it “a good day for the city…we’ve been looking forward to this day…” for almost 5 years.
Is Care More really no more? For 25 years, OMCA has reviewed, managed, contested and progressed in the constant battle against illegal use of prescription drugs.
Call us. We can do better.
Bill
READ ENTIRE ARTICLE >Healthcare’s One Percenters
Jan
25
Healthcare’s One Percenters
Much is being made in this political season of the 1 percenters – presumably those amongst us who make the most money- and who somehow have become tainted with this dubious vice. Healthcare seems to have its 1 percenters as well.
The federal Agency for Healthcare Research and Quality reports that in 2009 just 1% of Americans accounted for 22% of all healthcare costs. This amounts to about $90,000 per person. Imagine (or acknowledge) that you have one or two of the 1 percenters among your insured population. How quickly can this ruin your balance sheet?
OMCA is a group of specialists who effectively manage the 1 percenters. Our URAC accredited utilization management , experienced nurse case managers and broad range of Board Certified Physician Advisors have allowed us to manage over 50,000 cases in the last 20 years. Whether your costs come from hospitals, physicians, pharmacies or any other healthcare facility, we have extensive experience and resources in managing these cases to their optimal outcome.
Call us. We can do better.
Bill
READ ENTIRE ARTICLE >
Nobody uses like Kentucky uses
Jan
23
- Medical costs, as a percent of claims cost are soaring — 68% in Kentucky.
- Utilization is a bigger cost driver than price.
- Big utilization spike due to new therapies, pain management and co-morbidity.
- 7 million people abuse prescription drugs — an 80% increase in 6 years
- Misuse of painkillers represent 75% of the prob/em.
- Most frequently prescribed, hydrocodone, is also most commonly diverted and abused.
- Second most popular, Actiq, is approved only for terminal cancer patients and three
- years ago wasn’t on the list.
- 33% of chronic pain patients are currently taking more medication(s) than prescribed.
- 90% of the time, doctors are unable to detect a patient misusing medications.
William V. Faris, JD
Prescription Drug Abuse & Physician behavior
Jan
20
Dr. C. Kenneth Peters in Louisville has provided primary care to thousands of patients throughout 40 years of practice. Vast numbers of these patients presented work-related injuries. Dr. Peters relates that no one leaves the doctors office satisfied unless they have a prescription. Even if there is nothing that pharmaceuticals can do (e.g. a virus) or if over—the-counter remedies are almost as effective. Everybody wants a prescription!
USA TODAY, the Kaiser Foundation and Harvard School of Public Health studied the impact of drug advertising on physician behavior and they agree with Dr. Peters. They found that nearly one third of patients ask about a particular drug and 82% of the time, the physician recommended a prescription. Although not studied, it’s likely the numbers in work comp cases are even more dramatic. No one suffers from prescription drug abuse worse than Kentucky. We consume horrendous quantities of opioids and its not getting better. Claimants take narcotics for ridiculous periods of time and combine them with a variety of other medications. Often the worker who “won” his case is found 10 years out to be totally drug dependent, both physically and mentally disabled. Some winner.
We can do better. Long – term narcotics use is deadly to the person taking it and financially ruinous to whomever has to pay for it. lf you are dealing with cases of prescription drug abuse, call us. Our CIaimsCLEAR® review physicians are nationally-recognized experts in pharmaceuticals. Something can be done.
READ ENTIRE ARTICLE >
Utilization Review–A Nuisance or Cost Saver?
Jan
17
- In many situations will convince providers early on to voluntarily withdraw a request. Communicating/suggesting revised treatment protocols saves money on denials/appeals and improves outcomes,
- “Follows” (with voluntary participation) a patient after the approved procedure has been implemented. Any chance to improve communication, reduce misunderstandings and increase compliance with medical directions improves outcomes,
- Doesn’t hide from the co-morbidity issues (obesity, diabetes, smoking, hypertension, addictions) that diminish outcomes. Focusing just on a single requested procedures can miss the big picture a workers’ comp or group benefits carrier needs to address in order to improve outcomes.
Just When You Thought It Was Safe to……
Jan
12
It’s just what we need. A more powerful delivery system for hydrocodone. The drug that is the most diverted (sold on the street, used to support addictions, etc.) in the United States is about to become bigger and bolder. At least if the drug companies have their way.
Several companies are proposing a “straight” dose of hydrocodone that will increase the average daily dosage from 60 milligrams to 100 milligrams. This will be accomplished by stripping away non-narcotic medications like acetaminophen that are currently mixed with the time-released hydrocodone. (Hydrocodone is most familiar as Vicodin).
One of the companies testing the new formulation says it will be safer because acetaminophen is “known to cause significant liver toxicity when taken in large doses over time.” So the solution is to reduce the Tylenol and ramp up the opioid by 66%. That way new consumers can become addicts before their livers give out! Why didn’t we think of this sooner?
Watergate’s Deep Throat was right. Follow the money.
READ ENTIRE ARTICLE >
OMCA News
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02/17/12 | A Billion Here, A Billion There
What costs more than ALL cancers, ALL diabetes and ALL strokes? The answer is occupational injuries and illnesses. According to a study authored by J. [...]
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02/10/12 | why ARE prescription drugs like teenagers…or vampires for that matter?
Parents of teens know that teens are on the third shift. Just as the adults are ready for bed, the teens are just getting fired [...]
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02/07/12 | “How We Do Harm”
Perhaps the most important book written in the continual struggle to control medical costs in America is entitled “How We Do Harm: A Doctor [...]
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02/02/12 | To Err is Human…and Deadly!
A few years ago a seminal report was published by the Institute of Medicine. It concluded that medical errors caused 100,000 patient deaths per [...]
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02/01/12 | The Myth of “It will all work out”.
ACT 1 – Managing medical costs often comes under fire from a variety of groups. Libertarians say we should all be responsible for our own [...]
