News from Workers’ Compensation 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 >why ARE prescription drugs like teenagers…or vampires for that matter?
Feb
10
“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 >Good Gatekeeper–”Walking the Point”
Jan
31
A good Gatekeeper is a key component of effective workers’ comp networks. At OMCA we admire their dedication and appreciate that they are “walking point” as the first line of defense in managing medical costs. We look for the following qualities when we recruit for our select network:
- A true desire to practice Occupational Medicine;A fundamental belief that the “patient comes first”. However, getting back to work and reducing prescriptions are almost always in the interest of the patients’ well-being,
- Setting office protocols that triage the initial urgent comp visit ahead of allergy shots/back to school physicals. This allows some initial care to be seen out of the costly ER but with the same quality of care.
- Timely communication with our RN case managers including a willingness to discuss referral options/alternatives.
- Acknowledgment that certain diagnoses/treatments are not always appropriate for their practice (i.e. long term narcotic use/chronic mental health issues)
- A willingness to understand the employers operation. Many of our physicians will visit the workplace and help us get creative as to alternative/modified duty opportunities.
- Be a good listener and read “between the lines” when patient history is inconsistent confusing or contradictory.
- An aggressive RTW mentality as in a “sport’s medicine model” tailored for the comp industry.
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 >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
Secrets of an overworkered comp adjuster
Jan
18
- We rely totally on the PBM. If the treating doctor submits a script–we will pay it.
- The newest adjuster may get assigned the “ugly files”, no one else wants.
- My case load is up 25% over the last few years as home office thinks that is a smart way to reduce cost.
- I’m expected to keep up with ever changing medical issues with little support/training.
- Sometimes we skip the UR/PreCert Function to save money as some vendors are just rubber stamp approvals.
- It’s really hard to communicate what has transpired in my old, ugly, post award cases. The file is full of duplicates records and unintelligible medical reports.
We find that comp adjusters are the unsung heros in the system. They do the best they can to control costs and improve outcomes.
READ ENTIRE ARTICLE >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 [...]
-
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 [...]
