Reed Group‘s current attack on WCRI is unwarranted, misguided, and out of line. Several Reed employees have publicly chastised WCRI for a variety of sins ranging from poor quality research to a lack of concern about worker outcomes.
Reed’s frustration with WCRI first came to my attention in a post by Reed’s Carlos Luna a couple months back; Carlos said “I find it curious how WCRI, perhaps due to industry demand, focuses on one product (WLDI’s ODG).”
It’s not curious, Carlos. Much of WCRI’s research is driven by regulators looking for an independent, credible, analysis of potential changes. They ask, WCRI delivers.
More recently, a Reed researcher said that methodological concerns with one of WCRI’s studies (on opioids and disability duration) call into question ALL of WCRI’s research. In this morning’s WorkCompCentral Elaine Goodman quoted Reed Group’s Fraser Gaspar:
“Based on the substantial limitations and errors in their [WCRI’s] most recent opioid research paper…it is clear that their current review process is insufficient…[WCRI’s] information that does not meet basic research standards”
I strongly disagree.
Gaspar is claiming that WCRI should use blinded reviewers; that is, reviewers should not know that the research is coming from WCRI as that might bias their perspective. Couple of points here:
- WCRI uses outside experts to review all of its published research; I’ve helped a couple of times and I know many others who have as well.
- I know of NO other credible research entity involved in work comp that uses blinded reviewers. Does that mean the research by CWCI or NCCI is not credible or doesn’t meet “basic research standards?” Of course not.
- I have strongly disagreed with WCRI in the past, and they not only listened to what I had to say, they asked me to participate in a webinar to discuss my views.
Goodman reported Reed SVP Joe Guerriero “is also concerned that WCRI’s research focuses primarily on workers’ comp costs, with little attention paid to injured worker outcomes or the possibility of cost-shifting to other payers.” [her words, not his]
Quoting Guerriero:
“looking at reduced drug costs to determine the efficacy of any program is far too narrow…” [emphasis added]
Guerriero is mis-directing here; worker outcomes and cost-shifting weren’t within the scope of the study WCRI was asked to do.
Not to mention WCRI has done quite a bit of research on cost-shifting and case-shifting. Moreover, it is not possible for WCRI – or anyone else for that matter – to figure out if patients no longer getting drugs via work comp were obtaining drugs via another payer.
And, WCRI has published dozens of research reports on worker outcomes.
While I understand Reed’s frustration that most regulators are focusing on ODG, the fact is for years ODG’s publisher has been a much more effective marketer than Reed. In addition, the binary nature of the ODG formulary is simple to understand and relatively easy to implement.
FWIW, I’ve long viewed ACOEM’s (affiliated with Reed) approach to guideline development and it’s formulary as more rigorous and more patient-centric than ODG’s. I still do. I’ve been a fan of ACOEM’s clinical guidelines for years. Their methodology, diligence, and professional dedication to the right care has always impressed. Yes, it’s more work, but it’s better for patients.
But that’s beside the point.
WCRI has always been open to collaboration and conversation. I would encourage Reed to work with WCRI and not cast aspersions about WCRI’s research.
[note – I’ve long been impressed with Elaine Goodman’s reporting and pursuit of the details necessary to provide a complete picture. Kudos to Elaine for an even-handed piece]
ed note – NO REPUBLICATION OR EXCERPTING OF THIS POST IS ALLOWED WITHOUT EXPRESS WRITTEN PERMISSION FROM JOE PADUDA.
copyright 2018, Joe Paduda, all rights reserved.
There is no group I am aware of, regardless of business, that is more open to scrutiny and willing to listen and invite opposing perspectives, than WCRI. You make great points, Joe, and that is one of the reasons they are as respected as they are throughout the WC world – labor, attorneys, medical professionals, insurers, business, regulators, public policymakers and jurists. My apologies to anyone I left out. It appears, regrettably, Reed Group seems to blame WCRI for the greater popularity of ODG than their products. Wrong approach, Reed Group.
Hi Joe. What you don’t know is that we reached out to WCRI to discuss our concerns and we received a response essentially saying our concerns don’t need to be addressed due to the fact that the research in question was not published in a journal. In fact it was distributed more broadly than distribution provided by any journal. We believe any research regarding the efficacy of a drug formulary – ACOEM’s, ODG’s, whoever – should include long-term and short-term health outcomes information. Not doing so creates 2 types of challenges, neither very good. 1. Stakeholders make decisions based on cost only (not exactly a patient-centric approach from a quality of care perspective) 2. Folks write-off the value of EBM and EBM-based drug formularies as benefitting only insurers and businesses. Case in point, check out Gov. Wolf’s veto last week of the formulary bill in PA. He cites the reasons loud and clear in the last sentence of para 2. For your other commenter, this has nothing to do with ODG. This has to do with being responsible – fiscally and medically – to all. Always appreciate your support Joe P. of the quality of the work we do. Just thought I should clarify. And yes, as a result of WCC’s article, John Ruser has finally engaged Dr. Gaspar in what I hope becomes a more fruitful discussion.
Joe – thanks for the note. Allow me to respond to your points in order.
1. I actually DID know you reached out to WCRI.
2. My understanding of the dialogue about the opioid study is different than your’s.
3. The breadth of distribution of a paper is irrelevant to the standards for review. Moreover there WERE outside reviewers involved, as I noted and others have as well.
4. The opioid paper was about disability duration (arguably an outcome) and opioid usage, not about the efficacy of a formulary…the formulary Flash Report was done at the behest of LA WC regulators, and therefore comported with their request.
5. Your view on what should be included in research is entirely up to you.. That doesn’t mean your view should prevail.
6. As for Gov. Wolf’s veto, I would suggest that his written rationale for the veto is merely political cover. He vetoed the bill because his largest funding sources opposed it.
7. I spoke with Dr Ruser; in fact he had engaged with Dr Gaspar BEFORE the WCC article was published. That’s what WCRI does whenever this happens, just as Dr Victor engaged with me when I challenged him on case-shifting.
Net is Reed didn’t and isn’t handle(ing) this well.
It certainly looks like this has everything to do with ODG; your comment focuses on formularies and not the opioid paper. So, this gets back to the LA WC study that was done at the behest of LA WC regulators. Reed didn’t like the study. In my view, Reed went way too far when Gaspar inferred that WCRI’s research is of low quality (“substantial limitations and errors”), suffers from a poor review process, and doesn’t meet basic research standards.
Impugning others who are widely respected by intelligent and knowledgeable people for good reasons is rarely a good idea.
Mr. Paduda- Please post a link to my comments on Dr. Savych’s research with this blog. You have my full permission. I would like your readers to read for themselves my comments so they can decide if my comments are “out of line.”
Thank you for your time,
Fraser
All – Dr Gaspar’s comments are here. http://s3-us-west-2.amazonaws.com/wcc-public-news-storage-4081/WCRI%20Opioids%20Research_Dr.%20Fraser%20Gaspar_Comments.pdf
I still disagree with the central premise of his argument, namely:
“it is not surprising that opioids would be associated with longer disability
durations, because the specific type of low back condition would drive both opioid use and length of
disability duration.”
I’ve also discussed this with WCRI, and am comfortable with the methodology they used in the opioid study – and the LA and AL studies as well.
I would suggest there are a raft of assumptions in that statement that are not consistent with evidence about how opioids are prescribed. Opioids are used to “treat” all kinds of conditions – that’s precisely why we need evidence-based guidelines. If prescribers reserved opioids for specific diagnoses and conditions we would not have an opioid crisis.
Many things drive disability duration – drug treatment is one factor but by no means the most important one. Other research indicates medical treatment is much less significant than psychosocial characteristics, while employment satisfaction, wage level, previous injury indicators, and other factors are also important contributors.
What is troubling about this entire situation is the context; it stems from Guerriero’s broad and unfounded criticism of WCRI’s WC formulary study(ies), and Reed’s evident dissatisfaction with the opioid study and WCRI. Statements by Reed personnel in the WorkCompCentral piece then attempt to discredit ALL WCRI research.
While Gaspar’s document does make some good points, it is in my view, flawed and the conclusions derived are inappropriate.
Too bad there isn’t anyone who wants the opinion of the injured worker. Their opinion matters!
Crimes – WCRI surveys injured workers as part of their ongoing research. Other entities do as well.