Vennela Thumula PharmD and Randy Lea, MD doves into the presence and influence of psychosocial factors on recivery.

Dr Thumula led off by noting psychosocial barriers are the number one obstacle to recovery.

A variety of factors are barriers including:

• Poor recovery expectations, fear of pain
• Catastrophizing
• Perceived injustice
• Family system support issues, pre-ex psych factors
• Job dissatisfaction

Multiple guidelines recommend early identification of psychosocial risk factors. WCRI looked into prevalence of psychosocial factors in LPB patients seeking PT. do they recover differently

These factors were common, strongly associated with functional recoveries after PT care, and WC patient had more psycho risk factors and these facts were more strongly associated with functional outcomes.

Dr Thumula laid out the various screening tools used in the research and described the variation between WC and other payer types

Key takeaways:

• WC patients had high levels of fear avoidance and negative coping, both of which might impede return to work.
• Workers with higher levels of psychosocial risk factors (PF) had smaller functional improvements than those with lower levels.
• And, workers with elevated psychosocial risk factors were less likely to make meaningful improvements in function
• And, they had a much higher likelihood of “very limited” function at discharge from PT.

Dr Randy Lea summarized the findings and provided attendees with what they can tell colleagues upon return from the Conference.

• First, WCRI’s study is the most robust that focused on WC.
• Prevalence of PF was high – 1/3 to ½ were high risk.
• High risk factors result in 40% less improvement than workers without those factors.

So, stop, take a step back, and understand these are frequent, do occur, and are impactful.

Then, you may want to:

• refer the patient to a mental health professional, and/or
• make sure the treating clinician knows about the PF factors, and/or
• use the research to predict those who are most likely to benefit from care.

I connected with CWCI President Alex Swedlow  – and good friend and colleague – to find out what’s been going on in the Golden State and what the annual confab will feature.

Here’s the registration info.

note highlights are mine.

MCM – Please briefly describe the workers’ compensation industry in California…frequency, disability duration, cost drivers, outcomes, market share of major payers.

Alex – California has the biggest WC system in the county, bar none.  Whether it’s premium, frequency, medical care delivery volume, expenses.  We’re a high litigation state with significant friction costs. 

That said, our state has accomplished some remarkable changes and improvements through legislative reforms, regulations, and payer’s delivery systems that have significantly improved the efficiency and effectiveness of benefit delivery to CA injured work force.

MCM – I hear there are concerns about access to care in California for workers’ comp patients. What does the research say?

Alex – Access to care is a national crisis that is just now reaching full awareness.  We are all waiting longer for access to specialists whether you are hurt on the job or during a weekend softball game.

The concerns about access within WC has been a research topic for CWCI for 25 years.  Our most recent studies show that during the acute care phase (90 days) and the first year of treatment following the injury, the CA WC system delivers most services within a few days of the injury with little change in the mix or volume of professional services over the past 5 years.    Expensive, yes. But a remarkable and stable result.

Let’s remember that workers’ compensation represents less than 2 percent of the CA healthcare economy.

Also, the National Institutes of Health project CA will be short 35k physicians and 45k nurses by 2030 with almost 1 out of 3 physicians retiring within 5 years.  So right out of the gates, our system has very little leverage for addressing this problem.  This makes our current medical delivery systems all the more remarkable.

MCM – Thinking about the various sessions, which one will have the most long-term impact on workers compensation and why?  I noted a panel will explore the impact of exogenous influences on workers comp…can you give our readers a couple of examples and their impact?

Alex – The theme of our 60^th Annual Meeting is “An Altered State”.  We will explore how our system has expanded well beyond the original “Grand Bargain” and into its current form and function.  We will also focus on key bread-and-butter issues including fresh research on claim development, medical service delivery and dispute resolution, the controversial medical legal fee schedule, COVID, and that great, unique to CA imponderable, Cumulative Trauma claims. These are all issues that originate within our system.

CWCI just published a study on this (free to all here); here’s a top takeaway:

In 2022, CT claims represented more than one out of three litigated claims. And, as Alex notes, CT is a “condition” unique to California. 

I smell something…and it isn’t a rose.

(back to Alex)

We will also explore exogenous influences, trends and issues that originate outside of our system that nonetheless have a significant influence on CA WC. We will preview the results of one of the first studies to use our state’s CURES system (California’s prescription drug management program) which captures all control substance prescriptions issued to all Californians across all payer groups.  The results show state-wide changes in opioid use over a 5-year trend.  The study also provides a look into simultaneous prescribing patterns across payer groups.

Other sessions will address our state’s economy, political climate, the looming $70B budget deficit, workforce migration, access to care, and some key interstate comparisons that show how much CA WC has changed over time.

Joining our staff, we have two great guest speakers from the Public Policy Institute of CA, Sarah Bohn and Eric McGhee, who will present new data on specific external forces that impact the vitality of our WC system.  In addition, our long-time colleague, Ramona Tanabe, President of WCRI will discuss interstate comparisons to show how CA WC has evolved relative to other states.

What does this mean for you?

If you want to know, you’ve got to go.

 

 

 

Heat exposure has killed 40 workers per year since 2011.

Heat – and other exogenous factors related to human-caused climate change will likely be the fastest-growing driver of occupational injuries.

Fortunately others are stepping into the gaps caused by a failure of leadership by the Federal Department of Labor and outright stupid behavior by some state politicians. (note dozens of elected Representatives have authored a bill that would require and enforce heat protection standards for workers…of course, the House can’t even pass a ^%$%&#* budget, so this ish’t going anywhere.)

California has been a leader and is on the verge of implementing standards to protect indoor workers from heat exposure; Minnesota and Oregon also have indoor heat standards. Colorado, Oregon, and Washington also have rules for outdoor workers.

Meanwhile, OSHA has been dithering for years, failing to establish enforceable standards while more workers die.

The American Society of Safety Professionals just published standards for protecting construction workers from heat….these standards have no teeth, but would very likely have prevented this death.

Meanwhile politicians in Florida and Texas are doing their best to kill more workers. That is NOT hyperbole…Florida passed legislation protecting student athletes from heat, but has actively promoted legislation that would prohibit local governments from requiring employers to offer the same protection to workers.

And then there’s Texas…

Good news – WCRI’s annual meeting will include insights into climate-related drivers of occupational injuries.

What does this mean for you?

Higher workers’ comp rates, more injuries, and more dead workers in Texas and Florida – and elsewhere.

Ramona Tanabe, CEO of WCRI – a most excellent workers’ comp research organization – was kind enough to carve out a few minutes on the eve of this year’s gathering of the brainiacs to answer a few of your reporter’s questions.

MCM – Great to see a discussion of provider consolidation on the agenda – what was the trigger for this?

Ten years ago we looked at where care is being delivered across states…Massachusetts was particularly notable for how much care was delivered by hospital-based care providers. More recently this has been increasing in some states as facilities acquired practices. Stakeholders brought this up so WCRI decided to watch this and see how providers changed when they joined a larger group. [WCRI looked at provider billing before and after they were acquired by/joined a health system or hospital or large provider group]

• MCM – What was one of the surprising findings from the research on consolidation?

We had a hypothesis that assumed we would find duration of disability would decrease due to coordination of care – and lo and behold numbers were the opposite – duration increased. We will get into the causes at the conference next week.

• MCM – Thinking about the various sessions, which one will have the most long-term impact on workers compensation and why?

Two – excessive heat – this impact is external to comp system and is not going away…it is a different world.

And the changing medical workforce is going to have a long term effect – access to care specifically doctors RNs LPNs is changing . Prof Cutler will talk about changes to the healthcare workforce and what’s been happening about that – who is providing the type of care – how many providers, who owns them and hospitals it is all changing – it is not like it was 30 years ago and the effects of that will continue to impact workers’ comp.

• MCM – There’s been what can only be described as a misunderstanding around medical costs in workers’ comp – in your mind what accounts for this? What WCRI research can help stakeholders grasp what’s really happening with medical costs?

Yes to the second question; there will be a session on medical costs and effect on inflation. At the last conference some said there is a delay in how inflation in the economy affects workers’ comp and that was why we had yet to see medical inflation…Have prices changed over time? that is how economists think about inflation…there’s also been a shift in services – where it is being delivered or changes in the types of services that also factor into pricing…location of service, intensity, utilization all affect costs

• MCM – Drug costs have been declining for some years now – any indications this trend has ended or changed?

[Drug costs] have declined over time – [this varies] by categories of drugs, there have been decreases in some and increases in others – society helped with that change with publicity around drug issues…issuing report on this later this  year.

What does this mean for you?

Pay attention to WCRI. Their research will help you plan for the future.

 

Here’s stuff to brighten your day…

Our cities and rural areas are getting safer.

Overall crime rates have dropped – a lot...

unless you own a Kia or Hyundai.

 

Murder rates are dropping as well

Net – safer cities and towns.

Inflation???

Business owners’ consensus view is inflation will remain near 2 percent...this from the Atlanta Fed.

Healthier people!

2 Medicaid items of note

North Carolina is expanding Medicaid – terrific news for poorer folks in the Tar Heel State. Great news for the 346,000 residents who now can actually get healthcare.

In some states, Medicaid is expanding coverage to include housing and nutrition, a major step towards improving the health of Medicaid recipients.  What I love about this is research indicates housing and food stability enable people to a) get healthier, b) focus on school and work (hard to study or work when you are hungry and living on the streets).

Kudos to the Trump Administration for jump-starting CMS’ investment in social determinants.

CMS’ move is just the latest that recognizes the critical importance of stable housing and reliable nutrition. From WaPo:

social determinants of health — essentially, the conditions in which people live — have an enormous bearing on well-being. Medical care, studies have shown, accounts for only 20 percent of the difference in patients’ health, while social risk factors are responsible for half to 80 percent.

And it’s not just Medicaid…

Last year, the National Committee for Quality Assurance, which evaluates health plans and medical practitioners, updated a data tool used by 90 percent of health plans, requiring them to report whether they have assessed patients for shortages of housing, transportation and food.

See you in Boston March 5 – 6 for WCRI…it’s sold out BUT there is a waiting list… click on the link to sign up.