With long-time CWCI President Michael Nolan slated to retire in May, the Board named Alex Swedlow to replace Nolan, passing the torch to one of the leading figures in workers’ compensation.

Alex’ research rigor, insight into nuances and intricacies of the industry, and unparalleled ability to make complex and complicated information understandable for lay people has served the workers’ comp industry very well.  From ground-breaking research on the influence of provider’s workers comp claim volume on outcomes to their latest research demonstrating the link between physician dispensing of drugs and longer disability/higher costs/poorer outcomes, Alex and his colleagues have kept CWCI at the forefront of workers’ comp research.

It’s one thing to do great research; communicating the result of that research, making it understandable/approachable/usable for non-academics is an entirely different matter.  And that’s where Alex’ ability really benefits CWCI and the entire industry.  His dry sense of humor and straightforward presentation makes him a must-have for every conference.

I’d be remiss if I didn’t acknowledge the strides made at CWCI under Mike Nolan’s leadership.  He’s led the organization during a very tumultuous period marked by hard, soft, and rapidly-transistioning markets, keeping CWCI relevant and helping shape decisions in the nation’s largest workers’ comp market.

Kudos to CWCI’s board.  Smart move indeed.

(disclosure – I’ve counted Alex among my friends for several years, enjoy his company immensely, and will be speaking at CWCI’s annual meeting later this month.)

Senior researcher Dr. Dongchun Wang’s presentation delved into the details, looking at data from 300,000+ non-surgical lost time claims, with scripts filled thru March 2011.  I emphasize non-surgical, as its entirely understandable that a patient just out of surgery would get some opioids to help them deal with post-surgical pain for a few days.

Takeaways…

• Why are so many non-surgical claims getting opioids?  With rare exceptions, opioids are NOT indicated for these types of claims. Who’s prescribing these drugs and why is this allowed?
• Building off yesterday’s discussion of variation in prescribing patterns, we’ve seen huge variations in prescribing patterns – dosage, duration, long-term vs short term usage.
• The volume of opioids received per claim varied by a factor of four among the study states – lowest in Iowa, and highest in NY (on a morphine equivalent basis)
• In four states, more than ten percent of claimants who received opioids were still getting scripts six months later – and remember, these are non-surgical cases.  While only 3% of AZ claimants were using drugs for more than six months, 17% of those in LA were…
• 24 percent of drug claimants were tested in 2009/2011; a big improvement over the 14 percent from the previous two-year period – but still abysmal. (disclosure – Millennium Labs, a drug testing firm, is a consulting client)
• As bad as that rate was, it was better than the use of psychological evaluations which should be done prior to prescribing – only 7 percent of claimants had psych evals…

Dr Karen Mack of CDC led off this morning’s discussion of opioids with a review of the opioid crisis and provided a lot of data on death rates, usage trends, and mortality trends. Pretty scary stuff.

The most compelling slide shows a strong correlation between opioid sales and overdose death trend rates  which, if not parallel, are certainly quite similar.  Encoouragingly, the rate of treatment has actually accelerated over the last few years at a rate that is much higher than opioid usage trends.

Here are a couple takeaways.

First, I was surprised that there were multiple “ooohs’ from the audience when Dr Mack presented info that I would have thought we all knew – e.g. currently there are enough opioids sold in the US to keep every one of us doped up for a month. Ok, I know I’ve been up to my eyeballs in this issue for several years, and others haven’t spent the time on this that we research nerds do.

But.  Come on folks!  This should NOT be a surprise.  The issue has been front-page news in most newspapers, featured on many news broadcasts, discussed by politicians, media, celebrities, not to mention the issue is so pervasive it’s hard to find someone who doesn’t know someone else who’s been directly harmed by opioids.

This is the single biggest issue in workers comp. Kudos to WCRi for dedicating most of day two to the issue.  

Now let’s stop talking about the problem and get moving on solutions.

Let’s start off the week with another warning on the perils of marijuana.  Specifically, if you try to feed grizzly bears while stoned, they may try to eat you.

And that would be a compensable injury.

This actually happened in Montana – thanks to Kristie Wolter for providing the details.

Here’s the scene – at a tourist bear park, a guy ostensibly there as a volunteer – but getting paid – goes into a bear pen with food and gets mauled, escaping only by crawling under the electric fence.  Goes to hospital, then files a WC claim.  Park owner says the guy’s a volunteer so no WC, guy gets lawyer, goes to court, and judge renders opinion.

Which says, in part:

“[Bear park owner] Kilpatrick’s testimony that he gave Hopkins money on multiple occasions, “out of my heart” coincidentally while Hopkins was performing “favors” for Kilpatrick at the bear park is not credible. There is a term of art used to describe the regular exchange of money for favors – it is called “employment.” [emphasis added]

Further, Kilpatrick asserted that Hopkins’ decision to get stoned was a/the major contributor to Hopkins’ injury.

Again, the judge:

“Hopkins admitted to smoking marijuana before arriving at work on the morning of the attack, I cannot conclude based on the evidence before me that the major contributing cause of the grizzly bear attack was anything other than the grizzly. It is not as if this attack occurred when Hopkins inexplicably wandered into the grizzly pen while searching for the nearest White Castle. [emphasis added] Hopkins was attacked while performing a job Kilpatrick had paid him to do – feeding grizzly bears. The fact that the grizzly attacked Hopkins while he was performing this job is not exactly a “man bites dog” event. When a grizzly bear is sighted on a trail in Glacier National Park, the trail is closed to all hikers, not just the hikers who may have recently smoked marijuana. Kilpatrick installed multiple electrified fence lines at the bear park to separate the grizzly bears from all customers, not just the customers who may have recently smoked marijuana. When it comes to attacking humans, grizzlies are equal opportunity maulers; attacking without regard to race, creed, ethnicity, or marijuana usage. Hopkins’ use of marijuana to kick off a day of working around grizzly bears was ill- advised to say the least and mind-bogglingly stupid to say the most. [emphasis added]

And there you have it.  Our workers’ comp system protects even the mind-bogglingly stupid.  

One can only hope Mr Hopkins protects his progeny from similar disasters by not having any.

Warning, this post contains adult language.

Not content with reaching into employers’ pockets and taxpayers’ bank accounts, the physician dispensing industry’s slimy tentacles are oozing into the world of what passes for journalism at the Sunshine State News, and, based on SSN’s own writing, may well be spreading their noxious slime into the Florida Medical Association as well.

Nancy Smith, ostensibly an “editor” at the Sunshine State “News” said this: “A new report from the state Division of Workers’ Compensation (DWC) points to continued interference by insurance carriers into the doctor-patient relationship.”, citing payers’ efforts to control the cost of physician dispensed repackaged drugs.  I’ve read the report – I doubt Smith has – and that is NOT WHAT THE REPORT SAYS.  It doesn’t infer that, imply that, implicitly or explicitly state that or anything close to that.  There are a number of other completely false assertions in Smith’s pathetic piece, but my head will explode if I go into them individually…

Here is the report – and I’d encourage you to send it to Smith on the off-chance she actually decides to read it and correct her gross mischaracterization.  Her email is nsmith@sunshinestatenews.com.

It appears Smith is just parroting a blatantly misleading hatchet job put out by the Florida Medical Association. If the FMA wrote it, shame on them. If it was written by a physician dispensing company and just distributed by FMA, even worse

BTW, I emailed the FMA and asked for a copy of the FMA’s statement about the DWC report.  No response.

The DWC report indicates the number of reimbursement disputes is up some 872% over the prior year, driven primarily by “increases involving physician dispensed medication.”  That’s a good thing; employers and governmental entities, fed up with paying outrageous upcharges for repackaged drugs, are disputing physician dispensers’ bills.  As it is indeed their fiduciary obligation to do, and as they were encouraged to do by the previous CFO of the State of Florida.  In reality, in many of the disputes payers are paying a nominal amount, and end up agreeing to pay what they’d normally pay a retail pharmacy. 

So that’s what the DWC report said.  And somehow this shill who masquerades as a journalist – and/or the FMA, masquerading as a patient advocate – interprets this as insurers interfering in the doctor-patient relationship.

This is absolute, complete, total, utter bullshit.  

Here’s how a colleague put it when asked if insurers are “interfering” :

“…we’re interfering all right.

We’re interfering with their clear abuse of the workers’ compensation system, of employers who foot the bills; we’re interfering with their profit-seeking brethren who hide behind a curtain of their arrogant claim to be a sole protector of their patients, when they can’t know in dispensing repackaged drugs what all other medications their patient might be taking and thereby potentially jeopardizing their patient’s health.  And, we’re interfering with their unethical practices that even their own professional organization has frowned upon.  The AMA has an ethical rule against physician dispensing for profit.   So, yes we’re interfering – and we’re imploring Florida’s policymakers to interfere, to protect the public from the cost abuse, to protect patient safety, and enforce their own medical ethics.  Since the FMA is unable to do this themselves.  That’s what I’d say.”

Here’s what the AMA says in Opinion 8.06

(2) Physicians may not accept any kind of payment or compensation from a drug company [emphasis added] or device manufacturer for prescribing its products. Furthermore, physicians should not be influenced in the prescribing of drugs, devices, or appliances by a direct or indirect financial interest in a firm or other supplier, regardless of whether the firm is a manufacturer, distributor, wholesaler, or repackager of the products involved.

(3) Physicians may own or operate a pharmacy, but generally may not refer their patients to the pharmacy…

Hello, FMA!  Can you spell “conflict of interest”?

Sorry for the adult language – this is the first, and hopefully only – time.