Category: Research

Apr
21

A really bad idea

Posted by Joe Paduda on Wednesday, April 21st, 2021 | Comments

A long list of real and very difficult problems face California’s legislators; no where on that list is worker’s compensation.

  • Work comp premiums are at an all time low,
  • injured workers have no trouble accessing care,
  • are generally satisfied,
  • benefits are good and indemnity payments up by half a billion dollars since reform,
  • fewer workers are getting hurt or sick at work which means claims counts are dropping,
  • medical costs have actually declined,
  • opioid prescription volume has plummeted, and

  • even the IMR mess seems to be improving.

Oh, and rates are dropping again.

Not satisfied with leaving a good thing alone, two legislators are pushing to end all this good news. They’re proposing to return California’s comp system to the awful old days of rampant medical inflation, profiteering by a few shameless medical providers, rapidly rising premiums and much higher costs for taxpayers and employers.

What’s not to love?

AB 1465 is not a solution in search of a problem, rather it creates a problem – one identical to the problem we had before workers’ comp was reformed.

In essence, AB 1465 would allow any doc – regardless of their knowledge of workers’ comp  – to care for any workers’ comp patient who seeks them out. Employers and taxpayers would NOT be allowed to negotiate reimbursement, nor would they be allowed to evaluate physicians’ actual performance. (correction thanks to a diligent reader – thanks Sara!)

The bill’s sponsors claim there’s an “access to care” issue that prevents patients from receiving care.

No, there is not. There is no credible evidence that access is an issue – no studies, research, or data whatsoever. If you have any, please share.

Quite the contrary, there is NO significant difference in access to care for patients treated within or outside a Medical Provider Network.

This from CWCI’s report…

Similarly, there was no significant difference in distance from the patient to provider between MPN and non-MPN patients.

Solving this non-existent problem of access to care will cost California’s employers and taxpayers an additional third of a billion dollars.

But wait, there’s more.

Enabling any Tom Dick or Mary MD to treat workers’ comp patients will almost certainly lead to delays in return to work, higher medical costs, and lower recovery rates. Volumes of research show the more experience a doc has with workers’ comp, the better the outcomes. The contrary is true as well – the less the experience, the worse the outcomes.

I love California. The quality of life is generally excellent, services are generous and pretty good, it is beautiful and diverse and productive, the education system is among the best and higher ed is terrific.

It also has more than its share of problems, some created by stupid policy (restrictions on taxation, fire prevention initiatives, a poorly maintained electrical grid), others by all of us (climate-change-exacerbated wildfires and drought), a really problematic water situation, a major homeless population challenge, wildly expensive housing, awful traffic, and a complete inability to do important things like connecting cities by fast and efficient rail.

With fire season approaching and the grid in dire need of a major upgrade legislators should spend their very limited time fixing those real issues – not creating more problems. I have no idea why these two legislators think a non-existent “access to care” issue  merits increasing employers’ and taxpayers’ costs by a third of a billion dollars.

And I don’t think they do either.

What does this mean for you?

If you do business or are a workers’ comp patient in California, you’ve got to kill this bill.

Apr
15

Why are you using that metric?

Posted by Joe Paduda on Thursday, April 15th, 2021 | Comments

I’ve had several conversations with claims and managed care folks over the last few months about measuring performance, outcome metrics vs process metrics, and the challenges of data collection, aggregation and analysis.

Two takeaways.

Too often the discussion has been too focused on process, too down-in-the-weeds, too concerned about how and what to measure. While process and detail are important, they are secondary to the “why” question.

The most important question is “Why?”

Why are you doing this? Why are you using that metric? Why do you think that is the right metric?

Sometimes I’m a (very) slow learner, but I’ve finally figured out that it is far better to ask those questions than to tell the person what they should be doing. Telling someone something eliminates the chance for them to think through what they have done, why they’ve done that, and if it that was the best thing they could have done.

It forces them to take a step back and question themselves, their assumptions, their pre-conceived notions.

It’s easier – and more ego-gratifying – to tell someone what they should do. I’ve found that this can shift the discussion into a far less productive direction, one where the client may well disagree, to defend what they are currently doing. After all,  to hear someone say what you have been doing for X years is “wrong” will make anyone bristle a bit.

Second, metrics are almost never directly aligned with the organization’s overall goals.

For example, the goal of medical management is to improve the combined ratio.  Has anyone in your organization verbalized that…ever?

If they have, then you:

  • wouldn’t give a rat’s rear end about “savings” or “discounts”;
  • would focus on overall spend;
  • would evaluate providers not on how much of a “discount” they give but on what their services cost and how that compares to other providers;
  • would evaluate networks not on how big their directory is and how deep their discounts are, but on the quality of their providers and the cost of their services.

And that’s just the beginning.

Once you establish the “why” the “what” is pretty straightforward – with one big caveat – every time you settle on what you will measure, go back and see if it aligns with your “why”.

Don’t be surprised if it takes a bit to re-orient thinking. Be patient – with yourself and others. It took me 30+ years, so hopefully you’re a much faster learner.

What does this mean for you?

Asking the right questions requires one to invest time and thought. If you don’t have time to do it right on the front end, you’ll never have time to fix it.

Apr
14

COVID’s impact on workers’ comp…focus on the facts

Posted by Joe Paduda on Wednesday, April 14th, 2021 | Comments

Could COVID have a “very alarming potential outcome that could have a huge impact on workers’ comp” due to claims for neurological and psychiatric issues? That’s a concern raised by Mark Walls in tweet that was noted in a recent article in WorkersCompensation.com.

Before we opine on Mark’s fears, let’s look at the science. I know, you just want the takeaways, but you have to eat your veggies before you get dessert.

A few days back the Lancet published a study assessing the neurological and psychiatric “outcomes” of about 236 thousand US COVID survivors. Here are the key findings.

  • there was a statistical correlation between COVID-19 and higher frequency of neurological and psychiatric diagnoses (the Brits used “outcomes”, but for we Americans, in this instance the analogous word is diagnoses)
  • these diagnoses were more common in patients who had required hospitalisation, and more common still in those who had required ICU admission or had developed encephalopathy

The researchers compared the increased frequency of those diagnoses in COVID survivors to increases in a similar set patients with non-COVID respiratory diseases including flu.

OK, here are some key considerations.

First, these patients are in the US; many of them may not have had regular healthcare prior to contracting COVID, and the neuro/psych conditions may have been present but not diagnosed pre-COVID. While the researchers attempted to control for this by comparing the group to a similar demographic of patients with respiratory infections, it is indeed possible – if not likely – the post-COVID patients had much more thorough medical care during and after COVID than the control group.

Interpretation – The more care, the higher the likelihood of a diagnosis.

Takeaway – The more you look for something the more likely it is you’ll find it.

Second, the older the patient group, the higher the correlation – and the less likely the patient was employed (note I did NOT say “risk” as the study did NOT show that a COVID diagnosis caused the neuro/psych diagnosis.) The average patient that was hospitalized or in the ICU was about 15 years older than non-hospitalized patients (58 vs 43).

Interpretation – COVID hits older people much harder than younger folks; the older the person, the less likely they are working.

Takeaway – the higher the correlation, the less likely the patient is employed, so the lower the potential for a workers’ comp claim.

Third, patients who already had neuro/psych diagnoses may have had that condition exacerbated by COVID. The research showed that a patient that had a stroke before COVID, was more likely to have another one than a COVID patient that had not had a stroke before COVID.

This is especially true for the most severe neuro/psych diagnoses…see “any” vs “first”

Takeaway – very tough to blame an ostensibly work-caused disease for a second stroke or encephalitis event.

Fourth – the most common post-COVID diagnoses were anxiety disorders (occurring in 17% of patients), mood disorders (14%), substance misuse disorders (7%), and insomnia (5%).

But here, the differences between the COVID and control populations were minimal (HR is Hazard Risk – the risk that a member of that population will have that event occur)

Takeaway – very tough to blame an ostensibly work-caused disease for a mood/anxiety/psychotic disorder, especially when the control group’s incidence rate is so close to COVID survivors’.

Fifth – Mark makes the point that outcomes for workers’ comp patients are worse than under group health for similar conditions – he goes on to say costs are higher too – and this may well be the case with COVID. Couple thoughts…

The definition of “outcome” in comp vs group health is pretty different and highly subjective; in comp we care about functionality – group health doesn’t. If you are worried about functionality, you will pay more for more care to improve the patient’s functionality. Ergo…more dollars spent.

There are any number of other reasons costs are higher in work comp – but I’d argue – vehemently – the primary reason is this – compared to other payers, WC does a generally crappy job managing medical. I work in both comp and group/Medicaid/Medicare, and the sophistication of medical management in group, managed Medicaid and Medicare is far superior to comp.

As in a graduate student vs a junior high student.

Takeaway – Lower quality healthcare = poorer outcomes at higher cost.

Finally, Mark says “we’ve never had a global pandemic where the government has mandated it be covered under workers’ compensation.”

Well…we still don’t.

I’m not sure which – if any – government(s) have broadly  “mandated COVID be covered under workers’ compensation”. Sure some states have passed presumption laws or had executive orders re presumption – but those are few, far between, rarely cover all workers – and typically come with a rebuttable presumption.

  • Only California and Wyoming cover all workers with a rebuttable presumption
  • Several states (NJ VT IL) cover “essential workers” – with varying definitions thereof
  • MN UT WI only cover first responders and healthcare workers

An excellent and up-to-date resource on state laws is provided by the good people at NCCI…

I’m struggling to see how the science and current state mandates will cause anything like a “huge” impact on workers comp.

  • The people with the most “risk” are older and less likely to have contracted the disease at work.
  • The study did not show a causal link but a statistical correlation – and correlation is not causation.
  • There have been relatively few COVID claims accepted by work comp.
  • Only two states have passed broad presumption laws.

To his credit, later in the article Mark notes “when you see a study like this, it makes you pause.”

I agree. Pause, read the study, then step back and think it through. And avoid hyperbole. 

What does this mean for you?

There’s a lot of fear out there about COVID – much of it more FOTU [Fear of the Unknown] than fact-based. Focus on the facts, and don’t react until and unless you know the details.

Side note – I opined on a related story 14 months ago…

 

 

Mar
30

Chronic pain, opioids, and other drugs – the latest research

Posted by Joe Paduda on Tuesday, March 30th, 2021 | Comments

Dr Steve Feinberg pointed me to two studies conducted by the Agency for Healthcare Research and Quality on chronic pain, both systematic reviews [reviews of published studies of a specific topic]. One focused on opioid treatments for chronic pain, the other on non-opioid pharmacologic treatment.

The non-opioid research reviewed 190 studies, of which 185 were RCTs. Researchers concluded:

improvement in pain and function was small with specific anticonvulsants, moderate with specific antidepressants in diabetic peripheral neuropathy/post-herpetic neuralgia and fibromyalgia, and small with nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis and inflammatory arthritis.

The takeaways include there are some benefits from some drugs, often dependent on the patient’s medical condition.

The opioid treatment for chronic pain study was based on a review of 162 studies; “115 randomized controlled trials (RCTs) [the gold standard of clinical research], 40 observational studies, and 7 studies of predictive accuracy.”

Note that for research purposes, chronic pain is described as pain that lasts more than 3 to 6 months.

There was more credible research available to assess short-term outcomes vs longer-term outcomes; there was no RCT comparing opioids to placebo for medium or longer-term periods.

Takeaways included (and these are direct quotes):

  • There were no differences between opioids and nonopioid medications in pain, function, or other short-term outcomes
  • Opioids were associated with small benefits versus placebo in short-term pain, function, and sleep quality.
  • There was a small dose-dependent effect on pain, and effects were attenuated [reduced] at longer (3 to 6 month) versus shorter (1 to 3 month) followup.

Most concerning, “there is evidence of increased risk of serious harms that appear to be dose dependent” [the higher the dose, the greater the risk].

This crossed my desk the day before a good friend’s brother died of an apparent opioid overdose, adding a painful exclamation mark to the study’s conclusion.

Extensive research in Australia focused on long-term opioid use in patients with chronic non-cancer pain found that:

Despite limited evidence of efficacy, there has been a considerable increase in the long-term prescribing of opioids for chronic non-cancer pain in several countries

Here’s the thing; the research we do have clearly demonstrates the risk of opioids is high, and the benefits are limited. However, there isn’t near enough research on the efficacy of long-term usage of opioids for chronic pain.

Anecdotal evidence indicates some patients can do well on opioids for extended periods.

That said, the evidence we do have suggests that overall, efficacy may be limited at best, and the risks are high. Fortunately more research on opioid efficacy and risks and chronic pain has already been funded.

What we cannot do is force patients off opioids; this is dangerous and unethical.

What does this mean for you?

Opioids have their place – but be very careful, especially when use is long-term. Life is precious. 

 

Mar
29

Facilities, fee schedules, and what should be your takeaway

Posted by Joe Paduda on Monday, March 29th, 2021 | Comments

Perhaps the most practical presentation at this year’s WCRI conference focused on outpatient facility costs. While the content itself was excellent, what was more valuable were the implications for medical spend management.

Rebecca Yang PhD provided a wealth of information about outpatient fee schedules, Medicare reimbursement, and the impact of Medicare’s changes on workers’ comp fee schedules. Note that as the slides indicate, findings are preliminary so subject to change.

First, the findings.

Dr Yang noted that outpatient hospital and Ambulatory Surgical Center costs  [outpatient costs] represent about 15% of total medical spend across the 18 study states, with Louisiana the outlier at 28% of spend.

There are lots of different ways to manage spend via fee schedules; one can base reimbursement on a fixed amount, % of charges, cost to charge, Medicare or some hybrid mechanism.

All have strengths and weaknesses, issues and challenges, but – with one very big exception – in general it is better to have a fee schedule than not – except when the fee schedule is easily gamed (we’re looking at you, Florida).

That exception is cost-to-charge, a term describing the ratio between a hospital’s expenses and what they charge. As we’ve discussed here ad nauseam, all hospitals in C-t-C states have to do to make bank is jack up their charges. 

I won’t dive deep into details about how Medicare’s changes to reimbursement affect workers’ comp except to note that when the dog wags the tail, the flea on the end (that’s workers’ comp) gets whipped about.

Okay, maybe a little detail…

The Peach State adopted Medicare as the basis for the WC FS back in 2013.  Essentially, the change followed Medicare FS changes, except excluded device reimbursement and (if I heard this right) some associated charges.

Medicare made changes to its reimbursement in 2016 and 2017 which drove  reimbursement declines for some knee surgeries; others were unaffected.

The point of this is to note that basing a fee schedule on a third party’s reimbursement demands payers really deeply fully understand the underlying third party’s reimbursement policies, practices, requirements and nuances.

Most workers’ comp entities don’t. The result is they are unable to ensure medical bills and accompanying documents support reimbursement – or don’t. Far too often, bill review entities just assume everything is in order (if the surgery was pre-approved) and authorize payment for all billed services. Reality is it’s pretty common that some of those billed services should have been bundled into the overall surgical fee.

What does this mean for you?

This isn’t unique to Georgia, or knee surgeries. If your BR operation doesn’t know this stuff at a granular level, you’re probably overypaying. 

(WCRI published an excellent summary of outpatient reimbursement and drivers last year).

Oh, and don’t forget my annual Aril Fool’s post is coming up Thursday. Don’t be fooled!

Mar
23

WCRI on COVID and non-COVID claims, treatment delays (not) and drivers thereof

Posted by Joe Paduda on Tuesday, March 23rd, 2021 | Comments

The 2021 WCRI Annual Issues and Research confab kicked off today with several excellent presentations – not surprisingly there was a lot about COVID and its impact on employment, injuries, and claims.

The conference continues tomorrow – register here if you haven’t already…

I’ll get to those in later posts, but will start our coverage with Dr. Olesya Fomenko; she gave a very well-done – and very well-attended presentation on claims during COVID. Note that some of the findings and graphics may be preliminary so subject to change

Regarding COVID claims for Q2 2020 there was wide variation in the volume of COVID claims between the study states; in Massachusetts 42% of claims were COVID, compared to 1% in SC. On average 6% of claims in median state were due to COVID. COVID claims were-disproportionally LT claims.

There are a variety of reasons for these differences. Massachusetts has pay without prejudice, NJ’s presumption law went into effect pretty early, and the timing and severity of pandemic, impact of shutdowns and social distancing all affected the variability across states.

There was a relatively strong association between the COVID death rate and number of WC claims for COVID; this seemed to be more of an influence than presumption (slide below).

Not surprisingly the number of non-COVID claims dropped dramatically in Q2 2020 in WCRI’s study states; the majority of states had at least a 30% drop in non-COVID claims, with MA’s claims cut in half.  Employment also dropped dramatically, but there wasn’t much of a correlation between states’ employment reduction and drop in WC claims

Injury types weren’t didn’t change much from pre to post – altho the percentage of claims that were LT increased.  [This finding echoed research discussed by CWCI a few days ago]

Again, similar to CWCI’s research, there was no evidence of treatment delays for claims with injury dates in the first half of 2020. In fact, there was a slight improvement in time to surgery and PT. That holds true except for ER services which declined, perhaps driven by reluctance to go to a place where COVID might be present.

What does this mean for you?

Assumptions are dangerous – we now know that medical care wasn’t delayed, that COVID claims weren’t expensive (see CWCI), and that (shocker!) COVID claims counts were lower in states that did more to stop its spread.

Kudos to WCRI for excellent research giving us a much deeper understanding of the impact of the pandemic – and what drove the interstate differences.  And thanks to the organizations that support WCRI – you are helping all of us.

 

Mar
22

The cost:benefit of catastrophic case management

Posted by Joe Paduda on Monday, March 22nd, 2021 | Comments

A well-designed, thorough, and much-needed study of the impact of nurse case management on catastrophic claims was completed late last year by the University of Washington.

The UW study examined 216 cat cases insured by L&I, the state workers’ compensation fund, and evaluated workers satisfaction and self-reported outcomes, duration of time loss and total medical costs.

Among the conclusions were these:

there is a high level of worker satisfaction with nurse case management services, and

there were no changes in the average duration of time loss or average medical costs after implementation of the nurse case management pilot for catastrophic injuries.

One particularly striking conclusion was the Economic Analysis. The Analysis “examined the predicted and actual medical and NCM costs for one outcome based firm with the most referrals (Paradigm).” Of the 216 cases, there were a total of 25 referrals to Paradigm, of which 15 were accepted by L&I and managed by Paradigm. [A detailed description of the analysis of the Paradigm cases begins on page 104)

The report noted the small number of Paradigm cases precluded a formal “statistical assessment or economic evaluation, e.g., return on investment (ROI) analysis.” Instead, the UW researchers provided a “descriptive analysis involving comparisons of different cost measures in order to assess the economic value of NCM services provided by Paradigm.”

Regarding the Paradigm cases, the study concluded:

the cost for nurse case management alone was 1.8 times the total medical costs paid by L&I.  In addition, the medical costs estimated by the outcome-based firm were substantially higher than the actual medical costs paid by L&I, on average. For all other firms, the costs of nurse case management were substantially lower than the average medical costs for the injured workers. [emphasis added]

I reached out to Paradigm to get their take; this is their response:

Paradigm is aware of the UW research paper and has reviewed its findings. It is not possible to reach any of the conclusions made about the “economic value” of our services based on the limited scope and methodology of the report. The report fails to capture the most meaningful measure of success, which is the ability to achieve maximum functional outcomes at a lower total cost of care. This is the model that Paradigm, and our clients, uphold. As you know, Paradigm’s Catastrophic Outcome Plan product, which is the service that UW referenced in the paper, is not a traditional case management solution.

We confidently stand by our results and our 30-year record of delivering life-changing outcomes to catastrophically injured workers and their families, and value to our clients. We encourage you to read the October 2020 study conducted by independent actuarial firm Milliman which confirms Paradigm’s results.

I followed up with this request:

MCM – I’d appreciate a bit more explanation about what specifically about the limited scope and methodology prevents one from reaching any of the conclusions cited by the study’s authors?

Is there any comment re what could have accounted for the high costs of case management compared to medical costs for many of the patients?

Paradigm responded:

Our commitment to Washington L&I was to deliver our risk bearing outcome plan model that provides a total lower lifetime cost and a guaranteed outcome—verified by Milliman as recently as October 2020, and based on 30 years of clinical data. With this product, Paradigm provides an integrated system of clinical capabilities, data, and experts to deliver lower lifetime costs. Comparing case manager expenses to Paradigm’s outcome plan model is not valid. Further, the study focused on a short timeframe (less than 24 months) and could not have captured the outcome and total cost benefits that Paradigm delivers.

Three observations. 

First, the 24 month time period may well have been too short to capture the full impact of Paradigm’s program.

Second, the cost of case management services strikes me as “valid” indeed, if one is concerned about the total cost of a cat case. I cannot imagine a scenario where a VP of claims or Medical Director wouldn’t have some rather pointed questions about a cat case where case management costs were almost double medical expenses.

Third, Paradigm predicted medical costs that were much higher than what L&I actually paid.

Disclosures

Carisk is an HSA consulting client; it has a division that competes with Paradigm Outcomes.

I’m working with two of the researchers on a PCORI-funded analysis of the impact of different regulatory approaches on opioid prescribing in workers’ compensation.

Note – For more of my coverage of Paradigm, click on links for posts complimenting the company on its strategy and suggesting more payers should utilize their services.

 

Mar
19

COVID claims aren’t expensive, and treatment isn’t being delayed

Posted by Joe Paduda on Friday, March 19th, 2021 | Comments

Those are my two top takeaways from CWCI’s excellent analysis of 2020. I had the opportunity to tune into the virtual annual meeting, and Alex Swedlow was kind enough to walk me through questions on several key issues. (note that the data is preliminary)

The net:

  • Non-COVID claims were down by more than 25% in 2020;
  • WC Covid claims are pretty inexpensive;
  • COVID claim denials were actually less frequent than denials for non-COVID claims (when using an apples:apples comparison)
  • Most COVID claims aren’t incurring any medical cost;
  • Contrary to a previous post, there were no appreciable delays in accessing treatment

Let’s start with the last point. The data on all claims incurred in California May to October showed initial treatment delays were non-existent.

When looking at days to first Evaluation, pandemic-era claims actually had less delays than non-pandemic-era claims.

Overall, COVID hasn’t been expensive for workers’ comp payers. COVID claims that had medical expense were more expensive than non-COVID claims – BUT most had NO medical expense incurred. (Mark Priven and I predicted this 9 months ago...while others thought the opposite would happen.)

What does this mean for you?

Be careful making assumptions. 

I’m going to get more into the cost-of-COVID next week.

Mar
17

COVID quick update

Posted by Joe Paduda on Wednesday, March 17th, 2021 | Comments

Quick takes on stuff you need to know – and most of it is good news indeed.

Eli Lilly has what may be one of the more promising treatments, a cocktail of two unpronounceable drugs showed strong results in a recently-completed double-blind trial involving 769 patients.  The bamlanivimab-etesevimab duo cut the risk of hospitalization and death by 87% versus placebo.

Unlike the hydoxycholoroquine “research” touted by the former occupant of the White House, this is real science by reputable scientists which shows the drug has a positive impact.

Other research indicates the Pfizer vaccine works to stop the Brazilian variant; since I’m getting my first shot – and it’s the Pfizer version – Monday, that’s good news indeed. Pfizer also believes its vaccine will work against the South African variant as well.

These are all good news, as economists believe an economic recovery is highly dependent on stopping COVID.  One stated: “The vaccine is truly incredible…. It’s the best kind of stimulus we could want.” Excellent podcast for your morning walk or pm drive is here.

Terrific research out of CWCI last week; in their annual meeting, Alex Swedlow, Rena David and colleagues provided a lot of information on what’s happened with claim counts, costs, claim duration, and treatment timing. One very bright spot – February saw a huge drop in COVID workers’ comp claims. Rena also reported that “many workers with non-COVID claims got faster treatment than before the pandemic…” A big chunk was via telemedicine, which hit 25% of office visits in April and May, then dropped to about 18% in October. [thanks to WCC’s Mark Powell for his reporting]

I’m hoping to interview Alex and will provide more intel in a future post.

What does this mean for you?

Science, people. 

Mar
9

COVID, Claims, Employment, Opioids, and Physical Therapy – WCRI’s got it all

Posted by Joe Paduda on Tuesday, March 9th, 2021 | Comments

One  of the top work comp events is three weeks away – WCRI’s annual research conference kicks off on March 23 and continues the following day.

Registration is here.

I connected with John Ruser PhD to get the scoop on what we’ll learn at the Conference; here’s an edited version of our interview.

1)    We now have data to help us understand how the pandemic has affected workers’ comp. What are some of the key findings you and Dr. Fomenko will be discussing?

We have data over the first half of 2020, that is, the early part of the pandemic, which shows where claims were rising by state and industry. We show how COVID claims were associated with the severity of the pandemic in each state and with presumption laws in effect at that time. There was a large drop in non-COVID claims in the second quarter. We will address how these claims were linked to locations where the pandemic was more severe and employment dropped the most. We will also address the mix of medical-only versus lost-time claims. In the second quarter of 2020, there was an increase in the proportion of lost-time claims, likely due to COVID-19 claims that were much more likely to have more than seven days of time away from work, while non-COVID claims also had longer duration.

Regarding non-COVID claims, we continue to see the same distribution by type of injury, e.g., sprains and fractures, not a shift to fewer soft tissue claims – there were fewer of those but they were more severe.

We will also talk about how the pandemic affected the provision of medical care, that is, to what extent there were delays in the provision of care, particularly for elective surgeries.

2)    As we’ve tried to understand the impact of the pandemic, one of the biggest challenges has involved data – what should we be collecting, how fast can we get it, what sources are most useful, and how can we best use data to understand a novel situation. How has WCRI adapted to quickly understand what’s happening during the pandemic?

We accelerated data processing to accommodate for COVID-19, not necessarily getting data faster, but rather processing and analyzing it more rapidly. Our report on the impact of COVID-19 on claim composition is also shorter due to the need to focus on higher priority topics in a shorter period of time. While there is a need to have rapid and timely data to understand the early impact of the pandemic, there are still a lot of questions you can’t answer with quick data. Other fundamental questions will be answered with more mature data, specifically issues including long haulers, impacts on the injured worker of surgery delays and disruption in provision of care, and other longer-term impacts that are not so apparent now.

3)    Dr. Thumula and Dr. Savych will be discussing the latest research on prescription drug usage; our understanding of the impact of drugs on claims has evolved rapidly. What do we know now that we did not a few years ago?

They will bring together a couple of different WCRI studies, looking at the relationship between opioid policies and utilization in workers’ compensation and off-label prescribing. Regarding opioids, what is new is measuring the impact of policies on changes in opioid utilization, including prescription drug monitoring programs and prescribing limits. The session will also cover the rise in workers’ compensation of off-label prescribing of gabapentinoids and topical dermatologicals. Physician dispensing will also be addressed.

4)    WCRI had to change how it operated due to the pandemic and restrictions. Talk about how that happened, what the impact has been, and what you see changing over the long term.

Everyone is remote. There is a skeleton crew in the office every day to handle day-to-day stuff but nearly all work is done at home; we are fortunate that we had an emergency operations plan in place and had upgraded IT recently. On March 12 we had a staff meeting, planned a March 13 dry run of the operating plan, and planned to come back Monday – the dry run turned into a year working from home. We had to learn how to do work via video and maintain cohesion, handle staff meetings, and run social events. We have done several webinars – one with Judge Langham had 1,600 registrants.

 

We have been able to participate in more conferences and events, and with our virtual conference, we will reach a lot more people. Registration numbers are exceeding what’s normal for an in-person conference. Since the conference is virtual, we have been able to secure speakers we normally may not be able to get since the time commitment is less, such as

  • Katharine Abraham ─ who ran the Bureau of Labor Statistics (BLS) and is a former member of the President’s Council of Economic Advisers ─ will talk about the economic impact of COVID-19;
  • Jewel Mullen – former principal deputy assistant secretary for health and acting director of the National Vaccine Program Office in the U.S. Department of Health and Human Services ─ will talk about vaccines; and
  • Director John Howard of the National Institute for Occupational Safety and Health will be speaking on the future of work and work safety.

 

Our conference will be a blend of recorded sessions and live Q&A.

5)    More broadly, do you see the rest of the economy changing significantly ─ and for the long term ─ as a result of the pandemic? What does this mean for labor, employment, and workers’ comp?

Two plus years out, things will likely be different – we might anticipate more work from home and not as much business travel, and some structural changes such as more online shopping. The question is what will the magnitude of change be? Dr. Abraham will talk about that and what the future will look like. She ran the BLS and is well versed in the data. She’ll talk about the prospect of long-term unemployment and scarring effects of that. She will also talk about the extent to which changes in education might impact labor market prospects in the future.

 

 

Anything else you want to add?

 

We hope to see you at our conference, March 23 and 24. In addition to drawing upon the diverse perspectives of highly respected workers’ compensation experts and policymakers from across the country, we will be presenting our latest research findings. And it’s virtual, so you can attend from the comfort of your home or office. It is also shorter with four sessions per day in the afternoon from 1-4p.m. ET. Registration is free for WCRI members, state legislators, and members of the press, and $175 for non-members. To learn more and register, visit https://www.wcrinet.org/news/events/37th-annual-wcri-issues-research-conference.