Friends and colleagues Yvonne Guibert and Rafael Gonzalez went waaaay out on a limb and asked me to do another podcast.

I was all over the place, but Yvonne and Rafe were kind enough – and smart enough to rein me in when I diverged away from what was supposed to be the focus – impact of economics and the upcoming election on workers’ comp.

A deep dive into the economy started things off – how the House of Representatives affects physician reimbursement – and how that affects workers’ comp.

and how Medicaid dis-enrollment affects workers’ comp.

and how wage increases have outpaced inflation.

Listen on!

Kudos to WCRI – it is the first workers’ comp research organization to give center stage to the impact of climate change – primarily heat – on workers’ comp claims.

Dr David Bonauto of Washington’s Labor & Industry (state WC fund) led a session on Washington’s analysis of climate change’s affects on workers. A few quick takeaways…

There have been three studies re Heat Related Illness (HRI) in WA based on 16 years of data.  There were only about 850 accepted HRI claims out of 1.7 million…but the hidden impacts of heat are just beginning to be understood.

• Heat increases absorption of chemicals thru the skin and potentially increases toxicity, a major concern for ag workers working with insecticides and fertilizers
• Heat and wildfire smoke increases cardiovascular disease; it appears the mechanism is chronic inflammation.
• Excessive heat leads to “incredibly diminished productivity”
• There is a much higher [67%] risk of injury when temperatures are above 82-86 degrees compared to a baseline of 76 degrees.
• The most vulnerable industry?   Public administration…my guess is this is driven by first responders and fire fighters.

thanks to MTI America’s Nikki Jackson for the slide pic

WA L&I isn’t the only organization doing credible research – WCRI research found 14% more claims occurred at times of high heat – think of these as indirectly related injuries. Falls off ladders are an example.  Great to see WCRI dig into this, although it would have been even better if we had this information several years ago.

The second employer session provided much-needed perspective from executives dating with the fallout from climate change.

Joann Moynihan from Travelers said the industry needs to broaden this dicsussion…it’s not heat claims specifically, but heat-related claims…Ms Moynihan’s words to the effect of “this is an indication of where the. industry is headed” should be a wake-up call to stakeholders who are mostly sleepwalking through massive changes to the work environment. 

Chrissy Lynch of the Massachusetts AFL/CIO described how workers in Mass are now dealing with forest fires…”we never thought we would”…that and it “doesn’t really snow here any more…we are trying to figure things out on the fly.

What does this mean for you.

Wake the *&^%** up. 

275,000 new jobs last month – VERY good news indeed!

Since the beginning of 2021, over 10 million jobs have been created.

Yesterday’s jobs report showed strong employment growth across multiple industries;

Over the last 3+ years, 800,000 manufacturing jobs have been created..

Along with big job increases, wages are up too.

Last month average hourly earnings rose to $34.57 – a 4.3% increase YoY. (that’s about $69,000 a year)

From USAToday:

“Since the spring of last year, pay increases have outpaced inflation, giving consumers more purchasing power.”

What does this mean for you?

More jobs + higher wages = more payroll + more consumers buying more stuff.

Note – thanks very much to several folks at WCRI who thanked me for doing the Good News Friday posts – I appreciate you.

J.  – thanks for sharing that even though we may have different political views, you appreciate the posts.

Have a most excellent weekend!

Good decision to add three very different employers to the conference; Publix, Disney and Duke University.

[As a Syracuse alum, I thought WCRI could’ve made a better choice than Duke…]

Here’s my quick take…there was a ton of content with which your faithful reporter could not keep up…so apologies for the somewhat disjointed post.

None of the three are doing pre-employment drug testing (except as required by law)

Publix self-administers work comp – Michele Maffei has over a hundred employees managing the program. Michelle and her colleagues are very involved in the entire process, work diligently to engage with local operations, and focus tightly on return to work. They handle clinical management, claims, and bill review inhouse. RTW is a huge priority; they try to get everyone – even amputees – back to a job at Publix; during Covid a transitional job was checking in folks showing up for vaccination.

Publix identifies the medical providers they want to provide care to their associates and in some cases contracts directly with those providers; “we are very purposeful about what we do.” Oh, and consistent with earlier findings, telemedicine usage has dropped off post-Covid.

Sharon DelGuercio noted Disney can pay above fee schedule if they need to get specific specialties in central Florida to treat associates. Still it can be difficult to ensure ready access. Disney focuses on the full scope of recovery drivers, striving to keep them in their home location, a strong transitional program with over 400 job descriptions.  Disney’s focus is, quoting Sharon; “nobody goes home”

Duke University’s Charles Kyle weighed in on behavioral health, a main focus of the worker’s recovery program. Return to work is also key; as Duke is very de-centralized different units have their own priorities however costs are tracked back to those units.

A recent focus and rising concern among healthcare professionals [Duke has a major medical center as well] is violence, especially gun violence.  Other forms of physical violence seem to have increased as well across both the medical facilities and University operations. Duke has a task force assigned to this and is steadily improving prevention and recovery initiatives for workers injured by violence.

Panelists acknowledged that in general there’s a higher level of violence, a higher level of incivility, they are just meaner than they used to be.

Michele mentioned physician dispensing (PDD) as a key priority; with their operations in Florida this is NOT a surprise.  MDs should not be allowed to give patients drugs as they are not pharmacists.

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.