Workers' Compensation: Search results for health care debate

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Wednesday, November 20, 2013

New obesity treatment guideline released

Obesity is now been classified as disease. With such a designation of Worker's Compensation systems will be impacted by request for benefits in order to diminish obesity is a pre-existing and coexisting diagnosis. Treatment plans will need to be included for the reduction of weight in order to treat certain diseases by protocols including medication.Today's post was shared by RWJF PublicHealth and comes from www.bostonglobe.com

A new guideline for obesity treatment, released last week by the American Heart Association and American College of Cardiology, provides a solid road map for doctors challenged with helping overweight patients achieve a healthier weight.
Insurance coverage for weight-related counseling, such as helping patients plan new menus with fewer calories or outline a realistic fitness program, could improve under this new recommendation. More importantly, the panel of physicians and weight researchers outlined which interventions are the most effective based on clinical trials.
Doctors should treat patients who are obese — a BMI of 30 or above (180 pounds or more for a 5-foot-5 person — as well as those who are overweight with a BMI between 25 to 30 (150 to 180 pounds for a 5-foot-5 person) if they have certain heart disease risk factors such as type 2 diabetes, the guideline states. People at a healthy weight, or who are overweight without any health problems, should keep their weight steady.
“It’s not just about body weight, but whether excess body weight is associated with medical conditions,” said Dr. Timothy Church, director of preventive medicine research at Pennington Biomedical Research Center, who was not involved in writing the guideline.

Doctors can offer drugs or bariatric surgery to help reverse obesity, but they should first try providing patients with intensive counseling to help them exercise and eat right.

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Monday, December 1, 2014

Suit on Health Law Puts Focus on Funding Powers

Today's post is shared from nytimes.com/
WASHINGTON — In mounting the latest court challenge to the Affordable Care Act, House Republicans are focusing on a little-noticed provision of the law that offers financial assistance to low- and moderate-income people.
Under this part of the law, insurance companies must reduce co-payments, deductibles and other out-of-pocket costs for some people in health plans purchased through the new public insurance exchanges. The federal government reimburses insurers for the “cost-sharing reductions.”
In their lawsuit, House Republicans say the Obama administration needed, but never received, an appropriation to make these payments to insurance companies. As a result, they contend, the spending violates the Constitution, which says, “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.”
President Obama requested the money as part of the budget he sent Congress in April 2013, but Congress did not act on the request. Seeing the issue as an urgent priority, the administration began making the payments early this year, using money from a separate account established for tax refunds and tax credits.
“The cost-sharing reductions are really important and valuable,” said Judith Solomon, a vice president at the Center on Budget and Policy Priorities, a liberal-leaning research and advocacy group.
Under a standard insurance policy, for example, consumers might have to pay a deductible of $2,500 before the health...

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Friday, April 30, 2010

OSHA Releases 15 Years Worth of Valuable Measurement Data

The US Occupational Safety and Health Administration has released 15 years worth of measurement data and has placed the information on-line for easy access. This Chemical Exposure Health Data is comprised of measurements taken during the course of Occupational Safety and Health Administration (OSHA) inspections and includes exposure levels to hazardous chemicals including asbestos, benzene, beryllium, cadmium, lead, nickel, silica, and others.

Dr. David Michaels is the Assistant Secretary for the Occupational Safety and Health Administration, U.S. Department of Labor., stated that "....Making this dataset available to the public for the first time will offer new insight into the levels of toxic chemicals commonly found in workplaces, as well as how exposures to specific chemicals are distributed across industries, geographical areas and time. This information will ultimately lead to a more robust and focused debate on what still needs to be done to protect workers in all sectors, especially in the chemical industry."

To read more about health care and workers' compensation click here.

Sunday, September 28, 2014

Debate Grows Over Employer Plans With No Hospital Benefits

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.
“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”
Timothy Jost is pretty sure the whole thing was a mistake.
“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said.

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own.
At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits.
The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a...

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Thursday, November 13, 2014

MEDICAL PAYMENTS PER CLAIM IN FLORIDA WERE TYPICAL OF STUDY STATES AND GREW AT A MODERATE RATE FROM 2007 TO 2012, SAYS NEW STUDY

CAMBRIDGE, MA, November 12, 2014 – Medical payments per claim in Florida were typical of the 16 study states and grew moderately over the study period. The WCRI report, CompScope™ Medical Benchmarks for Florida, 15th Edition, said the average cost of a Florida claim with more than seven days of lost time that occurred in 2012 was $11,519, fairly close to the 16-state median at $12,167.

From 2007 to 2012, medical payments per claim in Florida grew 2.9 percent per year, less than the median growth of the 16 states WCRI studied, 4.5 percent.

Hospital outpatient care was used less frequently in Florida compared to other study states. Both the percentage of claims with hospital outpatient services and the average number of visits per claim billed by hospital outpatient providers were among the lowest of the 16 states. However, for claims receiving hospital outpatient care, the average payment per service of Florida’s hospital outpatient services was higher than any other study state, 60 percent higher than the 16-state median.

While the average payment per outpatient service was the highest of all states, the number of outpatient services performed per claim was the lowest. The two measures largely offset, giving an average hospital outpatient cost per claim near the 16-state median.

WCRI observed that the average payment per service for hospital outpatient services in Florida grew rapidly at 7.5 percent per year from 2007 to 2012. This trend may be related to some features in the percent-of-charge-based fee schedule in the state. For example, the average payment per service for hospital outpatient operating rooms grew 12 percent per year over the study period, closely following the increase of 13 percent per year in charges per service.

Among other major findings:

Florida had higher percentages of outpatient shoulder and knee surgeries done in ambulatory surgery centers (ASCs), and the average ASC payment per episode for those surgeries was in the middle group of study states.
Prices paid for professional services in Florida were among the lowest of the study states, while utilization of nonhospital care was relatively higher. Both metrics remained fairly stable over the study period.

The Cambridge-based WCRI is recognized as a leader in providing high-quality, objective information about public policy issues involving workers' compensation systems.

Click on the following link to purchase a copy of this study:http://www.wcrinet.org/result/csmed15_FL_result.html

Friday, August 23, 2013

UPS Won’t Insure Spouses Of Some Employees

Today's post was shared by WCBlog and comes from www.kaiserhealthnews.org

Partly blaming the health law, United Parcel Service is set to remove thousands of spouses from its medical plan because they are eligible for coverage elsewhere.

Many analysts downplay the Affordable Care Act’s effect on companies such as UPS, noting that the move is part of a long-term trend of shrinking corporate medical benefits. But the shipping giant repeatedly cites the act to explain the decision, adding fuel to the debate over whether the law erodes traditional employer coverage.

Rising medical costs, “combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost,” UPS said in a memo to employees.

The company told white-collar workers two months ago that 15,000 working spouses eligible for coverage at their own employers would be excluded from the UPS plan in 2014. The Fortune 100 firm expects the move, which applies to non-union U.S. workers only, to save about $60 million a year, said company spokesman Andy McGowan.

UPS becomes one of the highest-profile employers yet to bar working spouses from the company plan. Many firms already require employees to pay a surcharge for working-spouse medical coverage, but some are taking the next step by declining to include them at all, consultants say.

“They are simply saying to the spouse outright, ‘If you have coverage somewhere else you are not eligible...

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Wednesday, October 23, 2013

Questioning Statins for Older Patients

Limiting medication can reduce overall patient care costs. The efficacy of controlling cholesterol in the "very old" population is now being discussed. Today's post was shared from the NYTimes.com.

Should older adults take statins if they have elevated cholesterol but no evidence of heart disease? It’s a surprisingly controversial question, given the number of seniors taking statins.

Recently AMDA, a professional group representing physicians working in nursing homes, highlighted the issue in a list of five questionable medical tests and treatments. The list was drawn up as part of the national “Choosing Wisely” campaign, which alerts consumers to inappropriate or overused medical interventions, an effort that caregivers would do well to follow.

The standout item on the AMDA list: “Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.” That means anyone older than 70, according to the medical society.

Dr. Hosam Kamel, an Arkansas geriatrician who is vice chair of AMDA’s clinical practice committee, said that there is scarce scientific evidence supporting the use of statins by 70- or 80-year-olds without pre-existing cardiovascular disease. Only a handful of studies have focused on outcomes (heart attacks, strokes, premature death) in this older population.

Most of the data on the benefits of statin use come from larger studies that looked at adults of varying ages. The results...

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Monday, September 1, 2014

The Medicare Miracle

Today's post is shared fromPaul Krugman of the nytemes.com
So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate.
The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue.
But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago.
This is a really big deal, in at least three ways.
First, our supposed fiscal crisis has been postponed, perhaps indefinitely. The federal government is still running deficits, but they’re way down. True, the red ink is still likely to swell again in a few years, if only because more baby boomers will retire and start collecting benefits; but, these...

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Thursday, October 2, 2014

Maine Rolls Back Health Coverage Even As Many States Expand It

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

NORTHPORT, Maine – By the time Laura Tasheiko discovered the lump in her left breast, it was larger than a grape. Tasheiko, 61, an artist who makes a living selling oil paintings of Maine’s snowy woods, lighthouses and rocky coastline, was terrified: She had no health insurance and little cash to spare.

Laura Tasheiko, 61, sits in her home in Northport, Maine (Photo by Joel Page for USA TODAY).
But that was nearly six years ago, and the state Medicaid program was generous then. Tasheiko was eligible because of her modest income, and MaineCare, as it is called, paid for all of her treatment, including the surgery, an $18,000 drug to treat nerve damage that made it impossible to hold a paintbrush, physical therapy and continuing checkups.
But while much of America saw an expansion of coverage this year, low-income Maine residents like Tasheiko lost benefits. On Jan. 1, just as the Affordable Care Act was being rolled out nationwide, MaineCare terminated her coverage, leaving her and thousands of others without insurance.
Maine Gov. Paul LePage’s decision to shrink Medicaid instead of expanding it was a radical departure from a decade-long effort to cover more people in this small rural state of farmers, lobstermen, craftsmen and other seasonal workers, which at least until recently, boasted one of the lowest rates of uninsured in the nation.
Maine was the only state in New England, and...

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Thursday, October 30, 2014

Threat of Lawsuit Could Test Maine’s Quarantine Policy

A nurse who cared for Ebola patients in Sierra Leone was headed for a legal showdown with the State of Maine on Wednesday over whether the state can quarantine her against her will.

The dispute is heightening a national debate over how to balance public health and public fears against the rights and freedoms of health care workers, and troops, returning from West Africa.

“This is a tipping point in this whole process,” the nurse, Kaci Hickox, said in an interview, one of several she did from her home in northern Maine on Wednesday, as state troopers and television trucks stood outside.

“So many states have started enacting these policies that I think are just completely not evidence-based. They don’t do a good job of balancing the risks and benefits when thinking about taking away an individual’s rights.”

But Maine’s health commissioner, Mary Mayhew, said at a news conference late Wednesday that the state was seeking an immediate court order enforcing a 21-day quarantine of Ms. Hickox after she declared that she would leave her home if state officials did not lift the restrictions by Thursday morning.

“While we certainly respect the rights of one individual, we must be vigilant in protecting 1.3 million Mainers, as well as anyone who visits our great state,” Gov. Paul LePage, a Republican, said in a statement issued earlier in the day. In Maine and elsewhere, the fight over Ebola was poised to be one of the final defining...

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Tuesday, July 13, 2010

Synchronizing Federal Care for Oil Spill Workers

The need for coordination of Federal benefits for oil spill workers is now becoming a major concern. It is becoming more apparent, by the day, that the State programs are now stretched beyond their limits to respond to the crisis. As The Path To Federalization expands, this debate will expand.

A recent study by the Center for American Progress addresses these concerns.

"Health threats from the oil spill may linger unseen, perhaps for more than a generation. And we will not be fully prepared to address the public health problems that arise in the future unless there is an effective and coordinated handover of responsibilities for protecting public health from the emergency response agencies to agencies with the capability and capacity for long-term monitoring and management. Federal agencies have been pulled in as needed in the gulf spill response, but it’s not clear that the Health and Human Services response has been synchronized from the top to ensure effective delivery and coordination."

"In short, the spill reiterates why we need to better manage the short- and longterm responses required to address the public health threats such disasters pose whether they are manmade or due to natural causes."

Saturday, February 7, 2015

Overturning Obamacare Would Change the Nature of the Supreme Court

Today's post was shared by Steven Greenhouse and comes from www.nytimes.com

In the first Affordable Care Act case three years ago, the Supreme Court had to decide whether Congress had the power, under the Commerce Clause or some other source of authority, to require individuals to buy health insurance. It was a question that went directly to the structure of American government and the allocation of power within the federal system.

The court very nearly got the answer wrong with an exceedingly narrow reading of Congress’s commerce power. As everyone remembers, Chief Justice John G. Roberts Jr., himself a member of the anti-Commerce Clause five, saved the day by declaring that the penalty for not complying with the individual mandate was actually a tax, properly imposed under Congress’s tax power.

I thought the court was seriously misguided in denying Congress the power under the Commerce Clause to intervene in a sector of the economy that accounts for more than 17 percent of the gross national product. But even I have to concede that the debate over structure has deep roots in the country’s history and a legitimate claim on the Supreme Court’s attention. People will be debating it as long as the flag waves.

But the new Affordable Care Act case, King v. Burwell, to be argued four weeks from now, is different, a case of statutory, not constitutional, interpretation. The court has permitted itself to be recruited into the front lines of a partisan war. Not only the Affordable Care Act but the court itself is in...

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Friday, January 23, 2015

1,700 Hospitals Win Quality Bonuses From Medicare, But Most Will Never Collect

Today's post was shared by Kaiser Health News and comes from kaiserhealthnews.org

Medicare is giving bonuses to a majority of hospitals that it graded on quality, but many of those rewards will be wiped out by penalties the government has issued for other shortcomings, federal data show.

As required by the 2010 health law, the government is taking performance into account when paying hospitals, one of the biggest changes in Medicare’s 50-year-history. This year 1,700 hospitals – 55 percent of those graded – earned higher payments for providing comparatively good care in the federal government’s most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare. This incentive program, known as value-based purchasing, led to penalties for 1,360 hospitals.

However, fewer than 800 of the 1,700 hospitals that earned bonuses from this one program will actually receive extra money, according to a Kaiser Health News analysis. That’s because the others are being penalized through two other Medicare quality programs: one punishes hospitals for having too many patients readmitted for follow-up care and the other lowers payments to hospitals where too many patients developed infections during their stays or got hurt in other ways.

When all these incentive programs are combined, the average bonus for large hospitals — those with more than 400 beds — will be nearly $213,000, while the average penalty will be about $1.2 million, according to...

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Monday, July 20, 2020

Coronavirus (COVID-19) - The workers' compensation community should support TTSI

The workers' compensation community should play an active role to contain the spread of COIVD-19. Labor, Industry and insurance companies must be encouraged to participate in contact tracing, testing and supported isolation [TTSI]. All reports of illness and incidents of COVID-19 should trigger reportable investigations that are co-ordinated with local and state health agencies. Communication with employees should be encouraged for testing, isolation and expansion of contact testing.

Spinal fusions serve as case study for debate over when certain surgeries are necessary

The necessity of medical treatment is coming under increased questioning as payers want to rein in costs. This article is shared from the washingtonpost.com.

By some measures, Federico C. Vinas was a star surgeon. He performed three or four surgeries on a typical weekday at the Daytona Beach, Fla., hospital that employed him, and a review showed him to be nearly five times as busy as other neurosurgeons. The hospital paid him hundreds of thousands in incentive pay. In all, he earned as much as $1.9 million a year.

Yet given his productivity, some hospital auditors wondered: Was all of the surgery really necessary?

To answer that question, the hospital in early 2010 paid for an independent review of cases in which Vinas and two other neurosurgeons had performed a common procedure known as a spinal fusion. The review was conducted by board-certified neurosurgeons working for AllMed, a company accredited to audit health-care businesses.

Of 10 spinal fusions by Vinas that were selected, nine were deemed not medically necessary, according to a summary of the report.

Vinas is still working at Halifax Health, and a hospital spokesman said that, after the AllMed report, the hospital conducted an internal review that validated his surgeries. Another review conducted this year in response to litigation also validated them, the spokesman said. The hospital would not answer further questions or release details of those reviews.

Vinas “has never and will never perform an unnecessary surgical procedure on any patient,” his attorney, Robert H. Pritchard, said in a statement.

More than 465,000...

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Thursday, January 5, 2012

Contagion in The Workplace: Ready or Not

The recent scientific announcement that scientists have developed an airborne strain of a highly contagious and deadly H5N1 flu virus brings to front burner the issue, once again, of whether the workers' compensation system is ready to respond effectively to a large spread viral epidemic.

Whether the release is because of an unintentional act, or a terrorist attack, the workers' compensation system has not established a protocol for responding with urgent medical care and an elaborate and expedited medical delivery and benefit system.

Read more: Debate Persists on Deadly Flu Made Airborne (NY Times)

“This research should not have been done,” said Richard H. Ebright, a chemistry professor and bioweapons expert at Rutgers University who has long opposed such research. He warned that germs that could be used as bioweapons had already been unintentionally released hundreds of times from labs in the United States and predicted that the same thing would happen with the new virus.

“It will inevitably escape, and within a decade,” he said.

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Thursday, September 5, 2013

Confirmed: Fracking practices to blame for Ohio earthquakes

Today's post was shared by Mother Jones and comes from www.nbcnews.com

Wastewater from the controversial practice of fracking appears to be linked to all the earthquakes in a town in Ohio that had no known past quakes, research now reveals.

The practice of hydraulic fracturing, or fracking, involves injecting water, sand and other materials under high pressures into a well to fracture rock. This opens up fissures that help oil and natural gas flow out more freely. This process generates wastewater that is often pumped underground as well, in order to get rid of it.

A furious debate has erupted over the safety of the practice. Advocates claim fracking is a safe, economical source of clean energy, while critics argue that it can taint drinking water supplies, among other problems.

One of the most profitable areas for fracking lies over the geological formation known as the Marcellus Shale, which reaches deep underground from Ohio and West Virginia northeast into Pennsylvania and southern New York. The Marcellus Shale is rich in natural gas; geologists estimate it may contain up to 489 trillion cubic feet (13.8 trillion cubic meters) of natural gas, more than 440 times the amount New York State uses annually. Many of the rural communities living over the formation face economic challenges and want to attract money from the energy industry.

Youngstown quakesBefore January 2011, Youngstown, Ohio, which is located on the Marcellus Shale, had never experienced an earthquake, at least not since researchers began observations in 1776....

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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Nuclear Operator Raises Alarm on Crisis (workers-compensation.blogspot.com)
Statement on malignant mesothelioma in the United Kingdom (workers-compensation.blogspot.com)
Has the Internet Raised or Lowered Healthcare Costs? (workers-compensation.blogspot.com)
Lots of data to process for Calif. lead paint judge (workers-compensation.blogspot.com)
Respirators Are Not Enough: New Study Examines Worker Exposure to Silica in Hydraulic Fracturing Operations (workers-compensation.blogspot.com)
CDC estimates Lyme disease hits 300,000 each year (workers-compensation.blogspot.com)
Needlestick Injuries Are a Costly Problem for the Health Care Industry (workers-compensation.blogspot.com)

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Saturday, October 5, 2013

Now the Government Shutdown Is Stopping Blood Drives

Today's post was shared by Mother Jones and comes from www.motherjones.com

Here's how the government shutdown may literally be killing people: by causing blood shortages.

For all the scorn heaped on government employees, some people forget that the faceless bureaucrats who populate Washington are often, in fact, a bunch of do-gooders—people who genuinely believe in the notion of public service. As such, they contribute to the public good in a lot of ways that are taken for granted, like their immense contribution to local blood banks. Thirty-eight percent of the population is eligible to give blood, but only 5 percent actually does so. A lot of that 5 percent apparently works for the federal government. Thanks to the shutdown, in just two days, four federal agency blood drives scheduled by one DC-area health care system have been canceled. The regional Red Cross has had to cancel six others in the Washington region.

Inova Blood Donor Services projects that the cancelations will result in its projected loss of 300 donations that would have helped 900 patients in DC, Maryland, and Virginia. Inova's donated blood collections supply 24 hospitals, which bank much of the blood for inevitable disasters or, say, terrorist attacks. The Red Cross is suffering from similar disruptions, projecting the loss of 229 donations, each of which could potentially save up to three lives. A single major trauma event can easily deplete a hospital's entire blood store. The longer the shutdown goes on, the...

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Wednesday, November 20, 2013

New obesity treatment guideline released

Monday, December 1, 2014

Suit on Health Law Puts Focus on Funding Powers

Friday, April 30, 2010

OSHA Releases 15 Years Worth of Valuable Measurement Data

Sunday, September 28, 2014

Debate Grows Over Employer Plans With No Hospital Benefits

Thursday, November 13, 2014

MEDICAL PAYMENTS PER CLAIM IN FLORIDA WERE TYPICAL OF STUDY STATES AND GREW AT A MODERATE RATE FROM 2007 TO 2012, SAYS NEW STUDY

Friday, August 23, 2013

UPS Won’t Insure Spouses Of Some Employees

Wednesday, October 23, 2013

Questioning Statins for Older Patients

Monday, September 1, 2014

The Medicare Miracle

Thursday, October 2, 2014

Maine Rolls Back Health Coverage Even As Many States Expand It

Thursday, October 30, 2014

Threat of Lawsuit Could Test Maine’s Quarantine Policy

Tuesday, July 13, 2010

Synchronizing Federal Care for Oil Spill Workers

Saturday, February 7, 2015

Overturning Obamacare Would Change the Nature of the Supreme Court

Friday, January 23, 2015

1,700 Hospitals Win Quality Bonuses From Medicare, But Most Will Never Collect

Monday, July 20, 2020

Coronavirus (COVID-19) - The workers' compensation community should support TTSI

Tuesday, October 29, 2013

Spinal fusions serve as case study for debate over when certain surgeries are necessary

Thursday, January 5, 2012

Contagion in The Workplace: Ready or Not

Thursday, September 5, 2013

Confirmed: Fracking practices to blame for Ohio earthquakes

Saturday, October 5, 2013

Now the Government Shutdown Is Stopping Blood Drives

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For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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