Copyright
Monday, April 12, 2010
The Health Reform Act Charts a New Course for Occupational Health Care
Tuesday, January 1, 2013
Workers’ Compensation 2013 – What Happens on the Other Side of The Fiscal Cliff?
Overall health care devours 18 percent of the US economy and amounts to 25% of the Federal budget.
Medical treatment for injured workers continues to be delayed, denied and limited under current workers’ compensation programs. Medical costs continue to be shifted to other programs including employer based medical care systems and the Federal safety net of Medicare, Medicaid, Veterans Administration and Tricare.
While a trend continues to emerge to offer “Opt Out” and “Carve Out Programs,” they are not global enough to solve the critical budget deficit issues. The latest emerging trend is for employers to utilize ERISA based medical care plans to efficiently delivery medical care. In NJ a limited alternate dispute-resolution procedure between unions and employers has been introduced. See “NJ Care Outs –Another Evolutionary Step” authored by David DePaolo.
The US economy continues to be very weak. This in an ominous signal for the nation’s workers’ compensation program which is starved for premium dollars. Premiums are based upon salaries and real median incomes continued their dramatic decline over the last decade from $54,841 in 2000 to $50,054 in 2011. There just may not be enough dollars available in the workers’ compensation programs to pay for present and lifetime medical care.
Even the present Federal system leaves much to be desired. Whether Federal rationing medical care becomes a reality is unknown. Physicians are under economic scrutiny as the “Doc Fix” to limit provider fees continues as a cloud over all medical programs. The agreement reached by Congress still does not resolve the 26.5% percent cut reimbursement cut to physicians who treat Medicare patients. The law merely "freezes" payment to physicians.
Workers’ compensation programs presently structured provide no real economic incentive to monitor and compensate for more favorable medical outcomes. On the other hand, the Federal government, with broad and sweeping regulatory ability, is able to continue to make strides in many areas including present incentives to hospitals and proposed incentives to physicians to provide medical treatment with fewer complications and ultimate better outcomes
Steven Ratner in the NY Times points out the dramatic increase in the nation’s health care costs. He wrote, “…no budget-busting factor looms larger than the soaring cost of government-financed health care, particularly Medicare and Medicaid.”
Now that we are on the other side of the fiscal cliff, the opportunity to be creative is possible. The US needs to transition to a single-payer health care system subsuming a medical care program for injured and ill workers who suffer both traumatic and occupational conditions.
Read more about the "single-Payer System" and workers' compensation
Workers' Compensation: A Single Payer System Will Solve the ...
Nov 29, 2012
The question is whether the nation will recognize that the US needs tol take the bold step previously taken by the European Community, finally adopt a single payer medical care program. The perpetual cost generator that ...
http://workers-compensation.blogspot.com/
NJ Urged to Adopt Single Payer System for Workmens Comp
Jun 06, 2011
NJ Urged to Adopt Single Payer System for Workmens Comp. A coalition that has been formed in NJ is urging that the Garden State follow the lead of Vermont and establish a single-payer system. Single-payer movements ...
http://workers-compensation.blogspot.com/
Vermont Single Payer System Called the Dawn of A New Era
Apr 03, 2011
The proposed state based Vermont Single-Payer health care system, that would embrace workers' compensation medical care, is gaining momentum. A recent article in the New England Journal of Medicine, citing increased ...
http://workers-compensation.blogspot.com/
RICO Issues Can Be Cured With A Single Payer Medical System
Mar 22, 2011
Vermont's proposed single payer system would seperate medical care from indemnity. Vermont's single proposed single-payer system would likely also provide a primary care doctor to every resident of Vermont. This would ...
http://workers-compensation.blogspot.com/
Monday, November 24, 2014
When An Employer Should Not Deny Medical Care
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- Benzene Exposure Claim: Court Dismisses Alleged Fatal Multiple Myeloma (workers-compensation.blogspot.com)
- Workers' Compensation changes found unconstitutional in Florida and may effect California injured workers (workers-compensation.blogspot.com)
- Mississippi courts still sympathetic to lung litigation in wake of scandal (workers-compensation.blogspot.com)
- Oklahoma Firefighter Widow Wins Workers' Compensation Case (workers-compensation.blogspot.com)
- NJ Court Sets the Evidentiary Proof Standard for a Pulmonary - Cardiovascular Claim (workers-compensation.blogspot.com)
- Nebraska Supreme Court: Workers' comp includes PTSD, drug treatment after store shooting (workers-compensation.blogspot.com)
- Jury weighs talcum powder-cancer link (workers-compensation.blogspot.com)
Sunday, January 8, 2012
PROTECT America's Injured Worker Medical Rights
Why This Is Important
Injured workers are forced to obtain treatment from an inadequate, unspecialized list of providers, often with disastrous long term results and are barred from both timely and appropriate medical treatment through a complex paper trail of denials for basic medical care.
Before long, we’ll have to pay our employers when we’re injured, rather than the other way around.
Deliberate indifference is defined as requiring (1) an "awareness of facts from which the inference could be drawn that a substantial risk of serious harm exists" and (2) the actual "drawing of the inference." Elliott v. Jones, 2009 U.S. Dist. LEXIS 91125 (N.D. Fla. Sept. 1, 2009). (Wikipedia, 2011)
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- Huntsman Steps Up To Reform Workers' Compensation (workers-compensation.blogspot.com)
- Gingrich Calls Present Workers' Compensation System Dangerous (workers-compensation.blogspot.com)
- Contagion in The Workplace: Ready or Not (workers-compensation.blogspot.com)
- The Top 10 Workers' Compensation Blog Posts for 2011 (workers-compensation.blogspot.com)
- Penalties for Insurance Companies Who Fail to Pay Enough for Medical Care (workers-compensation.blogspot.com)
- The World Trade Center Health Program Expands The Path to Federalization (workerscompensation.com)
Wednesday, April 10, 2019
An Employer Must Provide Accommodation for Off-Hours Use of Medical Marijuana
Monday, December 3, 2018
Fee Schedules: A defense of bureaucracy in workers compensation
Friday, February 1, 2013
Universal Medical and Workers' Compensation: It's Not "If", It's "When" - California
My friend, and cycling inspiration, who keeps me trying to think I can enter the Tour de France while under the influence of Starbucks coffee, David DePaolo, points out that the "fusion" may be coming slowly through legislation of unintended consequences in California.
"The concept of universal care, 24 hour care, single stop shop, etc. has been floating for a couple of decades now with very little progress.David, an expert in analyzing what's around the curve, sees the next wave of change coming to workers' compensation. For so many reasons, including the expansion/reimbursement integration of the Medicare program, the writing is on the wall on this one.
"But the passage of the Affordable Care Act, the signing of HB 1 back in February 2009, and other Federal health related laws and regulations including ERISA, have accelerated the fusion of workers' compensation medicine and general health medicine. Outsourcing MPN [Medical Provider Networks] oversight to a health care related agency is just another step towards this outcome.
Every time the lobbyists think that have eliminated the imminent threat of Federal intrusion, ie. Enactment of The SMART Act, the reality of which is that the regulations will eat up the statute, and also their lunch. I plan to write more on The SMART Act in the coming weeks. Maybe that wasn't so smart after all for the cottage industries that supported it.
Sunday, January 11, 2015
High Compensation Medical Costs Raises Concern in New Hampshire
Lawmakers should make 2014 the last year that doctors and other health care providers are guaranteed payment no matter how much they charge when a worker is injured on the job. The workers’ compensation system is broken.
The state, and the employers who pay into its workers’ compensation fund, have been paying two and three times the going rate for medical services when the patient is a workers’ compensation recipient. On average, surgeons charge 156 percent more, according to a report by the state’s Department of Insurance. Bills for radiology are 107 percent higher, 95 percent higher for occupational therapy and for something as simple as an ice pack, 300 percent more.
The extra paperwork required to document workers’ compensation cases and perhaps the added severity of the average injury, probably explains some of the price difference. But, human nature being what it is, it’s likely that, when the bill has to be paid no matter what the provider charges, the temptation to pad it can be irresistible, especially when providers can rationalize the surcharge by using it to offset underpayments in areas such as Medicare or Medicaid.
Thursday, October 24, 2013
California: Medical Delay and Denial Protested
Operating Room Nurse Debbye Mazzucca, of La Mesa, has thirty-five years’ experience, and worked for Kaiser for 12 years. She was injured in 1998, when she tripped and fell over a parking lot barrier while at work. Kaiser treated her injured knee, but ignored multiple doctors’ reports that she had also injured her neck and back. In spite of four doctors reports confirming that fact, Kaiser denied that those injuries were from the fall. Now, due to complications from medications, and delays in approving medical care, Ms. Mazzucca has lost her teeth.
CAAA President Jim Butler said, “Insurers’ Utilization Review (UR) routinely delays and denies doctors’ legitimate requests for appropriate medical treatment. This is unnecessary and expensive, and has got to change. We’ve seen the evidence of out-of-control delay and denial in the 15,000 denials of recommended medical care in just the month of August. It’s time to bring UR to heel, and stop insurance carriers from using it as a routine roadblock.”
“A doctor, agreed to by the company and their insurer, determined this Kaiser operating room nurse’s injury was a result of her work accidents. The insurer still refused to provide urgent medical care. A judge ordered the insurer to provide urgently needed medical care. But Sedgwick continues to refuse medical care and Debbye lost all her teeth during the months of delay,” said Alicia Hawthorne, the president of CAAA’s San Diego chapter, and Ms. Mazzucca’s attorney. “This nurse has been in pain, and in need of medical treatment. Yet, the insurance company defied a judge’s order to provide care. Kaiser and its insurer have spent years fighting their responsibility to treat these injuries. Why does the State of California allow workers’ compensation insurance companies to further damage patients through delaying and denying medical care and disability compensation?”
“Kaiser has failed to provide the care needed to heal my injuries,” Mazzucca told a news conference outside Kaiser Foundation Hospital in San Diego. “For years, all they would approve were painkilling drugs. These drugs’ side effects have caused more medical problems, including ‘dry mouth syndrome,’ which is insidious and dangerous. The drugs prevent your saliva glands from working properly, causing your teeth and gums to deteriorate. Mine became infected, abscessed and threatened my health and my life. In 2010, my teeth started cracking and breaking off at the roots. I lost seven of my teeth this way.”
Sedgwick denied the dental treatment I needed, so Ms. Mazzucca took them to court. In February 2013, the judge ordered Sedgwick to provide this urgent medical treatment. To this day, they have refused to do so. “It has been more than a year and a half since the medical expert the insurer agreed upon said I urgently needed dental care. The pain and infection became so unbearable in July that my doctor sent me to the emergency room, and 25 of my teeth were removed. I then spent the entire month of July in the hospital, in agony, and on painkillers. Kaiser and their insurance company are defying a judge’s order to provide urgently needed medical care,” said Mazzucca.
Today’s release is the fourth in CAAA’s series of cases spotlighting the abuse of Utilization Review (UR) and other methods for delaying and denying legitimate medical care and disability compensation in the workers’ compensation claims handling practices of insurers like Sedgwick Claims Management Services.
Related articles
- Florida rejects workers' compensation rate hike (workers-compensation.blogspot.com)
- Where is the Deep Water? (workers-compensation.blogspot.com)
- Study: Calif. workers compensation overhaul too new to parse (workers-compensation.blogspot.com)
- The Government Shutdown is a Kick-In-Gut to Workers' Compensation (workers-compensation.blogspot.com)
- Is Workers' Compensation Just a Promise That Can't Be Kept? (workers-compensation.blogspot.com)
- New York Second in Nation for Questionable Workers' Compensation Claims (workers-compensation.blogspot.com)
Monday, January 5, 2015
NJ Medical Costs Per Claim Increase
NJ is a jurisdiction where the employer has exclusive control over the selection of medical providers for workers' compensation claims. NJ also has no medical fee schedule. Neverthe less, WCRI report that medical costs per claim are increasing above the national average.
The report, CompScope™ Medical Benchmarks for New Jersey, 15th Edition, found medical payments per claim grew less than 3 percent per year from 2010 to 2012―about half the annual rate of the prior three years.
The study cited changes in both key components of medical payments per workers’ compensation claim: the price paid for each service rendered and the number of services performed in each claim (generally called utilization).
The study found a decrease or little change in utilization of many nonhospital services─a key factor in the recent slower growth in medical costs because payments for nonhospital care accounted for roughly two-thirds of medical payments in New Jersey. Slower growth in hospital outpatient payments per service was also a factor. Payments for hospital inpatient treatment continued to rise though.
The recent trends coincided with an increase in the use of networks in caring for injured workers. States that do not regulate reimbursements for medical care through a traditional fee schedule (like New Jersey) often use medical networks to help control medical costs through the management of claims and negotiated payment discounts.
Despite the recent slower growth, medical payments per claim in New Jersey remained higher than most of the 16 states WCRI studied, primarily due to higher prices paid for medical care.
In several states, WCRI researchers saw slowdowns in claims growth similar to what they found in New Jersey, namely growth of 3 percent or less from 2010 to 2012, after growth of 4 to 8 percent a year, on average, from 2007 to 2010. Reasons for the slowdown differed by state, the study said.
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_NJ_result.html
Monday, October 23, 2017
Electronic Medical Bills for Workers' Compensation Claims
Thursday, December 11, 2008
Medical Costs Soar in Workers' Compensation
Wednesday, November 18, 2015
NJ Medical Payments Stabilize - But Why?
- Increased use of networks, which may be linked to a decrease in prices paid for non hospital care. In recent years, two-thirds of total medical payments came from non hospital services.
- Flat or decreasing trends in utilization of many non hospital services.
- Slower growth in hospital outpatient payments per service.
- A continued decrease in the percentage of claims that had hospital inpatient care.
Related articles
- NJ State Bar Association Opposes Workers' Compensation COLA Bill (workers-compensation.blogspot.com)
- NJ Medical Costs Per Claim Increase (workers-compensation.blogspot.com)
- High Compensation Medical Costs Raises Concern in New Hampshire (workers-compensation.blogspot.com)
Sunday, December 19, 2010
Medical Witness Cannot Be An Advocate - Knee Replacement Surgery Authorized
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- Defective Artificial Hips Maybe a Costly problem for Workers' Compensation (workers-compensation.blogspot.com)
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- Insurance Company Liable in Tort for Delay of Medical Treatment
- The Health Reform Act Charts a New Course for Occupational Health Care