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Showing posts sorted by date for query opioids. Sort by relevance Show all posts
Showing posts sorted by date for query opioids. Sort by relevance Show all posts

Wednesday, May 7, 2014

Employers Eye Moving Sickest Workers To Insurance Exchanges

Today's post is shared from Kaiser.org
Can corporations shift workers with high medical costs from the company health plan into online insurance exchanges created by the Affordable Care Act? Some employers are considering it, say benefits consultants.
"It's all over the marketplace," said Todd Yates, a managing partner at Hill, Chesson & Woody, a North Carolina benefits consulting firm. "Employers are inquiring about it and brokers and consultants are advocating for it."


Health spending is driven largely by patients with chronic illness such as diabetes or who undergo expensive procedures such as organ transplants. Since most big corporations are self-insured, shifting even one high-cost member out of the company plan could save the employer hundreds of thousands of dollars a year -- while increasing the cost of claims absorbed by the marketplace policy by a similar amount.
And the health law might not prohibit it, opening a door to potential erosion of employer-based coverage.
"Such an employer-dumping strategy can promote the interests of both employers and employees by shifting health care expenses on to the public at large," wrote two University of Minnesota law professors in a 2010 paper that basically predicted the present interest. The authors were Amy Monahan and Daniel Schwarcz.
It's unclear how many companies, if any, have moved sicker workers to exchange coverage, which became available only in January. But even a few high-risk patients could add...
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Wednesday, April 16, 2014

Prices Soaring for Specialty Drugs, Researchers Find

Workers' Compensation insurance covers the FULL cost of prescription drugs.Today's post was shared by The New York Times and comes from www.nytimes.com

Even as the cost of prescription drugs has plummeted for many Americans, a small slice of the population is being asked to shoulder more and more of the cost of expensive treatments for diseases like cancer and hepatitis C, according to a report to be released on Tuesday by a major drug research firm.
The findings echo the conclusions of two other reports released last week by major pharmacy benefit managers, which predicted that spending on so-called specialty drugs would continue to rise.
The report, by the IMS Institute for Healthcare Informatics, also found that consumers’ use of health care — visits to the doctor, hospital admissions and prescription drug use — rose in 2013 for the first time in three years, mainly because of the improving economy, it said.
“Following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. health care system,” Murray Aitken, executive director of the IMS Institute, said in a statement. He noted that the spike came before the Affordable Care Act, which has helped provide health insurance to millions of new customers, fully went into effect.
But even as consumers became more confident about spending money on health care last year, the report found that a divide is developing between those with medical conditions that can be treated with cheap generic drugs, and those with rare and often more serious diseases that can come with breathtaking price tags.
More than...
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Related Articles:
Dec 18, 2013
A major international pharmaceutical company has made a major change in strategy for the sale of prescription drugs. Part of the change was induced by the economics of litigation and the threat additional lawsuits. Today's ...
Jul 12, 2012
Prescription drugs have become an increasingly important issue in workers' compensation law. Their use in workers' compensation claims has resulted in both a major direct financial cost to the system, and has had .
Jun 18, 2013
The CDC latest statistics show close to 40,000 drug overdose deaths each year in the United States, more than half of which involve prescription drugs. Deaths in which opioids are used now exceed deaths involving heroin ...

Friday, March 28, 2014

Nurse Ratched Comes To Workers' Compensation or Why Workers' Compensation Should NOT be Involved in Criminal Drug Enforcement

State officials and legislators are increasingly concerned with the over-prescription of opiates and other controlled substances for pain management in the workers’ compensation program.

A bill pending in...

[Click here to see the rest of this post]

Related Story:
Workers' Compensation: Physicians Petition to Limit Opioid Abuse
Jul 27, 2012
The efforts to reform pharmacuetical use is a tough balancing act. The ulterior motive of cost savings and profits generates sensationalism, but what makes good medical sense and what benefits the patient should not go ...
http://workers-compensation.blogspot.com/

Wednesday, December 11, 2013

Characterizing the quality of supportive cancer care can guide quality improvement of veterans

Objective  To evaluate nonhospice supportive cancer care comprehensively in a national sample of veterans.
Design, Setting, and Participants  Using a retrospective cohort study design, we measured evidence-based cancer care processes using previously validated indicators of care quality in patients with advanced cancer, addressing pain, nonpain symptoms, and information and care planning among 719 veterans with a 2008 Veterans Affairs Central Cancer Registry diagnosis of stage IV colorectal (37.0%), pancreatic (29.8%), or lung (33.2%) cancer.
Main Outcomes and Measures  We abstracted medical records from diagnosis for 3 years or until death among eligible veterans (lived ≥30 days following diagnosis with ≥1 Veterans Affairs hospitalization or ≥2 Veterans Affairs outpatient visits). Each indicator identified a clinical scenario and an appropriate action. For each indicator for which a veteran was eligible, we determined whether appropriate care was provided. We also determined patient-level quality overall and by pain, nonpain symptoms, and information and care planning domains.
Results  Most veterans were older (mean age, 66.2 years), male (97.2%), and white (74.3%). Eighty-five percent received both inpatient and outpatient care, and 92.5% died. Overall, the 719 veterans triggered a mean of 11.7 quality indicators (range, 1-22) and received a mean 49.5% of appropriate care. Notable gaps in care were that inpatient pain screening was common (96.5%) but lacking for outpatients (58.1%). With opioids, bowel prophylaxis occurred for only 52.2% of outpatients and 70.5% of inpatients. Few patients had a timely dyspnea evaluation (15.8%) or treatment (10.8%). Outpatient assessment of fatigue occurred for 31.3%. Of patients at high risk for diarrhea from chemotherapy, 24.2% were offered appropriate antidiarrheals. Only 17.7% of veterans had goals of care addressed in the month after a diagnosis of advanced cancer, and 63.7% had timely discussion of goals following intensive care unit admission. Most decedents (86.4%) were referred to palliative care or hospice before death. Single- vs multiple-fraction radiotherapy should have been considered in 28 veterans with bone metastasis, but none were offered this option.
Conclusions and Relevance  These care gaps reflect important targets for improving the patient and family experience of cancer care.

Thursday, October 31, 2013

DePaolo's Work Comp World: Trucks, WBV and Cancer

The National Cancer Institute (NC!) reports that over 230,000 males in the US will diagnosed with prostate cancer in 2013 and that 29,790 deaths will result. David DePaolo, published of WorkCompCentral®, writes today of the potential new wave of workers' compensation claims arising from the association of whole-body vibration syndrome (WBV) experienced by truck drivers and its relationship to prostate cancer. He links source material to support the argument. This post is shared from http://daviddepaolo.blogspot.com .

You just never know what the next big risk category is going to be in workers' compensation.
I had been persuaded by an argument offered by Charlie Kingdollar, Vice President emerging issues unit for General Re Corp., that nanomaterials would be the next asbestos.

OSHA has been particularly concerned with silica in the past couple of years.

Wednesday, October 30, 2013

F.D.A. Shift on Painkillers Was Years in the Making

Narcotic pain killers have been the subject of concern and regulation by employers' and their insurance carriers nationally. The evolution of the FDA proposed action to regulate is revealed in today's post is shared from the NYTimes.com

When Heather Dougherty heard the news last week that the Food and Drug Administration had recommended tightening how doctors prescribed the most commonly used narcotic painkillers, she was overjoyed. Fourteen years earlier, her father, Dr. Ronald J. Dougherty, had filed a formal petition urging federal officials to crack down on the drugs.

Dr. Dougherty told officials in 1999 that more of the patients turning up at his clinic near Syracuse were addicted to legal narcotics like Vicodin and Lortab that contain the drug hydrocodone than to illegal narcotics like heroin.

Since then, narcotic painkillers, or opioids, have become the most frequently prescribed drugs in the United States and have set off a wave of misuse, abuse and addiction. Experts estimate that more than 100,000 people have died in the last decade from overdoses involving the drugs. For his part, Dr. Dougherty, who foresaw the problem, retired in 2007 and is now 81 and living in a nursing home.
“Too many lives have been ruined,” his daughter said.

The story behind the F.D.A.’s turnaround on the pain pills, last Thursday, involved a rare victory by lawmakers from states hard hit by prescription drug abuse over well-financed lobbyists for business and...
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Thursday, October 24, 2013

FDA Proposes Changes in Pain Medication Prescriptions

The US FDA has announced proposed changes will be forthcoming in labeling for pain relief medication:
Consumers and health care professionals will soon find updated labeling for extended-release and long-acting opioid pain relievers to help ensure their safe and appropriate use.
"In addition to requiring new labeling on these prescription medications, the Food and Drug Administration (FDA) is also requiring manufacturers to study certain known serious risks when these drugs are used long-term.
"The new labeling requirements and other actions are intended to help prescribers and patients make better decisions about who benefits from the use of these medications.

They also are meant to reduce problems associated with their use," says Douglas Throckmorton, M.D., deputy director of regulatory programs in FDA's Center for Drug Evaluation and Research. "Altogether, the actions we're now announcing are part of FDA's efforts to make opioids as safe as possible for those who need them," Throckmorton adds.
"He noted that the actions come after careful analysis of new safety information, including reviews of medical literature, and consideration of input from patients, experts and many other interested parties.

Tuesday, October 1, 2013

Bill Creating Clear Guidelines in Dispensing of Opiod Medications Introduced in New Jersey Senate

The post today is authored by John H. Geaney, Esq. of the NJ Bar, and is shared via njworkerscompblog.com

Opioid medications have become a major problem in the New Jersey workers’ compensation system.  The number of workers being prescribed opioids has increased dramatically along with other attendant problems, such as addictions to the medications, excessive periods of use, and large numbers of unused opioid pills due to over-prescribing. 

Every workers’ compensation professional can attest to these and other problems with opioid medications, not to mention cases where urine testing shows no trace of opioids in the system despite repeated renewals of opioid prescriptions.

On September 30, 2013, Senator Raymond Lesniak and Senator Stephen Sweeney introduced a bill in the New Jersey Senate proposing that medical expenses shall not include coverage of opioid drugs unless the prescribing doctor does the following:

1) takes a thorough medical history and physical examination focusing on the cause of the patient’s pain;

2) does a complete assessment of the potential addiction of the patient to opioids, which would include a baseline urine test and assessment of past and current depression, anxiety disorders and other mood disorders associated with risk of opioid abuse;

3) provides a written treatment plan with measurable objectives, a list of all medications being taken and dosages, a justification for the continued use of opioid...
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Tuesday, July 2, 2013

New Vital Signs Report How has the prescription painkiller overdose epidemic grown in women

The prescription painkiller epidemic is killing more women than ever before. New data shows prescription painkiller overdose deaths among women have skyrocketed. Since 1999, the percentage increase in deaths was more than 400 percent among women compared to 265 percent in men.

"About 18 women die every day of a prescription painkiller overdose in the US, more than 6,600 deaths in 2010. Prescription painkiller overdoses are an under-recognized and growing problem for women."

To read more about this report click here: US CDC

Click here to read "Press Release: Prescription Painkiller Epidemic Among Women"

Read more about painkillers and workers' compensation:
Oct 28, 2009
A pharmacy dispensed narcotic painkillers to a Patricia Copening, 35 year old doctor's office receptionist, who killed a 21 year old man in a fatal Las Vegas accident. A case is pending against the seven pharmacies (Wal-Mart, ...
Jun 18, 2013
Labels: Drugs, opioids, pain killers, Prescription medication, workers compensation. Posted by Jon Gelman at Tuesday, June 18, 2013 · Email ThisBlogThis!Share to TwitterShare to Facebook · Newer Post Older Post Home ...
Oct 14, 2011
Researchers from the Centers for Disease Control and Prevention report that Schedule II prescription painkillers, like oxycodone, today cause more drug overdose deaths than cocaine and heroin combined. Oxycodone and ...
Jun 21, 2013
When a physician overprescribes painkillers and the patient dies, it's criminal. Similarly, when a workers' compensation insurance carrier acts the same way, it should be a criminal act,” said Singer. To read the entire letter to ...

Friday, December 28, 2012

Legislation Goes to President Obama on CMS Condition Payment Procedures

The US House (H.R. 1845) and US Senate has passed legislation to modify procedures for processing conditional payments under the Medicare (S. 1718) Secondary Payer Act. It establishes parameters for repording, processing and appealing issues concerning conditional payments.

Under the proposed legislation time periods for reporting by parties to CMS (The Center for Medeicare and Medicaid Services) are eased, penalities for insurance carriers are reduced, and a 3 year statute of limitations is established.

The legislation was merged into another pending bill for medical services and was rushed to a favorable vote in both the House and Senate in the last moments before Christmas.

What remains to be determined are the regulations that will be established to implement the legislation. In the past, such regulations usually set boundries for such legislation and may in the end further complicate and even prolong resolution of the issues.

Read more about "The Medicare Secondary Payer Act" and workers' compensation


Oct 01, 2012
US Supreme Court Denies CMS-MSP Case - Hadden. 2012 WL 1106757. Supreme Court of the United States. HADDEN, VERNON V. UNITED STATES. No. 11-1197.Oct. 1, 2012. Opinion. The petition for writ of certiorari is ...
Apr 03, 2009
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
May 18, 2011
"IT IS FURTHER ORDERED that Defendant's demand for payment of her MSP reimbursement claims, under threat of collection actions before there has been a resolution of an appeal regarding the amount of the Defendant's ...
Dec 23, 2008
A formal process exits to obtain a waiver of an Overpayment Recovery request from The Center for Medicare and Medicaid Services [CMS]. If SSA advises you or your client that it has made an overpayment, ie. Medicare ...


Thursday, December 27, 2012

Who Calls The Shots, Your Employer-Selected Doctor Or The Insurance Company?


Insurance companies sometimes tell doctors that they will not pay for procedures that the doctor says are medically appropriate.

Today's post comes from guest author Nathan Reckman from Paul McAndrew Law Firm.

In Iowa, employers have the right to control an injured worker’s medical care. This means that if you are injured at work, your employer gets to send you to a doctor of their choosing. The doctors chosen by the employer are called “authorized treating physicians.” In theory, after an employer chooses their authorized treating physician, they are required to pay for any care that doctor believes is necessary to treat the work injury. In practice, the employer and their workers’ compensation insurance company often try to interfere with the care the injured worker is entitled to by refusing to pay for procedures or tests recommended by their handpicked doctor.

Typically, when an authorized doctor suggests an expensive course of care (like surgery) the first thing the doctor will do is check with the insurance company to make sure the surgery is going to be paid for. Instead of immediately scheduling the needed surgery, the doctor will wait until the insurance carrier agrees to pay for the procedure. Doctors do this so they don’t have to worry about how they are going to be paid. Asking for this unneeded authorization from the insurance company means the insurance company now has a say in determining what individual procedures are proper for the care of the work injury.

We often see injured workers whose injury was initially accepted by the employer until the doctor requests authorization for an expensive surgery. When faced with the additional cost of surgery, the insurance carrier denies the work injury hoping the injured worker will either forego surgery or try to pay for the surgery through other means, such as their personal health insurance.

This situation may also arise when the authorized doctor recommends expensive diagnostic procedures, like CT scans, or refers the injured worker to a specialist, for example a psychiatrist for depression related to the work injury.

To make sure your rights are protected, it’s often helpful to have an experienced workers’ compensation attorney on your side if you’re facing a situation where your employer is trying to interfere with the decisions of their handpicked doctor. Injured workers should get the care that their doctor, not an insurance company, determines is medically appropriate.

Read more about "medical treatment" and workers' compensation.


Nov 16, 2012
New York Worker's Compensation Board's proposed new medical treatment guidelines that will modify 2010 previously implemented. Adopt the new carpal tunnel syndrome (CTS) medical treatment guidelines (MTG) as the ...
Nov 09, 2012
On Tuesday, the American people expressed its support for a unified medical care program that will embrace all aspects of life, including industrial accidents and diseases. They validated, as did the Supreme Court, the ...
Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...
Jan 22, 2011
The court held that the failure of the employer/insurance carrier to provide medical care for out-of-state treatment, even though requested by the employee, was deemed a refusal of the employer to provide adequate medical ...

Related articles

Monday, December 17, 2012

Slow Recovery Affects Workers' Compensation Benefits and Costs

Today's post comes from guest author Kit Case from Causey Law Firm.
A Press Release by the National Academy of Social Insurance

WASHINGTON, DC - Workers' compensation benefits declined to $57.5 billion in 2010 according to a report released today by the National Academy of Social Insurance (NASI). The drop in workers' compensation benefits was largely due to a 2.1 percent drop in medical benefits for injured workers. Employers' costs for workers' compensation also fell by 2.7 percent in 2010. As a share of covered wages, employers' costs in 2010 were the lowest in the last three decades.

"As a share of covered wages, employers' costs in 2010 were the lowest in the last three decades."

"Employers' costs as a percent of payroll declined in 43 jurisdictions," said John F. Burton, Jr., chair of the study panel that oversees the report. "This decline is probably due to the slow pace of the recovery, with many jurisdictions still experiencing relatively high unemployment rates."

Workers' Compensation Benefits, Coverage, and Costs, 2010
Total
2010
Change   Since 2009 (%)
Covered workers (in thousands)
124,454
-0.3%
Covered wages (in billions)
$5,820
2.6%
Benefits paid (in billions)
$57.5
-0.7%
Medical benefits
$28.1
-2.1%
Cash benefits
$29.5
0.7%
Employer costs (in billions)
$71.3
-2.7%
Per $100 of Covered Wages
2010
Change   Since 2009 ($)
Benefits paid
$0.99
-$0.03
Medical benefits
$0.48
-$0.03
Cash benefits
$0.51
-$0.01
Employers' costs
$1.23
-$0.06
Source: National Academy of Social Insurance, 2012.

The new report, Workers' Compensation: Benefits, Coverage and Costs, 2010, is the fifteenth in the series that provides the only comprehensive data on workers' compensation benefits for the nation, the states, the District of Columbia, and federal programs. 

"This report represents the first time the Academy has released employers' costs by state."

This report represents the first time the Academy has released employers' costs by state. For a table showing employers' costs for all fifty states and the District of Columbia, refer to Table 12 (page 34).

Most states reported a decrease in the number of workers covered but an increase in covered wages between 2009 and 2010. During the same period, the total amount of benefits paid to injured workers declined in 26 jurisdictions and increased in 25. As a share of payroll, benefits paid to injured workers fell by three cents to $0.99 per $100 of payroll in the nation.

The share of medical benefits for workers' compensation has increased substantially over the last 40 years. During the 1970s medical benefits nationally accounted for 30 percent of total benefits, whereas in 2010 the share of benefits paid for medical care was almost 50 percent. Experts attribute this trend to the rising cost of health care.