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(c) 2010-2024 Jon L Gelman, All Rights Reserved.

Saturday, September 28, 2013

Building an Accountable Care Organization and Its Impact on Workers' Compensation

Medical cost containment is a universal problem for insurance companies and employers. For those states with fee schedules indexed to the Medicare system, limitations are in place. For those jurisdiction where fee limitations are not in place, ie. NJ,costs may continue to soar without containment. Today's post was shared by NEJM and comes from blogs.hbr.org

Suppose for a moment that you are an administrator in an organization that provides health care and your job is on the line for delivering both savings and improved care. Because you want to be part of the solution to the health-care-cost problem, you have signed contracts with payers that reward your institution or system for reducing the costs of care. These same contracts require you to pay a penalty if the costs of care go up more than inflation. What would be your first, second, and third move?

This is not a hypothetical question. More than 300 hundred administrators of accountable care organizations (ACOs) across the United States are facing it.

My team at Partners HealthCare in Boston is faced with this exciting (and daunting) challenge. Having signed shared-savings contracts with both commercial payers and Medicare, our CEO, Gary Gottlieb, established a Population Health Management unit. A major focus of our work is to achieve shared savings in our contracts. That means controlling costs for the populations cared for by our primary care physicians. Since doctors and hospitals within Partners bill for a majority of the care these patients receive, you could say our success depends on reducing the income of our colleagues. Harvard Business School’s Clayton Christensen has taught us this is not possible — that an organization will not cannibalize itself.

So when we go knocking on...
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Friday, September 27, 2013

The Impact and Echoes of the Wal-Mart Discrimination Case

This article is shared from propublica.

The post is shared from probulica.org.

Betty Dukes talks to the press on the steps of the U.S. Supreme Court after the class action lawsuit Dukes v. Wal-Mart was argued before the court in Washington, March 29, 2011
(Photo: Reuters)
When the U.S. Supreme Court issued its 5-4 decision in Wal-Mart v. Dukes in June 2011, no one needed a Richter scale to know it was a Big One. In throwing out a mammoth lawsuit by women employees who claimed that they’d been systematically underpaid and underpromoted by the world’s biggest corporation, the ruling upended decades of employment discrimination law and raised serious barriers to future large-scale discrimination cases of every kind.

Employers rejoiced. Others predicted serious setbacks for women and minorities, especially in employment discrimination cases brought under Title VII of the Civil Rights Act of 1964. That landmark law had opened the way to the use of the class-action lawsuit as a potent weapon for people who could not stand up for their rights on their own.
Two years later, it’s becoming clear just how much the ruling has reshaped the American legal landscape.

The Dukes decision has already been cited more than 1,200 times in rulings by federal and state courts, a figure seen by experts as remarkable. Jury verdicts have been overturned, settlements thrown out, and class actions rejected or decertified, in many instances undoing years of litigation. The rulings have come in every part of the country, in lawsuits involving all types of companies,...
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ARE YOU OVEREXPOSING YOURSELF IN SOCIAL MEDIA?

Today's post comes from guest author Laurel Anderson, from Causey Law Firm.
By Laurel Anderson from Causey Law Firm
     Facebook, Twitter, YouTube, LinkedIn, Pinterest, Instagram and other wildly popular social media websites have transformed how people both connect with each other and obtain information about other people. It has also created a change in the legal arena. For our clients who are currently applying for or receiving workers’ comp time loss benefits, or Social Security Disability Insurance (SSDI) benefits, our advice is to keep in mind the importance of privacy settings for both written information and photos on their individual accounts. While a Washington State law went into effect this weekend barring employers from requesting access to Facebook passwords, if your privacy settings are not tight, curious parties can randomly obtain information about you.
While a Washington State law went into effect this weekend barring employers from requesting access to Facebook passwords, if your privacy settings are not tight, curious parties can randomly obtain information about you.
     From our experience, you can now assume that claims managers, employers, and defense attorneys will search for information on the internet regarding your personal life that can impact your claim for benefits. Please make sure that any outdated information regarding your activities is removed from your personal page. Do not use social media to vent about your employer or state agencies that are the decision-makers in your claim. You may be under the impression that only your friends can see your personal page, and that you have some right to privacy. However, be aware that all of the content on your walls, including photos and instant messaging, could be potentially discoverable by your employer or opposing counsel in a litigated case if the content is relevant to your claim for benefits.
     The risk is somewhat less in the SSDI arena since there actually is an agency directive to ALJs and DDS adjudicators that they are not to use social media to research claimants. We nevertheless warn our SSDI clients concerning social media, as we are not convinced that agency people are always playing by the rules, or that those rules may not soon change.
Photo credit: lindes / Foter / CC BY-NC-SA

Antibiotic Resistant Threats in the US, 2013

Healthcare workers have something to worry about. Today's post is shared from the US CDC.

Threat Report 2013

This report, Antibiotic resistance threats in the United States, 2013 gives a first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs having the most impact on human health
Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection.
Antibiotic-resistant infections can happen anywhere. Data show that most happen in the general community; however, most deaths related to antibiotic resistance happen in healthcare settings such as hospitals and nursing homes.

OSHA cites Nebraska Cold Storage for 14 safety violations including ammonia exposure

Proposed fines total $132,800; company placed in Severe Violator Enforcement Program

Nebraska Cold Storage Inc. has been cited for 14 safety violations and fined $132,800 by the U.S. Department of Labor's Occupational Safety and Health Administration for exposing workers to anhydrous ammonia at its Hastings facility. The company has been placed in OSHA's Severe Violator Enforcement Program.

"Ammonia is considered a high health hazard because it can be corrosive to the skin, eyes and lungs. It is flammable at varying concentrations," said Bonita Winingham, OSHA's area director in Omaha. "Businesses that handle hazardous materials must take precautions to protect workers from exposure to chemicals, explosions and fire hazards."

The March inspection was initially conducted under OSHA's high-hazard local emphasis program. It expanded to include all items within the agency's national emphasis program for process safety management for covered chemical facilities. The company provides basic storage and shipping services for the frozen, refrigerated and perishable food industries.

Four willful violations were cited. Some involve PSM violations, including the failure to develop and implement written, safe operating and mechanical integrity procedures and measures to take for physical contact or airborne exposure to anhydrous ammonia. The remaining violations involve failing to correct deficiencies in equipment and to document responses to 2010 compliance audit findings, including 12 of 22 deficient audit items that remained uncorrected. A willful violation is one committed with intentional, knowing or voluntary disregard for, or plain indifference to, employee safety and health.

A total of 10 serious safety violations include lack of emergency action planning; failing to maintain the original ammonia refrigeration systems process hazard analysis; exposing workers to crushing hazards by failing to remove and/or repair damaged storage racks; and failing to evaluate the performance of a powered industrial truck operator every three years. The other violations include failing to prevent electrocution from ice buildup encasing electrical junction boxes; operating equipment within 30 inches of a fork truck charging station; and install fixed wiring and provide strain relief for power cords. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known. The current citations may be viewed at http://www.osha.gov/ooc/citations/Nebraska_Cold_Storage.pdf*

OSHA's Severe Violator Enforcement Program focuses on recalcitrant employers that endanger workers by committing willful, repeat or failure-to-abate violations. Under the program, OSHA may inspect any of the employer's facilities if it has reasonable grounds to believe there are similar violations.

The company has 15 business days from receipt of the citations and notice of proposed penalties to contest the citations and proposed penalties before the independent Occupational Safety and Health Review Commission. If a company does not file or contest within that period, it must abate the cited conditions within the period ordered in the citations and pay the proposed penalties.

Mets’ Harvey Is Covered Like Any Other Employee With a Workplace Injury

Today's post  comes from www.nytimes.com


If Mets pitcher Matt Harvey has Tommy John surgery on his right elbow, it will be paid for, partly, with workers’ compensation insurance. A partly torn ulnar collateral ligament like Harvey’s is considered a workplace injury, just as if he were a truck driver hurt on a loading dock.
The basic agreement between major league owners and players requires that teams pay the cost of injuries.

“The employer gets to recover, as an offset, any workers’ compensation recovery that is available,” said Rob Manfred, an executive vice president of Major League Baseball. “And the club is on the hook for what workers’ compensation doesn’t pay.”

At some point after an operation or procedure, a player signs a form that allows his team to pursue the insurance claim. So if workers’ compensation did not pay the full cost of Derek Jeter’s surgery for a fractured left ankle last year, the Yankees made up the difference — essentially the cost of doing business.

“The player never sees a bill,” Manfred said.

Another factor is that the cost of Tommy John surgery is not uniform. Dr. James Andrews, the renowned orthopedic surgeon, might charge more than the Hospital for Special Surgery, where the Mets’ medical director, David Altchek, is an orthopedic surgeon. (Andrews prescribed a six- to eight-week rehabilitation program for Harvey earlier this week that would precede any decision to operate.)

Altchek...

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Some players may be out of NFL deal

Today's post was shared by CAAA and comes from espn.go.com


NFL Concussion Settlement Details
New details from the NFL's $765 million proposed concussion settlement reveal that the first players diagnosed with football-related brain damage would be shut out of the deal. And with the number of confirmed brain damage cases growing, some players and attorneys told "Outside the Lines" they fear there isn't enough money to cover all eligible players diagnosed with such injuries.

Former players report widespread confusion over who will qualify for compensation and how the money will be distributed. Details described to "Outside the Lines" by sources familiar with the settlement -- along with new statistics on the incidence of football-related brain damage -- underscore the concerns voiced by some players and lawyers:

• The proposed settlement disqualifies most players who died before 2006, even if they were diagnosed with football-related brain damage. That would shut out the relatives of players like Hall of Fame Pittsburgh Steelers center Mike Webster, who died in 2002 and was later diagnosed with the first case of football-related brain damage. Webster's protracted battle with the NFL raised public awareness and helped ignite the NFL's concussion crisis.

A source familiar with the negotiations said the NFL sought to include only death claims that fell within the statute of limitations -- two years in most states. That would have cut out many players who died before 2009 and 2010. As part of the negotiations, representatives of the...
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