Insights Affecting Risk Management and Self-insurance
Quick reviews of new studies and related insights
affecting risk management and self-insurance.
We deal in conclusions, not opinions.
Workers' Compensation Research Institute: Special EditionMar. 16, 2017
Every March the WCRI holds its annual conference in Boston. The WCRI is dedicated to understanding the latest developments in workers' comp and its team of professional researchers is unparalleled in the industry. This issue and the following issue of The GB Journal are devoted to reporting the highlights from the WCRI's 2017 conference (also known as work comp's premier nerdfest). For further information on the formal presentations described below, please refer to the WCRI's website.
The conference began with a discussion of the potential impact of the 2016 elections on the course of workers' compensation. The discussion between former Senator Tom Coburn (R) of Oklahoma and former Representative Henry Waxman (D) of California examined the origins and probable revisions of the Affordable Care Act with a glance at its possible repercussions in health care and thus workers' comp.
Two specific workers' comp questions came up. Will changes to the ACA potentially drive cost shifting into workers' comp, assuming that fewer people will still have coverage or will have more restricted coverage? Both sides of the aisle agreed that it is too early to tell, given the incoherent state of the discussions for changing the ACA. The second question concerned a possible larger federal role in workers' comp. There was strong bipartisan agreement that this is unlikely, given that the federal plate is more than full right now with more pressing issues.
The discussion later veered into a brisk debate about what is or is not currently happening with growing enrollment in Social Security Disability Insurance. Is it a stampede or more of a trickle? And does this provide any insight into possible developments in workers' comp. Alas, the conversation was inconclusive. Some heat. Not much light.
(For a more detailed account, please see the March 4 entry on the Managed Care Matters blog.)
The conference moved on to solid research findings with an excellent presentation on new insights into worker attitudes and their correlation with timely RTW, or the lack thereof.
The first presentation by Dr. Bogdan Savych of WCRI focused on the injured worker's perception of being fired or suffering other negative repercussions for reporting a work comp claim. Not unexpectedly, those injured workers worried about losing their jobs fared much worse in RTW than those with no such concerns. They were also much more likely to litigate their claims. These findings dovetailed neatly into the following presentation.
Dr. Glenn Pransky of Liberty Mutual's Research Institute looked into initial contact with the injured worker and the consequences of those early exchanges on ultimate outcomes. Dr. Pransky's investigations show that the claim adjuster's use of the right language during the initial claimant interview is critical, as is the development of genuine empathy towards the new claimant. His report included a whole bestiary of words not to use when interviewing the claimant, such as "pending investigation", "acceptance of liability", and a real killer phrase, "legal standard for causation".
He also discussed the importance of including RTW early in the dialogue with the claimant. The most predictive question for the first interview was, "Do you think you will be able to do your regular job, without any restriction, four weeks from now?" This is neither long nor complicated, but how the claimant answers it should tell the adjuster a great deal about how to manage this new claim.
It turns out that simple things like not parading the wrong words and asking a short, straightforward question can have measurable impacts on favorable RTW outcomes. Sometimes doing it right is not that complicated. Who knew?
A California State of Mind
Alex Swerdlow of the California Workers' Compensation Institute easily won the gold medal for the most useful information presented in the shortest possible time. His CWCI research report covered a wide variety of topics concerning the impact of SB 863 and other regulatory changes on California comp which is generally the most expensive in the nation.
Alex's headlong dash covered major new California developments, including:
- Overall medical cost trends have stabilized
- The new RBRVS fee schedule appears to be working in controlling medical costs
- The trend in spine surgeries is down by 30% (due in some part to Operation Spinal Cap which shut down fraudulent operators in SoCal)
- Opioid prescriptions are down by 24% (in dollars) since 2009
- Roughly $1,300,000,000 has been saved in overall comp costs in recent years
For all that, however, California still has the highest rate of PPD settlements and the highest ALAE in the nation (83% higher than the median value for all states). California's new drug formulary (AB 1124) is still on the horizon, so California based employers may see yet more relief in 2017.
Mary Jane, M.D.?
Following a hopeful but preliminary series of presentations on the interstate variations and declining uses of opioids in comp*, a group of researchers, starting with Dr. Dean Hashimoto of the Mass Department of Industrial Accidents, grabbed the third rail of pain treatment in comp by examining the use of alternatives to opioids, including medical marijuana. Dr. Hashimoto started with the findings of the new National Academy of Sciences report on marijuana. In short, marijuana is a real treatment for chronic pain, so often encountered in comp, but it has a number of serious side effects which are still poorly understood. Moreover, since marijuana is not manufactured in standard formulations and doses, medical issues of dosage, administration and relative efficacy remain cloudy at best.
Follow up presentations looked at the hopeless tangle of legal issues surrounding marijuana, which remains a Schedule 1 controlled substance. State laws vary dramatically concerning the use of marijuana to control chronic pain under comp and federal law prohibits the use of the banking system to pay for it, even when state laws allow it to be prescribed. No resolution of these issues appears imminent and the use of marijuana as a treatment in comp remains a state by state, claim by claim, administrator by administrator process.
*WCRI requested that these still under revision studies not be reported until they are finalized. The GB Journal will cover them when they are ready for prime time.
The Friday Finale
Two of the most interesting and challenging sessions were on Friday morning. We'll cover these in our next issue.