Workers’ Comp Claim Reporting Delays Will Cost You

Workers Compensations Premiums by state for United StatesThe Longer You Take To Report A Claim, The More It Will Cost You

The longer you take to report a workers’ comp claim to your insurer or TPA, the more you run the risk of the claim costing more money.  This is due to a myriad of factors, the most important being that the sooner your adjuster gets the claim, the better they can control all aspects of what is going on.
Several online studies have shown a relationship between late reporting and increased claim costs, but it is hard to have a direct correlation.  This is because every claim is different, every person is different, every injury has different circumstances, and so on.  There is no blanket analysis applicable to just you, the employer.
I do however have a great example.  I came across some information from a Carrier where they did an internal study. It appears that they took the claims as they were, by associating reporting lag time with the costs on the file, in order to have something to show clients how reporting can be directly related to costs. This study encompassed thousands of claims, of all types of injuries, but the common thing is that they were all work comp claims.  The injuries were broken down by body location, injury type, and by claims that had litigation or not. I do not believe this was a report to be published, so the name of the carrier/TPA will be withheld, as will any other information which may point out to which carrier/TPA performed this study. Of course this study can’t apply to everyone, since this carrier has certain clients, of differing sizes, operating in certain states, etc.,
but it is one of the best examples I have seen.
Reporting Delay Study Findings:
1.  Injuries reported within 2 weeks of occurrence are 18% more expensive than those reported within 1 week of occurrence, and injuries reported between the 4th and 5th week following the injury were 45% more expensive.
2.  The biggest finding involves back injuries, which as a group are 35% more expensive if not reported within the first 7 days post-injury.
3.  Soft tissue strains and sprains are 13% more expensive if not reported within 7 days of occurrence.  For example, carpal tunnel injuries—whose onset are difficult to pinpoint in general—are 11% more expensive if the reporting comes after the first week of reporting.
4.  22% of injuries reported within 10 days are litigated, and 47% becomes litigated when the reports arrive more than 31 days following the injury. Continue reading Workers’ Comp Claim Reporting Delays Will Cost You

Era of Mobile Health Tracking Definitively Arrives …

Samsung S4 with stethoscopeSamsung Galaxy S4 & Accessories Focuses on mHealth

by Iltifat Husain, MD

The Galaxy S3 is the most popular Android smartphone on the planet. Their followup to the S3, appropriately dubbed the S4, was announced yesterday. Although the form factor has largely stayed the same, there are significant upgrades to the phone’s overall specs.

In addition to the announcement of the phone — Samsung also announced three key health device accessories that will launch with their feature phone.

We won’t get into the nitty gritty of the S4′s processor and some of their gimmicky software features  – but it’s important to note Samsung’s S4 will have a built in pedometer for tracking the number of steps you take.  This is notable as Samsung’s S4 will be the most popular feature phone with a native health tracking feature.

Sensors in the phone also enable it to measure ambient temperatures and humidity in the room you’re in.  This data feeds into Samsung’s S Health app.  I must admit, I have a difficult time appreciating what your surrounding temperature and humidity have to do with health fitness.

Samsung’s S Health app is a native app the phone comes with — enabling you to input the calories you consume in a day and a slew of other fitness metrics.

Samsung is also releasing three key external accessories — the S band, Body Scale, and Heart Rate Monitor.  For the S Band — think Jawbone.  For the Body Scale think of the already released Withing Wi-Fi Scale. For the Heart Rate monitor, think of the Wahoo Fitness HR monitor.

Why does this all matter?

All of these peripherals have a “been there, done that” feel. But Samsung’s foray into the accessory market is tremendous.  It shows the age of mobile health devices has arrived. Furthermore, Samsung has a knack of taking something that’s been done — and optimizing and mass producing it with wide consumer adoption.

They are applying this same model to mHealth.

When a company that had over $180 billion in net revenue (more than Apple) for 2012 decides to seriously get into mobile health devices, it’s safe to say the age of mobile tracking has definitely arrived.

For a Physician’s guide on the best self tracking devices, check out a compilation review done by one of our writers.

Healthcare Cost Increases and Demographic Shift Drive Consumers Online For Health Info

Seeking health info online has reached saturation among internet users. According to a January 2013 study from Kantar Media, 87% of US internet users looked online for health and wellness research in 2012; there are some key trends driving consumers to the web for this information.

An aging population and shifting demographics are playing a major role in uptake of online health seeking. Boomers are turning 65 at a rate of about 8,000 a day, according to AARP. Unlike the “greatest generation” who used the old patient model, boomers are familiar with technology and inclined to research their health options.

Another factor driving people online to research health info is the increased cost of healthcare. Health insurance plans with high deductibles have led to a decline in patients visiting their physician and an increase in patients putting off medical treatments. In an NPR poll last year, three out of four people who were sick said that cost was a “very serious” problem and nearly half said they felt burdened by what they had to pay out of pocket for care.







Gallup poll released in Decemeber 2012 confirmed these findings, with three out of 10 consumers saying they had put off medical treatment due to cost within the last 12 months. Although between 2007 to 2012 that percentage has stayed approximately the same, the general trend since 2004 is a rising number of people who put off medical care.


Since cost is an important issue for users of healthcare websites, many are now seeking resources that can help them estimate how much their medical expenses will cost. A February 2012 Deloitte survey found that 53% of health seekers said they would use a healthcare site that offered them a tool to tell them how much a health plan would pay for certain treatments or sevices. Patients also expressed a strong interest in seeing quality rankings and satisfaction ratings for specific doctors and hospital


The Doctor is In: Telemedicine – ‘Next Big Thing’ or ‘Chronic Underachiever’?

photo of Dr. Robert Cuyler

Telemedicine is a sweepingly broad term for the electronic delivery of            healthcare.  The landmark book “History of Telemedicine” grapples with   definition but settles on the following: “the delivery and receipt of personal

health services via electronic information and communication technology.”  In this blog series, we will look at the emerging world of telemedicine and focus on what is working well and not so well in the translation from concept to actual practice, as well as featuring new applications and trends in the field.

Telemedicine holds enormous promise in the future of healthcare.  Until we start cloning and mass-producing doctors and nurses, we will increasingly depend on porting services and information electronically to consumers, rather than depending on those consumers to travel, whether that’s across the street, the state or the globe. At the same time, the field has moved in fits and starts in the journey from grant-based, research and publicly-funded organizations to routine practice.

In my work in healthcare management and consulting, I’ve seen too many promising telemedicine projects under-perform or close. More often than not, the telemedicine technology works perfectly, but planning and implementation fails to take into account just how many other systems must work in sync to make a successful telemedicine project.  We’ll be highlighting those critical systems, which range from big picture organizational vision and strategy to nitty-gritty details of practitioner training.female doctor video chatting


If you have heard the following statements uttered in your healthcare organization, you may be headed on a difficult implementation road ahead:

  • “Ooh, ooh, we can get a grant for bandwidth and telemedicine equipment!”
  • “We have a telemedicine champion, one of our doctors wants to do this!”
  • “Wow, we can actually talk to a doctor over the television, we’re ready to go!”
  • “We’ll get senior management on board later.  In the meantime, just get IT talking to the doctor.
  • “Training? We just need to show the doctor and nurses how to turn on the equipment.”

If you find yourself or someone else in your organization sharing those thoughts, stay tuned to this series and we can guide you through the proper way to implement telemedicine in your healthcare  organization, and avoid some of the common pitfalls.

Have a question about telemedicine that you would like Dr. Cuyler to answer in his series, “The Doctors is In”? Submit them in the comment box below.

Robert N. Cuyler, PhD is President of Clinical Psychology Consultants Ltd, LLP, a consulting firm focused on telemedicine strategy and implementation.  He is author of the book ‘Implementing Telemedicine: Completing Projects on Target On Time On Budget’. He can be reached at

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For New Health Care Program to Work Small Employers Must Embrace Exchanges

Covered California (health exchange) logo
Is your small business Covered?

By Karen E. Klein on March 13, 2013

In the three years since President Obama signed his health-care overhaul into law, the Affordable Care Act has survived virulent opposition, multiple repeal attempts, and a U.S. Supreme Court challenge led by influential lobbying groups, including the National Federation for Independent Business. Many conservative lawmakers remain firmly opposed: Last week, Rep. Charles Boustany (R-La.) held a hearing in Washington on Obamacare, saying it threatens “to stifle small business growth across all industries” and “provides economic incentives to
reduce employee hours and drop health insurance coverage altogether.”

To help deliver on his promise to offer quality, affordable health care to the nation’s 48.6 million uninsured, Obama needs to get a lot more of
the nation’s small businesses to offer coverage to their employees. Only 61 percent of companies with from three employees to 199 employees offer employee health insurance, in contrast to the 98 percent of companies with 200 or more employees that offer coverage to at least some of them, according to a December 2012 Kaiser Family Foundation survey. Businesses with three workers to nine workers are least likely to offer coverage, with only half offering it in 2012.

To lower insurance costs, Obamacare is pushing a new type of marketplace called SHOP, for Small Business Health Options Program. Currently, 17 states and the District of Columbia are setting up SHOPs wherein small business owners can compare health plans and buy employee insurance, with enrollment beginning on Oct. 1 and coverage starting on Jan. 1, 2014. Seven states will run SHOPs in partnership with the federal government; 26 states have opted not to participate, and their residents will get access only through federal exchanges. Employers that prefer to do so will still be able to buy coverage outside exchanges, such as that available via insurance brokers.

To induce small businesses to change how they buy insurance, many state programs may offer incentives such as providing administrative services and allowing employees to choose among different insurance carriers at the same basic coverage levels. Businesses with fewer than 25 full-time employees that participate in the exchanges will get another benefit: They will be able to claim a 2014 tax credit for up to 50 percent of the cost of providing coverage. Continue reading For New Health Care Program to Work Small Employers Must Embrace Exchanges

Hazard of Not Having Your Heart In Your Work

keyboard keys for Stress and RelaxJob Burnout Can Severely Compromise Heart Health

Mar. 12, 2013 — Americans work longer hours, take fewer vacation days, and retire later than employees in other industrialized countries around the globe. With such demanding careers, it’s no surprise that many experience job burnout — physical, cognitive, and emotional exhaustion that results from stress at work. Researchers have found that burnout is also associated with obesity, insomnia, and anxiety.

Now Dr. Sharon Toker of Tel Aviv University’s Faculty of Management and her fellow researchers — Profs. Samuel Melamed, Shlomo Berliner, David Zeltser and Itzhak Shpira of TAU’s Sackler Faculty of Medicine — have found a link between job burnout and coronary heart disease (CHD), the buildup of plaque in the coronary arteries that leads to angina or heart attacks.

Those who were identified as being in the top 20 percent of the burnout scale were found to have a 79 percent increased risk of coronary disease, the researchers reported in the journal Psychosomatic Medicine. Calling the results “alarming,” Dr. Toker says that these findings were more extreme than the researchers had expected — and make burnout a stronger predictor of CHD than many other classical risk factors, including smoking, blood lipid levels, and physical activity.

Taking a toll on the heart

Some of the factors that contribute to burnout are common experiences in the workplace, including high stress, heavy workload, a lack of control over job situations, a lack of emotional support, and long work hours. This leads to physical wear and tear, which will eventually weaken the body.

Continue reading Hazard of Not Having Your Heart In Your Work

Mediterranean Diet Strikes Again! New Study.

Mediterranean diet pyramid graphicMediterranean Diet Study

This latest study that was published in the February 25 New England Journal of Medicine.[1] I will try to get some commentary, either from myself or other colleagues, about really important studies, and I believe that this is one of them.

We don’t talk enough about diet in medicine, but this is the largest randomized trial to date. The Mediterranean diet has been studied previously in randomized trials but not in a trial as large as this. It is fascinating that this was a study of more than 7400 individuals who were randomly assigned to 3 different diets. Two were Mediterranean diets enriched with either extra-virgin olive oil or nuts and other Mediterranean foods, both including more than 7 glasses of wine per week. The control diet was a low-fat diet, which some people have argued is not an ideal control. There was very good compliance with the diets in this large number of people for many years. The primary endpoint was death, heart attack, or stroke. There was a very important significant reduction of this cluster endpoint in the Mediterranean diet groups. Particularly noteworthy, even by itself, was the reduction in stroke.

Clinical Impact of the Mediterranean Diet Study

We now have dietary evidence that is fairly compelling. The absolute size reduction was not large, but the fact that the Mediterranean diets tested in this trial had such a positive impact gives us some anchoring about a diet that does lower critical cardiovascular endpoints. For many years, there has been discussion about this low-fat diet and whether it had a meaningful clinical impact. At one point, the Mediterranean diet was very much supported by the American Heart Association and other organizations. Now we see that it appears to be superior. The trial has had criticism, particularly honing in on the low-fat control arm of the study, but nonetheless, the evidence is compelling.

Why is this trial unique? It was funded by the Spanish government. Continue reading Mediterranean Diet Strikes Again! New Study.

Home Monitoring Helps Lower Blood Pressure

screen shot of blood pressure app for iphoneThe “real world” benefits of mobile apps and tele-medicine are more apparent every day.

By Chris Kaiser, Cardiology Editor, MedPage Today
Published: March 06, 2013
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points
Note that this randomized controlled trial demonstrated superior blood pressure control in subjects receiving pharmacist-guided home blood pressure (BP) monitoring compared with usual care.
Be aware that all patients had Internet access, and were able to upload home BP readings three times a week to the central database.

Usual care was no match for a home blood pressure monitoring program for keeping hypertension in check, a randomized trial found.

At 6 months, the mean blood pressure of patients in the home monitoring group was significantly lower than in the usual care group (128/79 versus 137/83 mmHg, P<0.001), reported David J. Magid, MD, MPH, and colleagues from Kaiser Permanente Colorado in Denver.

More patients being home monitored also reached their blood pressure goals compared with usual care at 6 months (54% versus 35%, adjusted RR 1.5, 95% CI 1.2 to 1.9), according to the study published online in Circulation: Cardiovascular Quality and Outcomes.

The benefits of the home monitoring program extended to a subset of patients with diabetes and/or chronic kidney disease, as 52% reached their target goal versus 22% in usual care (adjusted RR 2.5).

Patients in the home monitoring group used the American Heart Association’s web-based Heart360, a free, online tool for tracking heart health. From the site, users can upload blood pressure data and send it to their health providers. Heart360 also provides patients with educational information and allows them to track progress towards their health goals.

Patients were included in the trial if their two most recent blood pressure readings were at or above 140/90 mmHg (130/80 for diabetics), if they were prescribed three or fewer antihypertension medications, and if their primary care doctor worked at one of the 10 participating sites.

Continue reading Home Monitoring Helps Lower Blood Pressure

CDC Talks Stroke, Heart-Attack Prevention in Spanish

One Million Hearts logoTwo years into their campaign to prevent one million heart attacks and strokes, HHS and the Centers for Disease Control’s Million Hearts initiative is now churning out materials in Spanish, and the new collateral has started to gain attention.

According to the CDC’s latest tracking numbers, 407 visitors had sought out the new content within four days of its February 22 launch, gaining a particular bump in traffic after an NBC/Telemundo broadcast about the effort.
Not all of the materials have been translated, due to financial constraints. Currently, a translated toolkit is linked to the main information site. In addition to the CDC and HHS, the Centers for Medicare and Medicaid Services (CMS) and the National Institutes of Health’s Heart Lung and Blood Institute are also chipping in to support the effort.

Spokesperson Kathy Harben told MM&M that the in-Spanish initiative is far more complex than just paying for translation services, because the materials have to resonate as well as make sense. For example, the English-speaking site has a feature called the “ABCs of heart health,” which won’t work in Spanish, and had to be modified to four steps for heart health. Harben said the initiative’s starting point was an agnostic one, in that materials were not “tailored to any one demographic group,” but were designed to assist the health agencies in the overall goal of preventing heart attack and stroke.

Continue reading CDC Talks Stroke, Heart-Attack Prevention in Spanish

Medical and Risk Trends for 2013

Medical and Risk Trends for 2013By ReduceYourWorkersComp 02/27/2013 09:00:00

Each new year brings talk and speculation about what will be the “next big thing” during that year — a new medical procedure; a new change in laws; or increases in disability and reserving. Some common themes popping up on blogs and in discussion threads are about medical procedures and distracted driving hazard effecting risk management.

1.   Aggressive Total/Partial Joint Replacement Surgeries

Hip and knee joint replacements are among the most commonly performed surgical procedures in the United States, according the Center for Disease Control and Prevention. Between 1996 and 2006, total hip replacements increased by one third and total knee replacements by 70%.

Part of this new trend means doctors are finally realizing that months and months of physical therapy and other treatments are not resulting in outcomes patients’ desire. Injured people want to regain as nearly as possible most of their mobility and activity levels they enjoyed prior to an injury. This is particularly true of injuries taking years to develop before the joint finally gives out.

In addition, technology has changed, implants are better, more functional, and last longer and, depending on the comorbidities of the patient, recovery times have lessened. Therefore, physicians are going directly to joint replacement surgery, rather than waste a year on therapy.

Employers need to be aware of the actual causal relationship of joint failure to the issue of a workers compensation injury, keeping in mind most joint replacements are due to degenerative changes, not necessarily an occupational injury. The decision of whether or not an employer is liable for a workers comp claim can vary by state statute, meaning be very aware of all state statutes in every state where your company operates.

Rarely will a carrier opt to pick up a case with a joint replacement recommendation, since the costs are high, and the outcomes for total success can be limited. Be prepared to argue any case where a physician leans toward joint replacement following a workplace injury. Look for possible pre-existing conditions and be sure to have an independent medical examination (IME) done by a qualified and reputable physician.

2.   Increasingly Sophisticated Bionic Implants/Prosthetics

Great outcomes are rare for severe occupational injuries that include the loss of a limb since these cases are catastrophic in nature and carry a massive dollar reserve. The days of peg legs and hooks for hands are gone. Current prosthetics are capable of grasping objects with a mind/body connection doing the work, rather than plain mechanics.

Continue reading Medical and Risk Trends for 2013