Access to Medical Treatment for Injured Workers in California

Year 1 Annual Report

by Andrew W. MulcahyMadeline B. DoyleRosalie MalsbergerKandice A. Kapinos

worker in hard hat holding shoulder for article, Access to Medical Treatment for Injured Workers in CaliforniaAn estimated 16 million workers use workers’ compensation (WC) insurance annually in California. Many recent policy changes might have affected access to care for injured workers. For this report, the authors assess the various dimensions of access to care in the evolving policy environment to ensure that injured workers have adequate access to needed medical care and the opportunity to achieve better health outcomes. Access to care is an important domain to monitor, especially among vulnerable populations, as patients with better access to care systems are more likely to receive comprehensive, higher-quality care and are therefore more likely to experience better outcomes.

The key objective of this report is to describe access to medical care among injured workers in the state of California, as mandated by Labor Code Section 5307.2. The authors analyze administrative and medical service bill data to examine changes over time for measures related to access to care for injured workers. The authors aim to highlight potential access-to-care barriers in the WC system and to understand whether changes in the WC system may be increasing access for injured workers.

Overall, there were increases in claims, bill lines, and spending per provider. Although these increases were moderate to large in number, many of the differences were not statistically significant. These results suggest a concentration of treatment for injured workers, in which a relatively smaller number of providers furnished care to injured workers. Increasing concentration could offer opportunities for specialization in the treatment of work-related injuries. On the other hand, increasing concentration could lead to future access barriers related to scheduling.

Key Findings

Provider participation

  • Fewer providers provided care to California WC patients in 2014 than in 2010.
  • The specialties with the largest declines from 2010 to 2014 in WC-participating providers were family medicine/general practice, chiropractic medicine, and pharmacy providers. Most other specialties were relatively stable.
  • Over the same period, there was an increase in the number of WC injuries.

Utilization and payments per provider

  • The average number of claims per provider increased from 2010 to 2014.
  • Payments per provider increased by $8,813, on average, from 2010 to 2014.
  • The observed increases in average claims per provider, bill lines per provider, and payments per provider were likely driven by changes in very large practices or health systems treating many injured workers.

    [SEE FULL STORY HERE]

Technology Can Make Return-to-work More Effective and Efficient

September 24, 2018 by 

You are all probably aware of many of the standard strategies that can be employed to ensure timely return to work during and after recovery from an occupational injury or illness.

Technology Can Make Return to Work More Efficient

But are there any newer technologies and approaches that can facilitate this process to make it more effective and expedited?

arm in cast using iPad for article, Technology Can Make Return-to-work More Effective and Efficient

In a previous article, I discussed the critical need for an advanced form of “job description,” which we refer to as a digital job profile (DJP) containing a comprehensive physical demands analysis(PDA).  It bears repeating that the digital job profile is the cornerstone to understanding the explicit, quantitative demands of a job, and is utilized by all stakeholders in the claim management continuum. How can we return an individual to modified or full duty without knowing exactly what the job requirements are?

Psychological Component Can Play Greater Role Than Biological

Many of you are aware of the biopsychosocial model of injury or illness. In short, this is the recognition that non-physical factors highly impact functional restoration. In fact, many experts feel that the psychosocial components play a greater role than biological ones. You have undoubtedly noticed that the same type of injury may be devastating to one individual, while a more resilient person easily overcomes it. It is extremely helpful to predict whether your claimant is likely to be in the former or latter category.  If the claimant is fragile from a psychosocial perspective, many mitigation strategies can be employed to prevent the delayed return to work/life activities that inevitably accompanies these comorbidities.

Fortunately, there are automated, online screening tools available that allow you to enter claimant responses to a brief series of questions, and provide you with an immediate, calculated psychosocial risk level (high, medium, low). These validated tools may also recommend various interventions derived from the response pattern of claimants to the questionnaire. Some folks will benefit from cognitive behavior therapy, and others from family counseling, vocational guidance or psychiatric assessment. Risk screening helps to identify the level of risk, as well as appropriate strategies to help individuals better cope with the added stress of an injury or illness.

[SEE FULL STORY HERE]

Health Navigation – Finding a Path to Better Health and Lower Costs

September 20, 2018 by 

If you or a loved one has ever been hurt or sick, you know well that healthcare and insurance systems are complicated; the challenges can seem endless and overwhelming.

Health navigation helps individuals and companies through these challenges. It includes clinical services, of course, but it’s much more than that. Knowing what services are needed, where to get them, and in what timeframe are critical elements to getting on the right path to recovery.

Fundamental Premise of Health Navigation

health navigation signage for article, Health Navigation – Finding a Path to Better Health and Lower CostsPeople can’t always tell at the onset how serious an injury or illness is. So, sometimes they go to an ER when they could have gone to a doctor’s office, or they go to a doctor’s office when they could have cared for themselves. Other times people underestimate or don’t recognize symptoms, and look back wishing they had realized how serious something really was – this regret can make them more likely to overreact the next time they are confronted with a health concern.

The fundamental premise of health navigation is getting people the care they need when and where they need it, which removes burdensome guesswork. A best-in-class health navigation provider should:

  • Have clinicians which navigate people to the right level of care at the right time, in the right place.
  • Have systems to help people determine the severity of each case and the best course of action for treatment.
  • Provide the needed care or guide patients in self-care whenever possible.
  • Make a referral when further care is required

People know overtreatments and over prescribing exist, but they don’t know how to tell when it is happening to them. What’s the best practice?

[SEE FULL STORY HERE]

Educate Stakeholders on Effective Alternatives to Opioids

September 12, 2018 by 

A combination of ibuprofen and acetaminophen does a better job of relieving acute pain than opioids. Despite clear evidence that the combination of the less dangerous medications provides equal or greater pain relief, many physicians still prescribe opioids for injured workers with pain.

Doctor holding a note that reads, "Explore non-Opioid Alternatives" for article, Educate Stakeholders on Effective Alternatives to OpioidsThis statement was just one point made in a recent session at the Workers’ Compensation Institute’s Annual Conference in Orlando presented by:

  • Marcos A. Iglesias, Chief Medical Officer of Broadspire
  • Mark Pew, senior VP for Product Development & Marketing at Preferred Medical.

The Problem

The opioid epidemic in the U.S. has been well documented in recent years. Researchers say Americans consume more opioids than any other country, regardless of the myriad physical and psychological problems associated with their unnecessary use.

While stakeholders in the workers’ compensation system have made progress in curbing the unnecessary use of opioids in recent years, it will take a concerted effort of educating providers as well as employees about chronic pain, and effective treatment alternatives said Iglesias and Pew.

Findings released by the Society for Internal Medicine on a one-year comparison of patients with chronic low back pain who were treated with either opioids or ibuprofen included:

  • No difference in function
  • Those given opioids had statistically worse pain control

Among the side effects of opioids are

Change your diet to save both water and your health

September 10, 2018
Source: European Commission Joint Research Centre

Summary: Shifting to a healthy diet is not only good for us, but it also saves a lot of fresh water, according to a new study. Compared to existing diets, the water required to produce our food could be reduced by up to 55 percent for healthy pescetarian and vegetarian diets.Shifting to a healthy diet is not only good for us, but it also saves a lot of precious fresh water, according to a new study by the JRC published in Nature Sustainability.

sustainable diet info graphic for article, Change your diet to save both water and your healthCompared to existing diets, the water required to produce our food could be reduced by between 11% and 35% for healthy diets containing meat, 33% and 55% for healthy pescetarian diets and 35% and 55% for healthy vegetarian diets.

Researchers compared these three diet patterns, defined by respective national dietary guidelines, to the current actual food consumption, using available data from more than 43 thousand areas in France, the UK and Germany.

They found that eating more healthily could substantially reduce the water footprint of people’s diets, consistent across all the geographical entities analysed in the study.

The study is the most detailed nationwide food consumption-related water footprint ever made, taking into account socio-economic factors of food consumption, for existing and recommended diets.

Influences on the food we eat

The scientists also show how individual food consumption behaviour — and their related water footprints — depend strongly on the socio-economic factors like age, gender and education level.

They found interesting correlations between such factors and both the water footprint of specific foods and their resulting impact on overall water footprints.

For example, the study shows how in France, the water footprint of milk consumption decreases with age across the municipalities analysed.

Across London, they show a strong correlation between the water footprint of wine consumption and the percentage of the population of each area with a high education level.

[SEE FULL STORY HERE]

New blood pressure app

September 7, 2018
Source: Michigan State University

Summary: Researchers have invented a proof-of-concept blood pressure app that can give accurate readings using an iPhone — with no special equipment.Michigan State University has invented a proof-of-concept blood pressure app that can give accurate readings using an iPhone — with no special equipment.

smartphone app screen for article, New blood pressure appThe discovery, featured in the current issue of Scientific Reports, was made by a team of scientists led by Ramakrishna Mukkamala, MSU electrical and computer engineering professor.

“By leveraging optical and force sensors already in smartphones for taking ‘selfies’ and employing ‘peek and pop,’ we’ve invented a practical tool to keep tabs on blood pressure,” he said. “Such ubiquitous blood pressure monitoring may improve hypertension awareness and control rates, and thereby help reduce the incidence of cardiovascular disease and mortality.”

In a publication in Science Translational Medicine earlier this year, Mukkamala’s team had proposed the concept with the invention of a blood pressure app and hardware. With the combination of a smartphone and add-on optical and force sensors, the team produced a device that rivaled arm-cuff readings, the standard in most medical settings.

With advances in smartphones, the add-on optical and force sensors may no longer be needed. Peek and pop, available to users looking to open functions and apps with a simple push of their finger, is now standard on many iPhones and included in some Android models.

If things keep moving along at the current pace, an app could be available in late 2019, Mukkamala added.

“Like our original device, the application still needs to be validated in a standard regulatory test,” he said. “But because no additional hardware is needed, we believe that the app could reach society faster.”

[SEE FULL STORY HERE]

Conservative Care for Shoulders

By Mary O’Donoghue, Chief Clinical and Product Officer, MedRisk

 BY 

Mary O’Donoghue, Chief Clinical and Product Officer, MedRiskShoulder pain is one the most common musculoskeletal problems in workers’ compensation, second only to low back pain. In fact, it is even more prevalent in some industries. Like low back pain, shoulder pain has been shown to respond well to conservative care, especially physically therapy.

Strenuous work, including heavy lifting over a long period of time, carrying, pulling, or pushing can cause shoulder pain and problems. The type of repetitive overhead arm motion that warehouse workers, flight attendants and construction workers perform also contributes to shoulder issues.

Symptoms include pain at rest and when lifting and lowering the arm or with specific movements. Some patients feel weakness when lifting or rotating the shoulder or experience a crackling sensation when moving the shoulder in certain positions. Limited range of motion and/or pain associated with internal and external rotation and forward flexion can indicate a partial thickness tear of the rotator cuff. Another symptom is painful abduction, which is the movement away from the median plane of the body. Full-thickness tears are indicated by weakness of external rotation and abduction.

Until recently, surgery was the common approach to rotator cuff tears and similar shoulder injuries. Now, guided by research, clinicians are adopting more conservative methods. This usually involves a combination of physical therapy and temporarily modifying activity, such as avoiding heavy lifting or sustained overhead use of the arms.

[SEE REST OF STORY HERE]

12 Frequent Hard Hat Questions

If the hard hat has sustained an impact, dispose of it immediately, even if the damage is not visible.

workers with hardhats for article, Twelve Frequent Hard Hat Questions

Protecting employees from potential head injuries is a key element of a safety program in virtually all industries. The primary reasons for an organization to require hard hats in the work environment is to help protect employees from head trauma from objects falling from above; bumping into fixed objects, such as pipes or beams; or contact with electrical hazards. Head protection also can serve to help protect employees from splashes, rain, high heat, and exposure to ultraviolet light.

In this article, we will discuss many of the frequently asked questions related to hard hats.

When Is a Hard Hat Required?
OSHA requires, in 29 CFR 1910.135, that if the following hazardous conditions are present, then head protection is required:

  • Objects might fall from above and strike employees on the head
  • There is potential for employees to bump their heads against fixed objects, such as exposed pipes or beams
  • There is a possibility of accidental head contact with electrical hazards

Other countries or organizations may have additional requirements, but most regulations are hazard based and start with a thorough workplace hazard assessment.

What Industry Standard or Approval Do Hard Hats Need?
This can vary by country or global region because there are various standards in place. In North America, the current standards are the American National Standards Institute (ANSI) Standard for Head Protection, Z89.1 (current version is 2009) and the Canadian Standards Association (CSA) Industrial Protective Headwear, Z94.1 (current version is 2005). These two standards share the “Type” and “Class” descriptors, which makes it easier to ensure that the right hard hats are selected for your application. However, as you will see below, the tests are slightly different, so a hard hat manufacturer must test to all standards that it chooses to meet, based upon the markets in which it wants to sell.

[SEE REST OF THE STORY HERE]

90% of Americans use digital health tools, survey shows

Author:  Aug. 29, 2018

Dive Brief:
Consumers continue to embrace digital health tools, with 90% of respondents in a new Rock Health survey using at least one last year, up from 80% in 2016.
photo of person with a smart watch, smart phone and health apps for article, 90% of Americans use digital health tools, survey showsThe greatest adoption is occurring around online health information (79% vs. 72%) and online provider reviews (58% vs. 51%). A slower uptick was seen in mobile tracking (24% vs. 22%), while wearables held steady at 24% and live video televisits slipped three percentage points to 19%.
But while 77% of people prefer in-person doctor visits to telehealth, most who used video visits were satisfied with the experience. Among those who paid for their virtual encounter, 91% said they were satisfied. That number dropped to 62% when someone else paid.

Dive Insight:
Likewise, while not everyone is jumping at the idea of wearables, those who use them report progress meeting personal health goals. The chief reasons people use wearables are to track physical activity, lose weight, improve sleep and manage stress.

The tools for doing so are proliferating, with mobile operating systems and various apps offering to track the information. Fitibit has been upping the ante, and recently launched a product line update that includes detection of blood oxygen levels, goal-based exercise modes and a sleep tracking beta.

[SEE REST OF THE STORY HERE]