Tag Archives: medical

When does a condition become a medical issue?


Doctor shrugging shoulders for article, When does a condition become a medical issue?It has become a sign of legitimacy to call a personal problem “medical.”  This aims to distinguish the problem from those of morality or character.  It implies both that the problem is serious, and that it is unbidden and largely out of the sufferer’s control.  Unfortunately, it isn’t clear what exactly qualifies as “medical,” so this label serves more as a rhetorical device than a scientific finding.

Alcoholism is the paradigm and perhaps least controversial example.  Through the 19th Century, alcoholism was variously declared a disease, or a matter of will and character.  The disease model gained prominence in the 1930s and 40s with the “powerlessness” identified in the 12 Steps of Alcoholics Anonymous, as well as researcher E.M. Jellinek’s descriptions of progressive stages and subtypes of alcoholism.  The American Medical Association declared alcoholism an illness in 1956 and has endorsed the disease model ever since, partly as a strategy to ensure insurance reimbursement for treatment.

The model expanded to include other abused substances with the formation of Narcotics Anonymous in the 1950s, and as a result of widespread recreational drug use in the late 1960s and early 1970s.  The specialty of addiction medicine was first established in 1973 in California.  The American Society of Addiction Medicine now states: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”  Proponents of the disease model of addiction cite many documented brain changes and a plausible neuropathology, as well as the presence of genetic risk factors, cognitive and emotional changes, impaired executive functioning, and disability and premature death.  The model purportedly destigmatizes addicts — they are no longer “bad” or “weak” people — thereby making it more acceptable for them to seek treatment.

Nonetheless, the disease model of addiction remains controversial.  In addition to the existence of alternative models, the disease model itself has been criticized.  Some believe it removes personal choice and responsibility, and actually contributes to the problem of addiction.  Others cite surveys of American physicians who consider alcoholism more a social or psychological problem — even a “human weakness” — than a disease.  Critics note that about 75 percent of those who recover from alcohol dependence do so without seeking any kind of help, and that the most popular and recommended treatment, Alcoholics Anonymous, is a fellowship and spiritual path, not a medical treatment.


How to make sure your vacation isn’t a medical disaster

Recently while traveling overseas, I found myself in a predicament not often encountered nor taught to health professionals. I was requested to address an emergency at 30,000 feet in the air. This got us thinking: How many patients consider the possibility of a medical emergency in the air?

photo of person in beach chair with full body cast for article, How to make sure your vacation isn’t a medical disasterPeople with chronic illnesses and the older population (who find themselves retiring and having more time to travel) need to be prepared so their vacation isn’t ruined by a health crisis.

Below are a few tips to stay safe while traveling:

If you have serious medical conditions, be sure your travel companion is prepared to help in case of an emergency. In the event you lose consciousness you need someone to convey information to those on board trained to help you, primarily the flight attendants, or, if you are lucky enough, a medic, emergency medical technicians (EMT), nurse, nurse practitioner (NP), physician assistant (PA) or physician.

This cannot be overstated enough — pack ANY medications you might need in an emergency in a carry-on bag. This includes an epi-pen, albuterol, aspirin, nitroglycerin, antihypertensives, non-steroidal anti-inflammatory medications, insulin, glucose supplement, anti-emetics, oxygen, etc. If you’re not sure if you should carry certain medications on board, discuss it with your primary care physician prior to traveling. TSA states, “Medications in pill or other solid forms must undergo security screening. It is recommended that medication be clearly labeled to facilitate the screening process. Check with state laws regarding prescription medication labels.” Make sure to have plenty of medication for your trip, plan to have your primary care physician call these into the pharmacy at least one week prior to travel. Be prepared for anything. Most airlines only carry a basic first-aid kit, oxygen and a defibrillator.

If you have medical conditions, see if your primary care physician prior to take off for a travel clearance. If your physician detects early warning signs of illness then the risks of travel may far outweigh the benefit.

If you have serious food or environmental allergies (e.g., anaphylaxis — a multi-organ, life-threatening allergic reaction) alert the flight attendants as you board (and have your EpiPen!). Though awareness of serious allergies to peanuts has increased they are still served on some flights. Other commonly served food products include soy and wheat.


California online community college announces first health care pathway


California’s health care providers have a workforce challenge. The state is going to need 11,000 medical coders between now and 2024—that’s about 1,600 job openings a year.

keyboard graphic for article, California online community college announces first health care pathwayThe proposed California online community college has announced its first partnership to establish a program pathway in the health care industry to meet needs like more coders.

The California Community Colleges Chancellor’s Office and the Service Employees International Union-United Healthcare West & Joint Employer Education Fund met with reporters Tuesday to discuss the agreement.

The statewide online community college has been proposed by Governor Brown to help California’s stranded workers, those who lack job credentials and skills because they are unable to attend colleges because of family and work responsibilities.

If approved by the Legislature this summer, the college is expected to be activated by 2019.

Medical coders start at $30 per hour and can make as much as $50 per hour. Their task includes reviewing medical charts and assigning codes for insurance billing.

“These are attractive jobs to enter the health care industry,” said Rebecca Hanson of the SEIU UHW-West & Joint Employer Education Fund.

Lorraine Maisonet of Elk Grove, California was on the conference call. She works for Dignity Health and commutes two hours to work every day. She doesn’t have time to go to school but indicated that an online college would let her learn at her own speed when she could.

Alma Hernandez is the executive director of SEIU California, which represents more than 700,000 members. She said that many workers are stuck in dead-end jobs and don’t have access to the education opportunities that are already available. She also pointed out that the for-profit colleges that offer similar certificate programs are expensive and often result in workers being in debt.

“This is responding to the needs of California workers,” she said.

Community Colleges Chancellor Eloy Ortiz Oakley indicated that the system is working on other pathways as the system focuses on how to help California workers improve their economic mobility and rebuild the state’s middle class.


4 Reasons For Spike In Workers’ Comp Claims

upward arrow graph for article, 4 Reasons For Spike In Workers’ Comp Claims

Every day employers can introduce increased risk for worker injury. At any given time, outside or internal forces can create a new hazard for injury. With the injury comes medical cost, lost wages, decreased production, decreased profit margins, more strain on current workforce, and other negative issues.

Below we will discuss a few factors involved in the increased risk of worker injury and the way to decrease the hazard when these forces are present in your workplace.

1) New Equipment in the Workplace:

Your workforce has a span of experience that varies by employee. Some workers are new to your industry, whereas others may have decades of experience. But new equipment is a great equalizer.

When there is hazardous equipment on the work floor unknown to your operators, the risk of serious injury increases dramatically. Your workers are unfamiliar with these machines, and, without proper training, a severe injury may occur.

The way to prevent injury is to take the time to properly train each employee on proper use of the new machine. Make sure they complete the training course and can pass a safety test before operating the equipment. This should decrease your risk, and make your workers safe.

A lot of employers ignore training, letting experienced workers train others. Managers can be surprised that older workers typically do not have the advanced technological experience to know these new machines inside and out, and therefore, without a properly trained workforce, you run the risk of increased worker injury.

2) Benefit Reductions:

As the economic environment continues to evolve, employers are scrambling to find ways to stay competitive.  Some are experimenting with decreasing fringe benefits made available to employees, or by decreasing the employer contribution which increases employee cost for the same benefits package they may have had for years.


The Significance of Maximum Medical Improvement in Workers’ Comp

How MMI can both reduce your Workers’ Comp costs and benefit the overall health and well being of employees.

December 13, 2017  by Michael B. Stack

The concept of “maximum medical improvement” (MMI) is an important notion in workers’ compensation claims.  This concept is based on the fact that it often triggers the discontinuance of various wage loss benefits.  In other instances, once an employee reaches MMI, cases are prime for settlement.  Failure to identify this status promptly can add unnecessary costs to claims and the bottom line of a workers’ compensation program.

doctor viewing exray on a tablet for article, Significance of Maximum Medical Improvement in Workers' CompWhat is MMI?

Maximum medical improvement (in some instances referred to “end of healing period”) is a legal concept where no further significant recovery from or lasting improvement to a personal injury can be reasonably anticipated, regardless of subjective complaints from the employee.  In essence, additional medical care and treatment may still be required to keep the employee in a stable condition, but no noticeable improvement will take place in that medical care.

Each jurisdiction has a legally defined standard for MMI.  This standard is defined in statute or rule and interpreted via case law.  Any doctor or health care provider can usually declare an injured employee to be at MMI if they have an adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty.

Significance of MMI in Your Claim

Placing an employee suffering the effects of a work injury at MMI has a significant impact on the employee’s ability to receive future workers’ compensation benefits including entitlement to wage loss.  In some jurisdictions, it can reduce or limit the employee’s ability to receive future medical care via a workers’ compensation program.


Occupational Disease Claims Can Spike Work Comp Costs Without Warning

December 10, 2015 by Michael B. Stack Leave a Comment

Occupational Disease ClaimsOccupational disease claims can strike without warning.  They can be presented long after employment has ended, and may or may not be the result of employment.   Medical and scientific proofs for causal relationship can be vague or misleading, and more and more normal health failures are being alleged and adjudged as work induced.  When occupational disease litigation is necessary, the trend in these cases has been favoring the employee.

These are just a few of the problems accompanying Occupational Disease Cases.

Injury Factors:

On the job injury claims are usually associated with a definite date, time, and place; with medical recovery and return to work the expected outcome.  The majority of these claims can be adequately measured for expected cost and should follow a consistent protocol of injury response: claim investigation, medical management, return to work, etc. Litigation is usually a small percentage of claims.

Experience and premium ratings are easily determined since most injury losses are measurable.

Occupational Disease Factors:

There are occupations where employees can be exposed diseases contracted on the job, where the outcome is not as clear cut.  Medical, Police, and Fire Professionals can easily come in contact with many foreign elements on the job.  Drug manufactures or users, forensic laboratories, and chemical manufacturers are more places where employees can be exposed to situations not common to the public at large.  Jobs exposed to high noise levels, repetitive motion, vibrations, and airborne particles can also be expected to develop occupational diseases and disabilities. Continue reading Occupational Disease Claims Can Spike Work Comp Costs Without Warning

Proactive Identification and Management of Back Claims can Reduce Costs by 33%

Parsippany, NJ (WorkersCompensation.com)

cartoon of man with back ache York Risk Services Group, a leading provider of claims management, managed care and risk control services, today announced new research showing that the combination of sophisticated predictive analytics and early, expert medical assessment significantly reduces both the cost and duration of workers’ compensation back claims.
York calls this approach “TeamComp.”  In the study, which looked at 24 months of TeamComp back claim data:

• The average medical paid decreased 29% from $7,923 to $,5,631,

• The average total paid decreased 33% from $14,301 to $9,605, and

• Lost days decreased 35% from 64 days to 42 days.

The full report is published in the whitepaper “TeamComp Significantly Reduces the Cost and Duration of Back Claims
,” which is available on RiskCentral.com, the risk management information hub from Risk & Insurance Magazine.

“The key to TeamComp’s success is the way we integrate predictive analytic intelligence and medical expertise into the overall claims management process,” explains Doug Markham, President of Managed Care for WellComp, York’s provider of managed care services. Continue reading Proactive Identification and Management of Back Claims can Reduce Costs by 33%

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

The $21 Advil Debate in California

Golden pills
Thar's gold in them thar pills!

This could be the “golden toilet seat” of the health care debate in California. And guaranteed to be a conversation starter around your favorite water cooler or coffee machine!

Should California voters cap hospital costs?

 Download/Play Audio

A single Advil tablet costs around 8¢ at your local pharmacy, so would you be willing to pay $21 for one at a hospital? You might not have a choice if you’re in the hospital and $21 is the going-rate. Such extreme price mark-ups are evidence of “hospital price gouging,” according to union health care workers who are trying to stop it.
“We’ve learned that they charge 21 dollars for a single Advil – not the bottle, but a single Advil,” said Elizabeth Brennan, spokeswoman for the Service Employees International Union (SEIU.) Brennan maintains that such lofty prices are why health care costs are as high as they are. In order to stop the alleged unfair practices, union health care workers in Southern California are collecting signatures for two initiatives they hope to get on this Fall’s ballot.
The first initiative would prohibit hospitals from charging patients more than 25 percent above the actual cost of services and the second initiative would require non-profit hospitals to provide a pre-determined minimum amount of “charity care” for needy patients. Jim Lott, spokesman for the Hospital Association of Southern California, said the SEIU has identified a very real problem, but that limiting hospitals’ ability to charge is the wrong solution. Lott maintains that hospital costs are raised because of low payments received from customers who use Medicare and
Medi-CAL and that the situation could be resolved if the government covered more.


Are hospitals only out for profit or are they simply doing what’s necessary to spread the costs of California’s underinsured? How restricted, if at all, should hospitals be when it comes setting prices for services?


Dave Regan, president, Service Employees International Union, United Healthcare Workers WestJames Lott, spokesman, Hospital Association of Southern California

Laser Wand Scans Molecules for Melanoma Within Seconds

Melanoma laser wand
Captain's Log: Stardate 2011

Detecting potential skin cancer cells is an inexact process that depends on a doctor identifying a suspicious mole before waiting a few weeks for the biopsy results to come back from a lab.

But according to Technology Review, scientists at the British Columbia Cancer Agency (BBCA) have developed a handheld wand that could help doctors instantly identify melanoma by scanning the molecular makeup of a mole. Dubbed the Verisante Aura, the device uses Raman spectroscopy to scan for molecules that are characteristic of melanoma, the most deadly form of skin cancer.

The doctor holds the wand over the suspicious mole, and the Aura blasts laser light onto the molecules, thus changing their vibrational state. The light is then reflected back at different angles and magnitudes depending on the molecules. Within seconds, the device compares the scan to a database of skin cancer molecules. The results help doctors more accurately determine whether or not a biopsy is necessary.

by Caleb Johnson on February 2, 2011 at 07:30 AM