The Heat Death Of The Universe
Jul 12, 2022

We remember all too well the days when car air-conditioning was the 4/65 system—all four windows down, driving 65 down the highway. Add a family pooch hanging his head out a rear window and you had instant summer*. Maybe it’s age, but summers nowadays do not feel quite so benign. An article in workerscompensation.com, “Climate Change Impacting Working Conditions, Workers’ Compensation” adds to the picture of growing heat hazards noted in our Journal a couple of issues back.

 

The current discussion begins with a worker dying of apparent heat stroke in a non-air-conditioned delivery van. The risk is not hypothetical. OSHA recently issued a notice of proposed rulemaking seeking additional information about “the extent and nature of hazardous heat in the workplace and the nature and effectiveness of interventions and controls used to prevent heat-related injury and illness.” This means in part that good information on the actual impact of heat on deaths and injuries on the job is still sketchy at best.

 

One outfit estimates that environmental heat is likely responsible for 170,000 work-related injuries every year, and between 600 to 2,000 worker deaths. That may be high, but no one really knows the correct number, other than it’s too many. We suspect that the real key here is the impact of heat as a causal factor in any variety of non-heat specific injuries. In our world here at GB Journal World Headquarters, too much sticky heat/humidity can result in slippery fingers and some really dazzling typos, but what does this mean for people operating heavy equipment, driving big, non-air-conditioned trucks, people doing difficult jobs distracted by sweat getting in their eyes?

 

We do know this, “In April 2022, the agency [OSHA] did issue a National Emphasis Program (NEP) which covered 70 ‘high risk industries’ that will get increased inspections and enforcement activity.” This NEP is aimed at risks exacerbated by ambient heat. A handful of states-- Washington, California, Minnesota, and Oregon—have issued special regulations concerning heat related injuries in the last year or so as well, so, yeah, there’s a compliance angle too.

 

When we ran a crop insurance agency in the San Joaquin Valley many years ago, the local TV and radio stations all carried a regular segment on the “ag weather” to alert growers to such hazards as sudden changes in the evapotranspiration rate. Comp program managers may need to watch the weather news now for potential unusually hazardous heat conditions for certain types of work such as open-air construction projects.

 

Heat is a subtle risk. It can sneak up on people. It is more serious in older employees. A couple of degrees or a little more direct sun exposure can be the difference between feeling low-down miserable but functioning and face down, not functioning. Serious, non-fatal heat stroke can result in permanent damage to the brain, heart, liver, and kidneys. Not trivial.

 

So—cool it, people.

 

*We also remember vividly when father, out of the blue, came home with a new 1960 Lincoln Continental with factory air and announced that he had had it with sweating his butt off in Los Angeles summer traffic.

 

The Revenge Of The Phone Booth

In our last issue we lamented the retirement of the last public pay phone in Manhattan. Apparently, it is irony that actually makes the world go around because we immediately ran into an article on the return of the phone booth—in contemporary office design. The article in CITY A.M. looks at the downside of “open” office design:

 

One of the most desired features in offices now is phone booths, and those thinking about office design should take note. Humans are sociable creatures, but we also like privacy, and office design has been eating away at workers’ privacy for years.

 

The key word for risk purposes is “privacy” because it is near allied to “confidentiality.” How much of what your people do in company offices requires some degree of secrecy? How many phone calls, especially, involve dialog you don’t want broadcast across the cube farm? Calls about pricing? Special contract requirements? Vendor problems? HR matters? The list is potentially a long one.

 

Hence the 21st Century rise of the new phone booth. It may be a simple mini-office with a work surface, power and internet outlets, maybe even a desk phone, but the important thing is, it has a door and it’s soundproof. People can retreat from their open-as-the-Kansas-prairie cube and speak, demand, plead, cry in privacy. The newer offices we’ve seen have two or more per floor, depending on the number of open workstations.

 

The article in question looks at phone booths primarily as an HR related employee accommodation:

 

Offices need free-flowing space to allow collaboration to flourish and for staff to feel part of something. But it can’t be at the cost of personal space, staff also need to be able to retreat to quieter spaces with more privacy.

 

But we see the same spaces as vital to a number of aspects of risk mitigation. Does your organization have open floors with phone booths? If so, does every employee understand how these should be used for conversations involving anything even slightly confidential? Do you publish an internal list for when to use a phone booth? Keep in mind that ever since the first TV remotes* our electronics have been training us not to get out of our chairs for anything less than fire, explosion, or earthquake, so people need clear reminders when not to whip out their cell phone at their workstation and start talking five feet from a popular water cooler or coffee pot.

 

We humans are creatures of habit. Open office design inculcates a number of good habits such as inclusiveness and open collaboration, but it can also breed some bad habits, such as being lax with valuable proprietary information. One antidote is the humble phone booth (new style). Superman won’t change clothes in it**, but it still has an important function. Yep—everything old is new again.

 

*As early as 1950, Zenith marketed a wire connected TV remote control called…, ready?..., the Lazy Bones.

 

**In case you are too young to recall this regular event in the life of Superman, here’s a reminder, courtesy of the CW: Smallville: Booster (Clark Changes In Phone Booth) - Bing video.

 

Quick Take 1:
Il Prezzo?

When Baron Scarpia thinks he has the beautiful singer Tosca trapped, she turns the tables by asking, Quanto, il prezzo?* How much, what is your price? In Tosca’s world of early 19th Century Rome, everything has a price. The same is true in our wonderful world of workers’ comp. We call it the medical fee schedule. The good folks at the Workers’ Compensation Research Institute have just published their magnum opus on the topic, Designing Workers’ Compensation Medical Fee Schedules, 2022. (Free to members of WCRI at www.wcrinet.org.)

 

Unless you are, shall we say, detail oriented, you may not want to read the whole 110-page document, but we do recommend the Introduction and Major Findings sections which are a mere four pages. Taken together, these give you a masterful overview of how modern medical fee schedules operate. The report discusses the various trade-offs in each schedule for the 44 states (and the District of Columbia) and how these schedules reflect different ideas about the proper compromise between the relative value of procedures and historical cost norms, how conversion factors work, how high or low the fees should be set. Not to mention questions about what procedures do not have a scheduled value and how those should be handled. A medical fee schedule is not an arbitrary set of numbers. Each schedule has a controlling logic behind it.

 

Not surprisingly, since this is comp, different states have very different ideas about how a schedule should work or how it relates to Medicare values. In some states we see a very different relationship between the comp schedule and Medicare as well as between diverse classes of procedures, such as surgical versus radiological procedures. The report also spikes out a few trends from one state to another. Every state marches to its own drummer in comp.

 

MBR or Medical Bill Review—applying the fee schedules plus any provider network contracts-- is one of the central processes involved in paying comp claims. Chances are you and your calculator don’t want to take the place of the MBR system, but knowing what the states are up to and why can be very helpful if your organization’s comp plan is in your sphere of responsibility. WCRI’s analysis tells us that everything really does have un prezzo and a good MBR system always knows how to answer the question, quanto?

 

*Act Two of Giacomo Puccini’s great opera, Tosca.

 

Tosca and Baron Scarpia discuss pricing. 

 

Quick Take 2:
For Every Ill, There's A Pill And A..., Wait A Minute

In our opinion, one of the signal successes in administering comp in recent years has been the concerted effort of the states, regulators, and claim administrators to curb the abuse of opioids. Perhaps, like us, you were surprised at the decision handed down last month by the US Supreme Court on the linked cases of Ruan/ Kahn v. US. The Washington Post described the decision eloquently in its headline: “Supreme Court sides with doctors convicted of overprescribing opioids.” What does this mean—if anything—for the efforts all of us in comp have put into preventing opioid overprescribing?*

 

The Court’s decision seems to be pretty narrow. The cases involved were criminal prosecutions of the supposedly over-prescribing doctors for operating “pill mills.” According to the Post, “The court held that the government must prove beyond a reasonable doubt that the doctor knew or intended to prescribe the drugs in an unauthorized manner.” That’s a high burden of proof, as we expect in a criminal case.

 

What we do in trying to avoid over-prescription in comp claims is quite different. The claims administrator is making a judgment about the suitability of the proposed medication(s)** relative to the clinical facts of the claim. There is no issue of criminality; it’s just a matter of what is medically appropriate for this injured person at this time. The two cases at issue before the Supreme Court are complex and the subject of considerable legal maneuvering. The good news for comp is that this development seems highly unlikely to impact our work—our highly successful work—in curbing inappropriate prescribing in comp.

 

On the other hand, this decision serves as an apt reminder that we all work in a much larger context than our little risk world and we need to keep track of developments like this decision—just in case.

 

*As always, the GB Journal does not dispense legal advice. This discussion is for information purposes only. Always confer with your own counsel and your claim administrator concerning specific legal questions.

**It’s important to note in this regard that comp claims people and their medical advisors make these decisions all the time about other types of drugs and medical procedures—is it appropriate to the facts of the work-related injury/illness at the heart of the claim?

 

Say It Isn't So...

There’s too much honey—said no one, ever. Ah, but what about the bees? On July 2 a tractor trailer rig apparently took a highway curve in Utah a little too fast. The resulting crash spilled the cargo all across the roadway and surrounding areas. The cargo was 25,000,000 honeybees. The result is a textbook lesson in risk control and recovery.

 

“The trucking company hauling the bees, which had been in contact with the bees' owner, notified firefighters of the incident on Monday. The company said the owner asked that they spray down the bugs* with firefighting foam for safety and liability reasons.” The foam is fatal to bees. Local beekeepers, who tried to rescue as many bees as possible, said that only about 10% of the insects survived. One of them described the scene as “very sad.”

 

The common honeybee, apis millifera, is a major pollinator of food crops and bee populations have been in decline nationwide due to predatory mites and colony collapse disease, so the loss of so many bees is not trivial. In case you have not had your USDA allotment of irony for today—Utah is officially the Beehive State.

 

*Bugs indeed. Your author’s grandfather was a beekeeper by hobby and we grew up in the middle of dozens of hives, including a glass hive where we could study complex bee behavior. We think of bees to this day as very small friends.

 

Words To Remember:

Now is when our gardens are at their most lush with leaves, berries ripening, blooms—some fading, others opening—loud with bees, the shady spots dappled just right. This is when we know the truth of these simple words:

 

“To plant a garden is to believe in tomorrow.” (Audrey Hepburn)

 

A garden path is never more inviting than—right now.

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