Almost two generations ago most Americans (and the rest of the world, for that matter) still thought nothing of lighting up. Smoking was glamorous. The "smoke filled room" was not a metaphor; the smoke was real. Then came the Surgeon General's report on smoking on January 11, 1964. The Report on Smoking and Health by Dr. Luther Terry changed everything. Little by little, the smoke cleared and became the outlier activity it is today.
On November 17, 2016, the Surgeon General, Vice Admiral Vivek Murthy, MD, released a new report, Facing Addiction in America. This report pulls no punches either. Want to know how bad addiction is? Just start reading. The Executive Summary begins: "In 2015, over 27 million people in the United States reported current use of illicit drugs or misuse of prescription drugs, and over 66 million people (nearly a quarter of the adult and adolescent population) reported binge drinking in the past month." Those statistics are your family members, your neighbors, and your employees.
Those of us in risk management have our own little slice of this pie from hell - opioid over-prescription and abuse. If you haven't taken the problems surrounding pain management in workers' compensation seriously, or if you regard them as just one more routine cost control issue, think again. The Summary goes on to note that "It is estimated that the yearly economic impact of substance misuse is $249 billion for alcohol misuse and $193 billion for illicit drug use."
Are you and your workers' comp claims people doing everything you can to avoid, detect, and deal with opioid abuse? Is this on your priority list for your stewardship meetings? Once upon a time, employers wouldn't even consider sponsoring smoking cessation programs for their employees. Dr. Terry's report started changing that neglect into vision and action. This report offers hope for new approaches to addiction (see the conclusion of the report, "Vision for the Future"). The alternative, allowing the current course of events to continue unabated, is, in Joe Paduda's summary of the opioid epidemic: "hundreds of thousands of dead people, millions of addicts, destroyed families, devastated communities."
"THE FRAUDS, EMBEZZLERS, AND THIEVES YOU CALL DOCTORS"*
*Judge David Langham
The California Division of Workers' Compensation (DWC) announced in December (see the WorkCompCentral item here [fee or subscription required] or the official news release here) that it will soon begin to enforce California's new law (AB 1244) barring physicians found guilty of billing fraud or other criminal acts from reimbursement for care rendered under workers' compensation. Note that the State of Washington has long had a similar provision in place that seems to have worked well there.
Removing the bad actors from work comp medical care seems like an obviously good idea, but there are countercurrents, as explored in this opinion piece posted by David Langham, the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims and Division of Administrative Hearings. Judge Langham provided the neat quote in our headline and his essay is both witty and highly informative about this complex issue.
The GB Journal will be watching the California Workers' Compensation Institute and other like-minded organizations for follow-on studies of the actual impact of this new legislation on the roughly 16,000 California medical providers who appear likely to be included in the exclusionary provisions. Risk managers with large comp exposures in the Golden State may well wonder if 16,000 is too many, too few, or just a good start. We'll see.
THE "ACA DEATHWATCH" AND RISK MANAGEMENT
If you're in risk management, the battles now going on in Washington DC over the fate of the Affordable Care Act (ACA) have to be viewed from two different angles. What will happen to your corporate group health plans (and your own group insurance costs) and what will the knock on effects be for your cost of medical care in workers' compensation and liability programs? Most reports and op-ed columns you might read or see on the TV Sunday news talk shows focus only on the former, but there are a few folks watching the latter issues as well and you'll want to stay tuned to what they are saying as you try to anticipate what will happen to the medical component of your risk expenses in coming years.
Joe Paduda's blog, Managed Care Matters, is ground zero. For example, Joe's January 17 post takes a look at a recent Rand study which notes that workers' comp medical costs nationwide are about $930,000,000 lower with ACA in place. Guess what happens if ACA is repealed and not replaced? This post is just one installment in Joe's running commentary on ACA and workers' comp which started at the RIMS conference in Boston in 2010.
The blog WorkersCompInsider is also tracking the ups and downs of the ACA debate with occasional sidebars on its impact on workers' comp. Clearly, the details will count. The roughly 18 million people insured under the ACA have not needed to find ways to make their weekend warrior injuries work related since they signed up for ObamaCare. What happens if that changes back to the not-so-good old days?
The ACA debate is not just for your colleagues across the hall in HR and group benefits. This is of vital interest to everyone who writes a check to a doctor, a hospital, or a physical therapist.
AUTO FRAUD CHECKLIST
Got fraud? The good folks at Property/Casualty 360 have published a very handy checklist for potential auto fraud. While all of the tips listed are really just common sense, this is a neat resource and reminder. For example, seeing MRIs or CT scans in a medical file is not unusual, but something's afoot when these are among the first items billed. Heavy use of imaging up front is a red flag in many cases. This is one of those lists you might want to print out and pin to your bulletin board or clip in your audit instructions file.
A serious part of success in risk management is having the right checklists - and using them. Ask the next airline pilot you happen to meet.