Tuesday, September 13, 2011

Rx Abuse Issues Due to Poor Risk Management

Emergencies happen. Usually at the wrong time.

Such was the case yesterday. WorkCompCentral's site was down for a protracted period of time because the hosting location experienced the threat of a fire. The fire department shut down the power to the buildings HVAC system which caused our servers to heat up, and the excessive electrical draw from our server's fans caused a circuit to trip.

This should not have been a problem though because in good risk management we should have had our power adequately planned so no excessive load would be experienced.

But our design was insufficient so as a consequence WCC was off line for over an hour - it was corrected, we learned our lesson and changed some configurations.

What does this have to do with workers' compensation besides just me whining about our service being unavailable to our customers?

Workers' compensation, when it comes down to the basic nuts and bolts, is just a risk management tool.

It is a tool for businesses to ameliorate the financial catastrophe of a worker getting injured on the job.

It is a tool for employees to ease the tragedy of a work injury and hopefully prevent a family from losing home, hearth and mantle.

It is a tool for society to try and maintain as much productive up time with the labor force as possible thereby contributing to economic vibrancy.

But sometimes, even with the best of planning and best of techniques, the unexpected or unforeseen occurs - something that is just plain beyond planning and then the proverbial bovine excrement hits the fan.

Such it is with workers' compensation.

Yesterday Joe Paduda of Health Care Matters gave a free webinar to 100 enrollees to describe the advent of the prescription drug problem that has grown to a national issue, and how that problem differs significantly in workers' compensation than in the general health care system.

Why is the prescription drug problem different in work comp than general health?

The drugs that were developed for the general health care system to provide relief to terminal cancer patients are being prescribed in the work comp system for pain symptoms in low back patients where there is no clinical indication of serious abnormalities; and in general health care the payer (i.e. insurance company) can say "no" much more easily than a work comp payer.

Some carriers in the workers' compensation community are taking the "just say no" tact by essentially saying if the medication is not medically indicated by treatment guidelines standards then the physician and/or employee must be able to demonstrate with some other sound scientifically based evidence that the drug is indicated for the condition and for the duration being prescribed.

Will this hold up in court when the affected injured worker represented by the well meaning, able attorney seeks redress for such a position? I don't know nor am I willing to proffer a guess - the workers' compensation laws are generally to be liberally construed in favor of the injured worker to cure or relieve one from the effects of an industrial injury.

But to the administrative law judge and/or appeals panel that takes the case under consideration - does "liberally construed" mean that a person's life should be irreparably damaged on account of prescription drug addiction? When does prescription medication cease being a "cure or relieve" application and become a burden to the injured worker, his employer, his family ... society?

The prescription drug issue that is escalating in workers' compensation requires that all of the players "just say no" when the request for medication exceeds recommended guidelines.

And what about legacy claims where an injured worker has been on addictive pain medication for so long that there are serious withdrawal consequences if they are taken away? Failure to "say no" early on means that the payer/carrier/employer must foot the bill for intervention and treatment - and if this means "buying" additional "body parts" then so be it.

WCC failed to adequately distribute electrical load due to poor risk management planning. We paid the price and learned our lesson. Work comp systems failed to adequately monitor prescription pain medication abuse early on. We are paying, and will continue to pay, the price and hopefully we are learning our lesson.

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