Monday, March 19, 2012

Biology IS Different in Arizona, When Driven by Politics

The American College of Occupational and Environmental Medicine (ACOEM) and the Work Loss Data Institute (WLDI) have a constant public relations campaign going on convincing states that have not yet adopted medical treatment guidelines that it is more efficient and ethical to adopt national based standards rather than drafting state specific guidelines.

Representatives for both WLDI and ACOEM told WorkCompCentral last week that states that adopt their own state-specific treatment guidelines are missing an opportunity to employ evidence-based medicine to drive good outcomes.

“Biology is not different across state lines," said Phil LeFevre, a senior account executive at WLDI.

LeFevre is correct - biology is not different. But politics are.

LeFevre said the trend of states establishing their own set of treatment guidelines, a process typically hammered out in committee, results in consensus-based, not evidence-based, medical protocols. Worse, lawmakers are relying on the testimony and recommendations of profit-minded lobbyists and health care providers to create a new model, he said.

“This is being driven by self-interest,” LeFevre said.

No kidding...

A few weeks ago I gave a presentation to a group of orthopedists at Loma Linda University Medical Center. I received a very nice (hand written I might add) thank you note from my host. He commented that he didn't realize how politicized workers' compensation was!

I don't think that most people give much thought to how workers' compensation came to exist and how it has evolved over the years. Most folks just take it for granted that if one gets hurt at work (or claims to be hurt at work) that there is insurance to take care of the injury. Folks forget that workers' compensation is solely a product of legislative fancy. There is no real history behind it, like common law, unless you're a mariner (then one need only read up on the history of pirating to understand Jones Act codification of maritime injury law).

The folks who have figured out that workers' compensation is nicely manipulated through the political process, however, are in the best position to influence the direction and control of the system to ensure that interests are protected, or at least not significantly compromised.

For instance, in Arizona where the debate over treatment guidelines is really just starting, bio-tech behemoth, Medtronic, Inc. is weighing in on the debate stating that the company would endorse the current Arizona proposal (House Bill 2365) if a proposed amendment eliminated a provision that calls for defaulting to national standards if new guidelines cannot be agreed upon by July 2014.

Rep. Karen Fann, R-Prescott, introduced House Bill 2365 earlier this year. The measure would require the Arizona Industrial Commission adopt treatment guidelines by July 1, 2014. If the commission failed to meet that deadline, then ACOEM's guidelines would automatically become presumptively correct in the state's workers' compensation system (California did this in 2004).

“Medtronic is not opposed to Arizona-specific, state-developed treatment guidelines created with local physician input that is fair and balanced,” Marybeth Thorsgaard, senior director of public relations and communications for Medtronic, said. “We believe physician input should include specialists and subspecialists who are expert in treating workers’ compensation patients and familiar with the types of therapies being reviewed and prescribed in this population.”

And, I presume, are also expert at the installation of Medtronic's spinal implant hardware and other products the company manufactures...

The House Banking and Insurance Committee did not vote on HB 2365 after hearing three hours of testimony on the measure and other workers' comp bills during a hearing on Feb. 8. The committee proposed an amendment that would delete the requirement that ACOEM become the state standard after hearing opposition from Medtronic and medical providers.

Fann said she would not oppose the amendment stating a desire to improve medical service to injured workers and adhere to her state’s tradition of self-determination.

“The people of Arizona want to have their own medical treatment guidelines that fit the needs of its workers, not the so-called medicine in a can. Arizona has always been its own state. We do things our own way,” she said.

Right. Good buzz words: medicine in a can; textbook medicine; cookbook medicine; independence - after all, that's what America is all about, independence - right?

“How do we get medical service as quickly as possible to the right doctors with the right diagnosis and proper treatment? The primary goal is to improve access to medical treatment and get everybody back to work as soon as possible,” Fann said. “Secondly, we want to increase cost-effectiveness and create jobs.”

More good buzzwords: right doctors, right diagnosis, proper treatment, back to work, cost-effectiveness and increase jobs.

So, explain to me how deviating from carefully reviewed science does that? How is it that Arizona knows more about biology than California, or Nevada, or Texas or the Federal government?

Oh, that's right - they have people there - lobbyists and special interest representatives - that know more than the rest of us.

Okay, I get it now. Biology IS different depending on which state you're in. Glad we all figured that out.

Christopher J. Wolfkiel, Ph.D., Director, ACOEM Practice Guidelines, provided this clarification of ACOEM's position.

1 comment:

  1. David,
    Thank you for the interesting analysis.
    Adam Friedlander