Monday, August 19, 2013

Bloggers Disagree or Not

This morning I'm part of a panel of "bloggers" at the WCI 68th Annual Conference in Orlando, Florida.

My fellow bloggers, Bob Wilson of, Mark Walls of Marsh and the LinkedIn Work Comp Analysis group, and I are going to be asked to give opinion on several topics including the Affordable Care Act's impact on work comp, opioids and the nation, state reforms, and the cost of medical in the system.

Folks expect us to battle with disparate opinions. While sometimes I admit that we don't align on some details, in the couple of years that each of us has been in the workers' compensation "public" eye with our musings, I'd say we are more aligned in opinions than we are not.

Though I speak for myself, and not my fellow presenters, they would probably agree that workers' compensation is what it is: a collection of laws that, particularly in the past two decades, have modified the original underlying premise to fit the particular needs of various interests which had sufficient political power to influence lawmakers and regulators for the benefit of a few.

So we're going to opine on various topics, such as the Affordable Care Act, opioids, physician drug dispensing, reform across the nation, and probably a few other topics.

But really: Affordable Care Act? What the heck do I know about the ACA? Just as much, I suspect, as you reading this, which is to say woefully little.

I know what some are saying the ACA will do to work comp, but in actuality none of us really know what the impact is going to be, if any. And my guess is that this is a red herring to the system; the ACA is going to provide some additional medical insurance coverage to a demographic that didn't have it before.

That's about all.

Will there be a doctor shortage? I don't know. What I do know is that a lot of doctors don't like doing industrial medicine already because of the paper work and additional administrative hassle. So whether there are fewer doctors likely won't be felt in work comp - there are some docs that will put up with our demands, and there are many that won't. Those that decide to stay in the system will figure it out.

Perhaps one aspect of the ACA that the industry is overlooking, except for the underwriters, and that is the payrolls of the medical industry should expand dramatically making for a ripe market for the carriers that write that line of business.

What about opioids and physician dispensing? We'll be aligned in our opinion - yep, narcotics left uncontrolled are bad for the system and physician dispensing is part of that issue. And of course it all comes down to money. Trace the dollars and you'll find the root cause.

The Los Angeles Times last week ran a front page news story on Purdue Pharma's maintenance of a list of 1800 doctors who were prescribing more than what was expected so that sales people would be aware of the unusually high amount of drugs. But Purdue didn't do anything other than alert sales people to the phenomenon, presumably because the company has sold more than $27 billion worth of the drug since its introduction in 1996 so why ruin a good thing.

Don't want to derail that profit train before the patent expires...

And some physicians hired by pain management clinics were making millions of dollars a year issuing and filling prescriptions, paid on a per prescription basis, with incredible profit margins for the clinic owners (some now serving jail time).

We also know that the physician dispensing bill that was made law in Florida this past session was the product of a last minute deal in the legislative hallway when Sen. Alan Hays, R-Umatilla, and Brian Ballard, the chief lobbyist for South Florida-based Automated Healthcare Solutions, brought a compromise to the issue that allowed AHS to continue its operations and make a profit, albeit under a more controlled situation.

Company lobbyists have been very successful deterring other attempts to impair profit margins in Hawaii, Georgia and other states.

Reform states are sure to be highlighted in the session, most notably California with its SB 863 and Oklahoma with the move to an administrative dispute resolution system and the new regulated opt-out program. Are these programs good, bad, or indifferent?

I've opined before that the Oklahoma experiment should prove to be the catalyst of a change agent in the industry providing the companies that qualify with an opportunity to show the work comp community that they can manage claims better than the industry can, returning workers back to gainful employment and minimizing medical and indemnity costs along the way.

The jury is still out on the California reform - much of the savings were predicated on summary dismissal of hundreds of millions of dollars of liens but a pending lawsuit may derail the optimists' expectations, at least in the short term. Carriers and the rate making agency in California have thus far been pessimistic about savings...

I'm sure there's more that will end up in the debate, but I know one thing for sure - each of us remains committed to the premise that workers' compensation is a vital element to strong, viable economic and social activity. All we have to do is look at countries like Bangladesh or India to understand how the protection of workers and employers is important to sustained economic growth and social order.

While we may be divided in how we return to work comp Shangri-La, there is a basic theme that I think we are united on: if we as individuals performing our various duties and functions in the industry stay focused on a singular cause - providing medical treatment and reasonable indemnity to injured workers while ensuring that all employers participate with their fair share of the risk allocation - then we're doing as good as can be expected.


  1. I wish you luck, but the purpose of the ACA is to have employers provide medical insurance for their employees.

    It's a short leap for a Legislature to decide that since Thr ACS is federally mandated, then the employer is bring mandated to provide the same service twice. Since the Legislature has no control off the ACS, they'll mandate that the State benefit is duplicative, and no longer necessary. This will also be justified that it will reducer costs and litigation by letting the Federal government handle it under the single payer system.

    And because this works so well in Australia, then the next step is to substitute SDI for TTD, SSS/SSDI for PPD, and now the Federal government has effectively nationalized all Workers Comp.

    Most employers will love it, until they get socked with additional taxes (previously called premium), but they'll have no recourse.

    Of course, all of us will be out of a job, so I just hope I can put off retirement for a another decade or two, so that I can maximize my funds against what the government is going to demand I pay to subsidize these additional costs.

  2. Knowing the detail of the ACA in terms of Workers' Compensation is going to be key. Continuing to focus on medical costs and indemnity is not going to provide the cost savings that will be mandated. Initial and concurrent Medical Case Management with the emphasis of return to work is the key. Yes there is a pain management problem, look at the "why". Denied surgeries that are compensable, too large of caseloads for claims managers, etc. Doing the right thing for the patient (wherever they are on the healthcare continuum) always will produce cost savings. If we continue to look at indemnity and medical costs the eye is not on the ball. I look forward to the cliff notes!