Monday, January 4, 2016

Stop The Fantasy

It was really difficult to keep me away from posting over the holidays - all sorts of interesting things happened in the workers' compensation world: scandal, new rules and laws, studies, court rulings, controversy... some things never change.

And ProPublica published yet another story about workers' compensation, this time taking to task all of the intermediaries that have evolved in the past couple decades under the rubric of "cost containment."

Author Michael Grabell points to the lavish parties and other extravagances at industry conferences as examples that "cost containment" services have run amok. This drew fire, understandably, since most industries have wild parties and indulgent conferences - so why should workers' compensation be different?

Yet, if you see Vons/Safeway/Albertson's VP of Risk, Bill Zachry at any of these conferences, he is always carrying a camera and taking pictures of all of the vendor booths.

I asked him about this one day. He explained that when he gets back to the office he reviews all of the photos and counts up the number of vendors in any particular special service sector - that tells him where all the money is going and where he could potentially see some cost savings.

A brilliant strategy, I think.

Zachry has the luxury of working for, and with, a self insured, self administered (in most jurisdictions) business with the resources to conduct such investigation and implement mitigation strategies to drive the claim dollar where it has the most effect - providing medical care and indemnity to injured workers according to legal obligation.

Most employers don't have that luxury because they delegate the claims decision process to their insurance company.

So an outside observer notes that some of the marketing is over the top, perhaps creating in the least, as we were taught in law school ethics, an appearance of impropriety - not that there actually is any.

There's nothing wrong with promoting your business, even a "cost containment" business. Marketing is a necessary element of business. Without marketing people don't know you exist, much less know of the awesome service and/or products you provide.

And I like parties and shows, even though I won't stay up past 9 p.m. for any due to my unfortunate internal alarm clock that forces me awake at 3:30 a.m. every single morning (even on vacation ... ugh).

Why do we care if Grabell points out that there is lavish spending by vendors at big conferences? What's the big deal?

Some injured worker advocates have latched onto the story to express their opinion that all this money is better sent to injured workers and/or pay for their medical care. Maybe they are right, but maybe those are opinions that aren't well founded either - arguments go both ways.

And maybe stories like the latest in ProPublica need greater publicity and distribution, and provide more people with greater insight into workers' compensation - in my mind whether the portrayal is positive or negative is irrelevant; any time workers' compensation is before the public is good for the institution.

Workers' compensation should not be mysterious, should not be hiding, and should be exposed to the public good or bad, because it is for the public - each and every person that works in this country should be afforded reasonable work injury protection. It's good social policy. It's good economic policy.

Each time The Media comes out with a story, an expose, a critique, of workers' compensation is an excellent opportunity for the industry to reflect and look at ourselves: are we really doing as good of a job as we can with the resources we're given?

Every day I'm the recipient of numerous communications from someone that has seen, felt, heard or otherwise experienced something negative with workers' compensation. It could be from an authorized provider still not getting paid on time, or at fee schedule. It could be from an injured worker or his/her attorney describing some of the ludicrous machinations required to access benefits. It could be from an employer disgusted with the misdirection of its premium dollars. It could be from a claims specialist frustrated with relentless collection attempts by a vendor that should have been satisfied. It could be from a medical professional tired of the authorization gauntlet.

Overwhelmingly, though, such communications come from someone who is just doing their job, or in the least, performing the functions described in the "job description," be it attorney, doctor, claims specialist, broker, and yes, even injured worker.

Everyone has their job to do. In workers' compensation, everyone's job description is created in part by law, by regulation, by a company document and also by culture.

Getting upset about some negative portrayal in The Media is natural - after all, someone is taking to task something very close to us: our professional livelihoods in which a huge part of our egos are wrapped. It is absolutely natural to be defensive.

But it's not productive.

Here's the issue with ProPublica's latest story: "cost containment," despite what Robert Hartwig told ProPublica, ARE dirty words. That phrase sends entirely the wrong message. Yes, the category was started to stop the outflow of irresponsible money and, coincidentally, promote smart medicine. Whether it is used to in fact accomplish those goals is debated by physicians, injured workers and their attorneys (and some employers too).

As in any endeavor, particularly where social benefits are at stake, there are those who play well in the sand box, and others who don't.

Cost containment is an apt term if we, as an industry, are willing to accept its definitional reality - that the intent of cost containment is to save money for those who are paying it out.

Let's stop with the fantasy that cost containment is for the benefit of injured workers. It's not. Otherwise it would be called something else. That cost containment paradoxically results in medical treatment that should result in better outcomes is not the paramount reason for these businesses.

We all know that - so let's stop trying to pretend that it is something which it is not.

If the services are intended to benefit injured workers then there should be a better term for those services that should reflect that beneficial treatment,

Maybe we're misunderstood. Maybe our good intentions aren't appreciated.

But maybe cost containment really is an accurate term - and at whose expense?

Hate to say it folks, but we're getting the attention we all deserve.

The old Pogo comic strip is oft quoted because it is all too true, "we have met the enemy, and he is us." (Walt Kelly, 1953)


  1. IM so glad you were able to get a break to rest and refreshed.

    Do note that you and your reporting were missed.

    Well I may not always agree with you, you do always try and tell us all both sides of the story.

    Your contributions to the work comp industry are invaluable.

    So, glad to hear your back at the helm.

    Keep the stories and the TRUTH coming out, for the World to learn and for workers comp to improve.

    Best wishes for the new year, and all the great reporting to come.

  2. Thanks David! Thanks also for your stellar leadership with CompLaude Awards too!

    Time to start tracking for nominations for 2016! I have pen and paper handy, along with iPhone and Galaxy Note 5.

    See you at CAAA Winter 2016 Conference dinner? (A kind and compassionate attorney has invited me as a guest; I simply said, 'yes, thank you,'

    I hope to get a guest pass to hear so I can 'report' on your panel on the ProPublica/Demolition discussions, and also a guest pass for the Garvey panel on medical treatment. Tom and Keith know I want to attend also.

    I also want to walk the Exhibit Hall so I can collect more info, and yes, I like the idea of taking pictures... with the intent to share via blog. Everybody likes 'free publicity' and it will make the vendors more 'human' to the Injured Worker community! Win/Win/Win.

    If you guys can't arrange the panel guest passes, I'm working on a 'short' email to Bert. It's the least I can do in light of the fact that in my case, 'the parties reached resolution, subject to a confidentiality agreement' last year.

    There might be 'lessons learned' that I can share with a team of experts, in a general way, of course.

    I want to establish an organization along lines of INJURED AND DISABLED WORKERS ASSOCIATION - USA. IDWA-USA Interested?

    Imagine, Injured Workers as invited guests...that's leadership, too, huh? My blogs in 2016 will include interviews with some of the leading experts--industry and injured workers... I am working on the questions now!

    See you soon, and write on! WE ARE THE MEDIA NOW


      As David knew, CAAA Lost my dinner registration and made it very clear that Injured Workers are not welcome at any of their events… Even emancipated injured workers injured workers

  3. Good UR using evidence based medicine produces better treatment for the injured workers

  4. There are always opportunities to save money in the WC system

  5. Yeah BILL, I asked you at the FAC (Fraud Asessment Commission)in Sacramento CA, a few years ago how much you were paid by the FAC , which by the way is funded by CA. Selfinsured employers to the tune of 33 mil a year. There's a video on this too. How many times did we ask where do we go to report fraud, if you can't report it to the fraud assessment Commission , where else, you all never said. Your're comments on injured workers prior to that hearing was despicable at best, also on video. Don't pretend you give a damn at all about injure workers because you don't. We all know that the insurance industry has made many billions, far too much by denying injured workers their benefits, (just so the insurance business can buy the DELTA in Ca. a water way or buy any other real estate) especially the ones who suffer the serious injuries such as back, & head injuries or exposures to chemicals. You all here in CA in the comp industry are perhaps the most heartless & coldblooded people that ever walked on the face of the earth. By earning money off of those you don't give benefits to, is in fact deplorable at best and should be used as criminal acts & therefore charged & punished with crimes against humanity. Evidenced based medicine is B.S. medicine and those in the insurance industry know because it was you all who made it up..

    1. Thanks for the insights Dina. I don't know Bill, but I do know the pretenders of whom you speak. "heartless and coldblooded" incapable of empathy or compassion...those characteristic describe the psychopathic characteristics that permeate the industry. Even the business models and training of 'adjusters' seems to fit that profile.

      I do believe DOL will have to send in the National Guard to protect Injured Workers and Other Taxpayers. The May "National Discussions" and secret tribunals seem off to a most frightening start... Have you noticed all the focus on the OPIUM WARS.... TO DISTRACT AND DECEIVE? Yikes!

  6. New blog.... see and share, thanks. filled with action steps.

    As you know, David, I didn't get to attend that CAAA dinner after all.... the contempt and disdain for anything to do with Injured Workers, even those who have escaped, was made quite clear by the CAAA event coordinator when she said she didn't care who said they purchased my registration, I would not be allowed in, nor could the gentleman even be allowed to provide me with his event ticket, if indeed it was 'sold out' and his confirmation voided.

    She further accused me of lying, and said that Judge who invited me to coffee and the Exhibit Hall in Winter 2014 had violated the rules, and she nothing more to say when I said he walked me to the registration desk, introduced me as an Injured Worker, and I was given a guest pass, with his name and mine...she had nothing to say other than I would not be allowed at the dinner.

    I have been insulted repeatedly by numerous experts over the years, most recently, one called my blogs 'drivel.'

    I have also met a number of kind and compassionate people in your industry, with an obvious will-to-good.

    Be that as it is, I'm outraged at the Wilson "Top Blogs for 2016" list, with no mention of injured if no nominations were made. I know I nominated. So, here's my 3 cents. I still say you're #1 in critical thinking in your crowd. Injured Workers may have to count on your leadership to wake up your colleagues, or be assured, we will collectively find a way to get the National Guard involved in protecting citizens in California and across the USA. Enough if enough.


    Opiates? WorkComp Best Blogs Results? Malcolm X? Without a Blog, an Injured Worker is UNARMED AND UNPROTECTED in America's War on Workers and Opiates!
    Opiates? WorkComp BEST BLOGS RESULTS? Without a Blog, an Injured Worker is UNARMED and Unprotected in America’s WAR ON WORKERS

    #DodgeTheRads and #Blog4Freedom, Life, Liberty and Justice for All....