Friday, December 15, 2017

Nonsense from Trump on cutting regulations, shows no love for coal miners


It was a ridiculous photo op. The President standing next to piles of white paper stacked seven feet high.

“Regulations — oh, boy.  It’s a lot of regulations,” Trump said.

Next to the tall stacks were a few piles of paper only one foot high. The giant stack had a red label marked “TODAY” and the small stack’s label was “1960.” Trump proclaimed:

“In 1960, there were approximately 20,000 pages in the Code of Federal Regulations.  Today, there are over 185,000 pages.  …We’re going to cut a ribbon because we’re getting back below the 1960-level, and we’ll be there fairly quickly.”

Oh yes, the good old days. 1960, the year when 325 coal miners were killed on the job (compared to 8 deaths last year). A time when there were 20 deaths in motor vehicle crashes per 100,000 people (compared to 11 in 2015.) And the free market allowed industrial facilities to discharge chemical-laden waste into rivers and belch toxics from their smoke stacks.

Trump’s photo op to boast about “cutting the red tape of regulations” coincided with the release of his Administration’s semi-annual regulatory agenda. At the event, the President insisted he wants to “protect our workers, our safety, our health.” His plan however says otherwise. He invoked his love of coal and his success at ending “the war on coal.” But he doesn’t show any love for coal miners—particularly for their health—-in his regulatory plan.

The Mine Safety and Health Administration (MSHA), for example, will be revisiting a regulation put in place in 2014 to better protect coal miners from developing black lung disease. The rule took full effect in August 2016. Trump’s Labor Department says it soon will be asking the coal industry for ideas on ways to make the coal-dust reduction rules less burdensome and costly. Among other things, this likely means reducing the frequency of air monitoring which helps to assess whether dust control methods are working properly.

The President’s regulatory plan also runs counter to what I heard from MSHA chief David Zatezalo at his confirmation. He told Senator Tim Kaine (D-VA):

“Silicosis is not an acceptable thing for our [miners.]”

Zatezalo indicated that new rules may be necessary to protect miners from respirable silica dust:

“I figure we’re going to have to go some engineering type controls, and really increase ventilation, and really increase water to be able to control it.”

Hearing that, I thought Zatezalo was serious about tackling the epidemic of lung disease among coal miners. But the Labor Department’s regulatory agenda for MSHA lists respirable silica as a topic for “long-term action.” The due date for a next step is labeled: “undetermined.”

I thought President Trump’s crush on coal miners would extend to David Zatezalo. I thought the MSHA chief would have been able to influence the White House. To make the White House live up to the President’s professions of love for coal miners. I hoped that love would translate into defense of the coal dust rules and action on new rules to address silica dust.

I was wrong.



Article source:Science Blogs

Work-related injuries 60 percent higher than Labor Department estimates

Every year, about 1,000 workers in Michigan suffer an injury in which a body part is crushed. That’s 60 percent higher than the estimate published by the Bureau of Labor Statistics–the federal government’s official count of occupational injuries.

Michigan State University researchers Joanna Kica, MPA and Ken Rosenman, MD used hospital records and workers’ compensation data to identify 3,137 work-related crushing injuries in Michigan from 2013 through 2015. This compares to the federal government’s official estimate of only 1,260 incidents for the same period.

Crushing injuries can involve the upper or lower extremities, the head, neck, abdomen, back, and/or the pelvis. A crushing injury may cause damage to the skin, nerves, muscles and/or bones. The severity of the injury depends on the intensity of the force on the affected body part(s).

Nearly 73 percent of the crushing injuries identified by Kica and Rosenman involved the workers’ upper extremities. About 27 percent of the incidents occurred in workplaces classified as “primary metal manufacturing,” although many industry groups—from construction and agriculture to food production—were represented in the data.

Kica and Rosenman note that during the same three-year time period, Michigan OSHA (MIOSHA) conducted 77 inspections at worksites where these crushing injury incidents occurred. Of the inspections conducted, 74 percent resulted in citations for violations of safety standards. Especially troubling to me was reading that nearly 80 percent of the employers had not corrected the hazard that caused the injury.

The researchers describe, for example, the case of a 35-year-old worker whose right hand was yanked into a pulley system. His hand was crushed, he suffered burns up to his elbow, and was hospitalized for five days as a result. Three months after the incident, MIOSHA conducted an inspection at the workplace. The employer had not installed a guard on the machine or taken other measures to prevent the incident from repeating itself.

Another discrepancy identified by Kica and Rosenman was the incidence trend between their data and BLS’s estimate. The rate of work-related crushing injuries per 100,000 workers increased from 2013 through 2015 according to the hospital and workers’ compensation data, while BLS’s estimate indicated the decreasing rate. (See figure on left from their paper.)

This is the fourth analysis published by the Michigan State University research team that uses data from several surveillance systems to characterize the magnitude of a specific type of work-related injury. They also use their analyses, which have examined amputations, burns, skull fractures. (here, here, here) and now crushing injuries, to compare their tabulation to the annual injury estimates for Michigan prepared by the Bureau of Labor Statistics. BLS’s data is based on a survey of employers who are asked to report the data they’ve recorded on an OSHA injury log. Kica and Rosenman’s previous analyses found that BLS’s annual Survey of Occupational Injuries and Illnesses (SOII) underestimated the number of work-related amputations, burns, and skull fractures in Michigan by 59, 69, and 54 percent, respectively. Their analysis of work-related crushing injuries found an underestimate by SOII of 60 percent.

Because of research by these epidemiologists and others (e.g., here, here, here, herehere), BLS has been funding projects to examine the reason for the SOII’s undercount. Some are reasons are obvious. For example, BLS only collects data when an injury results in the workers missing one or more days of work. Many injured workers return to work immediately after an injury and given a “light duty” assignment. BLS also does not collect injury data from the self-employed or from farming operations with less than 11 employees. The agency has funded research to interview employers and identify errors in their injury recordkeeping practices, as well as a project to determine the feasibility of including questions about worker injuries in existing national data collection, such as the National Health Interview Survey and the Current Population Survey.

In the meantime, credit goes to Kica and Rosenman for providing a much more accurate picture of the magnitude of  work-related injuries and illness, and to the National Institute for Occupational Safety and Health for funding the research.




Article source:Science Blogs

How’d I do on my 2017 workers’ comp predictions?

Every year I dance the danger line, coming up with predictions for the upcoming year. And every year I hold myself accountable, reporting to you, loyal reader, exactly how those predictions worked out.

Clearly not a self-portrait; I could never grow that facial hair…

So here’s this year’s results…

(predictions are here)

  1. Premiums will rise as employment and wages continue to grow.
    It’s a yesRates continue to decline, but hourly wages have been ticking up for over a year now, and employment has been trending up for over 60 months. So, the combination has overcome the drop in rates. For now…
  2. Medical costs will remain flat or close to it.
    Not according to NCCI – at least not for last year in NCCI states. Medical costs increased 5 percent last year. California is not an NCCI state; trend was up 6 points last year. So, got that one wrong.
  3. Frequency will continue to decline.
    Because it always does. On average, by 3.6 percent a year.
    That means there will be about 10 percent fewer claims in three years, 20% fewer in six.
  4. Insurers will double down on efforts to reduce administrative expenses.
    Frequency’s down, investment returns are dropping, and medical costs pretty much under control; premium rates are headed lower as well. So, insurers have continued their efforts to slash admin costs by outsourcing more claims to TPAs (contacts in the TPA business indicate that’s their biggest source of growth).
  5. More payers will move their claims adjusters to home offices.
    No news on this – so I’ll count this as a no.  If you know of moves, let me know.
  6. Winners will focus on execution.
    . MedRisk [HSA consulting client] has taken the top spot in physical medicine management from competitor OneCall by out-executing OC. PBMs that deliver seamless customer service, lower drug costs and reduced opioid spend are winning; myMatrixx is perhaps the best example. Kaiser Permanente on the Job is another example; K-PoJ is delivering better results for patients and employers by doing what KP does so well – focusing on what patients need, not what creates billing opportunities. And BWC Ohio has made amazing progress in reducing unnecessary opioid use – by developing and implementing a comprehensive, careful approach.
  7. Telemedicine is coming fast
    Yes indeed.  Coventry, MedRisk (HSA consulting client), CHC Telehealth (Mitchell has helped fund CHC), Kura, and other entrants were all over the NWCDC. MedRisk’s telerehab program is up and running, and case management firms are moving quickly.
    Unlike other “innovations”, tele-services is going to change everything.
    8.  Mitchell will continue to add work comp services businesses via acquisition.
    Yes –
    Unimed and PMOA are additions this year, adding breadth to both the UR and PBM businesses. I’d expect more in the future – although there are fewer businesses to buy that fit well with the company’s strategy.
    9. Drug cost decreases will flatten out somewhat, while reductions in opioid spend will continue to increase.
    Well, I got this one partially – but pretty badly – wrong. Costs dropped by double digits, led by a 13.6 percent decline in opioids.  And I’m supposed to know a lot about this business…sheesh.
    10. More value-based payment pilots will hit work comp.
    That’s a really easy prediction, so I’ll quantify it – there will be more than five new pilots or program seeking to deliver care via bundled payments or similar mechanisms that will start in 2017.
    Well, except for K-PoJ I can’t find any evidence that this happened – and in fact in a post a few months after my 2017 predictions, I backtracked bigtime on this prediction. Any new news on this is welcomed.
    11. Bonus pick – more consolidation in case management
    As frequency and severity continue to slide, field case management businesses are going to have to find new revenues from new services they can offer to current clients/cases and get more revenue from current cases.
    Argh…haven’t seen much evidence of this – perhaps because there’s already been a lot of consolidation.

The net – I got 4.5 wrong out of 11.  Ouch.

I’m hoping to do a LOT better with next year’s prognostications.

Article source:Managed Care Matters

Thursday, December 14, 2017

Holiday for Health Wonks!

It’s the hap…happiest time of the year!  For healthwonks, start your holidays off early with this w(rapped) Health Wonk Review!

Article source:Managed Care Matters

It’s not a tax bill, it’s a healthcare bill

OK, a bit of hyperbole – but only a bit.

Here’s how the Trump Tax Bill will affect healthcare…

  1. Immediate $25 billion cut in Medicare spending followed by a total of $400 million over the next nine years
    This has to happen under “PAYGO” rules which require offsets in spending when revenues are cut (as will happen under the Trump Tax).  Medicare is NOT AN ENTITLEMENT, it is an EARNED benefit. Starting January 1, 2018, doctors, hospitals, and pharma are going to take the hit as Medicare will stop paying for some care delivered by doctors.
  2. 13 million (+/-) more people will lose health insurance
    If you can sign up AFTER you get sick, why would you pay premiums until you need insurance? The bill ends enforcement of the mandate, but insurers are still REQUIRED to take all comers. So, many younger and healthier people will not sign up, and when they don’t the “pool” of insured people will get older, less healthier, and therefore more expensive to insure.
  3. Individual health insurance premiums will go up about 10%
    So, Insurance companies will raise premiums by about 10% as healthcare costs for the older, less healthy population will go up.
  4. Drive insurers out of the individual and small group markets
    See above…
  5. Reduce drug development for “orphan” diseases
    Today pharma gets a major tax break for developing treatments for orphan diseases, such as cystic fibrosis, epilepsy, muscular dystrophy and Angelman syndrome. It appears that tax break goes away – and this will greatly reduce R&D. The tax credit has been cited as responsible for treatments for about 350 diseases; there are around 7000 in total.  Here’s one pretty amazing success story that will likely not be repeated due to the end of the tax credit.

With fewer people covered by insurance, and higher rates for those that are, we’re likely to see more insurers drop out of more markets.

The greatest impact will be seen several years down the road, when the overly-optimistic growth projections prove to be just that. Already, experts predict the Trump Tax Bill will add over a trillion dollars to our national debt. When that happens, there are going to be calls for massive cuts to ALL services – including Social Security, Medicare, and Medicaid.

What does this mean for you?

I’m thinking Medicaid for all by 2027.


Article source:Managed Care Matters

Wednesday, December 13, 2017

Occupational Health News Roundup

At Reveal, Amy Julia Harris and Shoshana Walter investigate retired Oklahoma Judge Thomas Landrith, who started the first rural drug court in the country. About 10 years ago, Landrith also started a rehab work camp — Southern Oklahoma Addiction Recovery or SOAR — where defendants had to work full time for no pay at a Coca-Cola plant and other companies under threat of imprisonment.

Coca-Cola guidelines prohibit forced labor and in response to the Reveal investigation, the Oklahoma bottling plant in question has already severed ties with SOAR. Harris and Walter write:

Reveal spoke with more than a dozen men who attended the SOAR program. All but one said the program was more concerned with work than their recovery. Cody Evans called it “the worst experience of my life.” Dustin Barnes called the people who run SOAR “crooks.”

“‘If you can’t work, your ass should not be here.’ They tell you that when you first get there,” said Lee Purdy, who was court-ordered to SOAR and worked at Leachco (a factory that makes pregnancy pillows). “This ain’t the place for you if you can’t work.”

If men got hurt or were too sick to work, the program often kicked them out, they said. Some worked despite being injured.

“It made me mad and feel like I really wasn’t worth nothing,” said Lucas Allen, one of the men Landrith sent to SOAR in 2015. He said he was forced to work with an injured hand. “It’s like they didn’t care what happened to me.”

Read the full story, which is part of a larger investigative series into rehab programs that funnel free labor into private industry, at Reveal.

In other news:

Huffington Post: Dave Jamieson reports that with a new conservative majority on the National Labor Relations Board, its members are considering scrapping worker-friendly union election reforms adopted under President Obama. Earlier this week, Jamieson writes, the agency published a Federal Register notice asking whether it should keep current union election rules in place, change them or get rid of them — the board’s three Republican members approved the notice, while the two Democratic members disapproved. The agency’s staff had spent thousands of hours “carefully” updating the election rules in 2014. In a dissent, board member Mark Gaston Pearce described the new Federal Register notice — known officially as a “Notice and Request for Information” — as a “Notice and Quest for Alternative Facts.” Jamieson writes: “Pearce’s Democratic colleague, Lauren McFerran, wrote that the timing of the board’s request suggests the majority is interested not in ‘objective data,’ but in ‘manufacturing a rationale’ for rolling back the rules now that Republicans are in power.”

KPCC: Leslie Berestein Rojas writes about the effects of California’s wildfires on farmworkers still reporting to work in the fields of Southern California. She spoke to advocates with Central Coast Alliance United for a Sustainable Economy, which reported a number of farmworkers in the fields without protective masks during the “worst of the smoke and ash.” KPCC contacted other growers who said they had given workers facemasks and the option of leaving the fields. Last week, the California Department of Industrial Relations issued an advisory, saying employers “must consider taking appropriate measures” from wildfire smoke, however when and which measures to take are up to employers. Critics, such as state legislator Judy Chu, who previously worked to protect farmworkers from heat illness, says such wildfire protections need to be stronger. Rojas quoted Chu, who said: “Certainly we see extraordinary hazards now because of these fires. And so there needs to be a renewed effort toward getting protections for our outdoor workers.”

NPR: Samantha Raphelson reports on growing concerns about worker safety inside the so-called gig economy, starting the article with the story of 19-year-old Antawani Wright-Davis, who was struck and killed by a dump truck while delivering food on his bike for DoorDash, another app that classifies its workers as independent contractors. Because he wasn’t considered an employee — which allows gig economy employers to sidestep a number of labor protections — Wright-Davis’ family wasn’t eligible for workers’ compensation. Fortunately, as the gig economy grows, some states, such as New York and Washington, are considering new protections for independent contractors. Raphelson quoted Jessica Martinez, co-executive director of the National Council for Occupational Safety and Health, who said: “It’s essentially the Tinder economy. When a temp worker is done with his or her shift, the boss swipes left and claims to have no further obligation.”

The Stranger: Heidi Groover reports that domestic workers and elected officials in Seattle have kicked off a campaign calling for a new set of labor protections for domestic workers. In particular, workers and advocates with Working Washington as well as members of the Seattle City Council are urging the city to create a Domestic Workers Bill of Rights that would require written contracts for domestic workers and ensure such workers are covered by local labor protections. The Seattle campaign follows in the footsteps of worker efforts in a number of other states, including California, New York and Illinois. Groover writes: “If recent history is any indication, the bill of rights stands a good chance at Seattle City Hall. Working Washington is a labor advocacy group funded in part by Service Employees International Union Local 775. SEIU 775’s president helped negotiate Seattle’s $15 minimum wage, and Working Washington advocated for secure scheduling and unionization for rideshare drivers. Both passed the city council unanimously despite business concerns.”

Article source:Science Blogs

Tuesday, December 12, 2017

What we missed while we were in Vegas

The world didn’t stop while we were meeting, learning, and socializing in Las Vegas at NWCDC. Here’s what happened…

Sedgwick is getting bigger – again. The acquisition of Cunningham Lindsey makes Sedgwick the largest TPA in the land, with about 20,000 employees handling various aspects of claims and related functions.

Pharmacy and related topics

California’s work comp formulary goes into effect in 3 weeks.  Make sure you’re ready by hearing from those who know it best – the folks at CWCI. Their webinar is available here (free to CWCI members, $50 for non-members)

An excellent primer on handling opioid treatment issues – specifically effective ways to end opioid treatment – comes from Coventry’s Nikki Wilson, PharmD via WorkCompWire.  It’s simple, clear, and concise.

Sticking with drugs, Adam Fein reminds us “In 2016, U.S. net spending on outpatient prescription drugs was $328.6 billion, up only 1.3% from the 2015 figure.” [emphasis added] In contrast, CompPharma’s latest Survey of Prescription Drug Management in Workers’ Comp shows a drop of 11 percent year over year. 


Employment is going to change – a lot – over the next decade. A thought-provoking report by McKinsey includes this prediction:

One result – “the share of the workforce that may need to learn new skills and find work in new occupations is much higher: up to one-third of the 2030 workforce in the United States” – with major implications for worker retraining, potential claiming behavior, and re-employment. 

A reminder about the unseen consequences of the gig economy: airport revenues are dropping as passengers increasingly use ride-sharing services instead of paying for parking, renting cars or using cabs. I’ve reduced my use of rental cars; even if Lyft is occasionally more expensive, the hassle reduction factor plus the ability to work in the car to and from the airport are compelling.

A total of $5.8 billion was collected by airports from cab companies, parking, and rental car fees, more than they get from hotels, shops and restaurants combined.

Auto mechanic employment is also going to change – as more people switch to electric cars, there’s going to be a LOT fewer problems for mechanics to fix and even regular maintenance is limited to tires and wiper blades.  We have an electric BMW i3; it has needed zero maintenance other than tires.

Takeaway – the downstream effects of the “gig economy” are far reaching indeed.


Article source:Managed Care Matters