Nancy Grover

Nancy Grover is co-Chair of the National Workers’ Compensation and Disability Conference and Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at riskletters@lrp.com.

Industry Research

Frequency, Severity of Injuries and Illnesses Down

Workplace injury and illness rates have continued to decline over the past few years despite a period of economic growth, which tends to be accompanied by a spike in injuries.
By: | January 19, 2015 • 2 min read
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“Slightly more than 3 million nonfatal workplace injuries and illnesses were reported by private industry employers in 2013, resulting in an incidence rate of 3.3 cases per 100 equivalent full-time workers,” announced the Bureau of Labor Statistics. “The rate reported for 2013 continues the pattern of statistically significant declines that, with the exception of 2012, occurred annually for the last 11 years.”

The first of two reports from the BLS last month noted that the reduction in the rate was “significant” for workers in the manufacturing, retail trade, and utilities sectors. Other sectors had similar results from the previous year.

For private industry workers, the incidence rate of injuries only in 2013 was 3.1 cases per 100 FTEs, down from 3.2 in 2012. The rate of illnesses was statistically unchanged.

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The rate of injuries and illnesses for state and local government workers combined is “significantly higher than the private industry rate.” However, it decreased to 5.2 cases per 100 FTEs in 2013 from 5.6 in 2012.

“We are encouraged that the rates continue to decline over the past few years even during this period of healthy economic growth when we would expect the rate of injuries to rise,” said Dr. David Michaels, assistant secretary of labor for occupational safety and health. “But we cannot ignore those 3 million workers. The severity of their injuries and illnesses varies widely; some are amputees, some suffer back injuries while others have to struggle for each breath.”

The second report released by the BLS tracked injuries and illnesses requiring days away from work in 2013.

“The overall incidence rate of nonfatal occupational injury and illness cases requiring days away from work to recuperate was 109.4 cases per 10,000 FTEs in 2013 down from the 2012 rate of 111.8,” the report said. “The median days away from work to recuperate, a key measure of severity of injuries and illnesses, was eight days in 2013, one fewer than reported in 2012.”

The rate for days away from work in the private sector in 2013 was 99.9 cases per 10,000 FTEs, relatively unchanged from 2012. However, the rate of falls on the same level increased to 15.4 from 14.8 in 2012. The BLS said that rate was up in:

Construction: from 12.6 to 16.1.

Wholesale trade: from 9.9 to 11.4.

Transportation and warehousing: from 22.9 to 28.3.

The rate for cases involving days away from work, job transfer, or restriction (commonly referred to as DART) declined for the first time since 2009.

Musculoskeletal disorders comprised 33 percent of all injury and illness cases in 2013 requiring days away from work with the highest numbers affecting nursing assistants and laborers and freight, stock and material movers.

The report also noted that violence and other injuries by persons or animals accounted for 4 percent of the cases in the private sector. Violence among workers in the health care and social assistance sectors accounted for 13 percent of injuries and illnesses with the rate increasing for the second year in a row — to 16.2 cases per 10,000 FTEs from 15.1 in 2012.

Nancy Grover is co-Chair of the National Workers’ Compensation and Disability Conference and Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at riskletters@lrp.com.
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Physician Dispensing

Study ‘Raises Concerns’ About Unnecessary Drugs

Researchers from the Workers Compensation Research Institute were surprised by evidence that physicians allowed to dispense medications prescribed unnecessarily strong opioids.
By: | January 19, 2015 • 2 min read
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Reforms addressing physician dispensing might need to target specific drugs in addition to prices, suggests a new study.

A review of workers’ comp claims in Florida points to evidence that physicians allowed to dispense medications prescribed unnecessarily strong opioids.

The Workers Compensation Research Institute looked at claims both pre- and post-reforms to curb physician dispensing in Florida. The results surprised the researchers.

“If the pre-ban strong opioids were necessary, researchers would expect that workers who received weaker physician-dispensed pain medications after the ban would later need strong opioids (that can be dispensed only at a pharmacy).

But only 2 percent of those with weaker physician-dispensed pain medications in the first six months after the ban received strong opioids at a pharmacy in the next six months,” the report said.

“This raises concerns that a significant proportion of pre-reform physician-dispensed strong opioids were not necessary, which means injured workers in Florida were put at greater risk for addiction, disability or work loss, and even death.”

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The researchers looked at the prescribing behaviors of physicians after Florida banned physician dispensing of strong opioids.

They found no material increase in pharmacy-dispensed strong opioids but instead an increase in the rate of patients receiving physician-dispensed weaker pain medications — nonsteroidal anti-inflammatory medications such as ibuprofen.

The percentage receiving weaker opioids increased from 9.1 to 10.1 percent.

The study comes as policymakers in several states focus on the prices charged by physician dispensers compared to pharmacies for the same medications.

But increasingly there is speculation that economic incentives associated with physician dispensing lead to unnecessary medications prescribed for injured workers.

“When we compare pre- and post-reform prescribing practices, it appears that physician-dispensers not only reduced their dispensing of strong opioids but also reduced prescribing of strong opioids,” said Richard Victor, WCRI’s executive director.

“Since Florida has banned physician dispensing of strong opioids, the lessons of this study are relevant for the other states concerned about eliminating unnecessary costs in their system while protecting injured workers from unnecessary medical care.”

Nancy Grover is co-Chair of the National Workers’ Compensation and Disability Conference and Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at riskletters@lrp.com.
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Managing Costs

Report Sparks NH Commissioner’s Call for Fee Schedule

State official says work should begin immediately on the creation of a fee schedule that is fair and based on the real costs of health care in New Hampshire.
By: | January 9, 2015 • 2 min read
cost cutting

A new report looking at the high workers’ comp costs in New Hampshire calls for creation of a database, implementation of a pharmacy benefit management program, and continuing the commission’s work. But several members of the gubernatorial task force rejected the majority report and said a medical fee schedule is needed.

Gov. Maggie Hassan received the report in December after the panel’s nearly three-month review of the system. She created the commission from insurance, business, health care, and labor to recommend ways to reduce workers’ comp medical costs.

The report’s first recommendation would require legislative approval to develop a database of workers’ comp charges and costs for collection, analysis, and a transparency tool to allow public access. But the three members opposing the report said rather than reducing costs, the database would “add substantial costs to the carriers that operate in NH since most do not track the claims in the manner expected by the commission.”

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Insurance Commissioner Roger Sevigny, who chaired the commission, disagreed with the minority report’s assertion. “While the creation of such a database would be time-consuming, the information it eventually would generate would be invaluable to the ongoing examination of workers’ compensation costs in New Hampshire.” However, Sevigny admitted it would take some time.

“Until such a database is constructed, however, we cannot afford to do nothing,” he said. “Work should begin immediately on the creation of a fee schedule that is fair and based on the real costs of health care in New Hampshire.”

The minority report recommended adoption of a fee schedule using group health as a benchmark of appropriate medical charges. “This fee schedule would be fair to medical providers and not difficult or expensive to implement,” the minority report said. “If medical providers are accepting group health payments for non-work related injuries, what is the rationale for requiring workers’ compensation payers to pay upwards of 200 percent or 300 percent more for the same treatment?”

Sevigny said he “agreed in principle” with the idea but said a fee schedule must be “well thought out and carefully crafted.”

The full report’s recommendation to implement a mandatory PBM program was approved by all 15 members. However, the minority report said pharmacy “represents a very small percentage of the overall medical pie,” and a PBM program “will not impact the cost burden in any meaningful way.”

The full report’s recommendation to continue the commission’s work was opposed by both Sevigny and the minority members. “While I agree that more work needs to be done, I am concerned that the many methodologies and possibilities the group has committed to examining in this recommendation will make any future effort on the Commission’s part unduly diffuse,” the commissioner said. “Thoughtfully limiting any future Commission’s scope is necessary if anything is to be accomplished.”

Nancy Grover is co-Chair of the National Workers’ Compensation and Disability Conference and Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at riskletters@lrp.com.
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