Workers’ Comp – Feeding the Heroin Dragon
CNN recently ran an article on a grandmother addicted to heroin. In what almost seems cliché these days, her heroin use started as a prescription drug addiction. This could have just as easily been the result of treatment for a workers’ comp injury.
Our nation spends billions fighting the “war on drugs,” militarizing the police, incarcerating people, and devastating lives, while the highly-regulated medical and pharmacy industry are free to dispense essentially the same substances. Consider that most inmates are jailed for non-violent crimes, and most of those are drug-related. The cost to society in money and disruption is astounding.
Prescription drugs account for more overdose deaths than all street drugs combined. Moreover, our healthcare system has basically become a primary feeder to the illegal drug market.
This is a health issue and a moral issue – not a criminal issue – and we need to fix our health system.
When you start doing some back-of-the-napkin math, you realize that the workers’ compensation system’s potential contribution to the heroin problem in America is staggering.
As workers’ compensation professionals, it’s critical we understand our impact on society. Every time we help prevent an addiction, we impact not just one person’s life, not just an insurance carrier or an employer and their employees, but the children and families of these potential addicts. We also impact the public’s price tag in emergency room visits, government treatment programs, drug-related accidents, etc.
Consider this. A WCRI study found that about 55–85 percent of injured workers were prescribed opioids. Of the roughly 3.6 million new injuries that occur each year, this equates to 1,980,000 to 3,060,000 potential addicts the workers’ comp industry is creating annually.
Now factor in that 75 percent of heroin users indicate that their “first opiate of abuse” was through prescription drugs, according to a recent JAMA study. Taking it one step past the patients themselves, you uncover that the family medicine cabinet has become a breeding ground for the heroin addictions of our youth.
When you start doing some back-of-the-napkin math, you realize that the workers’ compensation system’s potential contribution to the heroin problem in America is staggering. Bottom line, we need to take ownership – our industry is creating addicts who are creating a massive recurring demand for heroin and other illegal substances.
While I applaud the Drug Enforcement Administration’s recent reclassification of hydrocodone as a Schedule II medication with heightened restrictions, one has to wonder – will this simply drive users to illicit drugs, like heroin, faster? Some addiction experts think so.
Anyone in our industry that’s been involved with addiction weaning programs knows how hard it is to get patients off “the dragon.” The reality is that providers continue to prescribe opioids way too often and for way too long, rather than as a short-term or last resort option. This is a battle that needs to be waged from the front lines.
The key is to make sure we have the systems and processes in place to prevent addiction in the first place. We in the workers’ compensation industry are uniquely positioned to fight this battle and change people’s lives for the better.
Read more of Jason Beans’ Risk Insider articles
Privacy Options Added to Prescription Monitoring Programs
“Prescription Drug Monitoring Programs have great potential to curtail opioid abuse, misuse, and diversion, and granting a variety of interested parties access to PDMP data may further that objective. However, the more entities that can review PDMP information the more important it becomes to develop standards for patient privacy.”
With that statement, members of the National Council of Insurance Legislators added enhancements to its model law to address opioids in the workers’ comp system. The expanded options seek a balanced approach to ensure data privacy.
A majority of states have adopted PDMPs as a way for health care providers to determine what medications their patients are taking. NCOIL last year adopted Best Practices to Address Opioid Abuse, Misuse and Diversion. It addresses how to establish, evaluate, and fund PDMPs that require real-time reporting; create strong evidence-based prescribing standards that recognize one-size-does-not-fit-all and that crack down on so-called “pill mill pain clinics”; promote education among physicians and the public; and encourage treatment and prevention.
NCOIL is comprised of state legislators whose main area of public policy interest is insurance legislation and regulation. At this year’s summer NCOIL meeting in Boston, members of the committees on Health, Long Term Care and Health Retirement Issues, and Workers’ Compensation Insurance unanimously adopted the enhancements to the best practices.
“As states contemplate what privacy options they wish to pursue, legislators should keep in mind that an assurance of confidentiality is crucial to a patient-physician relationship,” the enhancement stated. “Though courts around the country are divided as to whether state efforts to regulate controlled substances outweigh a need for patient privacy, legislators should consider whether it is appropriate to in some way limit what entities other than the physician have a right to know about a person’s medical conditions and treatment.”
The enhancement calls for safeguards to be clearly stated in statutes and regulations “to avoid confusion and to help empower state officials to take action as needed.”
The potential safeguards are:
- Making PDMP data confidential and excluding it from open records or public records laws.
- Explicitly requiring PDMP administering agencies to adopt policies and procedures that reasonably assure that only those who are legally authorized to access the database actually do so.
- Imposing appropriate legal penalties and administrative sanctions such as actions against someone’s license for violations and ensuring that the penalties/sanctions are enforced.
- Specifying who is authorized to access the data and for what purpose.
- Implementing detailed authentication procedures to verify that a user is qualified to access the PDMP pursuant to state law.
The Re-Invention of American Healthcare
Consolidation among healthcare providers continues at a torrid pace.
A multitude of factors are driving this consolidation, including the Affordable Care Act compliance, growing costs and the ever-greater complexity of health insurance reimbursements. After several years of purchasing individual practices and regional hospital systems, the emergence of the mega-hospital system is now clear.
“Every month, one of our clients is either being bought or buying someone — and the M&A activity shows no signs of slowing down,” said Brenda Osborne, executive vice president at Lexington Insurance Co.
This dramatic change in the landscape of healthcare providers is soon to be matched by equally significant changes in patient behavior. Motivated by growing out-of-pocket costs and empowered with new sources of information, the emergence of a “healthcare consumer” is on the horizon.
Price, service, reputation and, ultimately, value are soon to be important factors for patients making healthcare decisions.
Such significant changes bring with them new and challenging risks.
Although physicians traditionally started their own practices or joined medical groups, the current climate is quite the opposite. Doctors are now seeking out employment by health systems. Wages are guaranteed, hours are more stable, vacations are easier to take, and the burdens of running a business are gone.
“It’s a lot more of a desirable lifestyle, particularly for the younger generation,” said Osborne.
Brenda Osborne discusses the changing healthcare environment and the risks and opportunities to come.
Given the strategic importance of successfully integrating acquired practices into a larger healthcare system, hospitals are rightfully focused on how best to keep doctors happy, motivated and focused on patient safety.
A key issue that many hospitals struggle with is how to provide effective liability insurance for their doctors. Physicians who previously owned their practice are accustomed to a certain type of coverage and they expect that coverage to continue.
Even when operators find comparable liability insurance solutions for their doctors, getting buy-in from their staff is often an additional hurdle to overcome.
“Physicians listen to two things — physician leaders and data,” said Osborne. “That’s why Lexington provides assessments that utilize deep data analysis, combined with providing insights from leading doctors to help explain trends and best practices.
“In addition, utilizing benchmarks against peers helps to identify gaps in best practices. It’s a very powerful approach that speaks to doctors in a way that will help them improve their risk.”
Focusing on the “continuum of care”
There’s been a fundamental shift in how healthcare providers care for patients: Treatment is becoming more focused on a patient’s overall health status and related needs.
A cancer patient, for example, should have doctors in a number of specialties communicating and working together toward a positive patient outcome. But that means a change in thinking: Physicians need to work collaboratively with one another — not easy for individuals or groups that are used to being independent. Healthcare is a team sport.
“If there isn’t strong communication, strong leadership, and the recognition of proper treatment procedures between physicians, healthcare providers can increase the risk of error,” said Osborne. “The provider has got to treat the whole patient rather than each individual condition.”
That coordination must extend from inpatient to outpatient, especially since the ACA has led to a rapid increase in patients being treated at outpatient clinics, or via home health or telehealth to reduce the cost of inpatient care
“Home health is going be a growing area in the future,” Osborne continued. “Telehealth will become an effective and efficient way of managing and treating patients in their home. A patient might have a nurse come in and help the healthcare provider communicate with a physician through an iPad or computer. The nurse can also convey assessment findings to the physician.”
Metrics matter more than ever
Patients have not always thought of themselves as healthcare consumers, but that’s changing dramatically as they pay more out of pocket for their own healthcare. At the same time, there’s an increase in metrics and data available to the public — and healthcare consumers are drawing upon those metrics more and more when making choices that affect their health.
“Consumers are going to start measuring physicians against physicians, healthcare systems against healthcare systems. That competition will force everyone to improve the quality of care.”
– Brenda Osborne, Executive Vice President, Lexington Insurance
Think about all the research a consumer does before buying a car. Which dealership has the best price? Who provides the best service? Who’s offering the best financing deal?
“Do patients do that with physicians? No,” said Osborne. “Patients choose physicians through referrals from friends or health plans with minimal information. Patients may be putting their lives in the physicians’ hands and not know their track record.
That’s all going to change as patients’ use of data becomes more widespread. There are many web based resources to find information on physicians.
“Consumers are going to start measuring physicians against physicians, healthcare systems against healthcare systems,” said Osborne. “That competition will force everyone to improve the quality of care.”
Effective solutions are driven by expertise and vision
The rapidly evolving healthcare space requires all healthcare providers to find ways to cut costs and focus on patient safety. Lexington Insurance, long known as the leading innovative and nimble specialty insurer, is at the forefront in providing clients cutting-edge tools to help reduce costs and healthcare exposures.
These tools include:
- Office Practice Risk Assessment: To support clients as they acquire physician practices, Lexington developed an office practice assessment tool which provides a broad, comprehensive evaluation of operational practices that may impact risk. The resulting report, complete with charts, graphs and insights, includes recommendations that can help physicians reduce risk related to such issues as telephone triage, lab results follow-up and medication management. .
- Best Practice Assessments: High risk clinical areas such as emergency departments (ED) and obstetrics (OB) can benefit significantly from external, objective, evidence-based assessments to identify gaps and assure compliance with best practices. In addition to ED and OB, Lexington can provide a BPA for peri-operative care, prevention of healthcare-acquired infections, and nursing homes. All assessments result in a comprehensive report with recommendations for improvement and resources along with consultative assistance and support. .
- Continuing Education: In an effort to improve knowledge, decrease potential risk and support healthcare providers in the use the most current tools and techniques, Lexington provides Continuing Medical Education credits at no cost to hospitals or their physicians.
- Targeting the Healthcare Consumer: With Medicare reimbursement impacted by patient-satisfaction surveys, assuring a positive patient experience is more critical than ever. Lexington helps hospitals understand and improve the patient experience so they can continue to earn the trust of healthcare consumers while preserving their good reputation. .
To learn more about Lexington Insurance’s scope and depth of the patient safety consulting products and services healthcare solutions, interested brokers may visit their website.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Lexington Insurance. The editorial staff of Risk & Insurance had no role in its preparation.