Opioids an Obstacle to Better Claim Outcomes
On a weekly if not daily basis, there are media reports about the growing impacts of addiction to opioids. The Centers for Disease Control and Prevention (CDC) reports that 78 people a day are dying from the effects of opioid overdose. Families are being systematically destroyed by the multiplicity of effects of this increasingly pervasive problem.
In 2014, there were more than 47,000 drug overdose deaths in the United States and more than 28,000 of those deaths were caused by opioids. The American population makes up only 5 percent of the global population, and yet it consumes 80 percent of all opioids produced in the world.
This strongly implies there is a societal, cultural profile in America that is unlike anywhere in the world, driving such demand and overuse.
As the national “epidemic” of opioid abuse continues to get increasing attention, it’s important to realize the effect it has on employers. Prescription opioid abuse alone cost employers more than $25 billion in 2007.
The American population makes up only 5 percent of the global population, and yet it consumes 80 percent of all opioids produced in the world.
In addition, when injured workers are prescribed opioids long term, the length of the claim increases dramatically — even more so when other addictive medications like benzodiazepines (alprazolam, lorazepam) are prescribed.
Perhaps the most troubling statistic of all, 60 percent of injured workers on opioids 90 days post-injury will still be on opioids at 5 years.
Strategies for the Claims Team
While there is certainly responsibility and accountability on behalf of the patient and his/her doctor to mitigate this risk, here are a few final things workers’ comp claim professionals should consider in the overall strategy of managing claims involving opioid prescriptions and which, if not managed closely, may lead to abuse and addiction.
Develop and define a strategy for identifying and then monitoring physician prescribing patterns and the specific use patterns in each affected case. Some of the tactics that should be considered include:
- Leveraging pharmacy utilization review services
- Directing patients to doctors who won’t overprescribe opioids, and those who use prescription drug monitoring programs and tools, which are available in most states
- Engaging nurse case managers early and regularly; their involvement and intervention can help deter addiction. Nurses can advocate for other more clinically appropriate options, and advocate for best practices including risk assessments, opioid contracts, pill counts and random drug screens
- Ensuring that injured workers are getting prescriptions through pharmacy benefit management networks
- Leveraging fraud and investigative resources that are often useful in uncovering underlying, unrelated patterns of behavior that would indicate a propensity for opioid abuse
- Considering the cost of opioids versus alternatives; while many alternate treatment modalities are on the front-end more expensive, certain drugs may be much more expensive in the long term, especially if they lead to addiction
- Addressing the opioid issue well before case settlement; as with most longer term open claims scenarios, those with opioid use will only produce worse outcomes and get more expensive over time without appropriate early interventions
Continued vigilance by claims professionals can enable and facilitate a better result at closure and avoid a lot of potential pain for the injured worker along the recovery path.
Nurses Provide Frontline Care
Discussions about physician performance and its impact on claims is a frequent workers’ compensation topic. But spend time around a hospital and you witness nurses providing more of the frontline care and comfort. They interact with patients more than doctors.
Yet I have rarely heard workers’ compensation observers discuss current nursing-profession challenges. That contrasts with the attention paid to selecting treating physicians, discussions on a doctor shortage impacting claims outcomes, physician pay and so on.
Sure, doctors make treatment decisions that largely determine how injured workers mend and recover. But the level of care and compassion hospital nurses provide also impacts an injured worker’s overall experience.
As it goes with all employees, there are always a few not suited for the job. Fortunately, there are many different roles for them.
That experience shapes their attitudes about their medical recovery. It also affects their views on returning to the job and whether they should call the attorney 1-800 numbers pitched on TV commercials.
Most nurses I’ve encountered in hospitals exhibit great care about their roles and their patients. They are competent professionals.
As it goes with all employees, there are always a few not suited for the job. Fortunately, there are many different roles for them.
You have noticed, for example, the growing number of nurses employed by the insurance industry. Some of those roles still require patient empathy, while others are more administrative, analytical or company leadership positions not requiring direct patient care.
While most hospital nurses I’ve encountered bring their compassion and professional acumen to the job every day, many are leaving the profession.
Some are retiring baby boomers. Others are leaving because of the stress of too large a patient load. A nationwide R.N. shortage and hospital systems attempting to control labor costs can strain their abilities.
Nursing burnout is a much studied and written about topic. It’s a point of contention in nurse labor union disputes with hospitals and it’s evident when talking to nurses.
The challenge is evident in other ways.
Only 168 out of 3,544 hospitals received a five-star rating while more than 600 received one or two stars in a recent, albeit controversial, U.S. Centers for Medicare & Medicaid Services survey of patient satisfaction with hospitals.
The nationwide survey asked about communication with nurses and the responsiveness of hospital staff.
Perhaps this means it’s time for workers’ comp claims payers to expand the discussion about the people caring for injured workers.
Personally, when I accompany friends or family to a hospital I make sure that the caring and compassionate nurses I see get my appreciation. &
Your Workers’ Safety May Be at Risk, But Can You See the Threat?
Deadly violence at work is covered extensively by the media. We all know the stories.
Last year, ex-reporter Bryce Williams shot and killed two former colleagues while they conducted a live interview at a mall in Virginia. In February of this year, Cedric Larry Ford opened fire, killing three and injuring 12 at a Kansas lawn mower manufacturing company where he worked. Also in 2015, 14 people died and 22 were wounded by Syed Farook, a San Bernardino, California county health worker, and his wife, who had terroristic motives.
Active shooter scenarios, however, are just the tip of the iceberg when it comes to violence at work.
“Workplace violence is much broader and more pervasive than that. There are smaller acts of violence happening every day that directly impact organizations and their employees,” said Bertrand Spunberg, Executive Risks Practice Leader, Hiscox USA. “We just don’t hear about them.”
According to statistics compiled by the FBI, the chance that any business will experience an active shooter scenario is about 1 in 457,000, and the chance of death or injury by an active shooter at work is about 1 in 1.6 million.
The fact that deadly attacks — which are relatively rare — get the most media attention may lead employers to underestimate the risk and dismiss the issue of workplace violence as media hype. But any act that threatens the physical or psychological safety of an employee or that causes damage to business property or operations is serious and should not be taken lightly.
“One of the core responsibilities that any organization must fulfill is keeping employees safe, and honoring that duty is becoming more challenging than ever,” Spunberg said.
“Workplace violence is much broader and more pervasive than that. There are smaller acts of violence happening every day that directly impact organizations and their employees. We just don’t hear about them.”
— Bertrand Spunberg, Executive Risks Practice Leader, Hiscox USA
Desk Rage and Bullying: The Many Forms of Workplace Violence
Bullying, intimidation, and verbal abuse all have the potential to escalate into confrontations and a physical assault or damage to personal property. These violent acts don’t necessarily have to be perpetrated by a fellow employee; they could come from a friend, family member or even a complete stranger who wants to target a business or any of its workers.
Take for example the man who killed three workers at a Colorado Spring Planned Parenthood in April. He had no affiliation with the organization or any of its employees, but targeted the clinic out of his own sense of religious duty.
Companies are not required to report incidents of violence and many employees shy away from reporting warning signs or suspicious behavior because they don’t want to worsen a situation by inviting retaliation. It’s easy, after all, to attribute the occasional surly attitude to typical work-related stress, or an office argument to simple personality differences that are bound to emerge occasionally.
Sometimes, however, these are symptoms of “desk rage.”
According to a study by the Yale School of Management, nearly one quarter of the population feels at least somewhat angry at work most of the time; a condition they termed “chronic anger syndrome.” That anger can result from clashes with fellow coworkers, from the stress of heavy workloads, or it can overflow from family or financial problems at home.
Failure to recognize this anger as a harbinger of violence is one key reason organizations fail to prevent its escalation into full-blown attacks. Bryce Williams, for example, had a well-documented track record of volatile and aggressive behavior and had already been terminated for making coworkers uncomfortable. As he was escorted from the news station from which he was terminated, he reportedly threatened the station with retaliation.
Solving Inertia, Spurring Action
Many organizations lack the comprehensive training to teach employees and supervisors to recognize these warning signs and act on them.
“The most critical gap in any kind of workplace violence preparedness program is supervisory inertia, when people in positions of authority fail to act because they are scared of being wrong, don’t want to invade someone’s privacy, or fear for their own safety,” Spunberg said.
Failing to act can have serious consequences. Loss of life, injury, psychological harm, property damage, loss of productivity and business interruption can all result from acts of violence. The financial consequences can be significant. In the case of the San Bernardino shootings, for example, at least two claims were made against the county that employed the shooter seeking $58 million and $200 million.
Although all business owners have a workplace violence exposure, 70 percent of organizations have no plans in place to avoid or mitigate workplace violence incidents and no insurance coverage, according to the National Institute for Occupational Safety & Health.
“Most companies are vastly underprepared,” Spunberg said. “They don’t know what to do about it.”
Small- to medium-sized organizations in particular lack the resources to develop risk mitigation plans.
“They typically lack a risk management department or a security department,” Spunberg said. “They don’t have the internal structure that dictates who supervisors should report a problem to.”
With its workplace violence insurance solution, Hiscox aims to educate companies about the risk and provide a solution to help bridge the gap.
“The goal of this insurance product is not so much to make the organization whole again after an incident — which is the usual function of insurance — but to prevent the incident in the first place,” Spunberg said.
Hiscox’s partnership with Control Risks – a global leader in security risk management – provides clients with a 24/7 resource. The consultants can provide advice, come on-site to do their own assessment, and assist in defusing a situation before it escalates. Spunberg said that any carrier providing a workplace violence policy should be able to help mitigate the risk, not just provide coverage in response to the resultant damage.
“We urge our clients to call them at any time to report anything that seems out of ordinary, no matter how small. If they don’t know how to handle a situation, expertise is only a phone call away,” Spunberg said.
The Hiscox Workplace Violence coverage pays for the services of Control Risks and includes some indemnity for bodily injury as well as some supplemental coverage for business interruption, medical assistance and counseling. Subvention funds are also available to assist organizations in the proactive management of their workplace violence prevention program.
“Coverage matters, but more importantly we need employees and supervisors to act,” Spunberg said. “The consequences of doing nothing are too severe.”
To learn more about Hiscox’s coverage for small-to-medium sized businesses, visit http://www.hiscoxbroker.com/.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Hiscox USA. The editorial staff of Risk & Insurance had no role in its preparation.