Keynote Speaker Driven to Improve Health Care
2014 NWCDC opening keynoter speaker Dr. L. Casey Chosewood, senior medical officer and director of the Office for Total Worker Health Coordination and Research at NIOSH.
Employers and workers’ compensation payers have grown increasingly interested in delivering quality health care that mitigates the rising costs of chronic health conditions, lengthy disabilities, and stubborn claims.
Yet determining what defines quality health care remains a challenge.
That is why the National Workers’ Compensation and Disability Conference® & Expo selected Arthur M. Southam M.D. to deliver the opening keynote presentation at this year’s event scheduled for Nov. 11-13 at Mandalay Bay in Las Vegas.
Southam is executive VP health plan operations for Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals. He is known for driving measured improvements in medical care quality delivered by Kaiser, which serves 9.6 million health-plan members. As a speaker, Southam is also respected for captivating audiences with his passion for health care.
“Kaiser is an organization that has achieved multiple awards in terms of clinical excellence and the highest star rating from Medicare and medical group health programs,” said Denise Gillen-Algire, director, managed care and disability in corporate risk management for Albertsons Safeway Inc., and the conference’s program co-chair.
The keynote will focus on “leveraging what organizations have been able to do on the group health side and how we can use those tools in workers’ comp, and why that is important to employers.”
“So many organizations talk about either quality-focused networks or provider quality or quality outcomes, but how do you define ‘quality’ and how do you get there?” — Denise Gillen-Algire, director, managed care and disability in corporate risk management, Albertsons Safeway Inc.
Kaiser is the recipient of multiple awards from a variety of organizations, including the National Committee for Quality Assurance, U.S. News and World Report’s Top Hospitals, the Leapfrog Group, and J.D. Power and Associates.
“So many organizations talk about either quality-focused networks or provider quality or quality outcomes, but how do you define ‘quality’ and how do you get there,” Gillen-Algire said. “That’s how we came to Dr. Southam for the presentation.”
Several studies from leading workers’ comp research organizations have suggested that injured workers with comorbid conditions such as diabetes, obesity, and hypertension have higher costs per claim and longer disability durations. Thus, employers and other claims payers are increasingly interested in quality health care that can help improve claims outcomes when more injured workers suffer from those conditions.
“That’s the context. So if that’s the case, how do you check the quality of your providers, hospitals, your delivery system,” said Cyndy Larsen, area vice president for Kaiser On-the-Job, sales and account management. “Dr. Southam will discuss how did [Kaiser] get from where we were maybe 10 or 20 years ago to all these outside parties — like the NCQA, Leapfrog and J.D. Power and Associates — ranking us up there. What types of things had to be in place?”
Employers need to understand the importance of employees’ overall health and its impact on the workers’ comp system. Conference organizers say Southam’s experience on the group health side can demonstrate how workers’ comp can make similar improvements that lead to better outcomes.
“Really, group health is the bigger piece of the pie, and when you think of (the nation’s) total medical spend, workers’ comp is 2 or 3 percent,” Gillen-Algire said.
As Gillen-Algire explained, injured workers should be viewed in terms of their overall health, not just the occupational injury at hand.
“That’s absolutely a focus,” she said. “You can’t split a person into pieces. A person doesn’t come to you as a 2 percent problem over here and the rest over here in group health. [It’s important to] be able to tie what organizations are doing on the group health side and why that is important for workers’ comp in employee health outcomes.”
Southam will deliver the opening keynote address, Achieving Excellence in Medical Treatment, on Wednesday, Nov. 11 at Mandalay Bay.
Take a Proactive Approach to Reduce Opioid Liability Risk
Workers’ comp payers are increasingly on the hook for problems related to opioids prescribed for injured workers, according to a new report. The National Safety Council examined several recent cases and issued a warning and suggestions for employers and insurers to take steps to protect injured workers and themselves.
“Recent court decisions have determined that in certain circumstances, overdoses suffered by injured workers from opioid pain medications prescribed for occupational injuries are compensable by the workers’ compensation insurer,” the report noted. “Employers and their workers’ compensation insurance carrier have been ordered to pay for detoxification and medical-assisted treatment services as well as death benefits to surviving family.”
The NSC cited more than two dozen cases from state appellate or state Supreme Court decisions between January 2008 and March 31, 2015. “These cases demonstrate that it is not a regional issue but a national problem meriting employer and workers’ compensation program action,” the report said. “The courts relied on several key legal concepts.”
Proximate cause, for example, is identified as “any legally recognizable set of facts which, in natural or probable sequence, produced the individual’s injury.” If a worker slipped on spilled water at work and sustained an injury, the spilled water is the proximate cause of the injury.
The “chain of causation” determines whether any injury after the original is related to the workplace injury. Sometimes a separate action by the injured worker can be considered an independent intervening act, or superseding cause. In such a case, the intervening act breaks the chain of causation and ends the liability for the workplace injury.
“For the cases reviewed in this paper, the chain of causation is clear,” the report said. “A workplace injury occurred. The injured worker received treatment that included prescription pain medications and subsequently died of an opioid-related prescription drug overdose. The legal question at the center of all these cases is whether an intervening action broke the chain of causation to the workplace injury.”
States differ in their workers’ comp laws and rules of evidence. Nevertheless, in the majority of cases noted in the report overdose deaths of injured workers may be compensable “even when the medication is not taken as prescribed, taken with alcohol or inappropriately prescribed.”
Employers and insurers are advised to reduce their risks and potential compensable costs related to the use of opioid pain medications in workers’ comp claims by:
- Requiring workers’ compensation and network providers to use opioid prescribing guidelines issued by the American College of Occupational and Environmental Medicine. These include guidelines on opioid prescribing thresholds and recommend precautions for the prescribing provider. Among the precautions are undertaking thorough patient histories with a more detailed screening if the treatment is to continue beyond two weeks, urine drug monitoring, checking the state prescription monitoring database, avoiding co-prescribing benzodiazepines with opioids, and discontinuing treatment when patients have reached meaningful functional recovery.
- Using caution and requiring prior approval for the use of methadone to treat chronic noncancer pain.
- Screening injured workers for depression, mental health conditions, and current or prior substance use.
- Requiring all pharmaceuticals be purchased and managed by a pharmacy benefit manager.
- Educating all workers about the hazards associated with prescription pain medication use. “Many workers do not understand the unique risks and dangers posed by opioid pain medications,” the report said.
Managing Patient Safety in a New Health Care World
Much like regular screenings, exercise and a healthy diet, patient safety in health care institutions should be thought of as preventive medicine.
“Patient safety aims to relieve the burden of fixing mistakes by taking steps to prevent them from happening in the first place,” said Aileen Killen, head of casualty risk consulting, AIG.
With the right strategies and protocols in place, human error in delivering patient care can, to some degree, be factored out, mitigating the risk of things like falls or medication mistakes. And the outcomes-based reimbursement model enforced by the Affordable Care Act provides extra incentive to improve patients’ overall experience and reduce readmission rates.
Some challenges stand in the way, though, of achieving better safety.
For one thing, increased consolidation in the industry has brought risks associated with integrating disparate safety cultures and ensuring continuity of care if patients are moved to a new doctor. The trend of shifting more care out of main hospitals to ambulatory sites instead also creates concern that those outpatient facilities are not up to the same safety standards as larger organizations.
Finally, advancing technology — while offering great promise to eventually make health care more efficient and error-free — presents significant risks in its implementation while doctors, nurses and other health care professionals learn how to best use it.
Lexington Insurance, a member of AIG, is meeting the demand for more innovative tools to navigate the changing environment with a suite of safety assessment programs that identify problem areas and provide recommendations for improvement.
Assessing Safety Culture
The first step in overcoming any challenge is assessing the situation in order to create the best strategy.
“Every health care organization should aim to become a ‘high reliability organization,’ or HRO,” said Brenda Osborne, division executive, health care, Lexington. “It’s a term borrowed from the airline and nuclear power industries, in which any employee has the right to shut down operations if they spot a safety issue.”
Lexington’s Best Practice Assessment tool allows organizations to compare their own protocols against evidence-based best practices and identify weak spots in their safety culture.
“We survey employees and ask if they feel free to speak up to people in authority,” Killen said. “If they can all say yes, you’re on the road to a safety culture. Then we drill down into specific high-risk areas.”
Clients can conduct specific assessments for error-prone areas like the emergency department, obstetrical department and operating room.
We give organizations recommendations on how they can improve in areas where they are deficient, and we can benchmark their performance against the best practice as well as against other institutions that have done the same assessment,” Killen said.
Those benchmark comparisons are key for securing leadership buy-in. Executives often need to see what other institutions are doing in order to feel confident in their decisions to make changes or invest more heavily in patient safety measures.
If another competitive hospital has better staffing ratios, for example, benchmark stats will show that and support the C-suite’s decision to hire more nurses to achieve a similar ratio.
“What it basically does is give the risk management, patient safety and quality improvement staff a roadmap for which areas to focus their activities for improving patient safety and risk management at their organization,” Killen said.
Acquisitions and Physician Employment
The flurry of merger and acquisition activity in the health care industry creates new risks for large hospital networks that acquire physicians’ practices. The integration of different patient safety and risk management practices can prove difficult.
“You have to take multiple approaches and mindsets and meld them into one fluid organization,” Osborne said. “That has a big impact on physicians’ ability to treat patients and deal with the appropriate hand-offs.”
“Patient hand-off is one of the biggest safety challenges,” Killen said. “Assigning a patient’s care to a different doctor leaves room for gaps in communication, which is so critical to making the correct diagnosis and keeping a medication schedule.”
Lexington’s Office Practice Assessment tool scores acquired practices on 14 different domains, including risk management and patient safety, communication, infection control and prevention, incident reporting and medication safety, among others. Recommendations are provided for any domain that scores less than a perfect 100 percent.
“We’ve been able to go in and help these growing organizations benchmark each of these acquired physician offices to show where they are at in terms of their safety protocols,” Osborne said. “It helps risk managers know where they need to start.”
Another major challenge for patient safety is the movement of care away from main hospitals to ambulatory care settings, an area that previously did not concern hospital-based risk managers very much.
“Historically, there has not been a big focus from a patient safety standpoint on outpatient services,” Osborne said. “The office practice assessment that AIG’s been doing for the last two or three years has actually put us out in front. Few other resources out there can assist hospital-based risk managers in dealing with outpatient-type services.”
“Now more people are thinking about safety in ambulatory areas, and we have more knowledge and experience there,” Killen added.
The same office assessment tools that survey physician practices can also be applied to ancillary services like ambulances, blood banks, and outpatient surgery centers, though benchmarking is not yet available for these sites.
Adapting to new technology is an ongoing challenge for health care risk managers.
“Everyone thought electronic health records were going to solve all our patient safety issues, but they’ve come with some unintended and dangerous consequences,” Killen said. Employees may accidentally order medications for or even discharge the wrong patient, for example, if they have multiple records open at once.
The upside to technology advancements, though, is more streamlined documentation and more opportunities for communication between doctors and patients via telemedicine, which is slowly growing in popularity for remote and elderly patients.
“When we’re underwriting, we look at these areas of growth in technology and the many ways it can be applied,” Osborne said. “We consider all the pros and cons.”
Lexington’s dedication to improving safety in health care shines through in their thorough assessment tools, expert recommendations, and attention to insureds’ changing risk management needs.
“Our unique tools help insureds identify risks and minimize potential claims,” Killen said.
“These services are homegrown and developed by a lot of very knowledgeable people over a period of time,” Osborne said. “They’re not available out in the market, and only Lexington insureds have access to them.”
For more information about Lexington Insurance’s risk management services for the health care industry, please visit www.lexingtoninsurance.com.
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.