Here is a look at several sessions:
Pain Forensics: Finding Missed Opportunities for Positive Outcomes.
The speakers are Dr. Fernando Branco, the medical director of the Rosomoff Comprehensive Pain Center in Miami, and Dr. Steven Moskowitz, senior medical director at Paradigm Management Services in Walnut Creek, Calif.
Managing workers' comp claims that involve patients in chronic pain is challenging to say the least. Often, there are missed opportunities that could have resulted in positive outcomes but were overlooked. The speakers say there are clear differences between correctly managed and mismanaged pain cases in terms of costs, outcomes, and satisfaction.
Treatment decisions have consequences, the doctors say. A prime example is the use of opioids -- whether, how much, and how long to prescribe them. Often, these medications are not prescribed in accordance with universal guidelines.
Additionally, there are many incidents of inaccurate or incomplete diagnoses in a patient presenting to a pain treatment center. Commonly used physical diagnostic tests are imprecise at making a diagnosis for cervical or lumbar radiculopathy, the doctors say.
While many cases go wrong early because of inaccurate diagnoses, all is not lost. In fact, the speakers say that even cases on track for bad outcomes can be turned around.
The medical experts will deconstruct a workers' comp pain case and show attendees step-by-step where the missteps were made and how the claim could have been handled differently based on the following three claim handling "crimes":
- Biomedical approach instead of biopsychosocial.
- Unscientific treatment approach.
- Lack of systematic rehabilitative approach.
With specific examples of case studies, the speakers will show attendees what could have been done to gain the best outcomes for all.
Breaking the Web of Needless Disability. The speaker is Robert Aurbach, CEO of Uncommon Approach Inc., and the editor of the Journal of the International Association of Industrial Accident Boards and Commissions. Aurbach is also the former general counsel of the New Mexico Workers' Compensation Administration.
Disability mind-set is like a habit. Once in the brain, it is hard to break, Aurbach says.
There are specific reasons why some workers' comp claims turn into permanent disability cases while others with the same injuries do not. Based on a scientific principle, some injured workers take on the role of victim or disabled person.
As Aurbach explains, it is something of a learned behavior. "Have you ever experienced a song, a scent, a picture that brought up memories of another time or place?" he asks. "When things are associated in neural networks, the stimulation of one part of the network fires all the things that are linked to it, including 'physical' experiences such as chronic pain."
Breaking the disability mind-set is much like breaking a habit. "If you merely become dormant in using it, and don't replace a behavior with something else, then the neural network remains." The disability mind-set must be replaced with something else.
Aurbach has extensively studied neuroscience and created a model of the acquisition of learned disability behavior and ways to replace disability mind-set in injured workers.
He will explain the unique broad-based intervention incorporating the claimant's perceived loss of control, the medicalization effects of the loss of identify, attorney impacts, and psychosocial flags to recognize needless disability, and offer steps to prevent needless disability.
Attendees will become versed in the neuroplasticity model of acquired disability behavior and learn strategies to help claimants stay on track toward recovery.
The Experience Rating Worksheet: An Ever-Changing Story of Your Costs. The speaker is Kory Wells, product director of broker analytics for Zywave Inc. in Milwaukee.
Can you answer the following questions?
- Is a mod of 1.0 good?
- How can an ex-mod increase when there have been no claims?
- How low can the mod go?
- High frequency points first to what area of improvement?
- High severity points first to what area of improvement?
- Why is it important to keep losses medical-only?
These are some of the questions Wells will address in this session.
From a simple explanation of what the ex-mod is and how it is used, she will then examine the connection between the ex-mod and premium paid. Attendees will see a deep exploration of how payroll and losses affect the ex-mod and premium, what the numbers mean, and steps to improve the mod.
Next year, a new split point goes into effect in many jurisdictions. This change, the first in 20 years, could affect a company's mod. It "may increase or decrease even if your loss experience did not change at all," Wells says. "Your minimum mod will likely drop several points." What that means and how to prepare for it will be dealt with extensively in the session. Finally, she will explain how quick calculations using values on the experience rating worksheet can point toward business initiatives that deserve more attention with calculations on:
- Minimum mod.
- Frequency ratio.
- Severity ratio.
- Premium estimate.
The 21st annual National Workers' Compensation and Disability ConferenceŽ
& Expo takes place at the Las Vegas Convention Center, Nov. 7-9. The conference is produced by LRP Publications.
For more information, visit the conference website at www.wcconference.com.
Read more at the WorkersComp Forum homepage.
October 22, 2012
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