High-risk claims, pain management, repackaged drugs highlight tracks
Medical and disability management issues are among those targeted for discussion and dissection this year at the National Workers' Compensation and Disability ConferenceŽ & Expo.
A plethora of experts will offer their insights and confer with attendees to determine the best practices for handling the many medical and disability-related challenges.
Among the breakout sessions in the tracks Disability Management and Medical Management are the following:
High Times in Workers' Compensation: The Impact of Medical Marijuana. The speakers are:
- Theresa Genovese-Elliott, M.D., Spine and Pain Institute of Santa Fe, N.M.
- Albert B. Randall, Esq., Franklin & Prokopik PC, Baltimore, Md.
- Jim Andrews, SVP, pharmacy services, Cypress Care/Healthcare Solutions, Duluth, Ga.
- Moderator: Mark Walls, SVP, workers' compensation market research leader, Marsh USA Inc., St. Louis.
The legalization of medical marijuana in an increasing number of states is wreaking havoc on the workers' comp system. The variety of state laws and the conflicts between state and federal statutes raise a multitude of questions. This panel of medical, legal, and workplace experts offers insights into the very latest trends and provides strategies to protect employers and their employees.
Best Practices in Nurse Case Management. Panelists include:
- Sue A. Cotten, RN, CCM, president, Cotten Case Management Inc., Albuquerque, N.M.
- Margie Matsui, RN, CRRN, COHN-S, FAAOHN, principal occupational health programs administrator, Northrup Grumman, Los Angeles.
- Pamela Highsmith-Johnson, RN, CCM, national director of case management, CNA Insurance, Dallas.
- Moderator: Denise Gillen-Algire, RN, COHN-S/CM, FAAOHN, principal, Risk Navigation Group, Albuquerque, N.M.
Since medical has overtaken indemnity as the priciest piece of workers' comp, the role of nurse case managers has become a cornerstone of the claims process. Successful outcomes and quicker return to work depend on the ability of nurse case managers and their interactions with key stakeholders. This unique panel of employer, insurer, and independent nurse case managers reveals the innovative strategies they are using and what constitutes the most important factors that impact claim outcomes.
Embracing the "F" Word in Workers' Compensation. The speakers are:
- Deborah V. DiBenedetto, COHN-S/CM president, DVD Associates, Ann Arbor, Mich.
- Jennifer Christian, M.D., chair, work fitness and disability section of the American College of Occupational & Environmental Medicine, president, Webility Corporation, Wayland, Mass.
In order for injured employees, doctors, and treating supervisors to help reduce lost time days and costs, they may need to hear different messages than they are getting, especially about functionality. Communications must be positive and proactive with the focus on remaining ability -- not just restrictions, the speakers say. Through role play, they will demonstrate how to get employees, doctors, and supervisors more willing to help get the injured worker back to normal -- in a way that benefits everybody.
Physicians Speak Out on Whether More Care Early Equals Better Outcomes. The speakers include:
- Greg Moore, CEO, Harbor Health Systems, Irvine, Calif.
- Martin L. Lee, adjunct professor, Biostatics, UCLA School of Public Health, Irvine, Calif.
- Douglas Benner, M.D., chief medical officer, EK Health, San Jose, Calif.
Paying for more medical care early in a claim produces the best medical and cost outcomes, says new research. But it runs contrary to most utilization review guidelines. Where does that leave physicians? In addition to the facts showing timing and type of care on outcomes, attendees will hear from occupational physicians about the challenges they face and their best approaches to get injured workers back on the job safely and quickly.
Strategic Communications: Bringing Stakeholders Together in Creeping Catastrophic Claims. The speaker is Lee Glass, M.D., J.D., associate medical director, Washington state Department of Labor and Industries, Seattle.
Most workers' compensation claims move through the claim management process at a predictable rate. Some, however, become stuck. The longer the forward progress of a claim is lacking, the greater the medical and disability costs become. Getting such cases "unstuck" can become increasingly difficult. Dr. Glass will describe one approach that Washington state has taken to get such cases moving to resolution. Using a case study approach, he will provide an in-depth look at how and when he interfaces with all parties to a claim to help simultaneously achieve the best outcomes for the employer, the injured worker, and the state's workers' compensation trust funds.
New Ideas for Your Worst Claims: Addressing Hidden Issues that Cause Poor Outcomes. The speaker is Jennifer Christian, M.D., founder and lead Maze-Masters guide, Maze-Masters Program; president, Webility Corporation, Wayland, Mass.
All injured workers are not created equally, and a one-size-fits-all approach to managing claims at inception is no longer the state-of-the-art. A tiny fraction of people with run-of-the-mill injuries will end up among the highest cost claims. A growing body of research has shown a connection between key features of the worker's life situation and the likelihood of timely recovery and return to function. Dr. Christian will share practical ideas to identify the special needs of people destined to be high-cost claims -- and take positive action to prevent that from happening.
Leading Regulators' Advice for Finding the Best Workers' Comp Physicians. The speakers are:
- Christine Baker, director, California Department of Industrial Relations, Oakland
- Gary Franklin, M.D., medical director, Washington state Department of Labor and Industries, Olympia, Wash.
- Dianna Chamblin, director of occupational medicine, Everett Clinic, Everett, Wash.
- Moderator: Robert Malooly, CEO, Claim-Mapps Holdings, Olympia, Wash.
The best physician networks can provide optimal care for injured workers while holding workers' comp costs in check. But building and maintaining them can be daunting. This prestigious panel of experts offers insight into their experiences -- from California's use of medical networks, to Washington state's definition of harm in a workers' comp setting and why that was necessary, to the concerns of an occupational medicine physician. Attendees will learn how to overcome the challenges and create a top-notch medical provider network.
A New Prescription for Pain Management: Interdisciplinary Team Approach. The speakers are:
- Michael Coupland, Integrated Medical Care Solutions, West Palm Beach, Fla.
- Pamela Ferrandino, executive VP, national practice, Willis North America, New York City.
- Tron Emptage, chief clinical officer, Progressive Medical Inc., Westerville, Ohio
The opioid epidemic transcends health care systems and requires a global approach, say pain management experts. It is imperative that all practitioners involved in the workers' comp process have a role in mitigating the increasing misuses and abuses from these medications. Attendees will find out how an interdisciplinary pain management and prevention team offers the best chance for the best outcomes.
Fee Schedules: What, Where, How, and Why. The panelists include:
- Jacob Lazarovic, M.D., senior VP, chief medical officer, Medical Department, Broadspire, Sunrise, Fla.
- Erica Fichter Sr., VP, medical management, Broadspire, Sunrise, Fla.
- Moderator: Rebecca Shafer, president, Amaxx Risk Solutions, Hartford, Conn.
Most states use some type of fee schedules to help contain medical costs. But do they achieve results or are they just hype? They can and do work when properly finessed, say the speakers. The trick is understanding which fee schedules apply to which services among and within states, and the many nuances inherent in them. Attendees will learn the similarities and differences of the fee schedules, how they can result in different reimbursement rates, and ways employers can get the most benefit from them.
Looking Beyond Opioids to Manage Rx Costs, Cut Expenses and Create Better Outcomes. The speakers are:
- Anne Kirby, chief compliance officer/VP medical review services, Rising Medical Solutions, Chicago
- James Masingill, VP of claims operations, FirstComp, a Markel Corporation Company, Omaha, Neb.
Early identification of claims involving long-acting opioids is vital to preventing ordinary injuries from becoming catastrophic claims. However, some industry experts say if you're only focused on opioids, you're missing a big part of the problem. Other drugs can wreak havoc on an injured worker when opioids are also involved. Attendees will find out how one insurer is acting on critical information and developing an expansive drug tracking and case engagement program that is saving millions of dollars in costs annually.
Orthopedic Controversies: Straight from a Surgeon's Mouth. The speaker is Paul M. Legant, M.D., board-certified orthopedic surgeon, Albuquerque, N.M.
Employers are needlessly spending money on unproven orthopedic medical procedures, says Dr. Legant. With medical costs continuing to outstrip the gross domestic product, practitioners need to understand medical outcomes and supporting evidence of such things as hyaluronic acid injections, platelet rich plasma injections, the use of constant passive motion machine after total joint replacement, Achilles tendon rupture surgery, and more. This orthopedic surgeon will discuss many orthopedic controversies and offer strategies to ensure injured workers are receiving only proper and necessary treatments.
Physician Dispensing of Repackaged Drugs: What You Should Know, What You Can Do. The speaker is Joseph Paduda, principal, Health Strategy Associates, president of CompPharma, author, ManagedCareMatters blog, Madison, Conn.
Physician dispensing of repackaged drugs is one of the top cost drivers in workers' comp pharmacy, costing payers millions of dollars a year unnecessarily, according to CompPharma's most recent payer survey. Research from the California Workers' Compensation Institute points to an additional $545 in average medical benefit costs and 37.3 percent more in paid medical benefits on claims with physician-dispensed repackaged drugs. Mr. Paduda explains how this controversial practice works, what he says are the "egregious" markups involved, what proponents say, and how jurisdictions and payers are addressing it.
Symptom Magnification and Malingering in the Workers' Comp Spine Patient. The speaker is Charles A. Gatto, M.D., orthopedic spine surgeon, Tri-County Orthopedics, Morristown, N.J.
While most injured workers are motivated to get back to their lives, some are malingerers. Those with spine injuries can be the most costly in the workers' comp system. Identifying them early in the claims process can save substantial time and money. Attendees will find out what to do to quickly identify patients who are consciously -- or unconsciously -- magnifying their symptoms, and strategies to keep these claims under control.
By Nancy Grover
The 22nd annual National Workers' Compensation and Disability ConferenceŽ
& Expo takes place Nov. 20-22 at the Mandalay Bay Resort and Casino in Las Vegas. 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.
July 8, 2013
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