Tag Archives: WCRI

Opioids and Workers’ Compensation

By Max Dorfman, Research Writer, Insurance Information Institute

As the opioid epidemic continues to roil the country, it’s easy to forget the number of issues that contribute to its severity. Indeed, for workers injured on the job, compensation can include opioid treatments—which can lead to opioid dependence. With this subject in mind, I spoke to Dr. Vennela Thumula, an author and policy analyst with the Workers Compensation Research Institute (WCRI), who was able to provide insight into opioid dispensing for injured workers.

This interview was modified for clarity.

What are you seeing as far as general trends in prescribing opioids for workers injured on the job, particularly as the opioid epidemic has become a more visible issue?

Our study – Interstate Variations in Dispensing of Opioids, 5th Edition – examined recent trends in opioids dispensed under workers compensation for workers from 27 states who had more than seven days of work loss due to their injury but who did not have a major surgical procedure related to the work injury.

Opioid dispensing to injured workers has decreased substantially in recent years in all 27 state workers’ compensation systems studied. Between 2012 and 2016 injuries followed for an average two years postinjury, the percentage of injured workers with prescriptions receiving opioids decreased by 8 percentage points (in Illinois) to 25 percentage points (in California). Among injured workers receiving opioids, the average morphine milligram equivalent (MME) amount of opioids dispensed per worker in the first two years of a claim decreased in nearly all study states, with 30 percent or higher reductions seen in 20 of the 27 states studied.

Which states are you still seeing higher-than-average prescribing rates for workers injured on the job? Why do you think these states are still seeing such high rates?

After the declines, opioid dispensing continues to be prevalent in some states. At the end of the study period, the percentage of injured workers with prescriptions receiving opioids ranged from 32 percent in New Jersey to 70 percent in Arkansas and Louisiana across the 27 states, and the average MME per worker in Delaware, Louisiana, Pennsylvania, and New York continued to be the highest among the 27 study states.

For instance, in Delaware and Louisiana, the average MME per claim was more than three times the amount in the median (middle) state and over five times that in the state with the lowest amount, Missouri. We should note that although New York is among states with the higher-than-typical amount of opioids, there were substantial decreases in opioids dispensed to New York workers over the study period. We should also caution that these four states have implemented other opioid reforms towards the end or after the study period whose impact could be monitored with more recent data.

I see non-pharmacologic treatments are being used more often for workers injured on the job. What are the most common non-pharmacologic treatments utilized under workers’ compensation?

We see that providers have switched from multi-pronged pain treatments, which involve pain medications (including opioids) and other restorative therapies, to a treatment protocol that more frequently relies solely on non-pharmacologic services. The most frequent non-pharmacologic services billed and paid under workers compensation were physical medicine evaluation; active and passive physical medicine services such as electrical stimulation and hot and cold therapies; and passive manipulations such as manual therapy and massage.

How are these non-opioid pain treatments changing the landscape of workers’ compensation for patients and insurance companies? Are these treatments now prioritized over opioids?

Our first look at the data suggests a shift in treatment patterns away from opioids to non-pharmacologic services, which conforms to the recommendations of opioid prescribing and pain treatment guidelines and policies implemented in a number of states. Many questions remain answered, including the impact of these changing treatment patterns on claim outcomes. We will be talking more about alternatives to opioids for pain management at WCRI’s 36 Annual Issues & Research Conference, March 5 and 6, 2020, in Boston, MA.

 

WCRI releases 2019 workers compensation law compendium

This week, the Workers Compensation Research Institute (WCRI) published its latest edition of workers compensation laws in the U.S. and Canada, which includes regulations and benefit levels as of January 1, 2019.

Per WCRI:

In Canada and the United States, workers’ compensation is entirely under the control of sub-national legislative bodies and administrative agencies. The differences between jurisdictional laws and regulations can be subtle and this survey gives you the ability to understand those differences.

WCRI members can download the report here.

For the more casual readers out there, check out our page on workers compensation and how it works.

REMINDER: WCRI ANNUAL ISSUES AND RESEARCH CONFERENCE

Looking for an excuse to brush up on your knowledge of workers’ compensation insurance and maybe catch a Cactus League baseball game? Look no further.

The Workers Compensation Research Institute (WCRI) is holding its 35th Annual Issues and Research Conference on February 28th at the Renaissance Phoenix Downtown in Phoenix, AZ. (You can register for the conference here).

Particularly interesting will be a session on the opioid crisis and its impacts on workers’ comp. WCRI will present its findings on correlates of opioid prescribing practices to injured workers, which could help predict which injured workers are likely to receive opioids.

Another important agenda item you won’t want to miss is the “State of the States” session, in which WCRI will discuss performance measures for various state workers’ compensation systems.

Anyone working to improve workers’ compensation systems or seeking to manage a changing environment would benefit from attending these and the other sessions in the conference agenda.

WCRI Annual Issues and Research Conference

The Workers Compensation Research Institute (WCRI) is holding its 35th Annual Issues and Research Conference on February 28th at the Renaissance Phoenix Downtown in Phoenix, AZ. Anyone working to improve workers’ compensation systems or seeking to manage a changing environment would benefit from attending.

Some of the highlights from the conference agenda include:

  • A keynote address by world-renowned economist Alan Krueger on the future of work, the impact of technology on the economy, and how the opioid epidemic has affected the labor force participation rate
  • The latest research on opioid prescribing to injured workers
  • A panel discussion of Washington State’s community-based program that brings together medical providers, employers, and injured workers to help ensure timely, effective, and coordinated services
  • The challenges and opportunities of telemedicine
  • A discussion of some of the latest findings and trends seen across WCRI’s core benchmark studies, including WCRI’s 18-State CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems

Past attendees have said that the WCRI’s is the one conference that offers an “independent point of view that covers the entire spectrum of works compensation” and that it is “a great place to learn and a great place to network.”

Click here to learn more about the conference agenda or to register.

 

Some states make progress in tackling opioid epidemic

Prescription opioid use among injured workers decreased in many states, but not all, according to the Workers Compensation Research Institute (WCRI).

Find out which states saw the largest decreases in this new WCRI study.

The National Safety Council (NSC) has developed a new industry specific online calculator that informs employers how much the opioid epidemic is costing companies each year.

The tool provides business leaders with specific information about the cost of substance use (including prescription drug abuse and misuse, alcohol abuse and misuse, opioid and heroin addiction as well as abuse of other illicit drugs and marijuana) in their workplace based on size of employee base, industry and state.

Posted here, the NSC calculator combines latest government and private sector research to estimate annual costs in three categories: time lost form work, job turnover and retraining, and health care costs.

A new NSC survey found only 39% of employers view prescription drug use as a threat to safety, and only 24% feel it is a problem, despite 71% saying they have experienced an issue.

Whither the Grand Bargain?

Insurance Information Institute chief actuary James Lynch reports from the final session of #WCRI17:

The Workers Compensation Research Institute’s annual conference saved the best for last, a provocative look at comp and the Grand Bargain.

That bargain, that workers sacrifice the right to sue for workplace injuries in exchange for a predictable set of benefits irrespective of fault, is threatened, some say, by a decades-long winnowing of those benefits. The rebuttal: comp is a resilient system changing with the times.

John Ruser, WCRI president and CEO, led the discussion. Panelists were Dr. David Michaels, a former assistant secretary of labor at OSHA; Bruce Wood, former general counsel at the American Insurance Association; Emily Spieler, a Northeastern University professor specializing in workers comp and labor issues; and David Deitz, a consultant with more than 20 years’ experience designing claims management systems in both workers comp and group health.

I have some background on the debate, presenting at a symposium on the Grand Bargain last year in Camden, N.J. I’ll oversimplify a bit here by calling it a faceoff between lawyers and insurers.

The lawyers say that reforms over the past 20 years or so have continually whittled away at worker benefits, so much so that the Grand Bargain is, from the workers’ point of view, no bargain. Insurers note that both medical and indemnity benefits have been rising faster than inflation for decades and that many of the supposed benefit cuts are controls on medical costs that have little if any effect on the actual treatment that the injured worker receives.

That debate is of long standing, but Wood pointed out that the discussion used to be fairly narrow.

Several states have debated whether employers should be able to opt out of the workers comp system entirely and provide a supposedly parallel set of benefits. Opt out passed in Oklahoma (but was found unconstitutional last year) while at least two other states (Tennessee and South Carolina) have kicked the idea around.

Wood compared the changes in the debate to a football game. The old discussion shuttled between the 45-yard lines, he said. Opt out “takes the debate between the goal lines.”

 

 

Some Facts About Medical Marijuana

Insurance Information Institute chief actuary James Lynch reports from last week’s Workers Compensation Research Institute (WCRI) conference: 

I shock no one, I hope, by saying the nation’s attitude toward marijuana has loosened. More than half the states allow marijuana use, either as a medicine or just for fun. The federal government still forbids its use.

It’s a tough spot for insurers. Auto insurers worry that high drivers will cause auto accidents. Workers compensation workers are concerned that high employees will cause work accidents. Insurers want to obey the law, but federal law conflicts with the law in most states.

There are also questions about using marijuana to treat pain, as an alternative to opioids.

Not surprising that weed was the topic of conversation several times at last week’s WCRI conference in Boston.

Alex Swedlow of the California Workers Compensation Institute noted the following:

  • Six states require workers comp insurers to reimburse injured workers who use medical marijuana: Connecticut, Maine, Massachusetts, Minnesota, New Jersey and New Mexico.
  • Six states forbid insurers from reimbursing for medical marijuana: Arizona, Colorado, Michigan, Montana, Oregon and Vermont.
  • The federal laws against marijuana mean it is illegal to use the banking system to purchase marijuana. So an insurer can’t write a check against to pay for the drug. They use cash.

Dr. Dean Hashimoto of the Massachusetts Department of Industrial Accidents provided these facts. They are taken from a National Academy of Sciences report published in January, which is itself a summary of all research on the issue:

  • There is conclusive evidence or substantial evidence that marijuana:
    • Improves the lot of adults in chronic pain.
    • Increases the risk of motor vehicle crashes.
    • Increases the risk of developing schizophrenia and other psychoses.
  • There is moderate support suggesting that marijuana:
    • Improves short-term sleep outcomes for people with fibromyalgia or chronic pain.
    • Increases impairment of learning, memory and attention span.
    • Increases dependence on alcohol, tobacco and illicit drugs.
  • It is not possible to determine whether marijuana use is statistically correlated with occupational injuries.

The California WC report is here www.cwci.org/document.php?file=3090.pdf. The National Academy of Sciences report is here.

Conference Shows How Workers Comp Wheels Are Turning

March brings my annual trip to the Workers Compensation Research Institute (WCRI) conference in Boston, writes Insurance Information Institute chief actuary James Lynch:

Workers comp is an intricate dance among regulators, lawyers, employers, insurers and the medical community. WCRI’s annual conference is one of the better places to catch up on the direction the many gears are turning on the workers comp machine.

Agenda items I’m looking forward to:

  • Alternatives to opioids: The opioid epidemic, until recently, was the silent mass killer in America. I first heard about this particular scourge at the 2014 WCRI conference. That year almost 19,000 people died from opioid overdoses, yet I had never heard the term opioid. After the conference, I wrote about how the workers’ comp world grappled with the epidemic for Contingencies magazine.
    This year the conference has an update on those efforts. It also has a session on emerging alternatives like mindfulness and other cognitive approaches. Included in that session is a look at medical marijuana, an issue most insurers are approaching with grave caution.
  • Appraising the Grand Bargain in 2017: Comp, of course, is the result of the Grand Bargain. Injured workers give up the right to sue and employers agree to indemnify the injured, regardless of fault. Most insurers will tell you that bargain holds up well more than a century after it was struck. But some challenge that idea. I attended a conference last year baldly titled, “The Demise of the Grand Bargain.” And a 2016 Department of Labor (DOL) study alleged states were engaged in a “race to the bottom,” scuttling benefits to keep employers happy.
    A new president may send DOL priorities in other directions, of course, but there’s still a discussion to be had. WCRI’s conference will end with a debate among experts representing government, insurers and the legal community.

The conference is, March 2 and 3 at the Westin Copley Place, Boston. Details and registration here.

 

D.C. Luminaries Headline Boston Workers Comp Conference

Insurance Information Institute vice president of Media Relations, Michael Barry, previews the upcoming Workers Compensation Research Institute (WCRI) annual conference:

Seldom have the political waters roiled as they have during the first weeks of the Trump presidency. A pair of political veterans will look at what that means for workers compensation insurance at a conference next month in Boston.

Former U.S. Senator Tom Coburn and former U.S. Representative Henry Waxman are appearing jointly in Boston on Thursday, March 2, to kick off the WCRI Annual Issues & Research Conference.

U.S. Senator Coburn, a Republican from Oklahoma, and U.S. Representative Waxman, a Democrat from California, will discuss the ‘Impact of the 2016 Election’ for health care, labor, and workers compensation at the Westin Copley Place Hotel in Boston, MA. Their session begins at 9:15 a.m. and will conclude at 10:30 a.m.

The two distinguished former federal legislators bring impressive credentials to these issues. Before his election to the U.S. Senate (2005-2015), Dr. Coburn, a medical doctor, was a U.S. representative (1995-2000) from Oklahoma.  Former Rep. Waxman served for four decades in the U.S. House of Representatives (1975-2015) and was chairman of the House Energy and Commerce Committee.

The theme of this year’s WCRI conference is Persistent Challenges and New Opportunities: Using Research to Accelerate the Dialogue.” The two-day program highlights WCRI’s latest research while also drawing upon the diverse perspectives of nationally respected workers compensation experts and policymakers.

The Insurance Information Institute will also be represented. Chief Actuary James Lynch will be blogging here at Terms + Conditions from the conference.

The WCRI conference is a leading workers compensation forum for policymakers, employers, labor advocates, insurance executives, health care organizations, claims managers, researchers and other interested parties.

For additional information about the conference, or to register, log onto http://www.wcrinet.org/conference.html

WCRI Insight Into How Well Workers Comp Process Works

Insurance Information Institute chief actuary James Lynch brings us another highlight from the Workers Compensation Research Institute conference:

A preliminary WCRI study showed little difference across states in how well workers recover from injuries but showed some significant differences in how satisfied injured workers were with the treatment they received.

WCRI researcher Bogdan Savych presented the results of a 15-state survey of 6,000 injured workers. The workers were interviewed three years after their injury. The goal was to learn how well workers recovered and to gain insight into how well the workers compensation process works, at least from the injured person’s point of view.

The health of workers was assessed on a 100-point scale in which the typical American’s health is at 50. Before they were injured, Savych said, workers were assessed at a 56. That score fell to 26 immediately after injury. Three years later, the median injured worker was 46, mostly recovered but not entirely.

Not all workers recover fully, Savych said. Depending on the state, between 9 percent and 19 percent of workers reported they had not fully returned to work. The 15-state median was 14 percent.

WCRI undertook the survey in part to determine how states differ in both recovery rates and patient satisfaction. The organization found that the severity of injuries was comparable across states, as was the level of recovery.

But worker satisfaction varied considerably. In the typical state, 17 percent of workers reported “big problems” getting the medical services they wanted. Wisconsin workers reported the best experience–only 11% reported big problems–while 21 percent of Florida workers said they had big problems getting the services they wanted.

Similarly, in the typical state, 14 percent reported “big problems” getting the medical provider they wanted, with Wisconsin the lowest and Florida the highest.

And 10 percent of Wisconsin workers said they were “very dissatisfied” with their overall care. Nineteen percent of Florida workers made the same assessment. In the typical state, 14 percent were very dissatisfied.

Savych noted that costs per claim were higher in Wisconsin than in the typical state, but the survey provides evidence that claimants from that state may be getting better outcomes for the cost.