Saving Billions with Collaboration

Saving Billions with Collaboration

Medical misdiagnoses happen. However, a recently released report shows a staggeringly-high incidence: As much as one-fifth of claims involve diagnosis errors that are extending the treatment of injured workers and costing the workers’ comp system billions.

Stunning Numbers

The 10-year study, conducted by Boston medical consultation service, Best Doctors, uncovered in an estimated 250,000 workers’ comp injuries 21% involved misdiagnosis and/or inappropriate medical treatment. In the most expensive top 5% of claims, error rates were estimated to jump as high as 50%. Cumulatively, these errors can add up to as much as $15 billion of the estimated $65 billion in workers’ comp claims expenditures annually nationwide.

Added Complications

Language barriers and misunderstandings may increase complications. Treatments take a wrong turn, sometimes resulting in the prescription of dangerous opioids and unnecessary treatment plans, increasing subsequent costs. Managing Director of Best Doctor Occupational Health Institute, Michael Shor, indicated that such findings remain consistent among all areas of the medical profession.

Blame?

It is irresponsible and simply wrong to place the blame on any one entity or component. It is critical to remember that medical professionals make every effort to ensure treatment is appropriate and that their patients receive the highest level of care available. But they are human, just like the injured workers, case managers, and insurance employees.

How to Improve

The first step in preventing the physical, emotional, and financial tolls of diagnoses errors that result in prolonged disability and jeopardized careers is simple: Collaboration. Essential to quality of care, particularly in complex cases, the collaborative effort of medical personal with employers, patients, carriers and workers’ comp case managers can provide improved quality assurance and help prevent these issues. Peer review of diagnoses and second opinions can likewise reduce issues at the pass, putting injured workers on a better path, circumnavigating unnecessary costs and extended recoveries.

About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Original content posted on http://ans-solutions.com/savings-billions-collaboration/

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Government Struggles to Hold Opioid Manufacturers Accountable

Government Struggles to Hold Opioid Manufacturers Accountable

For the first time ever, the U.S. DEA targeted a prescription drug manufacturer for their role in black market opioids and damages incurred. Mallinckrodt Pharmaceuticals, one of the largest national manufacturers of the highly addictive generic painkiller oxycodone, one of the leading drugs responsible for the more than 15,000 overdose deaths in 2015, was accused of shirking its responsibility to report suspicious drug orders.

Who’s to Blame For The Opioid Epidemic?

Created at Mallinckrodt’s Hobart, NY facility, oxycodone shipped via its distributor network, including KeySource, Sunrise Wholesale and Cardinal Health, who later supplied the pills to retailers, including pharmacies and hospitals accused of illegally diverting the drugs. Discovered in a 2009 Tennessee Drug Task Force sting and linked back to Mallinckrodt’s distributors Florida retailers, 2010-2011 DEA investigations uncovered large amounts of Mallinckrodt oxycodone – such as the 41 million KeySource Medical oxycodone tablets delivered to Florida retailers in 2010 – about 2.5 pills for every man, woman and child in the state. Accused of splitting orders to conceal shipment amounts, KeySource was ordered by the DEA to halt, later relinquishing its distribution license. Distributors Sunrise Wholesale and Cardinal Health likewise delivered vast quantities of Mallinckrodt’s oxycodone to pharmacies in Florida. 500 million Mallinckrodt pills ended up in Florida from 2008-2012 — 66% of state oxycodone sales. A 2011 subpoena following this the discovery further revealed, 6 weeks after the Tennessee task force alerted Mallinckrodt to the drugs found in the 2009 sting, Mallinckrodt shipped another 2.1 million tablets their Sunrise distributor, 92,400 tablets of which were sold to Dr. Barry Schultz, the Delray Beach doctor whose oxycodone was found in Tennessee. Schultz was later convicted of drug trafficking and manslaughter (for a related overdose death). In one day, he prescribed 1,000 tablets to a single patient. Ultimately, the DEA and federal prosecutors alleged Mallinckrodt ignored its responsibility to report suspicious orders, in violation of the Controlled Substances Act.

Shirking Responsibilities?
Under federal law and DEA policy, pharmaceutical companies are required to “know their customers,” monitoring amounts, frequencies, and patterns of drug orders, immediately notifying the DEA of suspicious activity – or risk losing their license to manufacture and sell controlled substances, as well as civil and criminal penalties. Though Mallinckrodt maintained publicly the company has worked hard to fight drug diversion, internal case summaries prepared by federal prosecutors indicated Mallinckrodt’s response was that ­‘everyone knew what was going on in Florida but they had no duty to report it.’ Sources familiar with settlement talks indicated Mallinckrodt acknowledged its responsibility to report suspiciously large orders, but contended the DEA did not require manufacturers to know about (or be responsible for) ‘their customers’ customers,’ further pointing to conflicting DEA advice as to legal responsibilities. Prosecutors considered a whopping 43,991 unreported orders from distributors and retailers suspicious.

Uncharted Waters
Appalled by the rising opioid death toll, the DEA’s push to hold drug manufacturers accountable was hoped to be a wake-up call, putting the industry on notice for its responsibilities in the diversion of drugs to the black market. Instead, after years of industry investigations spanning five states to build the massive case, the results mirrored the DEAs previous attempt to hold wholesale distributors accountable. The case stalled. Fierce company resistance and intense lobbying efforts may have played a role in the lack of legal action pursued. The case settled for $35 million in fines and no admission of wrongdoing.

Small Potatoes
The proposed settlement, a mere fraction of the 44,000 federal violations pointed to in the investigation which could have cost the company $2.3 billion in fines, amounts to small potatoes for a company that posted $3.4 billion in revenue and $489 million in profit in 2016. In a later February 2017 SEC filing, Mallinckrodt even noted the investigation “will not have a material adverse effect on its financial condition” because it had set aside the funds.

About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

SOURCES:
https://www.washingtonpost.com/graphics/investigations/dea-mallinckrodt/?_hsenc=p2ANqtz-9DxkF3wbuslmavvDf3o8CSw_0KLDObRAx7Ah4JgQ2Vi7_84yvAVhoUcmcpQyMQ-LDuL7935zGFyhc7J8njQ-cALSVCEg&_hsmi=51277531&utm_campaign=Rx%20Summit&utm_content=51277531&utm_medium=&utm_source=hs_email&utm_term=.ebaec91ff136
http://www.reuters.com/article/us-mallinckrodt-settlement-idUSKBN1751JM
https://www.opensecrets.org/lobby/clientsum.php?id=D000022900

Original content posted on http://ans-solutions.com/government-struggles-to-hold-opioid-manufacturers-accountable/ 

Are Primary Care Physicians Leaving Opioid Deaths to Chance?

A recently released study from the Journal of Addiction Medicine has uncovered an alarming trend. Patients with opioid addiction, also referred to as opioid use disorder (OUD), experience an alarmingly high death rate – one 10 times higher than those not suffering opioid addiction. Not surprisingly, the study has raised some tough questions about the existing treatment infrastructure, and the system’s failure to identify and aid such at-risk individuals.

The Sobering Stats

Using electronic health records from a major university healthcare system from more than 2,500 patients ranging in age from 18 to 64, all identified as having an OUD, 465 deaths were observed during the eight-year period studied, 2006-2014. Drug overdose and disorder was the leading cause of death (19.8%), with deceased patients commonly experiencing other substance abuse disorders (tobacco, alcohol, cannabis, cocaine). Other causes included cardiovascular disease (17.4%), cancer (16.8%) and infectious disease (13.5%, of which 12% had hepatitis C). Alcohol abuse and hepatitis C were identified as primary markers. Compared to the general population, the deceased were more likely to be male (41.7% vs 31.6%), uninsured (87.1% vs 51.3%), and older at the time of initial OUD diagnosis (48.4 vs 39.8 years).

Unintended Effects

Though health care reforms (Federal Mental Health Parity, Addiction Equity Act, and the Affordable Care Act) were intended to lead to an expansion of services for substance abuse disorders in primary care, shifting them from previously isolated treatment centers, there appears to be a significant portion of the population slipping through the cracks. This suggests multiple issues within the current healthcare delivery system in identifying and addressing patients battling addiction:

  • Ignorance of the true risks of opioid abuse and corresponding treatments.
  • A lack of timely and sufficient screening for identifying patients with addiction.
  • Identification of addiction issues too late to provide appropriate/effective interventions.
  • A lack of addiction specialists on-site, as well a as a lack of outside resources for treatment.

The healthcare industry must find a better way to identify and treat patients suffering substance abuse disorders – before they pay the ultimate price. Clinicians in the primary healthcare setting could be a driving force – provided they receive proper training and assistance. For the worker, an effective pharmacotherapy review program ensures that recommended prescription treatment plans are necessary and appropriate and can help eliminate the potential for addiction.

This was originally posted on http://ans-solutions.com/are-primary-care-physicians-leaving-opioid-deaths-to-chance/

The Position of Workers Compensation in 2017

With the election of a new president who is ushering in a new era for the government, the trickle-down effect to the workers’ compensation industry just might sweep you off your feet. Prepare yourself with the industry knowledge you need, and avoid being overtaken by the tsunami…

The 2017 Workers’ Compensation Industry Issues to Watch:

  • The Affordable Care Act (ACA)
    Like a rogue wave, changes to the ACA may pop-up with little notice. These changes will influence the industry, including claims frequency, claims shifting, and cost shifting if/when private insurance is lost by injured workers, potentially shifting the industry back into the role of “medical insurance for the uninsured.” Preparing for engagement and rapid response to proposed legislation will remain integral as ACA changes are ironed-out in the coming year.
  • Nationwide Physician Shortages
    America is projected to be short an estimated 12,000 to 31,000 primary care physicians by 2025, according to the Association of American Medical Colleges. Surgeons are also expected to be in short supply. Though effects will vary based on geographic location, coupled with population growth, the aging Baby Boom population, Affordable Care Act instability, and the nationwide opioid crisis, this single phenomena could converge in a myriad of issues within the workers comp industry.
  • Changes to the Workforce
    As the economic current in the U.S. changes, the manufacturing industry may re-emerge, detracting from what is currently a service-based economy. The mobile workforce will also continue to evolve, such as remote and telecommuting positions. Workforce changes aren’t simply labor-related, however, the aging American workforce across the country will also play a large role.
  • Prescription Drug Abuse
    The overuse and abuse of prescriptions drugs, particularly opioids, continues to be a turbulent issue in the industry, driving workers’ comp costs and leaving opposing forces facing-off at a line in the sand. As federal and state lawmakers continue to bandage this issue across the medical industry, claims management teams and attorneys will need to move forward in addressing this issue in claims, monitoring prescriptions, recommending “drug contracts,” and better engaging with physicians regarding the risks of abuse, where permitted. On the flipside of the drug abuse coin, the consequences of injured workers medical marijuana scripts influencing on-the-job risks will continue to be a sticky wicket.
  • Profit & Loss Scenarios
    Though the workers’ comp industry saw their first underwriting profits in 2013, the trend is not expected to continue. Falling rates and increasing exposures, particularly over the long term, point to a negative outlook overall, with combined ratios of 100% projected for the coming year. Medical providers still continue to increase reimbursement rates to offset costs from lackluster Medicare and Medicaid payments, and medical and pharmaceutical advancements increase the risk of loss. Maintaining proper reserves, conducting timely settlement reviews, and utilizing appropriate resources over the course of the year will be key.

Make Progress in Managing Risks & Costs
No matter how fast the tide rushes in, ground yourself in facing this year’s obstacles with positive change, putting yourself in the best position to avoid being washed out in the chaos. With the transparent, mutually beneficial workers compensation cost containment services of ANS Solutions and our medical cost containment strategies, you can support both financial savings and positive outcomes, with a program that actively engages workers compensation patients with a positive experience, gaining unmatched results via true, face-to-face interactions between all involved parties for a complete team approach to care. Ride the wave of the future, contact http://www.ans-solutions.com today.

Sources:

http://www.wci360.com/news/article/how-to-fix-the-primary-care-physician-shortage

http://www.beckershospitalreview.com/hospital-physician-relationships/15-things-to-know-about-the-physician-shortage.html

Original content posted on http://ans-solutions.com/the-position-of-workers-compensation-in-2017/

Landmark Reforms Hoped to Aid New York in the Fight against Opioid Addiction

It is hoped to be a happier new year for Empire State residents suffering from opioid abuse. In a landmark legislative package that took effect January 1st of this year, health insurance plans will now be required to cover treatment services to New Yorkers suffering opioid addiction. In a state plagued by the effects of opioids and heroin, whose overdose death rates are far outpacing nearly every state in the union, legislators are hopeful those grappling with the effects of these drugs can finally gain access to the help they need in overcoming addiction.

The Plan to Expand Access to Opioid Addiction Care

Signed into law by Governor Andrew M. Cuomo, the reforms are expected to remove burdensome treatment access barriers, help expand prevention strategies from within communities, and limit opioid over-prescriptions statewide. What is the governor’s Heroin and Opioid Task Force plan to stamp out abuse?

  • Insurance-Related Protections
    • Insurance pre-authorization no longer required for immediate access to inpatient care and (emergency) drug treatment medications when needed.
    • Utilization review (insurance) cannot become involved until after 14 days of uninterrupted treatment.
    • Insurers must use objective, state-approved criteria when making coverage determinations.
    • Opioid-reversal medication coverage is mandated.
    • Requirements apply to small, large group, and individual plans regulated by the DFS.
  • Addiction Treatment Services Enhancements
    • Individuals incapacitated by drugs can now receive 72, not 48 hours of emergency treatment and evaluation.
    • Hospitals are now required to provide follow-up service at discharge, connecting at-risk patients with nearby treatment options for continuous care.
    • Trained professionals no longer risk licensure when administering naloxone in emergencies.
    • Wraparound services (legal, support, transportation, childcare) have been expanded to support long-term recovery.
  • Community Prevention Strategies
    • Prescription limits reduced from 30 to 7 day supply maximum (with exceptions).
    • Required continuing education for all physicians/prescribers on addiction/pain management.
    • Pharmacists must provide materials on addiction risks and nearby treatment services.
    • Opioid overdoses and overdose medication use must be reported quarterly.

Ensuring Appropriate Treatment Options For Opioid Addiction 

Much like the measures put forth by the state of New York, ANS Solutions’ Pharmacotherapy Review Program strives to uphold appropriate treatment options for patients, offering protection against opioid dangers with a three-stage approach to injury recovery that far-surpasses drug utilization review. Comprehensive and effective, it both protects against unnecessary expenses and safeguards patient treatment outcomes. Utilizing personal, face-to-face communication and integrative case-management methods, over-prescription of dangerous narcotics and potentially deadly drug-to-drug interactions commonly experienced with multiple prescribers can be prevented, success achieved with evidence-based treatment protocols and cemented by written proposal to achieve maximum results.

Don’t stand on the sidelines of the epidemic. Take part in the solution. Reinvent the way you handle claims with the help of ANS Solutions today.

Original content posted on http://ans-solutions.com/landmark-reforms-hoped-to-aid-new-york-in-the-fight-against-opioid-addiction/

Alabama Doctor Arrested In Connection with Matt Roberts of 3 Doors Down Overdose Death

In mid-August of this year, fans were stunned by the death of 38-year-old Matt Roberts, former guitarist of 3 Doors Down. Alabama physician Dr. Richard Snellgrove was arrested November 16th for allegedly providing the rocker with drugs outside the course of his professional practice. Snellgrove prescribed some five different medications, including methadone, hydrocodone, lorazepam and fentanyl — all prescribed in the names of different individuals, but intended for Roberts.

Slated to perform at a charity event for veterans, the rocker’s father, Darrell Roberts, who often traveled alongside the star, learned of his son’s death the morning following rehearsals. The elder Roberts was informed his son was “either asleep or passed out in the hallway of his hotel” by authorities. Roberts’ father indicated that his son had been fighting a prescription medication addiction to combat his anxiety since joining the band.

A Serious Issue Beyond Over-Prescription
While Roberts’ father noted that he didn’t have any bitterness or anger toward the doctor, he drew attention to the seriousness of the issue in the medical community across the U.S. Prescription drug abuse causes the largest percentage of deaths from drug overdosing, with opioid painkillers the most common culprit. Roberts is among a string of stars over the past decade, including Prince, Whitney Houston, Michael Jackson, Brittany Murphy, Heath Ledger, and Anna Nicole Smith – alongside thousands of other unnamed “average” Americans – sons, fathers, mothers, daughters, brothers, sisters, and friends – all lost to the prescription drug abuse epidemic sweeping the nation, unheeded by age, race, gender, or income level.

Re-Thinking “the Norm”
In chronic pain treatment, particularly where opioids are concerned, there seems to be a disconnect between a drug’s approval for use and its potential for harm, leading to over-prescription and deadly drug interactions. This is why ANS developed its unique pharmacotherapy review program, the only drug utilization review system in the industry with a hands-on, state by state jurisdictional approach. Sometimes to help an injured worker, “it takes a village”, and the ANS face-to-face collaborative process uses locally based legal nurse experts to bring doctors, patients, insurers, and legal representatives all onto the same page. Other drug utilization processes act superficially and fail to follow up, but the ANS process consistently achieves the most impactful patient outcomes while producing the lowest MSA’s and most improved loss ratio’s in the industry. All this while offering a risk free “No Fee Assurance” guarantee for WC payers who wish to try the program.

To truly improve patient treatment outcomes and stop the opioid epidemic try http://ans-solutions.com/ scientifically-based, cost-effective pharmacotherapy review programs. Contact us today.

Original content posted on http://ans-solutions.com/alabama-doctor-arrested-in-connection-with-matt-roberts-of-3-doors-down-overdose-death/

New FDA Warning: Avoid Prescribing Opioids & Benzos Together

In a recent announcement by the FDA, boxed warning labels will now be required to advise against the utilization of prescription opioid pain medicines alongside benzodiazepines unless no other adequate alternative treatment method exists. Warnings about the risks of combining these two classes of drugs are nothing new. Already required on drug warning labels, additional black box warnings are an effort by the FDA to reach out to those who may have “missed the message.”

Classified as Central Nervous System (CNS) depressants, each drug alone can trigger side effects such as respiratory depression (slowed/labored breathing), coma, and death, the effects of which are enhanced in combination. For clinicians living in the dark, these risks will now be spelled out in the black boxes of 389 different pharmaceuticals. Additionally, opioid painkillers such as oxycodone and benzos like alprazolam (i.e. Xanax®) – even the combination of opioid cough medicines with benzos and other CNS depressants (like alcohol) should be avoided. If the drugs must be used together, clinicians have been advised to warn patients of these risks.

The FDA’s latest measure in battling the nationwide epidemic of prescription opioid abuse, essentially classifies this drug combination in the “last resort” genre. Rates of emergency room visits resulting from the nonmedical use of this combination of drugs has tripled from 2004-2011, with the rates of drug-related deaths following suit. According to the FDA, these rates coincide with a 41% increase in patients prescribed both an opioid and benzo between years 2002-2014. The measure is a win for public health officials from 17 states and territories and 13 cities who petitioned the agency in February to require the boxed warning in an effort to fight the routine but unproven treatment method.

Bridging the gap is possible, however, with the help of clinically proven injury and disability treatments from ANS Solutions. Our expert medical legal nurse consultation services and Pharmacotherapy Review Program get the result patients need – without side effects – protecting and enhancing the quality of life for injured workers, and guarding against the medical and financial risks of unproven treatment methods with scientifically-backed protocols. Are you ready to set out on a new path in worker’s comp injury management? Contact http://www.ans-solutions.com today!

Original content posted on http://ans-solutions.com/new-fda-warning-avoid-prescribing-opioids-benzos-together/