Medical Marijuana and the Workers Compensation Conundrum – Part 1

Medical Marijuana and the Workers Compensation Conundrum – Part 1

Because the U.S. Federal Government has dug-in its feet, leaving marijuana as an illegal, Schedule I drug under the Controlled Substances Act, state governments have been left to individually pave their own legalization paths, leaving a frustrated public in the wake. Employers, employees, doctors, workers comp case managers, and more feel frustratingly in-the-dark as ever-diversified, continually evolving legislation continues to change the landscape. This is the first post of our two part series of spotlighting medical marijuana in the marketplace.

What We Do Know About Medical Marijuana

Though state laws vary widely on the amount of legal possession and personal cultivation for medical use, to-date 29 states and D.C. have legalized marijuana for medical use, including 8 states who’ve legalized its use recreationally. For medicinal purposes, marijuana has been scientifically confirmed effective for pain relief, appetite stimulation, nausea control, and reducing ocular pressure. It is arguably cheaper and less addictive than opioids, however both research and quality control are lacking. For injured workers and those in the workers’ comp industry, its most-likely application is pain relief, however it’s typically not be the first drug in the treatment lineup for prescribing physicians.

What’s Murky About Medical Marijuana and Workers’ Compensation

Marijuana dispensing differs from run-of-the-mill pharmaceuticals, with product obtained from dispensaries or home growth, not pharmacies, leading to a gap in patient information on potentially dangerous drug interactions. Patient protections also remain muddy. Still illegal under federal law, stateside court rulings are chaotic. Fifteen states offer little to no employee protection, while 11 states explicitly provide protections from retaliatory actions to limits on drug testing from employers. Furthermore, all states with medical marijuana have pending legislation and litigation that could have a broad impact on the workplace, creating a landscape reminiscent of the Wild West.

Who’s Paying For Medical Marijuana Prescriptions?

Who knows? Medical marijuana’s Schedule I status prohibits its inclusion in the National Drug Code, leaving Medicaid and Medicare patients on the sidelines. This lack of regulation also equates to a dearth of coding, complicating processing for pharmacy benefits managers. And state-by-state case law for prescription coverage from employer-sponsored coverage to workers’ comp, like employee protection legislation, also varies widely.

Who’s Got a Headache?

Employers. Though there is federal protection backing drug-free workplace policies, including “zero-tolerance” for specific jobs such as heavy equipment operators, pilots, and surgeons, ever-changing legislation makes it difficult for employers to figure out which end is up. In the meantime, knowledge of state-specific legislation remains key to compliance, with an attitude of managing medical marijuana like any other powerful legal prescription drug that could impair mental capacity a logical choice: Accommodate the needs of injured workers – but uphold a safe work environment, as always. ANS Solutions Medical Cost Containment Programs are the only end to end pharmaceutical cost containment programs in the industry that genuinely put the patient first, while minimizing the cost of settlement in large loss workers’ comp claims.

 

ASansAbout 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. 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/medical-marijuana-and-the-workers-compensation-conundrum-part-1/

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/

Naloxone (Narcan): What Workers Comp Payers Need to Know

Though it has been on the market since 1971, this year is expected to be a landmark year in Naloxone (Narcan) sales nationwide, and this trend is expected to continue due not only to the opioid epidemic sweeping the nation, but the fact that opioids still remain the most frequently prescribed category of medication used in workers’ comp pain management.

Preventing Death from Opioid Overdose

In its hallmark form, Naloxone was approved for injection by the FDA in 1971. An opioid agonist, it was used in hospital and emergency settings to temporarily reverse the dangerous effects of overdose, including sedation, low blood pressure, and potentially fatal respiratory depression. However new outpatient options have recently entered the market, putting this potentially life-saving drug in the hands of the general public.

  • Evzio (2014)
    The first FDA-approved naloxone auto-injector available in the U.S., this small, portable device, similar in nature to an Epi-pen, can be used by patients or family members in the event of overdose. (Holds a significantly higher average wholesale price than Narcan and traditional injectables.)
  • Narcan (2016)
    A single-dose, ready-to-use nasal spray that requires the patient to be lying on their back for proper administration.

Not a Magic Bullet
Reversing the effects of opioids at the receptor site and blocking further binding, naloxone takes effect in 3 minutes, wearing off in about 30-to-90 minutes depending on the opioid taken. Though it reverses the clinical and toxic effects of overdose, it only displaces opioids for a short time.

Access Expanding
Despite its short-term effects, legislative and regulatory reforms are making naloxone increasingly available nationwide as states struggle to combat the opioid epidemic. Anesthesiologists, PMR physicians, physician assistants, nurse practitioners and pain management specialists are writing the majority of prescriptions for patients undergoing opioid treatment therapies. Civil liability protection has been expanded for First Responders employing its use. Some states have even made naloxone available for sale as an over-the-counter medication.

Turn the Tide
Due to opioid over-prescription and abuse in our country, Naloxone is unfortunately a necessary medication. However, at ANS Solutions, we believe the best way to prevent opioid overdose is by circumnavigating its use with the patient-doctor education and equally effective, scientifically-proven alternative medical treatments that protect the outcome of injured workers, and reduce unnecessary opioid treatments and associated costs. With our medical cost containment strategies, safe, efficacious cost-effective care is possible. Discover more at http://www.ans-solutions.com today.

Sources: http://helioscomp.com/docs/default-source/continuing-education-2016/072816-optum-naloxone-use-in-wc-ce_final.pdf 

Original content posted on http://ans-solutions.com/naloxone-narcan-what-workers-comp-payers-need-to-know/

Tips to Build an Effective Medical Cost Containment Strategy

Medical Cost Containment

Medical cost containment program is an end to end pharmaceutical cost containment programs which puts the patient first while reducing the cost of settlement in large loss workers comp claims. Today, businesses are challenged to control workers compensation cost and improve the income. Only framing an effective cost containment strategy focuses on different areas and provides possible tricks to avoid any mess.

Using comprehensive and well-coordinated medical cost containment strategies helps you to combat multiple lines of cost escalation. Incorporate the following useful options to your medical cost containment strategies while seeking improvements at your company.

Medical Provider Network

Medical provider network is a combined group of the most experienced workers’ comp physicians, doctors, hospitals and specialized providers who have a prearranged relationship with the company to treat employees who are injured on the job. They deliver consistent quality care and work closely while minimizing paperwork and treatment time and maximizing the results of quick, effective care. The major benefits of instituting a medical provider network are:

* Fewer lost workdays

* Lower medical costs

* Lower litigation rates

Nurse Case Management

Nurse case management requires an active coordination of medical services and communication among the injured employee, employer and physician. The nurse case managers play a major role in improving the patient’s outcome and have deep experience in managing catastrophic and complex injuries. They also keep the employer and the claim representative well-updated on the physical improvement of the injured employee and his ability to return to work.

Rehabilitation Networks

Rehabilitation networks are destined to offer specialized care for helping injured people recover from specific injuries. Like medical provider network, they also play a major role in stabilizing the injured person’s medical condition and maximize the medical outcome.

Utilization Review

Nowadays, utilization review is an integral part of most public and private health plans and is associated with a reduction in bed days and growing hospital costs. Utilization review is considered as the primary cost prevention tool and includes both precertification reviews and concurrent reviews. The process involved in utilization review also includes:

* Guiding patients to cost effective facilities

* Referral co-ordination

* Managing hospital admission and medical appointments

* Pre-certification

* Monitoring patient’s ongoing treatment process

* Planning patient discharge

* Coordinating follow-up appointments and more.

Utilization review managers also act as liaisons between insurance companies, service providers and the injured employee.

Chronic Pain Management

Chronic pain has a huge impact on the life of the injured worker in both monetary and personal fronts. Using data mining and virtual online “check-ins” to monitor and evaluate the physical, psychological and social impacts on the injured employee. This process of evaluation helps in reducing the impact of chronic pain and improves employee health.

Establishing these standards help companies to easily manage their complex claims and ensure the best possible medical outcomes for injured workers.

ANS Solutions, LLC, the fastest growing medical cost containment companies in the USA puts forward a comprehensive suite of programs to minimize the cost of settlement in large loss workers comp claims. Visit http://ans-solutions.com/ for more information.

Medical Cost Containment Strategies that Really Works

 Medical Cost Containment
Medical cost containment is a complex game and has certain strategies that address the financial costs of large loss claims. Employers and insurers should not limit these cost containment strategies to one or few areas, if they want it to be truly effective. The employers and insurers should utilize as many cost containment strategies as they can to save more money. In this article, we can discuss about the different cost containment strategies that are solely dedicated to reducing the overall medical costs.
Effective Cost Containment Strategies
Medical Cost Projection
Medical cost projection strategy is used to evaluate medical bills, medical savings and other comprehensive medical plans. The type of injury, prior medical treatment, co-morbidities, age health status, life expectancy and other pertinent factors are taken into account by medical cost projection professionals for an accurate analysis of the medical needs of the injured worker.
Legal Nurse Expert
A Professional Legal Nurse Consultant is destined to review medical records and gives advice and suggestions on the standard of nursing care. They are allowed to meet the doctor in person and negotiate any evidence supported pharmacy regime in a non-threatening way with the patient. They also assist with depositions and trial preparation and serve as an expert witness support for the compensation claim.
Medical Management
This is the process of having experienced legal nurse consultants to co-ordinate and to manage the medical care received by an employee. A legal nurse consultant would be dedicated to handle the accounts and medical claims for that company. They will review all the medical reports of the injured employees and recommend additional tests to get the employee back to full recovery.
Medical Bill Review
Medical bill reviewing is only done by the companies that are pioneers in performing accurate medical bill diagnosis and charges. Generally, the medical bill charges are compared with the reasonable and customary charges for the medical services provided.
Medical Examinations
These independent medical examinations are done when the patient is sent to another medical practitioner for an alternate opinion. These examinations are conducted in cases where the employee’s medical recovery process is slower than the normal.
Utilization Review
This review includes precertification review done before the medical care, concurrent reviews while the treatment is on progress and retrospective reviews for the medical services that is already provided.
Tactics Involved in Medical Cost Containment
•    Evidence based medical record review for prescription drugs
•    Co-ordination of drug therapies
•    Suggesting alternate medical regimes
•    Deep analysis and monitoring of prolonged duration of therapies
•    Examination and identification of duplicate drugs and therapies
•    Identification of excessive dosages of drugs
Visit http://ans-solutions.com/ to know more about the new medical cost containment approach.

What’s Trending with California Workers’ Compensation

Though workers’ comp claims frequency is declining, a recently released California hospital report indicates claim severity is on the rise. Obtaining data from 35 hospitals and individual facilities, the Milliman and Keenan Healthcare report sourced more than 3,500 claims for review.

Trends identified in the report:

  • A decline in indemnity and medical-only claims, with ALAE costs playing an increasing role in overall claims costs in recent years. More specifically:
    • Higher average costs per indemnity for workers over 30.
    • Lesser average severity of indemnity claims in workers 30 and younger, with payments more likely to be incurred as age increases.
  • Over the 10-year period ending in 2014, overall losses per $100 of payroll have remained flat. This cumulative effect is believed due to reform laws enacted during this time, as identified in the report:
    • 2005-2014: Severity per indemnity claim (indemnity, medical, and allocated loss adjustment) rises almost 5.5%.
    • 2003-2004: Drop in claim severity (reform laws enacted during this time).
    • 2003-2008: Indemnity claim frequency declines dramatically.
  • Costs per indemnity claim for 2014 accidents has decreased approximately 10% from the previous year.
  • Litigated claims showed a significantly higher average claim severity. They contributed to 20% of total claims with indemnity payment, and account for approximately 54% of total incurred losses.
  • Cost projections for 2015: $2.20 loss cost per $100 of payroll.

A Balanced Approach to Medical Cost Containment

In California’s complex and ever-changing workers’ comp environment, informed decision-making is essential to safeguarding results. At ANS, we pride ourselves at staying at the forefront of (legal and technological) industry changes to ensure the best possible outcomes for both our clients and injured workers.ANS’s three-staged Pharmacotherapy Review Program ensures economically balanced and appropriate treatment options for injured workers. Our legal nurse experts excel at presenting actionable treatment modification recommendations in clear, written proposals for treating physicians, including recommendations such as:

  • Consolidation and coordination of drug therapies between multiple prescribers.
  • Consideration of alternate therapies.
  • Specification of weaning programs for over-prescribed narcotics.
  • Use of generics where applicable.

The end result? A cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. Discover more about this advanced and comprehensive treatment strategy. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/whats-trending-with-california-workers-compensation/

The Importance of a Multifaceted Approach to Medical Cost Containment

The biggest hurdle in workers’ compensation medical cost containment is that the injured worker is not getting better. Even though WC claims have steadily declined over the last decade, medical costs keep rising as do the sub-par outcomes for the patient and the payer. What we are seeing is that the inter-connectivity of many factors is hindering the end goal of optimized outcomes. A multidimensional approach is crucial not only for combatting pharma costs, but also for ensuring optimal outcomes for injured workers.

At the end of the day medical care cost containment is more than finding savings, it’s also about examining the big picture to help identify potential areas of exposure while enhancing the quality of care and life for the injured worker.

How is this achieved?  Each case has to be approached individually to develop a custom tailored strategy. It has to start with well-established face-to-face communication with the physician. Once the line of communication is open, actionable treatment recommendations backed by evidence based clinical data can be implemented.

The industry also needs to focus on protocols that will ensure better outcomes and appropriate treatment for injured workers. Compliance protocols will result in improved outcomes for all stakeholders.

While medical expenses are the most obvious cost driver, the full picture involves much more than the number of medical services and associated expenses. Quality medical care directly impacts the speed and likeliness of the injured worker’s return to work. ANS Solutions understands the true cost of these practices and has taken an innovative approach to medical cost containment strategies.

Offering an innovative plan to assist payers, ANS Solutions’ proprietary Pharmacotherapy Review offers the integral assistance needed to optimize claim outcomes:

  • Expert review of cases by legal nurse experts, noting duplicate treatments and unnecessary/ineffective procedures.
  • Actionable, evidence-based treatment recommendations discussed via face-to-face meetings with physicians.
  • Ongoing compliance management with the help of clinical liason officers.

To learn more visit http://www.ans-solutions.com today!

 Original content posted on http://ans-solutions.com/the-importance-of-a-multifaceted-approach-to-medical-cost-containment/