Welcome to the second installment of the monthly Comp Medical News essential update series. On the first Wednesday of each month, Comp Blog will keep you informed of the most important national stories related to medicine and workers’ comp, with special focus on medical treatment guidelines and medical management.
First, chronic pain is the name of the game in two states considering workers’ comp reform. Plus, one state has entered the world of fee schedules:
California DWC sought new Chronic Pain Guidelines as a substitute for the ODG version
The California Department of Industrial Relations issued a proposal for amended guidelines on December 10th on its online forum. The new pain guidelines are adapted from a “frozen” version released by the Work Loss Data Institute (which produces ODG) in April 2014. DWC Executive Medical Director Dr. Rupali Das stated that “chronic pain is a public health problem, a significant factor in delayed recovery and the main reason for medical treatment disputes.” Das emphasized that the goal of the new chronic pain guidelines is to “incentivize a multidisciplinary approach.”
Read the release from the California DIR here.
Access the amended guidelines here.
California adopts a “biopsychosocial” model in its chronic pain guidelines
A feature in WorkCompCentral addressing the newly proposed chronic pain guidelines reveals that pain specialists and the medical community at large is moving away from a “classic biomedical approach” and toward a “biopsychosocial model” of pain management which “recognizes the complexity of the pain experience.”
Read full coverage at WorkCompCentral (paid content) here.
Michigan Workers’ Compensation Agency to amend workers’ comp rules in effort to curb opioid abuse in the state
The Michigan Workers’ Compensation Agency (WCA) recently announced that amendments to the Workers’ Compensation Health Care Services rules and fee schedule will address the problem of long-term opioid use in the workers’ compensation system. The amendments were effective on December 26, 2014 and have the support of the state’s business and medical communities. The amended rules prevent reimbursements for opioid treatment beyond 90 days for non-cancer related chronic pain, unless detailed physician reporting requirements and other processes are met.
Read further details from the Michigan WCA here.
Access the new Health Care Services rules for the state in entirety here.
Connecticut has adopted its first-ever hospital and surgery center fee schedule
Connecticut, the second most expensive state for workers’ comp in terms of premium (according to the 2014 edition of the biennial Oregon Premium Rate Study) is adopting a hospital and ambulatory surgery center fee schedule in an effort to control medical costs. Officials expect the new fee schedule to reduce the claim cost for inpatient services about 10 percent and outpatient around 20 percent. The state will also cap inpatient reimbursement at 174 percent of Medicare rates and outpatient reimbursement at 210 percent of Medicare. Surgery center reimbursement will be capped at 195 percent of Medicare.
Read full coverage from WorkCompCentral (paid content) here.
Meanwhile, Medicare and MSAs continue to be both headache-inducing and a bureaucratic model:
N.Y. Assembly Panel to consider converting its Medical Fee Schedule to the Medicare Resource-Based Relative Value Scale
The New York Assembly Labor and Insurance Committees held a meeting on December 19th to hear testimony on a proposal by the state’s Workers’ Compensation Board to convert the medical fee schedule to Medicare’s Resource-Based Relative Value Scale. The state’s fee schedule, which effectively has not been changed in 20 years, would bring reimbursements up to speed. The changes, which will be benchmarked by a vendor, are expected to eventually reduce payments to common workers’ comp specialists like orthopedic surgeons and radiologists.
Read full coverage from WorkCompCentral (paid content) here.
Medicare cut payments to 721 hospitals with high infection and injury rates
After cracking down on non-emergency ambulance transportation last month, Medicare continues to trim the fat and has penalized 721 hospitals in its network for high rates of hospital acquired infections and injuries. One out of every seven hospitals in the nation will have their Medicare payments lowered by 1 percent over the fiscal year that began Oct. 1 and continues through September 2015. The health law mandates the reductions for the quarter of hospitals that Medicare assessed as having the highest rates of “hospital-acquired conditions,” or HACs. These conditions include infections from catheters, blood clots, bed sores and other complications that are considered avoidable. Teaching hospitals have been hit the hardest, with half of them suffering penalties. Legally, Medicare can expel a hospital with high rates of errors from its program, but that punishment is almost never done, as it is a financial death sentence for most hospitals.
The following eleven Louisiana hospitals were penalized: Charity Hospital & Medical Center of Louisiana at New Orleans, Christus St. Frances Cabrini Hospital, Glenwood Regional Medical Center, Leonard J Chabert Medical Center, Monroe Surgical Hospital, Our Lady of the Lake Regional Medical Center, St. Elizabeth Hospital, Tulane Medical Center, University Health Shreveport, University Hospital & Clinics (Lafayette), Willis Knighton Medical Center.
Read the feature from Kaiser Health News here.
A federal case involving “crosstalk” between implantable devices prompts questions about MSA recommendations
Jennifer Jordan with MEDVAL blogs about a case in the 6th Circuit Court of Appeals upholding a Medicare coverage determination denying the implantation of an infusion pump because the patient already had a spinal cord stimulator in place since the mid-1990s. The pump was contraindicated because “crosstalk between devices may inadvertently change the prescription.” Jordan questions why pain pumps are then forced into MSAs. The case is Mary K. Woodfill v. Secretary of Health and Human Services.
Read the post here.
Finally, we find that history is repeating itself:
The New York Times explores the history of cyclical opioid abuse in America
The New York Times “Upshot” columnist Austin Frakt discusses the cyclical challenge of opioid abuse in all its forms and identifies three eras since the late 19th century in which it has reached “problematic” and policy-provoking levels, as it has today. Frakt goes on to trace over-prescribing to the 1980s and pegs 2010 as a tipping point in which the combination of hydrocodone and acetaminophen became the most prescribed medication in the nation. More than 16,000 people died as a result of opioids that year.
Read Frakt’s full editorial here.
Image Credit: Surgical Arts Center Las Vegas