Essential Updates: Comp Medical News for March

Welcome to this month’s edition of Comp Medical News, an essential update series. Each update features stories from around the country, with special focus on medical treatment guidelines and emergent issues related to medical management in workers’ comp.

First, fee schedules are undergoing renovation in two major states:

California Division of Workers’ Compensation has adopted and filed an amendment to the official medical fee schedule 

According to the Department of Industrial Relations in California, the amended regulation reiterates the applicable dates of fee schedule provisions that are declaratory of existing laws; addresses the operating disproportionate share hospital (DSH) adjustments to inpatient hospitals; addresses the inpatient hospital outlier payments for eligible transfer cases; updates inpatient hospital factors to 2014, and makes minor adjustments to other sections of the official medical fee schedule. The changes go into effect tomorrow, March 5th, 2015.

Read the news release and access the amendments in full via the California DIR here.

Updated fees for providers in Florida are causing a financial headache for the state’s Division of Workers’ Comp

The Florida Medical Association insists that changes to the provider fee schedule/manual in the state must be made, despite the DWC’s finding that the costs to do so will require approval from the state Legislature. The division has proposed to adopt changes by reference to the Health Care Provider Reimbursement Manual and the Ambulatory Surgical Center Reimbursement Manual. However, the costs are a level which triggers the need for legislative approval. DWC officials stated that the increase in reimbursement, “will have an adverse effect on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule.” The FMA has stated that the changes are necessary to bring the schedule up to date. NCCI issued its analysis of the proposed changes last month and found that physician payments would increase by a projected weighted average of 10.6 percent in the state.

Read full coverage from WorkCompCentral (paid content) here.

Second, federal oversight of the medical and public health communities was under a media microscope this month:

Drug safety and FDA adverse events reporting system under fire

In an editorial for MedPage Today, drug safety advocate Brian Overstreet assesses a new report from the Institute for Safe Medical Practices (ISMP) which found that pharmaceutical companies are largely responsible for collecting and reporting adverse drug events to the FDA themselves, and that the companies are outsourcing the duties en masse, resulting in incomplete and inaccurate reporting. Overstreet urges reform of the FDA Adverse Events Reporting System (FAERS) as it is the main source for FDA safety warnings for prescription drugs.

Read the editorial here. Access the report from ISMP here.

Environmentally conscious nutrition recommendations from federal panel provoke ire

The nation’s top nutritional panel issued a 571 page report which included a recommendation, for the first time, that Americans consider the impact on the environment when they are choosing what to eat. According to The Washington Post, this additional recommendation defied a warning from Congress and, if enacted, could discourage people from eating red meat and other animal proteins.

Members of Congress had sought in December to keep the group from even discussing the issue, asserting that while advising the government on federal dietary guidelines, the committee should steer clear of extraneous issues. In the final report, the panel states, “Consistent evidence indicates that, in general, a dietary pattern that is higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in animal-based foods is more health promoting and is associated with lesser environmental impact than is the current average U.S. diet.”

Read the full story from The Washington Post here.

Next, the fallibility of the physician came to the fore in assessments of biased treatment decisions for obesity and in developing a treatment plan for opioid addiction:

Health professionals are often misguided about obesity, let biases factor into treatment decisions

A review of obesity management studies by William Dietz, MD, of the Sumner M. Redstone Global Center for Prevention and Wellness at George Washington University, and his colleagues published in The Lancet found that the nation is poorly prepared to deal with the obesity epidemic and that policy and environmental changes were unlikely to help.

The researchers explained: “Successful clinical interventions exist, but innovative approaches to delivery of care have only just begun…Taxpayers, agencies, and governments need to redefine professional competencies and licensing that address obesity, provide incentives for care, and nurture and reward innovative approaches to the prevention and management of obesity.”

In particular, the review notes the lack of obesity-specific clinicians, plus the wealth of biases in the medical community with regard to the disease. Many think that “patients with obesity are lazy, noncompliant with treatment, less responsive to counseling, responsible for their condition, have no willpower, and deserve to be targets of derogatory humor, even in the clinical-care environment,” wrote the authors, citing a 2006 study of medical students and a 2013 one of U.K. healthcare workers.

Get a synopsis of additional findings from MedPage Today here.

A medical professor and clinician offers guidance on choosing the right opioid addiction treatment: methadone versus buprenorphine

Chinazo O. Cunningham MD, MS cites the huge uptick in prescription opioid and heroin deaths in recent years as the catalyst for change and careful choice, especially since rates of treatment have not risen in turn. As it stands, fewer than one in five people who need treatment for opioid addiction actually receive it. Cunningham explains, “Research clearly demonstrates that short-term detox is not effective. The risk of relapse after undergoing detox is extraordinarily high. This is why medication-assisted long-term maintenance treatment is optimal, as many studies demonstrate numerous benefits of receiving maintenance treatment.” He also advocates for psychological counseling but argues that it is rarely effective alone.

Read the full article and the pros and cons for the two major treatment medications via MedPage Today here.

Finally, a union and an environmental group are pushing for recourse related to what they claim are dozens of cases of toxic materials exposure in Washington state:

Since March 2014, nearly 60 workers at Hanford Nuclear Reservation have sought medical attention for on-the-job exposure to toxic waste

At a public meeting held in Pasco, Washington late last month and hosted by the United Association (U.A.) of Plumbers and Steamfitters Local 598 and Hanford Challenge, a Seattle-based environmental watchdog group, Hanford workers described symptoms that include chronic headaches, respiratory problems, nerve damage and bloody urine.

The meeting came on the heels of a February 10th release by Department of Energy contractor Washington River Protection Services (WRPS) of a “corrective action implementation plan. The plan was commissioned in response to worker exposures at Hanford’s toxic waste “tank farms.” The Savannah River report found ongoing emissions of toxic chemical vapors from waste tanks, inadequate worker health and safety procedures and evidence that “strongly suggests a causal link between chemical vapor releases and subsequent health effects.”

Read the complete feature from In These Times here.


Image Credit: Scientific American

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