The first day of the Louisiana Workers’ Compensation Educational Conference brought stakeholders from all sides to the table, beginning with an open forum update from Office of Workers’ Compensation Administration Director Patrick Robinson and continuing with national speakers, including Joseph Paduda, national blogger of Managed Care Matters.
Instead of the usual agency update, and stating that today (January 21st, 2016) was his last day in office, Robinson began the day by opening the floor to attendees. “We have a new administration, new people, and new ideas, it’s a time of change,” Robinson said. “So it’s an opportunity to make our system better – let’s talk about these problems.”
Several members of the crowd spoke up as Robinson looked for various distinct members of the system (judges, plaintiffs’ attorneys, defense attorneys, adjusters, medical professionals) to voice their opinions. However, the impromptu forum was as much an opportunity for the workers’ comp community to discuss their concerns as it was for Robinson to do so. In particular, he gave an overview of the significant issues – the opioid crisis, medical treatment guidelines updates, and the politicization of injured workers’ care – that have been the cornerstones of his year-long stint as Director.
“We had a Medical Director that started in January and was let go, because the administration decided to go in a different direction – that is the nature of politics,” Robinson explained. “But is it good that we have changed what was once a legal review of necessary medical treatment, to something that may have a little more of a political overtone? The Guidelines are such that there is some subjectivity…and suddenly, something that wasn’t in the Guidelines on January 10th is in the Guidelines on January 11th [when the new administration was inaugurated]. Do we want medical treatment to change with the tides of politics?”
Robinson also used his time to once again emphasize the importance of addressing opioids, especially opioid addiction and overprescription. Telling attendees that he was aware that he’s “spoken about it ad nauseum,” Robinson acknowledged that opioids are a public health problem, of which workers’ comp claimants are but one small component, but he urged action anyway, citing a formulary as a possible measure.
“Do we ignore [opioid abuse]? Do we wait for the rest of the health care system to catch up?” he asked. “We owe it to the people in this system to put something in place to control opioid abuse.”
Robinson again used language of obligation as he went on to discuss the palliative care versus functional improvement discrepancies in the Medical Treatment Guidelines. In addition to process issues with the updates – the physicians who update the Title do not receive compensation – the Guidelines are also rife with administrative and political difficulties, he said.
Fittingly, Robinson’s discussion was immediately followed by a presentation by Joseph Paduda, principal of Health Strategy Associates and a national commentator on the workers’ comp and group health spaces. Paduda spoke about the “landscape” of pharmacy management in comp, but focused especially on formularies, types of formularies and the issues that come with them.
Opioids were again a central question, as Paduda gave a series of alarming statistics on opioid spending. While states like Oklahoma and Texas have had financial success with formularies and other restrictions, Paduda cautioned against oversimplifying the matter. “So yes, in Texas, opioid prescriptions and prescriptions for other ‘N’ drugs have gone way down, but you have to ask yourself – where did those people go?”
By way of recommendations for Louisiana’s system, Paduda went on to encourage the crowd to publicize the positive capabilities of medical management in workers’ comp (such as preventing addictions and treating injured workers as whole individuals) rather than allowing the narrative to be hijacked by troubling anecdotes of denied care. He also suggested coordinating addiction specialists and pain management doctors once a claimant reaches a certain morphine equivalent level and ensuring that if a formulary is instituted, that UR procedures are in place. “You have to have both, if you’re not going to have good UR with a formulary, you’re better off not having either,” he said.
The conference continues through the rest of the day today and tomorrow morning. The schedule and further information is available here.
Editor’s Note: Louisiana Comp Blog is a sponsor of the Sixth Annual Louisiana Workers’ Compensation Educational Conference.