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Opioids and the IAIABC’s need to lead

The International Association of Industrial Accident Boards and Commissions is the trade group for workers’ comp regulators, the folks who have assumed the responsibility of  advancing “the efficiency and effectiveness of workers’ compensation systems.”

By failing to approve model language for regulations/legislation addressing opioids, the IAIABC’s Executive Committee failed to meet that responsibility.

This may seem like a very small issue, one scarcely deserving of attention or even note.

It is not.

Opioid overuse and abuse kills claimants.  Ruins families.  Destroys lives.  Keeps claimants out of work far longer than they should be, while dramatically increasing employers’ and taxpayers’ costs.  Everyone knows this, understands the implications, and realizes that we must do everything we can, as fast as we can, to address the issue.  Yet the model language, developed carefully and wisely in a structured process by a group of committed experts and dozens of stakeholders working hundreds of hours, over a year-long period, for reasons unfathomable, was not approved by the Executive Committee.

I asked the EC why.  They told me via email that “the models would be overreaching on the part of the IAIABC…We believed the consequences of advancing this prescriptive approach could potentially harm jurisdictions more than help.” Frankly, I don’t see the issue. Model language is just that – language that provides a basis, a framework, a starting point  – it is NOT the final word, the only way, the best practice.  Each state takes that language, refines it, adapts it to meet their unique situation, environment, current laws and regulations, and does so in a process that works for them.

How model language could “harm” states is beyond me – and everyone else I’ve spoken with.  When I asked for specific reasons for their decision, the EC responded:

“adopting model legislation and regulation would be too narrow and restrictive. We were concerned the models that were presented could unintentionally create conflict in jurisdictions that may be already taking steps to initiate regulations for appropriate guidelines.[emphasis added]

What conflict?  How?  Someone in some state might ask “Hey, how come our regs are different from IAIABC’s model language?” As if this never occurs, and is somehow a problem?  Would highly experienced, capable, intelligent, articulate regulators be stumped, unable to articulate a reasonable response, like “Things here in Texas/California/MIssissippi/Maine/New York are different than the rest of the states; we already have regulations/our laws require a different process/we have to address the issue primarily via utilization review/other intelligent response?”

I asked if this means the IAIABC will no longer promote model language, and got a nebulous response; “This decision will not impact future decisions to promulgate models and standards when appropriate.” 

Well.  If opioids are not “appropriate” than what, pray tell, is?

If you get the sense that I’m holding back here, you’re right.  I – along with many others who did a lot more work on the language than I did – are frustrated, angry, disappointed.  Yet I hold out hope that the EC will reconsider their decision, understand that this issue is far bigger than any individual concerns about how the model language may cause them a bit of stress, and approve the language.

The clock is ticking…

3 thoughts on “Opioids and the IAIABC’s need to lead”

  1. Joe why don’t we as the Payor community adopt the language and to the extent we can influence our local politicians perhaps we can realize the goal of better healthcare and less crippling medications?.

  2. I’m disappointed and sad. Every 15 minutes, someone dies from prescription drug abuse. It’s the biggest issue facing WC right now.

  3. I agree with John Swan. If the language is any good, there are a number of bright people, physicians and employers, managed care, injured workers and others, who can mold it to what works for each jurisdiction.
    The IAIABC’s endorsement isn’t necessary and yet its work need not be wasted. Successful implementation of a policy that actually works, will speak much louder than any single organization’s stamp of approval.
    I would differ with John’s proposal in one important way. I am pretty sure that our collective experience has taught us that when adult members of the entire community put their heads together with a common purpose, the success rate is nearly 100%. Not so when a one sided push is the tactic. So, rather than the payor community first “adopting the language,” I suggest starting with it, bringing the adult community together on a jurisdictional basis to refine it into a practical solution that works. I also believe we would agree that any legislature or regulatory body would welcome deciding the merits of a policy born of this process rather than dealing with opposing sides. There’s enough of that already. To Mark’s point, although my suggestion may look like it would take longer, I am very confident that the time necessary to realize a truly successful result will be much faster.
    Let’s get started.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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