Stuff you may have missed…

Spinal cord stimulators...Don’t work.

More specifically, multiple high-quality studies found little evidence of pain reduction, no impact on disability, no impact on opioid use, and a relatively high risk of complications (about one in five patients required device revision or removal)

Just as bad, the SCS industry fought back with highly questionable tactics: this from JAMA reported in MedPageToday:

 “Industry-funded critics of independent studies often do not follow the usual route of scientific discourse…

Rather than respond to the journal where the original study was published, critics frequently publish in journals where they are the editors and can control the discourse (15 of 18 letters criticizing the independent studies cited in this article appeared in journals with industry-affiliated editors)…

The journal can then choose to paywall the subsequent response from the independent authors, giving critics the last word.”

and criticisms are typically narrow (but they didn’t look into the benefits for left handed red heads who speak Swahili!) and/or specious.

The net – science indicates the risks of SCS are high indeed, while the benefits of SCS are sketchy at best.

FDA approves test to assess opioid addiction risk

From the FDA”

“The AvertD test is intended to be used before patients who are being considered for a 4- to 30-day prescription for acute pain (e.g., for a planned surgical procedure) are first exposed to oral opioids. It is not intended for patients being treated for chronic pain.”

Excellent news indeed!

The test is NOT yet available…check here for more info.

Net – get your Medical Director(s) on this post haste to determine coverage policies and reimbursement.

Opioid settlement dollars

are in high demand, with a bunch of companies coming up with very creative ways to stick their heads in the trough. Spiderman-type cord wraps for police, locking pill bottles, safe disposal envelopes are among the pitches governmental entities are getting for their opioid settlement dollars.

Two points – 

1. addiction counseling, behavioral health, and other patient care is what is needed – and where dollars should go.
2. illicit fentanyl is the big problem now – expensive locking pill bottles and disposal envelopes are marginally useful.

Texans may see rolling blackouts this winter, with implications for businesses, public safety employees, utility workers and essential workers.

In October ERCOT – the state’s power regulator, “… issued a request to increase [electricity producers] power capacity ahead of winter’s peak load season in Texas but canceled the request after it only found an additional 11 megawatts out of the 3,000 it was looking for.”

Power producers pointed to ERCOT’s request as too little, too late; University of Houston Energy Fellow Ed Hirs: “Just simply throwing some money out and hoping that people could bring a coal-fired power plant back out to operational capability within a period of weeks was really, ridiculously, ambitious.”

It’s not just Texas…with changing winter weather patterns driven by climate change other states are also at risk of similar blackouts.

 

In which we briefly discuss the power grid, jobs and what it means for you.

The good news is the Inflation Reduction Act (IRA) and bipartisan Infrastructure Investment and Jobs Act invest billions of dollars to upgrade the nation’s electrical grid.

courtesy Carbon Collective

(a connected grid enables operators to send power from places where there is plenty of electricity – say Arizona – to places where demand is super high – say Oklahoma during a deep freeze)

Dollars going to infrastructure are a major reason construction spending has jumped..it’s now more than a third higher than pre-COVID

Paralleling investment, construction employment has dramatically increased and is well above pre-pandemic rates..

source – FRED

What does this mean for you?

More investment = reliable infrastructure + more jobs = higher payrolls = higher premiums.

A very good explanation of the grid, transmission, and electricity production is here.

Why do some patients need more PT than others?

Why does a therapist’s treatment duration vary for patients with the same diagnosis?

What conditions have the most impact on patient recovery?

Thanks to WCRI’s Vennela Thumula PharmD; Randall Lea MD; and Te-Chun Liu there are answers.

WCRI’s latest research based on FOTO data digs into just how big an impact mental and physical health co-morbidities – and other factors – have on improvements in functional status.

The methodology is robust indeed, the data solid as it gets, and the insights provided by the researchers quite valuable.

Using FOTO’s 100 point scale, their research indicates patients with both physical health and mental health comorbidities see about 20% less improvement in functional status than patients with no comorbidities.

courtesy WCRI

Co-morbidities – aka health conditions a patient has in addition to the one you’re focused on – may be physical – think obesity, hypertension, arthritis – or mental – depression, anxiety/panic attacks, sleep dysfunction.

Quick takeaways…

About two-thirds of patients have a physical or mental health comorbidity, and these comorbidities definitely affect the patient’s ability to recover.

The more comorbidities a patient has, the greater the impact on recovery.

More troubling still, the more likely these patient would have “very limited” function at the end of therapy.

The researchers also looked at the same metrics for non-work comp patients…and found comorbidities had similar if not more impact on recovery.

And…it isn’t just comorbidities.

Quicker access to PT had an even greater impact on recovery than physical or mental health complications. The details are on page 43 of the study. If you’re not a WCRI member, become one to get access to all their great work at no charge.

Non members will have to pony up a few bucks to learn more.

What does this mean for you?

Great research is really useful…use this to help injured workers get better faster. 

 

 

The brainiacs at NCCI have a must-read post detailing physician services’ costs and utilization in most states.

Gotta say this is one of the most useful and insightful analyses I’ve seen from anyone. Kudos to NCCI.

Couple highlights…

• VERY wide range of physician costs – on a service year basis, state costs range from $800 to almost 4 times that.
•  Using NCCI’s utilization metric (units), utilization varied almost as much – from fewer than 1000 to more than 2500 units.
• one of the most insightful learnings is about the factors contributing to variations in utilization…

• “service intensity” is the most important driver of variation; NCCI’s definition is the “collection and type of physician services rendered on average for a claim given its diagnosis and whether there was a major surgery.”

What does this mean for you?

Your medical management strategy MUST be state-specific. 

It’s that time of year…when the brilliant minds at WCRI release the latest CompScope report.

The top finding…is likely to surprise many…

Couple observations:

• yes, this was during COVID….medical costs during COVID were LOWER, not higher than previous in previous years. Those who understand medical care delivery anticipated this, alas that is a very small group.
• no, medical costs in comp are NOT increasing significantly. Haven’t been for years.
• That’s because we’re still benefiting from the opioid hangover effect.

Warning – Medicaid disenrollment aka “screw the poor folks” will push facilities and healthcare systems in many states to look for revenue replacements.

And, because work comp is pathetically awful at controlling facility costs, we can expect facility costs to increase – which will increase medical costs.

You can register for WCRI’s  webinar highlighting findings from this year’s report here….tune in November 16, 2023 @ 2 pm eastern.

What does this mean for you?

It is long past time to start preparing for higher medical spend.

Over the last two decades work comp bill review has A) changed a lot and B) remained stagnant.

Both things are true…

Here’s the top takeaways from our just-released Survey of Workers’ Comp Bill Review (public version is available here; respondents received a much more detailed version).