Current Trends in Workers’ Comp and Bloodborne Pathogen Exposure

1. Current Trends in Workers’ Comp and Bloodborne Pathogen Exposure Sherri Hickey-Director of Medical Management

2. Industry TrendsIncreased Medical Costs • Utilization (frequency) and Severity (cost) of treatment • Overall decrease in utilization of medical • Severity continues to increase at approximately 6% annually from 2002-2010 vs. 3.4% for indemnity costs over that same time frame. (NCCI) • Medical now accounts for 60% of WC claim costs and rising

3. Treatment Inefficiencies • 29% of all medical diagnoses are wrong* • 60% of treatment plans require a correction* • 38% of surgeries are unnecessary* * Best Doctors 2011 U.S. data; consistent with findings of The American Journal of Medicine, The Journal of the American Medical Association and numerous other scholarly publications. Surgery data from U.S. National Institute of Health

4. Prescription Drug Use and Abuse • Since 1999, the number of prescription painkiller deaths has risen more than 300% • Narcotics account for 34% of total drug spending for WC as opposed to 3% for group health (IMS Institute for Healthcare Informantics) • Over 90% of all narcotics are consumed in the United States. • Narcotics accounted for 14,800 deaths in 2008. Second leading cause of accidental death. More than heroin and cocaine combined.

5. Prescription Drug Use and Abuse (continued) Problems associated with narcotics • Studies show that narcotics increase disability, litigation and chances for surgery • One study reports temporary total disability 3.5 times higher when narcotics prescribed • All prescription drugs have side effects which sometimes lead to more drugs or treatment • Off label prescribing for conditions not intended for the drug

6. Prescription Drug Use and Abuse (continued) Causes of Narcotic Problems • Few requirements for monitoring or accountability by prescribing physicians • No mandatory drug monitoring or testing • No control of off label prescriptions • Very little control of pain clinics The Good News • Tide seems to be starting to turn • Physicians are starting to be prosecuted. • States are putting controls in place, Washington, Texas, California.

7. Co-morbidities Co-morbidities are pre-existing medical conditions that might impact the recovery from a subsequent injury or illness. • In 1996, no state had more than 20% of the population considered obese (BMI > 30%). As of 2010, no state had less than 20% of population considered obese. (CDC) • According to a June 2012 NCCI study, obese workers are likely to have 5 times the disability of a non-obese worker with comparable injuries. • NCCI also states that claims with co-morbidity treatments have 2-5 times the cost of otherwise comparable claims.

8. Other Medical Challenges Medical cost shifting to Workers’ Compensation • WC has long been considered by medical providers as being one of the best sources of reimbursement • Historically WC treatment was paid at 1.5 to 2.5 times higher than HMOs, Medicare and group health. • This has decreased due to fee schedules, PPOs, bill re-pricing vendors, etc., but WC rates are still higher than non WC. • Higher reimbursement rates might create incentives for medical providers to submit as WC or prolong treatment

9. Physician Dispensing Physician Drug dispensing • Increases costs of drugs and could be a conflict of interest due to financial incentive for physicians to prescribe drugs • CWCI study – If an MD is dispensing: • Total medical spend is 37.3% higher • Indemnity is 28.2% higher • Paid TTD days are 8.9% higher

10. Medicare Set-Asides Problems with this process: • Delays the settlement process by months • Funding for medical treatment or drugs that employees might never use • Future projections are based on current treatment even if we know it will change, e.g., narcotics, stimulators, pain pumps • If an MSA is necessary and not completed, the claim might stay open for the claimant’s lifetime • We used to settle for reasonable amounts but now cannot

11. Medicare Set-Asides (continued) Examples of Safety National MSAs: • MSA amount = $72,784 CMS demand/revision = $125,619 • MSA amount = $64,016 CMS demand/revision = $361,752 • MSA amount = $248,089 CMS demand/revision = $726,149 • MSA amount = $37,026 CMS demand/revision = $247,699 • MSA amount = $8,022 CMS demand/revision = $44,023 Average increase on these claims about $215k, or 250%.

12. Biopsychosocial Issues Factors to consider that could cause problems with the WC claim: • History of drug or alcohol abuse • Work dissatisfaction • Family, legal or financial problems • Low expectations of recovery • Disabled spouse or young children at home • Low wage earner • History of depression or moodiness

13. Biopsychosocial Issues (continued) • Studies have shown that Cognitive Behavioral Therapy (CBT) has had impressive results in treating these injured workers. This treatment does not involve medications but rather therapy or counseling from psychologists or psychotherapists. • Studies have also shown decreased disability when these factors are treated rather than ignored. • IMCS provides this therapy without using a psych diagnosis code.

14. Bloodborne Pathogens

15. Session Objectives Identify bloodborne pathogens (BBPs) Understand how diseases are transmitted Determine your risk of exposure Protect yourself from exposure through prevention Respond appropriately if exposed

16. What Are Bloodborne Pathogens? • Microorganisms present in human blood that can cause disease • Viruses, bacteria, parasites, fungi • Primary workplace pathogens • Human immunodeficiency virus (HIV) • Hepatitis B virus (HBV) • Hepatitis C virus (HCV)

17. Hepatitis B Virus (HBV) • 1.4 million people infected • Symptoms • Jaundice, fatigue, and abdominal pain • No appetite, nausea, and vomiting • Vaccine is available • HBV can survive outside the body

18. Hepatitis C Virus (HCV) • HCV is the most common chronic bloodborne infection—3.2 million infected • Symptoms can take years to manifest • Flu-like symptoms, jaundice, dark urine, and fatigue • Loss of appetite, nausea and vomiting, and abdominal pain • Treatment is marginally effective

19. Transmission of Pathogens • Contaminated sharp objects or needles • Broken skin, including rashes • Mucous membranes • Eyes • Mouth • Nose

20. Bloodborne Pathogens Law 29 CFR 1910.1030 requires: • A written Exposure Control Plan (ECP) • Engineering and work practice controls • Personal protective equipment (PPE) • Training

21. Protect Yourself • Review the ECP and OSHA regulation • Take universal precautions • Use personal protective equipment • Follow safe work practices • Get the hepatitis B vaccination • Follow decontamination and disposal procedures

22. What is the Exposure Control Plan? • Identifies jobs and tasks for potential exposure • Describes engineering and safe work practices • Outlines training requirements • Identifies the placement and use of signs and labels • Explains how to decontaminate equipment and work surfaces

23. Take Universal Precautions • Treat all blood and bodily fluids as if infected • Use barrier protection to avoid contact with infected bodily fluids • Immediately clean up and decontaminate surfaces and equipment Image Credit: OSHA

24. Use Personal Protective Equipment • Barrier protection prevents exposure • Use gloves when applying bandages or cleaning up • Eyewear or masks protect against splashes • Protective clothing or aprons protect against spurting blood

25. PPE (cont.) • Use a mask for nose and mouth protection • Use a CPR mask • Be prepared to use impromptu barriers such as a garbage bag, plastic, paper, or your shirt

26. Avoid Puncture Wounds • Use tongs, forceps, or similar tools to pick up potentially contaminated items Image Credit: State of WA-WISHA Services

27. General Decontamination • Wear appropriate gloves and glasses to protect eyes, nose, mouth, and skin • Use a bodily fluid disposal kit • Use 10% bleach or EPA-approved disinfectant for spills • Dispose of contaminated items

28. Exposure Incident • Wash cuts and skin thoroughly • Rinse nose and mouth • Flush eyes with clean water or sterile solution • Clean all contaminated surfaces • Report all incidents

29. Post-Exposure Evaluation • Confidential medical evaluation • Document route of exposure • Identify source individual • Test source person’s blood • Provide results to source and exposed employees Image Credit: State of WA-WISHA Services

30. Key Points to Remember! Bloodborne pathogens can cause fatal disease Be aware of exposure at work Take universal precautions Use PPE and safe work practices Decontaminate yourself and equipment Understand and follow exposure incident procedures Report exposure incidents

31. Thank you!