May 21, 2015



We're just a few short days away from Memorial Day, a time to remember those who died while serving in the country's armed forces. It's also the tail end of National Physical Fitness and Sports Month so our prescription is to get your fill of health wonkery here today, but then kick off a little early tomorrow. Find some time to pay your respects this weekend and then get out there and get active. All wonk and no play leads to Type 2 Diabetes.

OK, here's this week's roundup of wonkery:

Joe Paduda tells us that 21 states have not (yet) chosen to expand Medicaid. In his post at Managed Care Matters -- Medicaid and Workers' Comp -- he explains the impact that decisions to expand / not to expand have on workers' comp patients, premium payers, and insurers.

At Colorado Health Insurance Insider, Louise Norris offers her thoughts on the Luis Lang story. Don't know his story? She points to a number of media stories, including an interview with Henry Pollack. She says that the interview is an excellent look into how the law is perceived, particularly by those who are resistant to it based on their politics and their information sources. She notes that a year and a half after the first Obamacare open enrollment period began is testament to the fact that there's still an uphill battle in terms of getting accurate information out to the people who need it the most.

Emergency Department visits are up post-Obamacare and opponents are using that to bash supporters. But at Heath Business Blog, David Williams says, "of course emergency department visits are increasing" - and it's not really fair to blame supporters, since many (including him) predicted that ED visits would rise, not fall. He reminds opponents that before Obamacare, many were bashing the uninsured for clogging up emergency rooms.

The FDA is generally concerned with efficacy and safety, but now does the FDA care about what patients think? A new draft guidance recommends measuring patient preferences for medical devices. Jason Shafrin at The Healthcare Economist investigates.

Despite the Genetic Information Nondiscrimination Act of 2008 (GINA), the issue of genetic testing in the workplace keeps resurfacing in one form or another. At InsureBlog, Henry Stern discusses the latest twist in his post Your Genes vs Your Job.

Indiana has recently become a place where health and politics intersect with striking consequences: One of the largest outbreaks of HIV ever identified in the U.S. continues to unfold in the state writes Preeti Malani, a Professor of Medicine in the Division of Infectious Diseases at the University of Michigan She says that needle exchanges and substance abuse counseling and treatment are crucial in fighting HIV. See her post at Health Affairs Blog: Allow Evidence, Not Politics, To Drive Prevention: Lessons From Indiana's HIV Outbreak.

Over at the newly designed HealthBlawg, David Harlow reacts to Overkill, Atul Gawande's recent New Yorker piece on the problem of over-diagnosis and over-treatment. David offers a prescription for an approach to eating the elephant in his post: An avalanche of unnecessary care.

Could healthcare be much more efficient - ie lower cost and higher quality - if we were to leverage the full potential of information technology? Peggy Salvatore says we are oh-so-close to being there. In her post at Health System Ed, she talks to Dr. Sandeep Pulim, the CMIO,of a company that developed an application that is pulling all the pieces together.

Trade negotiations may be unfamiliar territory to those interested in addressing health care dysfunction, but Roy Poses explains why it shouldn't be in his post at Health Care Renewal. The new trade pacts under recent senatorial dispute could potentially have major effects on health care and public health. They allow for the creation of international tribunals, which lack the sorts of due process and accountability of court systems in most developed countries, but which could be used to fight national health and safety regulations. Learn more: All the President's Trade Negotiators - Revolving Doors, Regulatory Capture, and Health Care Corporate Friendly Trade Agreements

Charles Gaba says that with the May 15 start of the 2016 rate review season, we should expect to start seeing stories with scary-sounding headlines in on- and off-line media. Pre-emptively, he lets the air out of rate-increase hysteria in his post at blog. (We note that in addition to being a contributor there, Charles is the proprieter of, which tracking enrollments for the Affordable Care Act.

Here at Workers Comp Insider, we look at the "State of the Line" for the workers comp industry, as depicted in the release of several key indicators issued and discussed by NCCI at the recent Annual Symposium. How are things looking? Calm for now, but turbulence ahead.

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May 20, 2015


At its Annual Issues symposium held last week, NCCI offered it's State of the Line, an overview of the health of the work comp industry. The press release NCCI offers a summary:Calm Now ... But Turbulence Ahead Outlook for Workers Compensation Industry. For more detail, see Chief Actuary Kathy Antonello's presentation slides (PDF) reviewing workers compensation trends, cost drivers, and the significant new developments shaping the industry. And for other presentations and reports, see News from the Annual Issues Symposium 2015.

Some of the report highlights:

  • The workers compensation calendar year combined ratio for private carriers was 98 in 2014, a four-point decrease from 2013 and a 17-point decline since 2011
  • Total market net written premium increased by approximately 6% to $44.2 billion, driven primarily by an increase in payroll
  • Claim frequency declined 2% in NCCI states
  • Claim severity increased slightly more than inflation measures for indemnity and medical costs
  • While workers compensation premium volume continues to increase, construction and manufacturing employment totals remain well below prerecession levels--restraining even higher premium growth rates
  • A continuing low-interest-rate environment threatens investment results over the long term
  • Last year marked the fourth consecutive year of workers compensation residual market premium growth. Premiums grew by approximately 7% in 2014, while the average market share in the residual market held steady at 8%

In addition, NCCI President Stephen Klingel added commentary on market turbulence:

"From ongoing threats to exclusive remedy, to the risk of benefit increases without appropriate rate adjustments, to the rapidly changing nature of our workforce and workplaces, our industry is being tried on all sides today. While I am confident that we will work our way through these challenges, it is important to be realistic about current conditions and to recognize that the current positive results may not last."

For the next best thing to being at the symposium, it's worth checking out Joe Paduda's running commentary on the various NCCI sessions...

First up at NCCI - Work comp is looking better...

The State of the Workers' Comp Line - 2015 ed.

Listening fast to Bob Hartwig

NCCI's PM sessions - hard core research geeks only

Listening fast to Bob Hartwig

Another great source of conference blogging is Mark Walls at Safety National - who blogged not just this NCCI symposium, but many other industry events and reports too -- if you don't have Conference Chronicles bookmarked, you should!

Here are reports from some other media outlets

Stephanie Goldberg, Business Insurance
Turbulent times ahead for workers compensation

Andrews G. Simpson, Claims Journal
Workers' Compensation Results Improved in 2014 But Industry Anxious About What's Ahead

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May 8, 2015


You'd think with spring in the air, everyone would be in a better mood, but apparently not. Steve Anderson found there is "a general vibe of grumpiness out there in the health policy blogosphere" and he taps into it to bring you the Grumpy Cat edition of Health Wonk Review posted at his blog. Go find out what everyone is complaining about.

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May 6, 2015


May is Mental Health Month and while the focus of workers comp prevention generally revolves around issues of physical safety, perhaps employers should expend more energy in promoting the mental/emotional well being of workers, as well. We just had a dramatic example of the effects of mental illness in the workplace in the horrific case of the suicidal Germanwings pilot who crashed the commercial jet he was flying, resulting in 150 casualties. While this might seem an outlier, an extreme case, the workplace has all too many examples of violence resulting in injuries and death. Depression and mental health issues are a workplace reality and, on the whole, they aren't being addressed all that effectively. This should be no surprise - society at large isn't doing such a great job when it comes to mental health issues.

Mental Health America has designated this year's Mental Health Month theme as a prevention/early intervention one: B4Stage4. They note that we need to change the way we think about mental health:

"When we think about cancer, heart disease, or diabetes, we don't wait years to treat them. We start before Stage 4--we begin with prevention. When people are in the first stage of those diseases and are beginning to show signs or symptoms like a persistent cough, high blood pressure, or high blood sugar, we try immediately to reverse these symptoms. We don't ignore them. In fact, we develop a plan of action to reverse and sometimes stop the progression of the disease. So why don't we do the same for individuals who are dealing with potentially serious mental illness?"

Among the many steps to rectify this, MHA suggests Getting informed;
Getting screened and Getting help. The site has a plethora of communication resources, graphics and fact sheets that would help in an employer communication program.

"Employers should Treat the individual, not the stigma." That's the advice from Terri L. Rhodes, Executive Director of the Disability Management Employer Coalition (DMEC) in a recent issue of Risk and Insurance. She cites the prevalence of depression in the general population at about 9 percent, according to the centers for Disease Control. This makes it likely that about 1 in every 10 workers is grappling with depression at some point in their work life.

Rhodes says:

Employers in particular need to become educated about recognizing signs and symptoms of depression and anxiety. This alone sends a powerful message that mental illness, like all illness, respects no title or position. Utilize the services of EAPs."

She notes that while EAPs are an almost ubiquitous benefit, "they are woefully underutilized." Managers should be trained in when and how to best use and refer to EAPs.

Mental health as a preventive issue is important, but it also an important consideration in post-injury recovery and return to work. An article in LexisNexis talks about post-injury depression as it relates to dealing with disabilities, the process of pursuing workers' compensation benefits, and anxiety related to the ability to return to work.

The article cites the costs from a recent study on post-injury depression conducted by Abay Asfaw, Ph.D., and Kerry Souza, Ph.D., of the Centers for Disease Control and Prevention.

The study further quotes the determination of the Bureau of Labor Statistics that "after-injury depression costs workers, group health insurance plans and/or taxpayers at least an extra $8.2 million ... within a 3-month study period in 2005 dollars. Such costs of treating depression as a sequel to injury are typically not included in estimates of the economic burden of occupational injury." These numbers do not include related costs, such as inpatient care and prescription drugs.

Employers can play a significant role in fostering workplace mental health, both in the general work population and specifically with workers who are in post-injury recovery. Here are some resources for learning more.

Partnership for Workplace Mental Health - a program of the American Psychiatric Foundation in conjunction with various employers. It offers employer case examples, publications and services.

ACOEM's Work Disability Prevention Guideline: "Preventing Needless Work Disability by Helping People Stay Employed"

The Disability Management Coalition

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April 27, 2015



April 28 is Workers Memorial Day, a day dedicated to remembering those who have suffered and died on the job and renewing the fight for safe workplaces.

Here are some resources and events about tomorrow's observances.

OSHA: 4,585 [U.S.] workers died on the job in 2013

Interactive Map of 2014 Worker Fatalities

Death on the Job report, 2014

Workers' Memorial Day -- April 28, 2015
CDC's Morbidity & Mortality Weekly Report

Find Workers Memorial Day events near you

Intolerance for Unsafe Workplaces
Edward Wytkind, President of the Transportation Trades Department, AFL-CIO

Occupational exposure is OSHA's focus for this year's Workers' Memorial Day

5 "Easy" Ways to Improve Temp Worker Safety
Alliance for the American Temporary Workforce



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April 23, 2015


Our esteemed colleague Joe Paduda is hosting the current edition of Health Wonk Review over at Managed Care Matters: The Everything-PPACA edition of Health Wonk Review

We have a tiny cavil with the title of Joe's post though because although Affordable Care Act issues are prominent in this edition, there are numerous other health policy topics included too -- so it's more accurate billing would be: The Everything-PPACA edition PLUS. Grab a coffee and check it out!

Hats off to Joe, who is the founder and sponsor of Health Wonk Review, which has been going strong since 2006. Thanks also to the many participants who have submitted thoughtful posts over the years and to the regulars who have borne the not insignificant work of hosting. Check out the impressive Health Wonk Review archives for the all-star cast.

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April 22, 2015

"Between 2003 and 2010, a total of 1,719 people died by suicide in the workplace. Workplace suicide rates generally decreased until 2007 and then sharply increased. This is in contrast with non-workplace suicides, which increased over the study period. Workplace suicide rates were highest for men (2.7 per 1,000,000); workers aged 65-74 years (2.4 per 1,000,000); those in protective service occupations (5.3 per 1,000,000); and those in farming, fishing, and forestry (5.1 per 1,000,000)."

From the recent study of workplace suicides between 2003 and 2010, published in the American Journal of Preventive Medicine, Suicide in U.S Workplaces, 2003-2010:

Aimee Swartz looks at the study data and the issue of suicide in Workplace Suicides Are on the Rise in a recent issue of The Atlantic, noting that In 2013, the last year for which data are available, 270 people in the U.S. committed suicide at work - a 12 percent increase over the prior year.

There are many factors that contribute to the rise. Mental health experts caution that potential causal factors can't be generalized based on occupation, but that job factors may present additional stressors that tip the balance. Individual factors such as depression, financial losses, mental and physical health issues play a role.

Swartz looks at potential contributing job factors in each of the highest professions. In law enforcement, trauma is high and a "macho" culture means that people often are reluctant to share or deal with feelings of stress that may be perceived as weakness, Plus, ease of access to a methodology may come into play: 84% of law enforcement suicides involved a firearm. In farming, isolation and financial losses are contributing factors. In the auto repair industry, many think that long-term exposure to chemical solvents may be linked to depressive symptoms.

Mental Health Daily looks at 15 common causes of suicide, as well as the Top 11 Professions with Highest Suicide Rates

  • Medical Doctors 1:87
  • Dentists 1:67
  • Police Officers 1:54
  • Veterinarians 1:54
  • Financial Services 1:51
  • Real estate 1:38
  • Electricians 1:36
  • Lawyers 1:33
  • Farmers 1:32
  • Pharmacists 1:29
  • Chemists 1:28

Farmer suicides on the rise
Madeleine Thomas of Grist takes a deeper look at farmer suicides in her excellent article How can we stop farmer suicides? Thomas says that "farmer suicides tend to increase when farm economics falter." Rates were high during the farm crisis of the 1980s, when more than 900 farmers took their own lives. Many mental health experts fear that current hardships may lead to an increase in farmer suicides. Calls to hotlines are spiking, with droughts, cold, heavy snow and other climactic woes taking a deep financial toll.

Other factors include the isolated, insular nature of rural farming and easy access to weapons. When the business of farming falters for family farms, it can be ruinous for families, and farmers are often unprepared for other professions.

Experts say that behavioral health in farming populations is an underfunded and often ignored public health issue, particularly in an era when funds for the CDC and the National Institute of Occupational Safety and Health are scarce and funding priorities compete.

"Behavioral health is the area of healthcare that agricultural people understand the least well," says Michael Rosmann, a licensed clinical psychologist specializing in agricultural behavioral health and one of the field's leading researchers. "It is the area that probably is in most need of research and clarification so that we improve the understanding and treatment of behavioral health issues." Rosmann and other experts believe the country's rural agricultural population should be classified as a health disparity group, which according to the CDC, would mean that farmers consistently face greater barriers to proper healthcare due to the unique environmental, cultural, and economic factors. If farmers and rural America were more widely recognized as a health disparity, more government funding could be directed toward addressing the issue."

National Suicide Prevention Lifeline (U.S.) 1-800-273-8255

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