Transcript of 2013 NCSI Annual Meeting May 19-22, 2013 Rancho Bernardo Inn San Diego Presented by: Kevin Glennon,...
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- 2013 NCSI Annual Meeting May 19-22, 2013 Rancho Bernardo Inn
San Diego Presented by: Kevin Glennon, RN, BSN, CDMS, CWCP, QRP
Vice President Home Health & Complex Care Services MSC Care
Management-A One Call Care Management Company
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- Disclosure Statement Kevin T. Glennon, RN, BSN, CDMS, CWCP, QRP
works for MSC Care Management-A One Call Care Management Company as
their Vice President of Home Health and Complex Care Services. A
provider of Home Health, Infusion Therapy, Complex Care
Coordination, Medical Equipment, Devices and Supplies and Assistive
Technology Products and Services in the Workers Compensation
Industry. Off label use of certain medications may be discussed
during this presentation along with Nursing considerations.
Discussions related to urine drug testing companies may be
discussed during this presentation. Additionally no financial
relationships exist with any commercial party.
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- Objectives Review case studies to learn to expect the
unexpected Identify the needs of the aged worker, the
obese/overweight worker and the injured worker with significant
co-morbidities Discuss the level of medical care and treatment
needed, the increased costs associated and how co-morbidities
adversely affect recovery and indemnity benefits Understand
increased recovery times for better return to work planning based
on injury, age and adverse factors
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- The Current Trend NCCIs latest review indicates: Overall claim
frequency has increased for the first time since 1997 (3%). Prior
years trend -4.3% Indemnity decreased by 3% and Medical increased
by 2% Workers compensation medical costs per claim average more
than $6,000 and soar to nearly $25,000 for lost-time claims
Prescription drug (Rx) use, a medical expense that makes up 19% of
all workers compensation (WC) medical costs
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- Complex Injuries and Complicating Factors Head Injuries Spinal
Cord Injuries Amputations Spinal Fusion Surgeries Multiple
Fractures Pelvic Fractures Crush Injuries Burns Upper & Lower
Extremity Injuries Diabetes Obesity Circulatory Disorders Cardiac
Conditions Hypertension Neurological Abnormalities Age Infection
Home Environmentort
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- OBESITY - ICD 9 278 Obese claims are 2.8 times more expensive
than non-obese claims at the 12-month maturity This cost difference
climbs to a factor of 4.5 at the three year maturity and to 5.3 at
the five year maturity The cost difference (at the five year
maturity) is less for females than for males
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- Obesity Supersizing Workers Compensation Costs $78.5
Billion/1998 $147 Billion/2008 46.6% Increase 27% of increased
medical costs directly related to obesity Medical 29%-117% greater
than normal weight Approximately 1/3 of all Americans are obese
(>72 million) $62.7 billion direct costs (medical) $56.3 billion
indirect costs (includes lost work days)
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- Obesity Statistics
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- Obesity Related Co-Morbidities Hypertension Dyslipidemia
Diabetes Coronary Heart Disease Stroke Gall bladder Disease
Osteoarthritis Orthopedic Problems Impaired Mobility Peripheral
Vascular Disease Kidney Failure Sleep Apnea
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- Osteoarthritis is the most common joint disorder affecting
Hands Hips Knees Neck Back 10 extra pounds of weight increases the
force on the knee by 30-60 pounds with each step
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- Body Composition
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- Know Your Weight Limits
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- Rising obesity will cost U.S. health care $344 billion a year
If Americans continue to pack on pounds, obesity will cost the USA
about $344 billion in medical-related expenses by 2018, eating up
about 21% of health- care spending, says the first analysis to
estimate the future medical costs of excess weight. "Obesity is
going to be a leading driver in rising health-care costs," says
Kenneth Thorpe, chairman of the department of health policy and
management at Emory University in Atlanta Emory University
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- The Aging Workforce
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- The Generation Gap Traditionalists (born 1927-1945) - Typically
loyal, hardworking with the best collective work ethic Baby Boomers
(born 1946-1964) 73 mil- Typically competitive, political,
hardworking, and entrepreneurial Generation X (born 1965-1981) 49
mil- Typically entrepreneurial, independent, looking to improve
skill set Millennials (born 1982 - 2000)80 mil - they're
trustworthy, loyal, helpful, friendly, courteous, kind, obedient,
cheerful, thrifty, brave, clean, and reverent
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- The Aging Workforce This increase does not just reflect the
aging of the baby-boom population, since none had yet reached age
65 BLS expects the growth in employment to continue During the
period 2006-2016 Workers age 55-64 are expected to climb by 36.5%
Workers between the ages of 65 and 74 and those aged 75 and up are
predicted to soar by more than 80%
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- The Risk Older workers pose an increased risk for fatal work
injuries Require more time to return to work following an injury or
illness And are less likely to receive training as their jobs
change With many employees staying in the workforce past retirement
age, there is growing concern for aging worker safety There are
many challenges that face this group of people that, if not
appropriately addressed, could lead to serious, long- term injury
in the workplace with little or no hope of recovery to a normal
life
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- Managing Safety for the Aging Workforce Many employers have
shifted their focus to wellness and prevention as a means to
address the healthcare costs of an aging workforce, with an
emphasis placed on such services as smoking cessation and weight
management in addition to addressing the current physical demands
of jobs Risk Management Shift to Job Modification for current
employees What needs to be done to keep the aging workforce safe in
the current work environment
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- Managing Safety for the Aging Workforce Specific safety
concerns for older workers: Shorter memory More easily distracted,
e.g., by environmental noise Slower reaction time Declining vision
and hearing Poorer sense of balance Denial of decreasing abilities,
which can lead to employees trying to work past their new
limits
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- Managing Safety for the Aging Workforce These physical
limitations lead to the following injury types for older workers:
Falls caused by poor balance, slowed reaction time, visual
problems, or distractions Sprains and strains from loss of
strength, endurance, and flexibility Cardiopulmonary overexertion
in heat or cold, at heights, using respirators, or in confined
spaces Health- or disease-related illnesses, such as diabetes,
cancer, osteoporosis, coronary artery disease, or hypertension
Accumulation injuries from years of doing the same task, e.g.,
truck drivers who experience loss of hearing in left ear from road
noise with cab window open
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- Challenges Equipment needs change Potential for additional
surgery Medications may be contraindicated or no longer effective
Liver and Kidney issues Loss of family caregiver/support Are all
these changes related Is anyone monitoring who is prescribing what
medications
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- Mitigating Risk With varying perspectives on what constitutes
an older worker, there is no set definition. The Age Discrimination
in Employment Act of 1967 (ADEA) applies to individuals aged 40 and
over The majority of workers in their 50s work full-time regardless
of health status. 3 These workers are often affected by health
conditions that can limit their ability to work. For example, more
than one-third (35%) of workers in their 50s who report being in
fair to poor health indicated that a health condition limits the
type or amount of work they can do
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- Proportion of workers age 51-59 with work limitations, by
health status
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- Managing Safety for the Aging Workforce Look for these signs
that older workers may need accommodations: Physical signs, such as
fatigue, tripping Psychological or emotional signs, such as loss of
patience, irritability Feedback from supervisors or co-workers on
declining performance Numbers and patterns of sick day History of
minor injuries or near misses
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- Antibiotic Resistant Infections
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- Increased Risk Infectious diseases continue to be a leading
cause of death worldwide It is the third leading cause of death in
the United States Emergence of new infectious diseases Re-emergence
of old infectious diseases Persistence of intractable infectious
diseases
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- Increased Risk The Institute of Medicine estimates that the
annual cost of treating antibiotic resistant infections in the
United States may be as high as $90 billion Doctors currently
prescribe antibiotics for outpatients approximately 150 million
times a year CDC estimates that approximately 50% of all antibiotic
prescriptions are unnecessary
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- A Classic Example The literature on the management of ankle
fractures in patients with diabetes has shown outcomes to be
generally poor 42.3 % incidence of complications in patients with
diabetes compared to people without (McCormick and Leith)
Conservative management may be preferable to surgical treatment 32
% higher infection rate found in people with diabetes ( Flynn, et.
al.) Those patients with diabetes who were treated conservatively
had a greater tendency to become infected over those who treat with
open reduction internal fixation (ORIF) People with diabetes who
are poorly controlled and had evidence of neuropathy were shown to
be very difficult to manage
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- Prolonged Recovery 04-29-199706-30-1997
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- A Cost Comparison Claimant A 130 lbs with post-op infection
Needs cubic in 5mg/Kg/Q24 59Kg @ 5mg/Kg = 295 mg/day Cost @
$1.19/mg x 295mg = $351.64/day Claimant B 330 lbs with post-op
infection Needs cubic in 5mg/Kg/Q24 150Kg @ 5mg/Kg = 750 mg/day
Cost @ $1.19/mg x 750mg = $892.50/day
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- NCCI Reports Pharmacy costs are 19% of total medical spending
in Workers Compensation
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- Drug Deaths now outnumber Traffic Fatalities in US
Approximately 38,000 deaths annually 1 death every 14 minutes Death
toll has doubled over the last decade Prescription Drugs now cause
more deaths than Heroin & Cocaine Combined OxyContin Habit can
run twice as much as a Heroin Addiction Most commonly abused Drugs
OxyContin Fentanyl Actique Vicodin Xanax Soma
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- TOP 50 DRUGS OXYCONTIN LIDODERM HYDROCODONE-ACETAMINOPHEN
LYRICA CELEBREX GABAPENTIN SKELAXIN CYMBALTA MELOXICAM
CYCLOBENZAPRINE HCL TRAMADOL HCL OMEPRAZOLE FENTANYL FLECTOR
OXYCODONE HCL ULTRAM ER OXYCODONE HCL-ACETAMINOPHEN CARISOPRODOL
NAPROXEN KADIAN ZOLPIDEM TARTRATE OPANA ER AMRIX TIZANIDINE HCL
AMBIEN CR PERCOCET IBUPROFEN NAPROXEN SODIUM
OXYCODONE-ACETAMINOPHEN ACTIQ ENDOCET AVINZA LUNESTA DURAGESIC
NEXIUM LOVENOX FENTANYL CITRATE MORPHINE SULFATE EFFEXOR XR
DENDRACIN, NEURODENDRAXIN TOPIRAMATE TOPAMAX DICLOFENAC SODIUM
PROPOXYPHENE NAP-ACETAMINOPHEN ETODOLAC NABUMETONE PROVIGIL LEXAPRO
ZANAFLEX SEROQUEL
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- Adherence/Efficacy All individuals are different: Slow
Metabolizers Fast Metabolizers NON Metabolizers
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- Based on adherence studies Less than 30% of claimants take
their medications as prescribed More than 30% fill their
medications but do not take them More than 30% take additional
medications and/or substances that can reduce or eliminate the
efficacy of the prescribed medications
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- Economic Impact For every dollar Medicare spends on
medications, it costs $1.33 to manage the complications of those
medications Medication-related problems account for $88.2
billion/annually Infectious Disease is the third leading cause of
death in the United States The Institute of Medicine estimates that
the annual cost of treating antibiotic resistant infections in the
United States may be as high as $90 billion Doctors currently
prescribe antibiotics for outpatients approximately 150 million
times a year CDC estimates that approximately 50% of all antibiotic
prescriptions are unnecessary
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- Learn to Expect the Unexpected