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Game Changing Strategies to Transform Workers’ Compensation Results. RIMS Chicago. Kevin Glennon , RN, BSN, CDMS, CWCP, QRP Vice President-Home Health & Complex Care Services Email: kevin_glennon @ onecallcm.com Phone: 407 -448- 5879. Disclosure Statement. - PowerPoint PPT Presentation
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www.onecallcm.com© Copyright 2013 One Call Care Management. All rights reserved.
Game Changing Strategies to Transform Workers’
Compensation Results
RIMS Chicago
www.onecallcm.com© Copyright 2013 One Call Care Management. All rights reserved.
Kevin Glennon, RN, BSN, CDMS, CWCP, QRPVice President-Home Health & Complex Care Services
Email: [email protected]: 407-448-5879
www.onecallcm.com© Copyright 2013 One Call Care Management. All rights reserved. 3
Disclosure Statement
Kevin T. Glennon, RN, BSN, CDMS, CWCP, QRP works for One Call Care Management 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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Topics for discussion Discuss current claims industry trends and the current
financial impacts
Review challenges such as co-morbidities, obesity, and the aging workforce
Review strategies to foresee and proactively manage potential costly adverse events
Discuss strategies they may assist in mitigating the rising medical costs of workers’ compensation claims
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The Current Trend According to preliminary estimates, lost-time claim frequency declined
by 5% in Accident Year 2012
Claim frequency for workers compensation injuries increased 3.8% in Accident Year 2010 marking the first increase since 1997 Prior to the 2010 uptick, claim frequency had been declining at an
average rate of more than 4% per year since 1990 Following the 2010 uptick, claim frequency declined in 2011, albeit by a
modest 0.9%
In 2012, while frequency decreased by 5%, the average cost per lost-time claim increased 1% for indemnity and 3% for medical
Prescription drug (Rx) use, a medical expense that makes up 19% of all workers compensation (WC) medical costs
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Factors that increase the aging worker’s potential for risk
Muscle Weakness
Balance Problems
Vision Problems
Side Effects from Medications
Mental status changes
Manic behavior
Any change in affect
Confusion
Not eating/sleeping properly
Somnolence/Agitation
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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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A Classic ExampleThe 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 Recovery04-29-1997 06-30-1997
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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.
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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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 Related Co-Morbidities
Hypertension Dyslipidemia Diabetes Coronary Heart
Disease Stroke Gallbladder Disease Some Cancers
Osteoarthritis Orthopedic Problems Impaired Mobility Peripheral Vascular
Disease Liver &Kidney Failure Sleep Apnea
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Overly involved family members
Over time, patients adapt to their conditions and some stop working out
Stop using prescribed equipment or agreeing to therapy
Family prevents nursing from completing necessary interventions
Physicians and nurses will not pursue aggressive treatment when a patient refuses
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A Costly Scenario 35 year old Quad
Recurrent Hospitalizations for Respiratory Failure
Average cost per hospitalization~ $76,500.00
Average time between hospitalizations~ 3 weeks
8 Hospitalizations over 6 months
$1,224,000.00 annual expense/hospitalizations
24 Hour/day RN @ $96.50/hour~ $2,316.00/day
CNA 17 Hours/day @ $32.50/hour ~ $552.50/day
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Proactive Interventions Back to inpatient rehab for a “tune up”
Re-education for Family (the medically necessary reason to use the respiratory aids in the home)
Re-education regarding the need to allow the nurses to complete physician orders
Installed ceiling lift system $22,395.73
Purchased Cough Assist and Suction Pump $10,211.28
Changed Nursing Agencies (lowered hourly rates)
Lowered level of care from RN to LPN/LVN
Total Spend $58,767.01
Total Estimated Annual Savings $1,446,467.50
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How do you implement needed change
This is when the case needs the home health care professional to transform into a super educator
It’s essential to demonstrate how the equipment, treatment or other therapeutic change will speed recovery, enhance quality of life, and extend a person’s independence
That – along with controlling the costs of claims – is the whole purpose of pro-actively managing any claim
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NCCI Reports
Pharmacy costs are 19% of total medical spending
in Worker’s Compensation
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Physician Dispensing Varies by State
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Narcotics Share of Paid Rx
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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 DRUGSOXYCONTIN®LIDODERM®HYDROCODONE-ACETAMINOPHEN LYRICA®CELEBREX®GABAPENTINSKELAXIN®CYMBALTA®MELOXICAMCYCLOBENZAPRINE HCLTRAMADOL HCLOMEPRAZOLEFENTANYLFLECTOR®OXYCODONE HCLULTRAM® EROXYCODONE HCL-ACETAMINOPHENCARISOPRODOLNAPROXENKADIAN®ZOLPIDEM TARTRATEOPANA® ERAMRIX®TIZANIDINE HCLAMBIEN CR®
PERCOCET®IBUPROFENNAPROXEN SODIUMOXYCODONE-ACETAMINOPHENACTIQ®ENDOCET®AVINZA®LUNESTA®DURAGESIC®NEXIUM®LOVENOX®FENTANYL CITRATEMORPHINE SULFATEEFFEXOR XR®DENDRACIN, NEURODENDRAXIN®TOPIRAMATETOPAMAX®DICLOFENAC SODIUMPROPOXYPHENE NAP-ACETAMINOPHENETODOLACNABUMETONEPROVIGIL®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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Thank You
Kevin Glennon, RN, BSN, CDMS, CWCP, QRPVP Home Health & Complex Care Services
One Call Care ManagementPhone: 800-700-9393 ext. 2048
Fax: 407-710-1683Cell: 407-448-5879
www.onecallcm.com© Copyright 2013 One Call Care Management. All rights reserved. 25
• NCCI Publishes New Research on Prescription Drug Expenditures• Posted Date: September 26, 2013• Source: NCCI Medical Data Call, for Service Year 2011. • The 35 jurisdictions for which NCCI provides ratemaking services are AK, AL, AR, AZ,
CO, CT, DC, FL, GA, HI, IA, ID, IL, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, UT, VA, VT, and WV. The seven independent bureau states for which NCCI collects the Medical Data Call are IN, MA, MN, NC, NJ, NY, and WI.
• Data used with permission. • Source: NCCI Medical Data Call, for all states except CA, DE, MI, PA, and TX, which
were derived from sample data provided by carriers • Relative Service Years 1 through 10 • Data used with permission • Source: NCCI Medical Data Call, for all states except CA, DE, MI, PA, and TX, which
were derived from sample data provided by carriers • Relative Service Years 1 through 10 • Data used with permission
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