Friday, April 2, 2010, 07:45 AM - Political developments"If you voted for Obama, seek urologic care elsewhere"....
Check it out......The healthcare debate has turned into a healthcare pout on the part of some, including this Orlando, Florida urologist:
http://www.orlandosentinel.com/news/loc ... 401,0,6040
In a politically divided country, it's not surprising that we're seeing some litmus tests. In many instances passion is eclipsing reason. Here is a riff by Newsweek's Howard Fineman on the poll numbers behind that passion:
http://blog.newsweek.com/blogs/thegaggl ... print=true
But if you were a urology patient there in Orlando with your own personal plumbing problem, you might just want to relieve yourself on the spot.
Thursday, April 1, 2010, 09:44 PM - Political developmentsIf you are in the "comp community" you're not going to the WCAB tomorrow. The furloughs-declared illegal-are back on, for tomorrow at least. Or until the "stay" is lifted.
What to do with your free time?
You could take a minute to read about the Republican National Committee mailer that included a toll free phone sex number:
http://www.politico.com/blogs/bensmith/ ... umber.html
But you're in not in a kinky mood just now.
Perhaps you should listen to "Job Cuts Mean More Work for the Employed".
It's an interesting NPR radio piece analyzing the effects of the current economic malaise, as workers are asked to do more. Productivity has risen, as workers fear to change jobs and employers hold back on hiring.
You can stream the radio segment from NPR's Thursday 4/1/2010 "Talk of the Nation" show, searchable on this link:
http://www.npr.org/templates/rundowns/r ... hp?prgId=5
Happy furlough day. May this prove to be the last.
Wednesday, March 31, 2010, 10:47 PM - Understanding the CA WC systemThere's a Food Network. A Shopping channel. C-Span for political junkies. Fashion TV.
Now there's IWTN.
In my inbox yesterday was an announcement about IWTN, the Injured Workers Television Network. IWTN is the brainchild of injured worker Sam Gold. For several years Sam has produced and directed a show about workers' comp from the public access studios on Market St. in San Francisco.
Now Gold and his group, the National Organization of Injured Workers, have more ambitious plans.
Here's their press release:
"The National Organization of Injured Workers, America’s only national injured workers advocacy organization is pleased to announce the formation and launch in mid-April of the Injured Workers Television Network, (IWTN) an internet television broadcasting network utilizing the Microsoft Windows Media Player as a distribution platform. Their network will be capable of up to 3000 concurrent streams at any one time.
This will be a primary vehicle for “Injured On The Job,” their flagship television program now seen on Public Access cable stations around California.
IWTN will be broadcasting at start for 6 hours a day, three days a week from 4 till 10pm with information, videos and programs that are of importance to injured workers and their advocates. As laws change and significant events manifest themselves, they will comment and cover these events to the best of their abilities.
They are also looking into videotaping and re-broadcasting important committee meetings such as the Commission on Health Safety & Workers’ Compensation, Fraud Assessment Commission and DWC meetings, live streaming where at all possible.
It is hoped that IWTN will be a very loud media voice for injured workers and their advocates who up till now have had to rely on 2 minute video bytes on the 6 o’clock news to get their message out.
They also will be taking their cameras into the homes of the occupationally injured to show the human carnage that our dysfunctional system is causing on the working people of America.
IWTN will also be looking for interested organizations to underwrite their broadcasting infrastructure costs in exchange for network exposure.
To watch IWTN, simply go to the website located at www.injuredworkerstelevision.com and press the play button on the embedded Windows Media Player during broadcast hours ONLY or you will get nothing on the screen."
For further information contact:
640 Bailey Road, Suite 129
Pittsburg, CA 94565
Toll-Free 1 (877) 484-3990
Sunday, March 28, 2010, 11:21 AM - Political developmentsThe long slog is over.
Obamacare is here.
Legal attacks by attorney generals in various states focusing on the mandate for individuals to purchase insurance are likely to fail based on the Federal authority to regulate interstate commerce. Here's an interesting analysis by Wake Forest University law professor Mark Hall:
http://www.thehealthcareblog.com/the_he ... rance.html
And as conservative pundit David Frum noted, it's unlikely that future Congresses will repeal many aspects of Obamacare once the public gets used to no preexisting exclusions, coverage of young adults on their parents policies, etc. Frum got the ax from the American Enterprise Institute for saying so, but he's probably right.
Many progressives and unionists are underwhelmed by the bill. One example, is Rose Ann DeMoro of the California Nurses Association writing "Diary of a Wimpy Health Care Bill". DeMoro's piece documents many of the ways the bill falls short in providing for funding of coverage expansion and in regulating abusive insurer practices:
http://www.californiaprogressreport.com ... =node/7584
So with the bill taking fire from both the left and the right, it's unclear whether opposition will peter out as some of the front-loaded benefits
are understood and as the overheated "death panels" rhetoric is discredited. That may depend on the public's attention span as other national and world events unfold.
But what does the bill mean for the workers' comp world?
Despite the massive length of the bill, many details are not spelled out. In the coming months regulations and procedures will be drafted by the Secretary of Health and Human Services to implement the bill. Even if one has a degree in healthcare economics, it's difficult to assess the impacts with any degree of confidence, but here are some issues to ponder.....
As more currently uninsured individuals gain coverage over time (remember that Obamacare has phased in impacts), will claim frequency decline? Will some workers elect to "not bother" with workers' comp? Blogger Joe Paduda has cited data that those who have health insurance are more likely to file workers' comp claims than those who don't have health insurance. Even if that data was accurate in the past
that may not reflect the future as millions of currrently uninsured people will gain access to some coverage.
A thorny aspect to Obamacare may be access to doctors. As more people gain access to coverage, availability of doctors may become a big issue. Take California's Central Valley for example, where in many counties there is a shortage of doctors:
http://www.fresnobee.com/2010/03/26/187 ... ow-in.html
If there are doctor shortages generally or in certain regions, will this affect the available pool of doctors treating workers' comp cases? As California tinkers with RBVS fee schedule revisions, these access issues will come into play.
As insurer ability to refuse coverage due to pre-existing conditions is phased out, will workers who settle medical as part of a comp case settlement be able to purchase health coverage that does not exclude
the industrially caused treatment? If the bill addresses this, I haven't seen the provision.
MEDICARE SET ASIDES
How will MSAs be affected? If a worker is not on Medicare but is receiving subsidies to help purchase insurance will a MSA be required? It has been estimated that as many as 1.6 million Californians will join Medi-Cal under the bill. What will the rules be for settling workers' comp cases where the individual receives subsidies (including those who are sufficiently low income to qualify for Medicaid)?
COST DRIVER IMPACTS
In his blog Managed Care Matters, Joe Paduda postulates that the bill will reduce cost shifting by hospitals onto the comp system to make up for the costs of treating the uninsured. But he predicts cost shifting by other providers to make up for cuts in Medicare reimbursement:
Paduda also notes that taxes on medical device manufacturers and Pharma could be passed along, resulting in price increases that impact workers' comp.
Essentially California currently has an "effectiveness research" policy in workers' comp. MTUS treatment guidelines (including ACOEM) are supposedly "evidence based". Current efforts to revise utilization review
are in the pre-rulemaking comment phase:
http://www.dir.ca.gov/dwc/dwc_newslines ... 18-10.html
As Federal "effectiveness research" progresses, there will undoubtedly be significant effects on the comp treatment system.
BENEFITS OF PREVENTIVE CARE
Will the requirements that insurers cover wellness and preventive care
succeed over time so that many workers are generally healthier with less "co-morbitities"? If a worker's diabetes or hypertension is under control, perhaps the work injury will be easier and less costly to treat. Again, these are speculations that can't be quantified.
Efforts to improve medical records technology in the healthcare system generally will probably spill over into workers' comp. As more health data is online, privacy issues will be substantial.
EFFECT ON CALIFORNIA'S BUDGET
There are major concerns as to how the states will handle costs mandated under the bill. In California the Medicaid expansion costs could be in the $4 billion range. When Federal subsidies expire after 2018 these costs could play havoc with the state budget, bringing us back to....DWC furloughs?....Oh well, that's well down the road and besides, no one really can be confident how all these revenue and expense numbers will play out.
DEATH OF 24 HOUR CARE
Politically it appears 24 hour care is dead for good. There was almost no support for it in the first place politically. And there will be no stomach for that kind of reform for years to come.
Joe Paduda makes another good point. He sees a shift from insurers focusing on risk selection to getting better at managing cost containment. That's likely to be the continuing mantra in California workers' comp.
Readers, what do you think? What are the implications (intended or unintended) for California workers' comp? I'll be glad to share your insights in future posts. You can e -mail me at jyoung@boxerlaw,com.
Meanwhile, for those tea partier readers who doth protest too much that we have currently have the world's best healthcare system, here is the Robert Woods Johnson Foundation report "Barely Hanging On: Middle Class and Uninsured":
Wednesday, March 24, 2010, 08:52 PM - Political developmentsThe breaking news today is that the California Supreme Court has decided to hear the Duncan v. WCAB case, also known as the XYZZ case.
Duncan/XYZZ is a case involving interpretation of the start date for computing cost of living increases (COLAs) in life pension cases (cases with permanent disability of 70% or more).
Under the miserly AMA Guides system, a worker must have a severe disability to get to the "life pension" level. As a result, the COLA start date argument affects a limited number of cases.
The Duncan/XYZZ case was somewhat of a surprise, as the California Court of Appeals, 6th District in Duncan/XYZZ rejected a decision by the WCAB which ruled that COLA calculations begin as of the date of injury.
Duncan/XYZZ holds that the date for calculating COLA increases is 1/1/04, irregardless of the date of injury.
Commentators have done seminars on COLAs. Several years ago I was on a panel at the CAAA convention along with defense attorney Richard Jacobsmeyer and applicant attorney Jeff Greenberg. We debated various rationales for different start dates of COLA calculations.....1/1/04
(the date the COLA law went into effect)....the date of injury.....the P&S date....
The 1/1/04 start date has been criticized by some commentators as creating a "double dip". The DWC challenged the 6th District decision, seeking Supreme Court review. Insurers have reacted with alarm over possible large payouts on future cases (few cases have been affected yet). Advocates for disabled workers cheered, noting that the 6th District interpretation would result in more just awards for severely disabled workers whose earning capacity was substantially affected by injury.
This disputed interpretation of Labor Code 4659(c) appeared to have been resolved by Duncan/XYZZ.
Reading the tea leaves, it seems likely that the California Supreme Court may not have taken the case unless there was substantial interest in
revisiting the calculation start date.
Interests of injured workers have not fared well at the California Supreme Court since the 2004 SB 899 reforms. The applicants bar did not prevail in the Brodie case which dealt with apportionment calculations. Several years later workers were dealt a setback in the Smith and Amar cases, which rejected a lower court ruling that would have allowed attorney fees for prevailing in court on treatment denial issues.
The attorneys who argued on behalf of workers in the Duncan/XYZZ case, Art Johnson of San Jose and Marc Marcus of Sacramento, are among the best and brightest in the applicant bar. But they may have their work cut out for them.
To see an earlier post I did on the issue, click here:
http://www.workerscompzone.com/index.ph ... 130-223021