Evidence Based Medicine: How Lawyers/Workers Compensation Professionals Should Use It to Benefit Their Clients

Size: px
Start display at page:

Download "Evidence Based Medicine: How Lawyers/Workers Compensation Professionals Should Use It to Benefit Their Clients"

Transcription

1 Evidence Based Medicine: How Lawyers/Workers Compensation Professionals Should Use It to Benefit Their Clients by Brian P. McElreath, Esquire of Luzuriaga Mims, LLP 50 Immigration Street, Suite 200 Charleston, South Carolina 29403

2 I. Introduction What is evidence based medicine (EBM) and how can I, as a lawyer or workers compensation safety professional, use it to best advance the needs and interest of my clients? So, what is evidence based medicine? Evidence based medicine is integrating individual clinical expertise with the best available external research to produce the best and most cost efficient medical decision making for the patient. 1 The object of EBM is to minimize the effects of bias, whatever they may be, in determining an optimal course of care. 2 With the implementation of the Patient Protection and Affordable Care Act (ACA) evidence based medicine is again a hot topic for clinicians, public health practitioners, purchasers, planners, and the public. The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, An element of the ACA that could have a substantial influence on the workers compensation system is the creation of the Patient-Centered Outcomes Research Institute (PCORI), which was created to perform comparative effectiveness research. Comparative effectiveness research is the type of essential research necessary for EBM. PCORI is tasked with identifying the most effective medical treatments and preventive medicine. PCORI s effectiveness research compares all medical treatment available for a given condition and explores what treatments work best. 3 At its best, such research looks to identify what treatments will lead to the best health outcomes, ideally giving patients and doctors better information on 1 Sackett, D. L., W. M. Rosenberg, J. A. Gray, R. B. Haynes, and W. S. Richardson, Evidence-Based Medicine: What It Is and What It Isn t, Brit Med J, 312 (7023), January 13, 1996, pp Cohen, A. M., P. Z. Stavri, and W. R. Hersh. A Categorization and Analysis of the Criticisms of Evidence-Based Medicine, Int J Med Inform, 73(1), February 2004, pp Kliff, S. (January 18, 2012). PCORI: Funny acronym, serious work. Washington Post. Available at 2

3 the care they receive. There is also hope that PCORI s work can reduce the cost of health care with a better understanding of which interventions do not result in improvement, which would in turn allow both the government and private insurers to focus their resources on high-value treatments. II. Why is there a Need for Evidence Based Medicine in Workers Compensation Claims? A. Prescription Drug Abuse The New Yorker published a great piece on the prescription drug epidemic this week. The article is written by Celine Gounder, M.D. Dr. Gounder is a physician with personal experience dealing with chronic pain patients. In his article, Dr. Gounder notes from 1999 to 2010, sales of opioid analgesics medications like Vicodin, Percocet, and OxyContin quadrupled. 4 And by 2010, the United States, with about five percent of the world s population, was consuming ninety-nine percent of the world s hydrocodone (the narcotic in Vicodin), along with eighty per cent of the oxycodone (in Percocet and OxyContin), and sixty-five per cent of the hydromorphone (in Dilaudid). 5 Studies consistently show that patients who receive narcotics for chronic pain are less likely to recover function, and are less likely to go back to work. 6 The potential side effects of prescription narcotics include constipation, sexual dysfunction, cognitive impairment, addiction, and overdosing. 7 Of particular concern in the workers compensation setting is the fact that if a patient is being prescribed prescriptions narcotics for a work related injury and those narcotics subsequently cause constipation, sexual dysfunction, cognitive impairment, and/or addiction the 4 Celine Gounder, M.D., Who is Responsible for the Pain-Pill Epidemic, The New Yorker, November 12, Available at 5 Id. 6 Id. 7 Id. 3

4 employer/carrier is likely on the hook for the subsequent side effect in most jurisdictions. Additionally, studies show that when patients receive narcotics for long periods, they can even become more sensitive to pain, a condition called hyperalgesia. 8 When confronted with these staggering statistics, a natural question is why do doctors continue to prescribe these potentially harmful medications, when the risks seem to outweigh the potential benefits. Dr. Gounder attempts to explain why doctors prescribe these medications even when many of them know it's wrong for the patient: "The pain-pill epidemic has also forced doctors like me to consider our own role. Doctors have a duty to relieve suffering, and many of us became doctors to help people. But giving that help isn t straightforward, especially when it comes to chronic pain. Try explaining the downsides of narcotics to a patient while declining to give him the medication he wants. He might accuse you of not understanding because you re not the one in pain; he might question why you won t give him what another doctor prescribed; he might give you a bad rating on a doctor-grading Web site. He might even accuse you of malpractice. None of this is rewarding for doctors: we re frustrated that we can t cure the pain, and that our patients end up upset with us. Doctors have a hard time saying no, whether a patient is asking for a narcotic to relieve pain or an antibiotic for the common cold. We are predisposed to say yes, even if we know it isn t right. Some of us just don t want to take the extra time during a busy day to explain why that prescription for a narcotic isn t a good idea. Some of us also use the promise of prescription narcotics to persuade patients to keep their medical appointments, or to take their other medications." 9 8 Celine Gounder, M.D., Who is Responsible for the Pain-Pill Epidemic, The New Yorker, November 12, Available at 9 Id. 4

5 The realities of dependence and addiction are something that that medical providers have to deal with on a daily basis. Unfortunately, the overutilization of prescription pain killers is not going away any time soon. Medical treatment guidelines are a great tool in noting that a particular drug regimen is inappropriate; however, we must go beyond medical treatment guidelines and offer the doctor and injured worker alternatives. Some of those alternatives are a slippery slope that those of us on the employer/carrier side of the fence are not altogether comfortable with. However, paying for a few months of cognitive behavioral therapy, rehabilitation, or a comprehensive pain programs may save us from paying for a lifetime of prescription drugs. Consider these statistics. The United States comprises 4.5% of the world population yet the U.S. consumes: (1) 65 percent of all illegal drugs; (2) 80 percent of all opioids; (3) 49 percent of all morphine; and 99 percent of all hydrocodone. 10, 11, 12 According to the AMA Guides March/April 2011 Newsletter, non-compliance, including misuse, overuse, and nonconsumption, occurred in more than 70 percent of patients. 13 Prescription drugs are, on average, 19 percent of medical costs in workers compensation claims. 14 OxyContin is the number one prescribed drug, Lidoderm is number two, Hydrocodone/Acetaminophen is number three. 15 Per claim prescription drug costs increased 12 percent from 2008 to These cost increases are 10 Kuehn, B., Opioid prescriptions soar: increase in legitimate use as well as abuse. JAMA Manachikanti, L., and Singh, A., Therapeutic Opioids: A Ten-Year Perspective of the Complexities and Complications of Escalating Use, Abusse, and Nonmedical Use of Opioids. Pain Physician, March Joint Meeting of Drug, Safety, and Risk Management Advisory Committee, Non-prescription Drugs Advisory Committee, and the Anesthetic and Life Support Drugs Advisory Committee Meeting, June 20-30, AMA Guides March/April 2011 Newsletter 14 National Counsel on Compensation Insurance, Inc., Workers Compensation Prescription Drug Study: 2011 Update Id. 16 Id. 5

6 driven more by utilization than price. Employers and insurers spent approximately $4 billion on prescription drugs in Drug abuse costs the Untied States more than $120 billion in lost productivity each year. 18 The street price of OxyContin is between $0.50 and $1.00 per milligram. 19 According to the 2013 Workers Compensation Research Institute presentation more than 50% of all injured workers who receive pain medications include opioids. 20 B. The Overuse of Surgery and Spinal Cord Stimulators i. A Case Study in Spinal Cord Stimulator Use in Workers Compensation Claims 1. Introduction Spinal cord stimulators (SCS) have been in use since the 1960s to treat subjective pain syndrome, especially chronic low back and leg pain that have failed to respond to back surgery. This is often termed failed back surgery syndrome (FBSS). Despite the many years of use there was very little evidence based medicine regarding the use of SCS in a workers compensation setting to treat subjective pain until The purpose of the 2008 study was to evaluate the outcomes of patients with FBSS who had compensable workers compensation claims for back injuries and who received at least a trial of SCS, as compared with patients who were referred to a multidisciplinary pain clinic and with patients who were not referred for either SCS or pain 17 CompPharma s 2012 Prescription Drug Survey. 18 National Drug Intelligece Center. 19 Id. 20 Workers Compensation Research Institute Conference Turner, Ph.D., J. A., W. Hollingworth, Ph.D., B. A. Comstock, M.Sc., R. A. Deyo, M.D., MPH, Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes. State of Washington State Department of Labor & Industries, September 30,

7 clinic evaluation. 22 The assessed outcomes were pain, physical functioning, opioid medication use, adverse events, work disability, and work productivity, and medical care costs Participants and Criteria The study compared three groups of patients with compensable workers compensation back injuries: (1) patients who received at least a trial of SCS; (2) patients who received pain clinic (PC) evaluation; and (3) patients given usual care (UC). 24 Criteria for a patient to be eligible for participation were radiating pain into one or both legs for more than six months, radicular pain greater than axial pain, average leg pain in the last month rated as six or greater, and one to three previous open lumbar spine operations. 25 The total sample consisted of 158 patients (51 SCS, 39 PC, and 68 UC). 3. Baseline Measures At baseline those in the SCS group were more likely to have attorney representation, and also had longer wage replacement compensation, leg pain, and claim duration as compared with those in the PC group, but not the UC group. Additionally, those in the SCS group reported greater leg pain intensity and worse physical function, but the differences were not clinically meaningful Findings 22 Turner, Ph.D., J. A., W. Hollingworth, Ph.D., B. A. Comstock, M.Sc., R. A. Deyo, M.D., MPH, Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes. State of Washington State Department of Labor & Industries, September 30, Id. 24 Id 25 Id. 26 Turner, Ph.D., J. A., W. Hollingworth, Ph.D., B. A. Comstock, M.Sc., R. A. Deyo, M.D., MPH, Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes. State of Washington State Department of Labor & Industries, September 30,

8 At the primary endpoint of 12 months, the SCS group did not differ significantly from PC or UC in back pain intensity, mental health scores, ability to perform everyday tasks, or medication use. 27 Fewer than 10 percent of patients in each group were working at 12 months and at 24 months slightly less than one-fourth of patients in each group reported that they were working. The groups did not differ significantly in work status at any of the measured points in time. 28 The medical records of the 51 patients who had a trial of SCS reveal that 8 patients, or 16 percent, had an adverse event associated with the trial, one of which was life threatening. 29 Of those that had an adverse event associated with the permanent implantation of a SCS within 18 months the percentages were: 11 percent had a superficial infection, 4 percent had a deep infection, 19 percent had persistent pain in the region of the stimulator components, 11 percent had other biological complications, and 19 percent required revision surgery. 30 One of the five patients requiring revision surgery had three revision operations within 18 months. Additionally, five patients, or 19 percent, had the SCS permanently explanted, one due to a deep infection and the rest due to insufficient pain relief Costs 27 Turner, Ph.D., J. A., W. Hollingworth, Ph.D., B. A. Comstock, M.Sc., R. A. Deyo, M.D., MPH, Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes. State of Washington State Department of Labor & Industries, September 30, Id. 29 Id. 30 Turner, Ph.D., J. A., W. Hollingworth, Ph.D., B. A. Comstock, M.Sc., R. A. Deyo, M.D., MPH, Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes. State of Washington State Department of Labor & Industries, September 30, Id. 8

9 The unadjusted mean cost of medical treatment per patient in the year prior to enrollment was similar across the three groups and ranged from $1,516 to $1,783 per month. 32 Over the 18 months after enrollment, total unadjusted medical costs per patient were a mean of $19,246 in the UC group, $29,250 in the PC group, and $47,190 in the SCS group Conclusions The 2008 study found little evidence for the superiority of SCS over alternative treatments among workers compensation claimant with failed back surgery. 34 A small advantage of SCS was noted in improving leg pain and function at six months, but that later disappeared. There is a recurrent six month improvement in symptomatology when using SCS that is often attributed to the placebo effect. A patient goes through counseling and education on the benefits of SCS and, therefore, they often perceive those benefits in the first few months even if the data does not objectively bear out those same benefits. There was no statistically or clinically meaningful difference between groups in any comparison of leg pain, function, or opioid use at the 12 and/or 24 month assessments. 35 A substantial percentage of those in the SCS group experienced adverse events and almost 20 percent of patients with permanent SCS had them removed within 18 months Turner, Ph.D., J. A., W. Hollingworth, Ph.D., B. A. Comstock, M.Sc., R. A. Deyo, M.D., MPH, Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes. State of Washington State Department of Labor & Industries, September 30, Id. 34 Id. 35 Id. 36 Turner, Ph.D., J. A., W. Hollingworth, Ph.D., B. A. Comstock, M.Sc., R. A. Deyo, M.D., MPH, Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes. State of Washington State Department of Labor & Industries, September 30,

10 Additionally, no evidence was found of SCS reducing medical costs. In fact, the data reveals the exact opposite with costs in the SCS group more than double those in the UC group and almost double those in the PC group. III. The Use of Evidence Based Medicine In Workers Compensation Claims The philosophical origins of EBM extend back to mid-19th century Paris and earlier. However, the active use of EBM within workers compensation is less than a decade old. Obviously, medical research, studies, and scientific evidence for when particular treatments should/should not be used have long been available. However, California s 2004 landmark healthcare reform legislation, SB 899, is widely credited with introducing the use of EBM in the workers compensation setting. The driving force behind SB 899 was that medical decisions for treatment of workers' compensation injuries should be made by medical professionals, rather than by nonmedical specialists such as attorneys, claims examiners or appeals board judges. The overarching goal of introducing EBM into the workers compensation system is to reduce medical costs, reduce lost-time days, and reduce permanent disability. A. The California Model EBM was originally introduced to workers compensation to combat increased costs in the California workers compensation system. From 1997 to 2002 medical costs for injured workers, in California, grew by 111 percent. 37 Medical costs grew to represent more than half the total costs of workers compensation in California. 38 Medical care payments, in California, were more than twice the national average in These costs were acting as a deterrent to employers locating and/or expanding in California. The Workers Compensation Research 37 California Workers Compensation Institute, Frequently Asked Questions, available at last accessed November 11, Id. 39 National Academy of Social Insurance, 2004 report. 10

11 Institute (WCRI) conducted a comparative study across 12 states and concluded that California s higher medical costs resulted from high utilization rather than high prices. 40 The study found that California had more visits per claim than any of the other states that were studied. 41 Additionally, the study found that California s average number of visits for more mature claims was 31 percent higher for hospitals, 70 percent higher for physicians, and 150 percent higher for chiropractors than the 12 state median. 42 In response to the rising costs and in an effort to make California a more attractive state for potential employers, the California legislature passed a series of initiatives aimed at reducing workers compensation costs and inappropriate medical care. Senate Bill 228 passed in 2003 and called for the adoption of medical treatment guidelines to define the appropriate utilization of medical care provided to injured workers. SB 228 required the California Commission on Health and Safety and Workers Compensation (CHSWC) to survey and evaluate existing medical treatment guidelines and adopt either the American College of Occupational and Environmental Medicine (ACOEM) guidelines or a better alternative in the longer term. Senate Bill 899 was signed into law by Governor Schwarzenegger on April 19, SB 899 further refined the requirements of SB 228. SB 899 changed the California workers compensation systems presumption of correctness from the treating physician to American College of Occupational and Environmental Medicine (ACOEM) as the standard of care (and since then the custom-written MTUS guidelines were added). 40 Telles, C., D. Wang, and R. Tanabe, CompScope Benchmarks: Multistate Comparisons, 4th ed. Cambridge, MA: Workers Compensation Research Institute, Telles, C., D. Wang, and R. Tanabe, CompScope Benchmarks: Multistate Comparisons, 4th ed. Cambridge, MA: Workers Compensation Research Institute, Id. 43 First Annual Report of Progress: Workers Compensation Reforms Under Senate Bill 899, California Division of Workers Compensation (April 2005). 11

12 SB 899 focused on controlling escalating medical costs, which accounted for 51 percent of every dollar and indemnity benefits, which account for 49 percent of every workers compensation dollar spent. 44 The goal of SB 899 was to mitigate the problem of escalating costs by providing prompt, effective medical treatment to injured workers so they recover from injuries and return to work. 45 SB 899 introduced medical provider networks (MPNs) to provide a framework for effective medical treatment; medical treatment guidelines to determine whether proposed medical treatment is necessary and will be effective; new permanent disability rating schedule (PDRS) provides objective and consistent methodology to determine disability rating; and return to work provision supplies incentive for employers to return injured workers to the job. 46 The proposed goal of implementing SB 899 was more effective medical treatment and more accurate disability ratings. More effective treatment and more accurate ratings would obviously result in significant cost savings to the workers compensation system. SB 899 attempted to incentivize treating injuries and returning employees to work while eliminating the incentive for those who profit from the system by encouraging injured workers to hold out for higher disability awards. i. Medical Treatment Guidelines Medical treatment guidelines are an important tool for implementing EBM. Guidelines are systematically developed statements that assist practitioner, patient, and payor decisions about appropriate health care for specific clinical circumstances. 47 High quality guidelines can 44 First Annual Report of Progress: Workers Compensation Reforms Under Senate Bill 899, California Division of Workers Compensation (April 2005). 45 Id. 46 Id. 47 Field, Marilyn J., and Kathleen N. Lohr (eds), Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine, Clinical Practice Guidelines: Directions for a New Program, Washington, DC; National Academies Press, 1990, available at 12

13 help curtail the effects of bias in formulating a treatment plan. 48 The most common use of treatment guidelines is condensing research evidence into a usable form for busy practitioners. Additionally, insurers and payors can also consult guidelines to determine whether a specific treatment is appropriate for a particular patient, which is paramount when deciding whether the treatment should or should not be authorized. ii. Utilization Management Utilization management is a method of assessing the appropriateness of care provided to individual patients to reduce health care costs. 49 There is substantial variability in utilization management practices, particularly in the criteria used for assessing whether care is appropriate. 50, 51 The California reform guidelines noted that a lack of standardization may affect access to and quality of care for patients, and, therefore, required payors to employ review criteria consistent with the guidelines adopted by the state of California. 52 To manage the selection of treatment and quantity of care provided, a payor must address frequency, duration, intensity, and appropriateness. Appropriate medical care is defined as care for which the potential benefits to the patient outweigh the potential risks, regardless of cost. 53 Likewise, inappropriate care is defined as care for which risks outweigh the potential benefits The AGREE Collaboration, Appraisal of Guidelines for Research and Evaluation, AGREE Instrument, September 2001, available at 49 Gray, Bradford H., and Marilyn J. Field (eds.), Institute of Medicine, Division of Health Care Services, Committee on Utilization Management by Third Parties, Controlling Costs and Changing Patient Care? The Role of Utilization Management, Washington, DC: National Academies Press, Id. 51 Wickizer, T. M., D. Lessler, and G. Franklin, Controlling Workers Compensation Medical Care Use and costs through Utilization Management, J Occupational and Enviromental Med, 41(8), 1999, pp State of California, Labor Code Division 4, Workers Compensation and Insurance, State of California, Department of Industrial Relations, California Code of Regulations, Title 8, available at 53 Fitch, K., S. J. Bernstein, M. D. Aguilar, B. Burnand, J. R. LaCalle, P. Lazaro, M. van het Loo, J. McDonnell, J. P. Vader, and J. P. Kahan, The RAND/UCLA Appropriateness Method User s Manual, Santa Monica, CA: RAND Corporation, 2001, available at 54 Id. 13

14 UM is often used to reduce costs by either preventing inappropriate care from being provided or refusing to pay for such care after the fact. 55 How does a state implement guidelines? For example, California began by conducting a thorough search to identify potential guidelines. Then the guidelines were rated on the basis of criteria required by the legislation. Subsequently, the guidelines that passed the screening were evaluated and presented to California stakeholders. Finally, the guidelines were distributed to the public and implemented. ii. Results from the Introduction of Evidence Based Medicine into Workers Compensation Systems California From the implementation of SB 899 through 2008, insurers in California realized a 70 percent reduction in costs from 2003 levels. 56 Florida From the implementation of SB 50A through 2008, Florida has achieved a 58.3 percent overall reduction in rates. 57 Texas From the implementation of HB 7 on 5/1/2007 to 1/15/2008, average medical cost per claim declined by 26 percent. Costs are down by 39 percent from 2006 to In California, the statutes and subsequent rules were required because workers compensation costs were increasing drastically each year. These increasing costs were driving employers away. Additionally, payors had little leverage in contesting the medical necessity of 55 Gray, Bradford H., and Marilyn J. Field (eds), Institute of Medicine, Division of Health Care Services, Committee on Utilization of Management by Third Parties, Controlling Costs and Changing Patient Care? The Role of Utilization Management, Washington, DC: National Academies Press, Insurance Commissioner Poizner 1/1/2008.State Report Card 57 Sengupta, I., V. Reno, J. F. Burton, Jr., and M. Baldwin, Workers Compensation: Benefits, Coverage, and Costs, 2010, National Academy of Social Insurance, Washington, DC (August 2012). 58 Id. 14

15 care as the treating physician s opinion was irrefutable. The advent of EBM and scientificallybased standards of care are helping to level the playing field and slowed the growth of costs. C. Current Status of Evidence Based Medicine Currently there are: 14 states that use ODG, ACOEM, or a combination of both (9 use ODG exclusively); 21 states currently have no guidelines (although 10 are considering them); 16 states who crafted guidelines locally (6 use excerpts from ODG). 15

Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg

Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Spinal Cord Stimulators (SCS) for Injured Workers with Chronic Back and Leg Pain after Lumbar Surgery A Prospective Study to Describe Costs, Complications, and Patient Outcomes: Final Report September

More information

SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS Senator Tony Mendoza, Chair 2015-2016 Regular KEY ISSUE ANALYSIS

SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS Senator Tony Mendoza, Chair 2015-2016 Regular KEY ISSUE ANALYSIS SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS Senator Tony Mendoza, Chair 2015-2016 Regular Bill No: AB 1124 Hearing Date: July 13, 2015 Author: Perea Version: June 1, 2015 Urgency: No Fiscal: Yes

More information

Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute.

Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute. osition Official Title and Summary Prepared by the Attorney General Requires drug and alcohol testing of doctors and reporting of positive test to the California Medical Board. Requires Board to suspend

More information

Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute.

Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute. Proposition 46 Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute. Yes/No Statement A YES vote on this measure means: The cap on medical malpractice damages for such things

More information

Taming Medical Cost Inflation

Taming Medical Cost Inflation Taming Medical Cost Inflation How to Combat the Rising Costs Associated with Workers Compensation Claims During the past decade, medical costs associated with workers compensation claims have risen dramatically.

More information

June 2012 Jacob Lazarovic, M.D. Chief Medical Officer, SVP Broadspire. Escalating Pharmaceutical Costs in Workers Compensation: One Clinical Solution

June 2012 Jacob Lazarovic, M.D. Chief Medical Officer, SVP Broadspire. Escalating Pharmaceutical Costs in Workers Compensation: One Clinical Solution June 2012 Jacob Lazarovic, M.D. Chief Medical Officer, SVP Broadspire Escalating Pharmaceutical Costs in Workers Compensation: One Clinical Solution One Clinical Solution Pharmaceutical (Rx) costs have

More information

California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs)

California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs) California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs) Coventry/First Health has designed this manual for The Coventry/First Health Network providers participating

More information

Adoption of the ODG Treatment Guidelines for Medical Necessity Determinations in Workers Comp. FAQ s:

Adoption of the ODG Treatment Guidelines for Medical Necessity Determinations in Workers Comp. FAQ s: Adoption of the ODG Treatment Guidelines for Medical Necessity Determinations in Workers Comp FAQ s: What is ODG? What is the purpose of adopting ODG? Why is it necessary? What states have done this already,

More information

MEDICAL CONTESTED CASE HEARING NO 12090 M6-12-38043-01 DECISION AND ORDER

MEDICAL CONTESTED CASE HEARING NO 12090 M6-12-38043-01 DECISION AND ORDER MEDICAL CONTESTED CASE HEARING NO 12090 M6-12-38043-01 DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers Compensation Act and Rules of the Division of Workers Compensation

More information

Chapter 3. Medical Care

Chapter 3. Medical Care Who pays for my medical care? Your employer pays for medical care for your work-related injury or illness, either through a workers compensation insurance policy or by being self-insured. The claims administrator

More information

Workers' Compensation in California: Questions & Answers

Workers' Compensation in California: Questions & Answers Workers' Compensation in California: Questions & Answers prepared for the California Commission on Health and Safety and Workers' Compensation October 2006 Page 2 Introduction. How To Use This Booklet.....................................

More information

Prescription Drug Abuse and Pain Management Clinics 2015 Report to the 109 th Tennessee General Assembly

Prescription Drug Abuse and Pain Management Clinics 2015 Report to the 109 th Tennessee General Assembly Prescription Drug Abuse and Pain Management Clinics 2015 Report to the 109 th Tennessee General Assembly Andrea Huddleston, Chief Deputy General Counsel Tennessee Department of Health Office of General

More information

Visit www.takebackmylife.org to hear more of my story or call 211 for help and treatment options

Visit www.takebackmylife.org to hear more of my story or call 211 for help and treatment options In high school, I experimented with alcohol and pot. Then I moved on to narcotics and cocaine, which landed me in jail several times. By 25, I was a daily heroin user with a long-term prison sentence.

More information

Substance Use: Addressing Addiction and Emerging Issues

Substance Use: Addressing Addiction and Emerging Issues MODULE 6: SUBSTANCE USE: ADDRESSING ADDICTION AND EMERGING ISSUES Substance Use: Addressing Addiction and Emerging Issues Martha C. Romney, RN, MS, JD, MPH Assistant Professor Jefferson School of Population

More information

Arkansas Emergency Department Opioid Prescribing Guidelines

Arkansas Emergency Department Opioid Prescribing Guidelines Arkansas Emergency Department Opioid Prescribing Guidelines 1. One medical provider should provide all opioids to treat a patient s chronic pain. 2. The administration of intravenous and intramuscular

More information

THE QUESTION OF THE HOUR

THE QUESTION OF THE HOUR WORKERS COMPENSATION THE QUESTION OF THE HOUR Of the emerging trends for Workers Compensation in 2009, several will help answer what for many is the main question of the moment: How have the economy and

More information

What Parents Need to Know

What Parents Need to Know What Parents Need to Know About Prescription Drug Abuse Office of District Attorney Jonathan W. Blodgett A Message From the District Attorney Prescription drug abuse is a growing problem. According to

More information

Opioids and the Injured Worker Tools for Successful Outcomes

Opioids and the Injured Worker Tools for Successful Outcomes Opioids and the Injured Worker Tools for Successful Outcomes Tim Pokorney, RPh Director, Clinical Express Scripts Workers' Compensation Division Goals and Objectives Alarming statistics for narcotic utilization,

More information

Transitioning a Pain Program Away From Chronic Opioid Prescribing

Transitioning a Pain Program Away From Chronic Opioid Prescribing Transitioning a Pain Program Away From Chronic Opioid Prescribing 1 Steve (Stephen Z. Hull, M.D.) HullS@MercyME.com 2 Transitioning a Pain Program Away From Chronic Opioid Prescribing 3 30% of patients

More information

Utah Clinical Guidelines on Prescribing Opioids

Utah Clinical Guidelines on Prescribing Opioids Utah Clinical Guidelines on Prescribing Opioids Presented by: Erin Johnson, MPH January 2009 www.useonlyasdirected.org Overview Utah s prescription problem Why guidelines? Guideline process Guideline content

More information

A Healthesystems Clinical Analysis. Insidious Incrementalism of Opioid Use in Workers Compensation

A Healthesystems Clinical Analysis. Insidious Incrementalism of Opioid Use in Workers Compensation A Healthesystems Clinical Analysis Insidious Incrementalism of Opioid Use in Workers Compensation Prescription opioid use in the United States has grown significantly over the past 20 years. In 1991, there

More information

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications Primary Care & Specialist Prescribing Guidelines Introduction Partnership HealthPlan is a County Organized Health System covering

More information

OKLAHOMA TREATMENT GUIDELINES FOR

OKLAHOMA TREATMENT GUIDELINES FOR OKLAHOMA TREATMENT GUIDELINES FOR The Use of Schedule II Drugs as contained in the Uniform Controlled Dangerous Substances Act Developed and Adopted by the Physician Advisory Committee Adopted by the Administrator

More information

Workers Compensation Overview

Workers Compensation Overview Workers Compensation Overview November 2013 Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which

More information

Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER

Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER November 17, 2015 Today s Speakers Karmen Hanson, Program Manager, NCSL Cynthia Reilly, Director,

More information

Workers Compensation in California and in the Nation: Benefit and Employer Cost Trends, 1989 2005

Workers Compensation in California and in the Nation: Benefit and Employer Cost Trends, 1989 2005 Workers Compensation Brief April April 2008 2008 No. No. 9 9 Workers Compensation in California and in the Nation: Benefit and Employer Cost Trends, 1989 2005 By Ishita Sengupta, Virginia Reno, Christine

More information

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths Joanna G Katzman, M.D., M.S.P.H Director, UNM Pain Center Associate Professor,

More information

Pension & Health Benefits Committee California Public Employees Retirement System

Pension & Health Benefits Committee California Public Employees Retirement System California Public Employees Retirement System Agenda Item 9 ITEM NAME: Proposition 46 Drug and Alcohol Testing of Doctors and Medical Negligence Lawsuits PROGRAM: ITEM TYPE: Legislation State Initiative

More information

September 1, 2015. Maureen Gray Regulations Coordinator Department of Industrial Relations Fax: (510) 286-0687

September 1, 2015. Maureen Gray Regulations Coordinator Department of Industrial Relations Fax: (510) 286-0687 September 1, 2015 Maureen Gray Regulations Coordinator Department of Industrial Relations Fax: (510) 286-0687 Letter to Administrative Director, Destie Overpeck Department of Workers Compensation Re: Medical

More information

Frequently asked questions

Frequently asked questions Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently asked questions What is Naltrexone? Naltrexone is a prescription drug that completely blocks the effects of all opioid drugs

More information

Treatment of Chronic Pain: Our Approach

Treatment of Chronic Pain: Our Approach Treatment of Chronic Pain: Our Approach Today s webinar was coordinated by the National Association of Community Health Centers, a partner with the SAMHSA-HRSA Center for Integrated Health Solutions SAMHSA

More information

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Section I: Preamble The New Hampshire Medical Society believes that principles

More information

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently Asked Questions What is Naltrexone? Naltrexone is a prescription drug that effectively blocks the effects of heroin, alcohol,

More information

Does Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation

Does Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation Does Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation Beginnings of Workers Compensation Liability and Litigation in the 19 th Century The problem of industrial accidents

More information

Opioid Treatment Guidelines. Denis G. Patterson, DO University of Nevada, Reno 7/15/2015

Opioid Treatment Guidelines. Denis G. Patterson, DO University of Nevada, Reno 7/15/2015 Opioid Treatment Guidelines Denis G. Patterson, DO University of Nevada, Reno 7/15/2015 Opioid Treatment Guidelines Opioid Treatment Guidelines Chronic opioid therapy to treat chronic non-cancer pain (CNCP)

More information

PRESCRIPTION PAINKILLER OVERDOSES

PRESCRIPTION PAINKILLER OVERDOSES IMPACT{ POLICY PRESCRIPTION PAINKILLER OVERDOSES National Center for Injury Prevention and Control Division of Unintentional Injury Prevention What s the Issue? In a period of nine months, a tiny Kentucky

More information

2013-2014: Top Ten Trends and Emerging Issues in Workers Compensation

2013-2014: Top Ten Trends and Emerging Issues in Workers Compensation The following chart includes ten workers compensation topics that are surfacing nationwide: (1) Opt Out, (2) Eliminating liberal construction of interpretation of work comp act, (3) AMA impairment guides

More information

Comparing The Indiana Workers Compensation System With Other States

Comparing The Indiana Workers Compensation System With Other States Comparing The Indiana Workers Compensation System With Other States August 8, 2013 Today s Outline About WCRI CompScope Benchmark studies Other WCRI studies Major findings from CompScope Benchmarks, CompScope

More information

Workers Compensation Claims Services Favorable Outcomes for Employers and Employees

Workers Compensation Claims Services Favorable Outcomes for Employers and Employees Workers Compensation Claims Services Favorable Outcomes for Employers and Employees Medical Case Management Resources Preferred Medical Provider Networks Nurse Case Managers Pharmacy Benefit Management

More information

Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution.

Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution. TM Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution. Goals of Opioid Defense Manager TM Opioids are the most common drugs prescribed

More information

American Cancer Society Cancer Action Network

American Cancer Society Cancer Action Network American Cancer Society Cancer Action Network 555 11 th Street, NW Suite 300 Washington, DC 20004 202.661.5700 www.acscan.org Tom Frieden, M.D., M.P.H. Director, Centers for Disease Control and Prevention

More information

Massachusetts Substance Abuse Policy and Practices. Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District

Massachusetts Substance Abuse Policy and Practices. Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District Massachusetts Substance Abuse Policy and Practices Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District November 2014 Substance Abuse and Addiction National and State opioid abuse

More information

Pain Management Tools Information Technology. Mohit Rastogi, MD The University of Michigan Department of Anesthesiology Division of Pain Medicine

Pain Management Tools Information Technology. Mohit Rastogi, MD The University of Michigan Department of Anesthesiology Division of Pain Medicine Pain Management Tools Information Technology Mohit Rastogi, MD The University of Michigan Department of Anesthesiology Division of Pain Medicine Information is not knowledge. -Albert Einstein "Americans

More information

Drug Testing to Support Pain Management

Drug Testing to Support Pain Management NATIONAL REFERENCE LABORATORY Drug Testing to Support Pain Management 500 Chipeta Way, Salt Lake City, UT 84108 (800) 522-2787 (801) 583-2787 www.aruplab.com www.arupconsult.com ARUP is an enterprise of

More information

EXECUTIVE SUMMARY. Associated Industries Of Florida

EXECUTIVE SUMMARY. Associated Industries Of Florida EXECUTIVE SUMMARY Proposed "WORKERS' COMPENSATION REFORM ACT OF 2001 Recommended by Associated Industries Of Florida There is a major crisis looming on the horizon on the Florida's Workers'' Compensation

More information

State Spending for Corrections: Long-Term Trends and Recent Criminal Justice Policy Reforms

State Spending for Corrections: Long-Term Trends and Recent Criminal Justice Policy Reforms State Spending for Corrections: Long-Term Trends and Recent Criminal Justice Policy Reforms September 11, 2013 Overview State spending for corrections has risen steadily over the last three decades, outpacing

More information

7Questions Toward. More Effective Workers Comp Programs. by Ron Skrocki. benefits magazine november 2014 MAGAZINE

7Questions Toward. More Effective Workers Comp Programs. by Ron Skrocki. benefits magazine november 2014 MAGAZINE 7Questions Toward More Effective Workers Comp Programs by Ron Skrocki MAGAZINE Reproduced with permission from Benefits Magazine, Volume 51, No. 11, November 2014, pages 48-52, published by the International

More information

BUSINESS REFORM COMPENSATION A ROCHESTER BUSINESS ALLIANCE REPORT

BUSINESS REFORM COMPENSATION A ROCHESTER BUSINESS ALLIANCE REPORT BUSINESS 5YRS of W O R K E R S COMPENSATION REFORM S T I L L A W O R K I N P R O G R E S S A ROCHESTER BUSINESS ALLIANCE REPORT Essential reforms are failing to achieve their promise About 100 years ago,

More information

Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013

Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013 Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013 Chairman Lee, members of the Senate Human Services Committee,

More information

Pain Therapeutics, Inc.

Pain Therapeutics, Inc. Pain Therapeutics, Inc. Pioneers in Preventing Prescription Drug Abuse Remi Barbier President & CEO June 2014 1 Forward-Looking Statements This presentation contains forward-looking statements within the

More information

Protecting your employees, physicians and you.

Protecting your employees, physicians and you. Protecting your employees, physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution - now with real outcomes. Opioids are the most common drugs prescribed in workers

More information

AIG/HealthSmart Managed Health Care Plan

AIG/HealthSmart Managed Health Care Plan AIG/HealthSmart Managed Health Care Plan Your Workers Compensation Medical Solution Employer Manual Contents AIG/HealthSmart Managed Health Care Plan Overview...2 Program Description and Objectives...3

More information

The Chiropractic Profession s Role in Helping to Meet Vermont's Health Care Reform Goals. Better care Better health Lower costs

The Chiropractic Profession s Role in Helping to Meet Vermont's Health Care Reform Goals. Better care Better health Lower costs The Chiropractic Profession s Role in Helping to Meet Vermont's Health Care Reform Goals Better care Better health Lower costs Chiropractic Abstract: Chiropractic is now more than a century old, and it

More information

Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain

Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain Division of Workers Compensation 04.01.2015 Background Opioids

More information

ADVANCE DIRECTIVE VOLUME 19 SPRING 2010 PAGES 306-315. The Effect of Medical Malpractice. Jonathan Thomas *

ADVANCE DIRECTIVE VOLUME 19 SPRING 2010 PAGES 306-315. The Effect of Medical Malpractice. Jonathan Thomas * ANNALS OF HEALTH LAW ADVANCE DIRECTIVE VOLUME 19 SPRING 2010 PAGES 306-315 The Effect of Medical Malpractice Jonathan Thomas * I. INTRODUCTION: WHAT IS MEDICAL MALPRACTICE Every year, medical malpractice

More information

Treatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy

Treatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy Category: Heroin Title: Methadone Maintenance vs 180-Day psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial Authors: Karen L. Sees, DO, Kevin L. Delucchi,

More information

Opiate Abuse and Mental Illness

Opiate Abuse and Mental Illness visited on Page 1 of 5 LEARN MORE (HTTP://WWW.NAMI.ORG/LEARN-MORE) FIND SUPPORT (HTTP://WWW.NAMI.ORG/FIND-SUPPORT) GET INVOLVED (HTTP://WWW.NAMI.ORG/GET-INVOLVED) DONATE (HTTPS://NAMI360.NAMI.ORG/EWEB/DYNAMICPAGE.ASPX?

More information

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION MICHAEL L. McDONALD Claimant VS. FIBERGLASS SYSTEMS, LP Respondent Docket No. 1,003,977 AND PACIFIC EMPLOYERS INS. CO. Insurance

More information

STATE OFFICE OF ADMINISTRATIVE HEARINGS 300 West 15th Street, Suite 502 Austin, Texas 78701 ' ' ' ' ' ' ' ' I. Background Facts

STATE OFFICE OF ADMINISTRATIVE HEARINGS 300 West 15th Street, Suite 502 Austin, Texas 78701 ' ' ' ' ' ' ' ' I. Background Facts HIGHPOINT PHARMACY, Petitioner V. STATE OFFICE OF ADMINISTRATIVE HEARINGS 300 West 15th Street, Suite 502 Austin, Texas 78701 SENTRY INSURANCE, A MUTUAL COMPANY Respondent DOCKET NO. 453-03-2098.M5 [MDR

More information

Testimony before Texas Senate Select Interim Committee on Workers' Compensation. About WCRI

Testimony before Texas Senate Select Interim Committee on Workers' Compensation. About WCRI 1 Testimony before Texas Senate Select Interim Committee on Workers' Compensation April 29, 2004 About WCRI Independent, not-for-profit research organization, established 1983 Has diverse membership support

More information

TRENDS IN HEROIN USE IN THE UNITED STATES: 2002 TO 2013

TRENDS IN HEROIN USE IN THE UNITED STATES: 2002 TO 2013 2013 to 2002 States: United the in Use Heroin in Trends National Survey on Drug Use and Health Short Report April 23, 2015 TRENDS IN HEROIN USE IN THE UNITED STATES: 2002 TO 2013 AUTHORS Rachel N. Lipari,

More information

BACKGROUND. August 28, 2013. Hon. Kamala D. Harris Attorney General 1300 I Street, 17 th Floor Sacramento, California 95814. Initiative Coordinator

BACKGROUND. August 28, 2013. Hon. Kamala D. Harris Attorney General 1300 I Street, 17 th Floor Sacramento, California 95814. Initiative Coordinator August 28, 2013 Hon. Kamala D. Harris Attorney General 1300 I Street, 17 th Floor Sacramento, California 95814 Attention: Ms. Ashley Johansson Initiative Coordinator Dear Attorney General Harris: Pursuant

More information

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth Prescription drug abuse trends Minnesota s Prescription Monitoring Program Carol Falkowski Drug Abuse Dialogues www.drugabusedialogues.com Barbara Carter, Manager MN Board of Pharmacy www.pmp.pharmacy.state.mn.us

More information

Senate Bill 899, the workers compensation reform legislation signed

Senate Bill 899, the workers compensation reform legislation signed California Workers Compensation Institute May 2010 Medical Provider Network Utilization in California Workers Compensation John Ireland, MHSA, and Alex Swedlow, MHSA Senate Bill 899, the workers compensation

More information

Outstanding Outcomes

Outstanding Outcomes Outstanding Outcomes New study reaffirms s industry leading clinical results and long-term savings for catastrophic claims Catastrophic injuries are infrequent, highly complex, and extremely volatile,

More information

Questions and Answers About Prop. 46 A costly threat to people s personal privacy Californians can t afford.

Questions and Answers About Prop. 46 A costly threat to people s personal privacy Californians can t afford. Questions and Answers About Prop. 46 A costly threat to people s personal privacy Californians can t afford. What will Prop. 46 do? Prop 46 does three things: Quadruples the limit on medical malpractice

More information

Provider Reference Manual Introduction and Overview of Medical Provider Networks (MPNs)

Provider Reference Manual Introduction and Overview of Medical Provider Networks (MPNs) Provider Reference Manual Introduction and Overview of Medical Provider Networks (MPNs) To meet the requirements of SB899, First Health has designed this manual for The First Health Network providers participating

More information

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION Effective June 13, 2010 02-313, 02-373, 02-380, 02-383, 02-396 Chapter 21 page 1 02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 313 BOARD OF DENTAL EXAMINERS 373 BOARD OF LICENSURE IN MEDICINE

More information

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Section I: Preamble The Michigan Boards of Medicine and Osteopathic Medicine & Surgery recognize that principles of quality

More information

DOCKET NO. 453-05-9160.M5 MDR Tracking No. M5-05-1420-01. CROWNE CHIROPRACTIC BEFORE THE STATE OFFICE CLINIC, Petitioner VS. OF

DOCKET NO. 453-05-9160.M5 MDR Tracking No. M5-05-1420-01. CROWNE CHIROPRACTIC BEFORE THE STATE OFFICE CLINIC, Petitioner VS. OF DOCKET NO. 453-05-9160.M5 MDR Tracking No. M5-05-1420-01 CROWNE CHIROPRACTIC BEFORE THE STATE OFFICE CLINIC, Petitioner VS. OF AMERICAN HOME ASSURANCE COMPANY, Respondent ADMINISTRATIVE HEARINGS DECISION

More information

2015 REPORT Steven W. Schierholt, Esq. Executive Director www.pharmacy.ohio.gov

2015 REPORT Steven W. Schierholt, Esq. Executive Director www.pharmacy.ohio.gov OHIO AUTOMATED RX REPORTING SYSTEM 2015 REPORT Steven W. Schierholt, Esq. Executive Director www.pharmacy.ohio.gov OHIO AUTOMATED RX REPORTING SYSTEM What is OARRS? To address the growing misuse and diversion

More information

Opioid Prescribing Practices and Pain Management: Role of FDA Douglas C. Throckmorton, MD Deputy Director for Regulator Programs, CDER, FDA

Opioid Prescribing Practices and Pain Management: Role of FDA Douglas C. Throckmorton, MD Deputy Director for Regulator Programs, CDER, FDA Opioid Prescribing Practices and Pain Management: Role of FDA Douglas C. Throckmorton, MD Deputy Director for Regulator Programs, CDER, FDA American Academy of Hospice and Palliative Care Medicine October,

More information

A BRIEF OVERVIEW OF THE BENEFITS AND PERILS OF THE VIRGINIA WORKERS COMPENSATION ACT

A BRIEF OVERVIEW OF THE BENEFITS AND PERILS OF THE VIRGINIA WORKERS COMPENSATION ACT A BRIEF OVERVIEW OF THE BENEFITS AND PERILS OF THE VIRGINIA WORKERS COMPENSATION ACT If you were injured at work or know a family member or friend who was injured at work, I hope that the following information

More information

Provided By Heath Benefit Partners Workers Compensation Employee Benefits

Provided By Heath Benefit Partners Workers Compensation Employee Benefits Provided By Heath Benefit Partners Workers Compensation Employee Workers compensation laws in California regulate the determination and payment of benefits for employees injured in the course of employment.

More information

EXPENSES IN WORKERS COMPENSATION CLAIMS

EXPENSES IN WORKERS COMPENSATION CLAIMS PAYMENT OF MEDICAL EXPENSES IN WORKERS COMPENSATION CLAIMS By: Marla A. Joseph, Esq. & Joseph P. Turchi, Esq. I. SCOPE OF EMPLOYER S LIABILITY Employer s Voluntary Payment of Medical Bills is not an admission

More information

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008 PRESCRITPION DRUG ABUSE: AN EPIDEMIC What is Addiction? By: Lon R. Hays, M.D., M.B.A. Professor and Chairman Department of Psychiatry University of Kentucky Healthcare Addiction is a primary, chronic disease

More information

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion Angela Huskey, PharmD, CPE Case Bill is a 47 year old man with a history of low back pain and spinal stenosis Not a real

More information

Frequently Asked Questions About Georgia Workers Compensation Ty Wilson Attorney At Law 1-866-937-5454 www.tywilsonlaw.

Frequently Asked Questions About Georgia Workers Compensation Ty Wilson Attorney At Law 1-866-937-5454 www.tywilsonlaw. Frequently Asked Questions About Georgia Workers Compensation Ty Wilson Attorney At Law 1-866-937-5454 www.tywilsonlaw.com Special Report Frequently Asked Questions About Claims Special Report Ty Wilson

More information

EPIDEMIC 4.6 % OF INDIVIDUALS 18 25 USED PAIN RELIEVERS FOR NON-MEDICAL REASONS. 1.5 MILLION YOUNG ADULTS USED PAIN RELIEVERS IN THE PAST MONTH.

EPIDEMIC 4.6 % OF INDIVIDUALS 18 25 USED PAIN RELIEVERS FOR NON-MEDICAL REASONS. 1.5 MILLION YOUNG ADULTS USED PAIN RELIEVERS IN THE PAST MONTH. Drug Court EPIDEMIC In the 10 years (1997 2007) the per capita retail purchases of Methadone, Hydrocodone and Oxycodone in the United States increased 13-fold, 4-fold and 9-fold, respectively. 4.6 % OF

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. NEW products from the Medicare Learning Network (MLN)

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. NEW products from the Medicare Learning Network (MLN) Medicare Advantage Outreach and Education Bulletin Anthem Blue Cross Prescription Drug Monitoring Programs Prescription drug abuse and diversion are acute problems in the area of pain management. The Centers

More information

How the Affordable Care Act Affects Workers Compensation Part Two

How the Affordable Care Act Affects Workers Compensation Part Two How the Affordable Care Act Affects Workers Compensation Part Two By Mark Noonan Part one of this series examined the potential impact of the Affordable Care Act (ACA) on workers compensation and general

More information

SCOPE of Pain: Safe and Competent Opioid Prescribing Education

SCOPE of Pain: Safe and Competent Opioid Prescribing Education SCOPE of Pain: Safe and Competent Opioid Prescribing Education Disclosure of Support Our program is funded by an independent educational grant awarded by the manufacturers of extended-release (ER) and

More information

Nebraska Ticket to Work Palliative Care Program

Nebraska Ticket to Work Palliative Care Program APRIL 2008 ISSUE 1 NUMBER 1 MIG INNOVATIONS Program Summary The program coordinates pain management techniques with employment supports. Services are provided to individuals who have chronic pain that

More information

Research Informing Public Policy: Workers Compensation in California

Research Informing Public Policy: Workers Compensation in California Research Informing Public Policy: Workers Compensation in California 2011 Nachemson Lecture Robert T. Reville RAND Politics and Research-Informed Public Policy Politics involves compromise between divergent

More information

L E G I S L A T I V E A N A L Y S T S O F F I C E. Assembly Judiciary Committee Hon. Bob Wieckowski, Chair

L E G I S L A T I V E A N A L Y S T S O F F I C E. Assembly Judiciary Committee Hon. Bob Wieckowski, Chair September 29, 2014 Proposition 46: Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. L E G I S L A T I V E A N A L Y S T S O F F I C E Presented to: Assembly Health Committee Hon. Richard

More information

What you should know about treating your pain with opioids. Important information on the safe use of opioid pain medicine.

What you should know about treating your pain with opioids. Important information on the safe use of opioid pain medicine. What you should know about treating your pain with opioids Important information on the safe use of opioid pain medicine. If your healthcare provider has determined that opioid therapy is right for you,

More information

B-11-3. Response: Page 1 of 1

B-11-3. Response: Page 1 of 1 Information Request No..1 RR BCCA.BI.1.a-b Dated 04 May 16 March Insurance Corporation of British Columbia B-11-3.1 RR BCCA.BI.1.a-b Reference: Page 5-2, paragraph 6, the first bullet point refers to "An

More information

Fraud, Waste and Abuse

Fraud, Waste and Abuse Fraud, Waste and Abuse CT - Fraud Hotline submitted by Connecticut The Fraud Hotline at the Department of Social Services (DSS) is a proactive approach to handling complaints regarding fraud and abuse

More information

How to Select a Lawyer by J. Sherrod Taylor

How to Select a Lawyer by J. Sherrod Taylor How to Select a Lawyer by J. Sherrod Taylor Persons with traumatic brain injury (TBI) and their families must make many important decisions in the early days following injury. One significant decision-that

More information

For a Healthier America: Reducing Prescription Drug Misuse and Abuse

For a Healthier America: Reducing Prescription Drug Misuse and Abuse For a Healthier America: Reducing Prescription Drug Misuse and Abuse The misuse and abuse of prescription medicines is a growing public health problem. In addition to the tragic toll on families and communities,

More information

Helpful Suggestions for Appealing a Denial of Benefits

Helpful Suggestions for Appealing a Denial of Benefits Helpful Suggestions for Appealing a Denial of Benefits This free ebook provided by: Law Offices of Tom Bush www.themilwaukeedisabilityattorney.com 161 W.Wisconsin Ave., Suite 5185 Milwaukee,WI 53203 800-772-1213

More information

Long Term Disability Insurance Benefits Guide

Long Term Disability Insurance Benefits Guide THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK Long Term Disability Insurance Benefits Guide For The Employees of The State University of New York Answers to your questions about coverage from The Standard

More information

WORKERS COMPENSATION In California. Workers Compensation Online Test

WORKERS COMPENSATION In California. Workers Compensation Online Test WORKERS COMPENSATION In California Workers Compensation Online Test DIRECTIONS: Simply list your answer in an email. Write down your letter choice only (a, b, c, d) in a NUMBERED VERTICAL COLUMN. Please

More information

IN THE GENERAL ASSEMBLY STATE OF. Ensuring Access to Medication Assisted Treatment Act

IN THE GENERAL ASSEMBLY STATE OF. Ensuring Access to Medication Assisted Treatment Act IN THE GENERAL ASSEMBLY STATE OF Ensuring Access to Medication Assisted Treatment Act 1 Be it enacted by the People of the State of Assembly:, represented in the General 1 1 1 1 Section 1. Title. This

More information

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Information for Family Members Family members of patients who have been prescribed buprenorphine/naloxone for treatment of opioid addiction

More information

Maryland Cancer Plan Pain Management Committee

Maryland Cancer Plan Pain Management Committee Maryland Cancer Plan Pain Management Committee IDEAL MODEL FOR CANCER CONTROL PROBLEM or ISSUE Lack of provider awareness regarding appropriate pain assessment and management and relevant policy Definition:

More information

Zurich Handbook. Managed Care Arrangement program summary

Zurich Handbook. Managed Care Arrangement program summary Zurich Handbook Managed Care Arrangement program summary A Managed Care Arrangement (MCA) is being used to ensure that employees receive timely and proper medical treatment with respect to work-related

More information

Summary. Program Background

Summary. Program Background Integrative Therapies Pilot Project: A Holistic Approach to Chronic Pain Management in Medicaid The Florida Medicaid Experience A report by Health Management Associates, Inc. Summary Chronic pain remains

More information