Author: WorkCompAcademy

Regenerative medicine is a new field of medicine in which orthopedic surgeons aim to move away from replacement and toward joint preservation. Using orthobiologics, they plan provide the body with the cells, materials, and stimulation it needs to heal without you ever going under the knife.

According to the report on News-Medical.net, the promise of regenerative medicine in orthopedics is a future where a joint replacement can be delayed for as long as possible, perhaps offering a solution to long transplant waiting lists for other disciplines of medicine. The main debate in orthobiologics is whether the body of evidence currently supports incorporating regenerative medicine techniques into national guidelines and conventional treatment strategies.

Case studies and anecdotal evidence often support orthobiologics (biological substances orthopedics surgeons can use to help the body heal) as a treatment option. However, the size and consistency of available studies are still a problem. There is plenty of evidence to support regenerative medicine techniques in specific circumstances such as osteoarthritis and tendinopathy. Still, a broader evidence base will be required before these treatments are accepted as standard practice in wider orthopedic circles.

The idea behind regenerative medicine isn’t new. More recently, regenerative medicine has focused on the implantation of cells to initiate healing in musculoskeletal structures, with the introduction of modern interventions such as platelet-rich plasma, mesenchymal stem cells, and injections of biomaterials that can induce a healing response.

Modern orthopedic regenerative medicine treatments still struggle to find a place within standard practice and large healthcare organizations, owing to the debate over whether the evidence base currently supports its use. Therapies such as platelet-rich plasma and adipose (fat cell) derived stem cell injections often require patients to pay out of pocket as insurance companies refuse to cover these forms of treatment.

There is, however, a growing number of practitioners who use orthobiologics as part of their standard practice. With a growing evidence base, these practitioners have started to treat conditions such as osteoarthritis and tendinopathy in this way, offering treatments including injection of:

– – Platelet-rich plasma – blood plasma with a high concentration of platelets taken from the patient’s blood.
– – Mesenchymal stem cells – stem cells sourced from fat tissue, bone marrow, and pregnancy-related sources such as the umbilical cord, amniotic fluid, and the placenta.
– – Biomaterials – biological substances such as autologous chondrocytes (cells taken from the patient which produce cartilage), bovine collagen, bone matrix, and proteins.

These orthobiologics are generally considered conservative treatments, meaning they are used as a less invasive alternative to surgery or as an additional option when other treatments have failed.

The popularity of orthobiologics is increasing, in no small part due to media coverage of famous athletes undergoing these procedures – Tiger Woods, Steph Curry, and Raphael Nadal, to name just a few. This may have added to the controversy surrounding regenerative medicine. In these circumstances, therapies were used to treat injuries and aid post-surgical healing – an area with less research backing.

Regenerative medicine holds the promise of delaying and possibly reducing surgical intervention in patients with degenerative joint conditions and musculoskeletal injuries. In the near future, we may see orthobiologics used as a middle-ground for conditions like arthritis, sitting somewhere between conservative treatment (such as steroid injection) and surgery.

In the far future, we may even see a complete overhaul of how we replace joints – moving away from metal and ceramic joint replacements towards biological replacement and regeneration. We can also expect a move towards orthobiologic injection as a preventative measure for degenerative joint conditions.

On July 8, Los Angeles Mayor Eric Garcetti signed an ordinance establishing a $25 minimum hourly wage for workers at eligible privately owned healthcare facilities. The signing came after the Los Angeles City Council voted unanimously June 29 in favor of raising the minimum wage.

The ordinance will affect workers in a range of roles at certain privately owned healthcare facilities in the city, such as acute care hospitals, affiliated clinics and skilled nursing facilities. Affected roles include clinicians, nurses, aides, technicians, maintenance workers, janitorial or housekeeping staff, groundskeepers, guards, food service workers, pharmacists and administrative or clerical workers. The increase excludes managers and supervisors.

According to a July 8 news release from the mayor’s office, the new minimum wage becomes effective 31 days after the ordinance is published. The office estimates the minimum wage increase will affect about 20,000 healthcare workers.

SEIU-UHW originally collected more than 145,000 signatures to put the pay increase on the Nov. 8 ballot. Councilmen Curren Price and Marqueece Harris-Dawson decided to move more quickly, pushing their colleagues to adopt the measure immediately.

But some are not happy with the new law.

A coalition of Los Angeles hospitals and other health facilities launched a campaign on Tuesday to repeal a newly enacted ordinance boosting the minimum wage for thousands of healthcare workers to $25 per hour, saying the law will have a harmful effect on medical care across the city. The coalition acted just days after Mayor Eric Garcetti signed the measure into law.

The No on the Unequal Pay Measure Coalition, a group sponsored by the California Assn. of Hospitals and Health Systems, said it will start gathering signatures this week for a referendum to put the wage hike question in front of voters.

The coalition claims that the new $25/hr minimum wage standard applies to certain workers at private hospitals, hospital-based facilities and dialysis clinics, but completely excludes workers who do the exact same job at public hospitals, clinics, and health care facilities, including all University of California and county hospitals and clinics.

The also complain that the measure also completely excludes workers at health care facilities not affiliated with hospitals, including community health clinics, Planned Parenthood clinics, nursing homes, medical centers, and more.

They say “hospitals and health care providers go to great lengths to pay all health care workers competitive, living wages with strong benefits. In fact, the average nurse working in a Southern California hospital earns $57 per hour, the average clinical worker earns $28 per hour, and the average non-clinical worker in a hospital earns approximately $18 per hour.”

To qualify the referendum for the ballot, the coalition would need to gather nearly 41,000 valid signatures from L.A. voters within 30 days. Such a move, if successful, would block the wage increase from going into effect – at least until an election to determine its fate.

A Los Angeles Times report on the new law says that at Gateways Hospital and Mental Health Center in Echo Park, administrators said they are weighing whether to scale back operations – possibly by as much as 20% – as a way of absorbing the increased costs. That 300-bed psychiatric facility serves a large number of people who are either homeless or at risk of becoming homeless, hospital CEO Phil Wong said in an interview.

In Woodland Hills, the nonprofit Motion Picture and Television Fund is now looking at how to cover a $1.5-million yearly increase in labor costs, according to Bob Beitcher, the fund’s chief executive. That increase is currently set to take effect in August.

Beitcher said some security guards at the motion picture fund’s 300-bed campus, which provides care for seniors who have retired from the entertainment industry, would receive pay increases of 40% to 50%. Some nursing assistants would see pay hikes of 30% to 40%, he said.

“The only way we could absorb that is either to cut back on services, which isn’t something we’d like to do, or fundraise another million and a half [dollars] per year,” he said.

WinCo Foods operates a supermarket chain with just over 100 locations across the western United States, including California.

When WinCo hires new employees, a Hiring Manager calls successful applicants to extend what WinCo terms a contingent offer of employment. The Hiring Manager informs the applicant of a mandatory drug test as part of the contingent job offer. When an applicant consents, WinCo instructs applicants to report to a testing location. It pays the drug testing facility’s fee, but does not compensate for the travel expenses and time required to undergo the testing.

Plaintiff Alfred Johnson, on behalf of himself and other WinCo employees in California, filed this class action in California state court. Johnson alleges violations of the California Labor Code relating to the payment of wages and business-related expenses and the California Business & Professions Code §§ 17200, et seq., proscribing unfair business practices. WinCo removed the case to federal court under the Class Action Fairness Act, 28 U.S.C. § 1332(d).

The federal district court certified the class, and then entered judgment in favor of WinCo on the ground that under California law, plaintiffs were not yet employees when they took the drug test. Plaintiffs appealed contending that they were employees. The 9th Circuit Court of Appeals affirmed in the published case of Johnson v WinCo Foods 21-55501 (June 2022).

The same issues have arisen in a number of similar cases removed from California state courts to federal district court. The other district courts in those cases have also ruled in favor of the employer. There is as yet, however, no authoritative California state court decision. Thus the 9th Circuit affirmed in a published opinion.

Plaintiffs argue on appeal that because the tests were administered under the control of the employer, plaintiffs must be regarded as employees, as California law applies a control test to determine whether an employment relationship exists. See Martinez v. Combs, 49 Cal. 4th 35, 64 (2010). Second, and alternatively, they contend that under California law the test should be regarded as a “condition subsequent” to their hiring as employees. See Cal. Civ. Code § 1438.

The 9th Circuit rejected both arguments noting that “the class members were not performing work for an employer when they took the preemployment drug test; they were instead applying for the job. They were not yet employees.”

Johnson relies in major part on a workers’ compensation case, Bowen v. Workers’ Compensation Appeals Board, 73 Cal. App. 4th 15 (1999). At issue in Bowen was whether an injured baseball player had been hired in California, where he accepted an offer subject to approval by the Commissioner of Baseball, or out of state, where the Commissioner was located and where the plaintiff worked. Johnson argues that this case is like Bowen and the employment contract was made when the class members accepted a comprehensive offer of employment over the phone.

The 9th Circuit distinguished this case by noting that the “court in Bowen, however, went to great lengths to explain that it was deciding a workers’ compensation case and its decision was guided by the policy of liberally construing contracts in favor of employees in accordance with California workers’ compensation law.”

“The Bowen opinion suggests that if the court had applied California contract law, rather than workers’ compensation principles, there would not have been a contract until all of the conditions were satisfied.”

In April 2022, COVID-19 returned to the top five telehealth diagnoses nationally for the first time since January, according to FAIR Health’s Monthly Telehealth Regional Tracker.

COVID-19 also returned to the list of top five telehealth diagnoses in every US census region except the South; it had been off the list in all four regions (Midwest, Northeast, South and West) since January.

The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid. The reappearance of COVID-19 on the national and regional lists coincided with a rise in COVID-19 cases in April reported by the Centers for Disease Control and Prevention.

Also in April 2022, telehealth utilization, as measured by telehealth’s share of all medical claim lines, grew nationally and in every region after two months of decline, according to the Monthly Telehealth Regional Tracker. National telehealth utilization increased 6.5 percent, from 4.6 percent of medical claim lines in March to 4.9 percent in April. Regionally, the greatest increase was in the South, where telehealth utilization grew 11.8 percent in April. The rise in telehealth utilization may have been due to the growth in the reported number of COVID-19 cases, which may have led more patients to avoid in-person care.

Various other diagnoses dropped off the lists as the share of COVID-19 diagnoses increased. Nationally, substance use disorders fell off the list; in the Midwest and Northeast, joint/soft tissue diseases and issues did so; and in the West, endocrine and metabolic disorders did so. In all regions and nationally, mental health conditions remained the top-ranking telehealth diagnosis.

The rankings of the top five telehealth specialties did not change nationally or regionally in April 2022 when compared to March 2022, with social worker remaining the top-ranking telehealth specialty in all regions and nationally. But primary care physician increased its percentage share of telehealth claim lines by about one percent nationally and in the Northeast and South.

In April 2022, the rankings of the top five telehealth procedure codes did not change nationally or in any region when compared to the prior two months. The number one telehealth procedure code nationally and in every region remained CPT®2 90837, one-hour psychotherapy.

For April 2022, the Telehealth Cost Corner spotlighted the cost of CPT 90832, 30-minute psychotherapy. Nationally, the median charge amount for this service when rendered via telehealth was $115.40, and the median allowed amount was $64.84.3

Although farm and food production workers were considered essential workers during the pandemic, many of California’s food employers endangered those workers, violating Cal/OSHA’s COVID-19 guidelines more often than most industries, a new report said.

The California Institute for Rural Studies’report said farm and food production employers routinely failed to provide workers with face masks, nor did they enforce physical distancing or notify workers when there were COVID outbreaks at worksites. The study was based on OSHA inspections from April 2020 through December 2021.

Though farms and food companies had the most violations of all the industries, they had some of the smallest penalties, the report said; the average penalty was $22,473.

Cal/OSHA did not answer CalMatters’ question about the size of the fines. It issued a statement Wednesday saying, “Cal/OSHA recognizes and appreciates the importance of this issue, and is reviewing CIRS’ report and recommendations.”

Dvera Saxton, a researcher with the rural studies institute, said Cal/OSHA cited food production employers four times more than any other California industries during the first year of the pandemic. But food companies utilized the judicial and appeals process to try to reduce their penalties, she said.

“Oftentimes the fines will be reduced or eliminated,” she said. “We know that the food production employers – and the companies they’re producing for – have very powerful legal teams to reduce the fines.”

The companies’ violations often included failure to provide and implement a health and safety system, which is required by a 1991 state law, the study said.

The report describes food production workers as those working in meat packing, dairy operations and agriculture – primarily Black, Latino, and Indigenous people, often undocumented immigrants.  
Keeping workers safe

Among 36 agricultural workplaces that utilize contractors, the report names Brutocao Vineyards. Cal/OSHA fined Brutocao Vineyards $3,710 in September 2020 for allegedly failing to provide face masks for three workers and neglecting to keep workers six feet apart.

Len Brutocao, director of vineyard operations, blamed the violations on the workers.  “We provided the masks, and they just didn’t wear them,” he said in an interview, adding that the company has since increased training and stressed wearing masks.

California’s food and farm employers aren’t very different from similar employers around the country, said Suzanne Adely, co-director of the Los Angeles-based Food Chain Workers Alliance, a national coalition of food workers unions. The 21.5 million farm and food workers make up the nation’s largest workforce, she said. The lack of COVID protections is just one of their many vulnerabilities.

“Food workers have the lowest median wage than any workforce and are the most food insecure,” Adely said. “They have some of the highest rates of health and safety violations – and high rates of wage theft.”

As the pandemic continues, the report recommends that state leaders and Cal/OSHA officials strengthen paid sick leave protections, increase workplace inspections and ensure that employer health and safety data is more accessible to the public.