Author: WorkCompAcademy

Doctors in Australia have carried out a pioneering procedure to treat chronic pain, fitting a permanent spinal cord implant which can record signals from the nervous system and adjust the strength of impulses sent to affected areas.The procedure is claimed to be a breakthrough for treatment of chronic pain and could help patients to avoid pain-killers.

Joe Grewal, the first human to be fitted with a permanent implant, said he has suffered chronic back pain for more than 30 years and now “feels amazing”. The 60-year-old said his pain level had dropped from eight of ten before the treatment to “two or three” immediately afterwards. The device, developed by Saluda Medical, was fitted at the Royal North Shore Hospital in Sydney on Tuesday.The implant was inserted within the spinal canal, about five millimetres from the spinal cord. From there, the implant sends an electrical current through the nerves to provide relief in the area of the body that is experiencing pain.

Dr Charles Brooker, the specialist who fitted the implant, said it was a “big advance” because the device could record signals emerging from the nervous system. “Spinal cord stimulators [send] signals into the spinal cord and so the person with pain feels tingling in the pain area and that confuses the brain and they don’t feel the pain, they just feel a pleasant tingling sensation,” Dr Brooker told ABC News.

The Evoke closed loop neuromodulation control system is designed to automatically adjust stimulation levels for maximum symptom relief irrespective of patient movement. A major drawback of conventional spinal cord stimulation products is that the electrodes placed along the spine move relative to the location of the nerves of the spinal cord. As they move, the level of stimulation of the nerves changes. Simple activities like coughing, sitting down or moving the head can cause changes in the nerve signals of up to 10 times, often causing unpleasant sensations, ranging from uncomfortable tingling to severe shocks. The new machine can adjust itself to produce whatever set level the patient wants, and that’s a big advance because previously, whenever people moved or their heart was pulsating, various things would make the electrical signal waver up and down quite significantly.

Saluda chief executive John Parker said his implant, which will initially cost about $30,000, had the capacity to reach a market 10 times the size of the current one and had the potential to help patients with other nerve conditions, including Parkinson’s disease and overactive bladder syndrome. Parker was formerly an executive director at Cochlear, a global biotechnology company based in Australia that designs, manufactures and supplies the Nucleus cochlear implant, the Hybrid electro-acoustic implant and the Baha bone conduction implant that has restored the sense of hearing. Cochlear was named Australia’s most innovative company in 2002 and 2003, and one of the world’s most innovative companies by Forbes in 2011.

The Monterey Herald reports that about 30 people who say workers’ compensation law SB 863 has created a complicated and convoluted system expressed their frustrations in a protest outside the Workers’ Compensation offices in Salinas on Wednesday. “It is driving them down,” said Dr. David Torrez, spokesman for the protesters. “There are increases in depression, anxiety, suicide, divorce and fractured families.”

SB 863 is considered one of Gov. Jerry Brown’s landmark reforms. The bill took effect in 2013 and made wide-ranging changes to the state’s workers’ compensation system, including increased benefits to injured workers and cost-saving efficiencies, says a report by the Department of Industrial Relations and its Division of Workers’ Compensation.

Torrez said workers he sees are dissatisfied with the effects of SB 863 and “the draconian methods that various workers’ compensation insurance carriers are using to deny them some very basic medical rights and benefits.”

Gilbert Stein, a lawyer who specializes in workers’ compensation, told the crowd they were protesting in the wrong place. He said they should be protesting the law with their legislators.

Torrez is a chronic-pain specialist and marched with the other protesters. He said he was speaking for and showing his support of injured farmworkers from the Monterey, Santa Cruz and San Benito county areas. Torrez, who is an assistant professor at Stanford School of Medicine, says there have been complaints of major delays in the access, treatment, medication and follow-up of patients. Torrez said the processes keep the patient from getting needed treatment, therapy or medicines.

And it is getting more difficult to find doctors who accept workers’ compensation patients because, he said, of the amount of paperwork involved. “It has become punitive,” said Torrez. “The very people these laws were enacted to benefit and protect” are being hurt by them.

High rates of inappropriate opioid use, physician drug dispensing and the increased utilization and cost of pharmaceuticals in the California workers’ compensation system have been well documented by public policy research. These issues are now associated with another emerging cost driver — drug testing.

Prior CWCI research on the topic, published in May 2012, documented the viral-like growth in the volume of drug testing in the system that began a decade ago. This new CWCI study builds on that initial research, using more recent and detailed data. Utilization of quantitative drug tests between 2007 and 2014 increased by 2,431 percent. Quantification of opiates remains the leading test by volume, followed by quantification of substances (PCP/Cocaine/Ethanol) that would be illicit or problematic in conjunction with the use of prescribed medications. Among the injured workers who were drug tested, the average number of tests per employee per date of service more than tripled driving the average amount paid per date of service up from $96 in 2007 to $307 in 2014 – a 220 percent increase.

There is evidence of a migration to physician in-office/non-laboratory drug testing. In 2008, 74 percent of Urine Drug Tests (UDT) services were provided by just four laboratories, but during the ensuing four years the mix of providers shifted, with the big laboratories accounting for a declining share of the market while the number of non-laboratory providers billing for these services increased. Between 2008 and the end of 2014, the total number of UDT providers receiving workers’ compensation reimbursements more than doubled from 428 to 876.

Absent an accepted empirical, evidence-based protocol on the appropriate level and scope of testing, it is difficult to reconcile the noted increases in the volume and variety of drug testing with clinical appropriateness and favorable outcomes for the injured worker. There is likely a dearth of empirical evidence showing improved clinical outcomes when UDT is used for patient adherence.

U.S. prices for the world’s 20 top-selling medicines are, on average, three times higher than in Britain, according to an analysis carried out for Reuters. The finding underscores a transatlantic gulf between the price of treatments for a range of diseases and follows demands for lower drug costs in America from industry critics. The 20 medicines, which together accounted for 15 percent of global pharmaceuticals spending in 2014, are a major source of profits for companies including AbbVie (ABBV.N), AstraZeneca (AZN.L), Merck (MRK.N), Pfizer (PFE.N) and Roche (ROG.VX).

Researchers from Britain’s University of Liverpool also found U.S. prices were consistently higher than in other European markets. Elsewhere, U.S. prices were six times higher than in Brazil and 16 times higher than the average in the lowest-price country, which was usually India.

The United States, which leaves pricing to market competition, has higher drug prices than other countries where governments directly or indirectly control medicine costs. That makes it by far the most profitable market for pharmaceutical companies, leading to complaints that Americans are effectively subsidizing health systems elsewhere.

Manufacturers say decent returns are needed to reward high-risk research and prices reflect the economic value provided by medicines. They also point to higher U.S. survival rates for diseases such as cancer and the availability of industry-backed access schemes for poorer citizens. In recent years, the price differential has been exacerbated by above-inflation annual increases in U.S. drug prices at a time when governments in Europe have capped costs or even pushed prices down.

In fact, U.S. prices for top brand-name drugs jumped 127 percent between 2008 and 2014, compared with an 11 percent rise in a basket of common household goods, according to Express Scripts (ESRX.O), the largest U.S. manager of drug plans.

The U.S. Pharmaceutical Research and Manufacturers of America (PhRMA) says international comparisons are misleading because list prices do not take into account discounts available as a result of “aggressive negotiation” by U.S. insurers. These discounts can drive down the actual price paid by U.S. insurance companies substantially. However, similar confidential discounts are also offered to big European buyers such as Britain’s National Health Service.

On September 18, 2015, the California Insurance Commissioner approved numerous changes to the California Workers’ Compensation Uniform Statistical Reporting Plan – 1995 (USRP), the California Workers’ Compensation Experience Rating Plan – 1995 (ERP) and the Miscellaneous Regulations for the Recording and Reporting of Data – 1995 (Miscellaneous Regs) effective January 1, 2016. See Commissioner Issues Decision on Regulatory Filing for more information.

The WCIRB’s January 1, 2016 Regulatory Filing which was submitted to the California Department of Insurance (CDI) on June 26, 2015 and subject to a public comment period that ended on September 2, 2015. In the decision, the Commissioner approved all of the WCIRB’s proposed changes.

In 2016, changes to the Standard Classification System clarify the application of some classifications and to amend minimum and maximum payroll limitations. An amendment to the unit statistical reporting requirements to specifies that the cost of independent bill review (IBR) and independent medical review (IMR) will no longer be included as part of the medical cost containment component of allocated loss adjustment expense effective on all IBR and IMR reports paid after January 1, 2016. The cost of IBR and IMR will continue to be included in reported allocated loss adjustment expense. An amendment to the ERP to use expected loss rates rather than pure premium rates as the basis for experience rating eligibility was also approved. This change in the basis of eligibility, while not significantly impacting which employers will be eligible for experience rating, allows the WCIRB to begin issuing January 2016 experience modifications almost immediately – months sooner than previously possible.

For 2017, changes to the ERP will allow the WCIRB to issue debit experience modifications, in specified circumstances, excluding the unaudited payroll for policyholders who are uncooperative at the time of a final audit. The Commissioner also approved a significant change to the experience rating formula, replacing the fixed $7,000 primary and excess loss split point with a split point that varies based on the size of the employer. This change enhances the accuracy of the experience rating formula, especially for smaller employers; reduces volatility and provides flexibility for simplifying the experience rating formula in future years. The WCIRB conducted extensive outreach regarding this change prior to the close of the public comment period.

The WCIRB has also updated the Classification Search tool to reflect changes to classification phraseologies effective January 1, 2016.