Author: WorkCompAcademy

The Division of Workers’ Compensation (DWC) today posted three documents to provide the public with tools which assess proposed rulemaking on the Official Medical Fee Schedule.

The first document is a revised RAND working paper, providing a quality assurance review of the impact for a transition to a resource-based relative value scale (RBRVS) based physician fee schedule. The revised working paper includes updated impact tables, revised estimated transition conversion factors, and an explanation of the changes made.

The other documents include a detailed impact file intended for public use as well as a supporting document with a description of the data elements included. The impact file is a comprehensive data table which allows members of the public to focus on specific components of the proposed changes.

“I am pleased to provide this impact file so that stakeholders can better assess areas that are of specific interest to them. I believe providing this data file improves the opportunity for meaningful public participation in the rulemaking process,” said Christine Baker, Director of the Department of Industrial Relations (DIR). DWC is a division of DIR.

The revised RAND working paper and the public use data file can be found on the proposed regulations page.

In a preliminary study of patients who had simple surgeries, most did well and seemed satisfied with post-operative checkups by telephone instead of seeing their surgeon in a clinic visit. According to the article in Reuters Health, the phone follow-up saved doctors and patients the time and effort involved in clinic visits without compromising patient care, according to the study of California patients. “These clinic visits are usually five minutes or less, very brief, the doctor asks ‘how are you, do you feel well, are you going to the bathroom okay, that kind of thing,” said senior author Dr. Sherry Wren of the Stanford University School of Medicine. Those questions can easily be asked over the phone, and only patients with unusual symptoms need to come see a doctor in person, she told Reuters Health. The study included patients who had hernia repairs and gallbladder removals, both routine surgeries with very low post-op complication rates. But so-called telehealth follow-up would not be appropriate for all surgeries Wren said; for cancer patients, for example, follow-up doctors’ visits include discussions of continuing care and treatment plans.

For the new study, Wren and her colleagues identified patients of the Palo Alto Veterans Administration Health Care System who were scheduled for one of two surgeries. In total, 115 patients had hernia repairs and 26 had gallbladders removed. All were scheduled for a follow-up clinic visit three weeks after their surgeries. But two weeks post-surgery the patients were called by a physician assistant. The assistant asked scripted questions about the patient’s pain and activity levels, swelling, the look and feel of the incision, appetite and bowel movements. If patient responses indicated normal recovery, the patient’s scheduled follow-up clinic visit was canceled with the patient’s consent. If recovery seemed abnormal, the patient was encouraged to keep the clinic appointment. Any patients who wanted in-person follow-up were also allowed to keep their appointment. Calls went through to 110 of the patients; 63 hernia patients and 19 gallbladder patients agreed to have surgical follow up by phone only and canceled their clinic appointments.

None of the gallbladder patients and three hernia patients had surgical complications up to 10 months after surgery, which is comparable to complication rates in the general population, according to the results published in the journal JAMA Surgery. The authors did not compare the outcomes of the telehealth group to a group going to traditional clinic visits.

Of the patients who said they wanted to visit the clinic, even after the phone checkup, most wanted to pick up a return-to-work form and thought they had to do so in person, whereas it can actually be mailed or faxed, Wren said. Most patients said they were very satisfied with the telehealth checkups and seemed grateful that they didn’t have to drive to the clinic, Wren said, Of the patients who accepted the telehealth follow-up, the average round-trip travel distance from their homes to the hospital was 141 miles, and the average driving time Wren’s team calculated would have been about two and a half hours. Though research supports the safety and efficacy of telehealth, it is only used in some pockets of healthcare, Wren said. Some physicians balk at leaving behind the “gold standard” of in-person visits, she said.

The current study indicates that even the relatively low-tech telephone call can be a reliable telehealth option, and it may be more appealing to people, she said. “Nothing about this was surprising, especially in this patient population and with what we would consider relatively routine procedures, especially if they travel great distances, we know people would like an alternative,” said Dr. Glenn Ault of the department of surgery at the University of Southern California in Los Angeles. Using telemedicine to make sure only surgical patients who need to be seen end up going to a clinic could help cut down on crowds and wait times, said Ault, who wrote a commentary to accompany the research. He already uses telemedicine in his practice in L.A. health system, and has also had patients send pictures of their wounds before coming in to the office. The next step will be to study telehealth options for other procedures, he said. “Healthcare as we view it will undergo some significant transformation in the years ahead, the status quo cannot continue,” he said. “We are going to have to look for different ways to safely and efficiently provide care,” and telehealth could play an important role, he said.

Getting back surgery to fix fractures caused by compression of the spine may not be any more beneficial than more conservative treatments, according to a new study of Medicare patients. According to the summary in Reuters health, researchers found that people who had so-called spinal augmentation had a similar likelihood of dying or having major complications as those who didn’t have the surgery. “I can’t say there is no effect in patients who swear by their procedure, but in looking at objective measures we can’t say it’s effective,” said Dr. Brendan McCullough, the study’s lead author who did the research while at the University of Washington in Seattle.

During spinal augmentation, doctors fill compression fractures – usually caused by the bone-thinning condition osteoporosis – in people’s vertebrae with a bone cement. Research has found that spinal augmentation relieves the pain of back fractures, but more recent studies suggest the procedure’s perceived benefits may be due to a placebo effect – or mind over matter. Spinal fractures, however, can lead to more problems than just chronic pain. They have, for example, been tied to a doubled risk of death. Therefore, some believe the procedure may help reduce the risk of death in people with fractures.

For the new study, the researchers used medical billing data for people on Medicare, the U.S. health insurance for the elderly and disabled, between 2002 and 2006. They identified 10,541 people who had spinal augmentation to treat their fractured back bones, and 115,851 people who used more conservative approaches, which typically include pain medicine and back braces or girdles. On average, the people included in the study were about 80 years old, mostly female and white.

The researchers found that spinal augmentation patients had fewer complications – such as cardiac arrest, pneumonia and stroke – within the 30 days following the discovery of their fracture, compared to those who used more conservative treatments. But that difference disappeared one year after their fractures were discovered, when about 29 percent of people in both groups had major complications. People who had spinal augmentation, however, did appear to have a consistently lower risk of death over the first 30 days and one year after their fracture was discovered, compared to the conservative treatment group. That advantage, however, went away once the researchers accounted for the fact that people who had spinal augmentation appeared to be healthier overall than the people who picked more conservative treatments. What’s more, people who had the procedure ended up in the hospital more often over the next year, compared to the conservative treatment group. They were also more likely to be admitted to an intensive care unit or sent to a nursing home. The researchers can’t say that the procedures didn’t give some of the patients relief from pain, said McCullough, who is now a neuroradiologist with Radia in Seattle.

In an editorial accompanying the study in JAMA Internal Medicine, Dr. Douglas Bauer writes that the study “convincingly” shows that spinal augmentation is unlikely to reduce deaths after back fractures. “Until better evidence becomes available, the potential benefits of vertebral augmentation remain unproven, and it should not be routinely offered to patients with osteoporotic vertebral fracture to improve pain, improve function, or reduce mortality,” Bauer, a professor at the University of California, San Francisco, added. However, Dr. Kirkham B. Wood, chief of the orthopedic spine service at Boston’s Massachusetts General Hospital, said the new study has limitations. For example, it did not separate the two main forms of spinal augmentation surgery from the other, and an older form of augmentation made up the majority of the included procedures. “It’s not going to change anyone’s practice,” Wood said about the study, adding that the procedure is still important to consider.

The WCIRB announced that it is on schedule for a July 22 deployment of the second phase of its new STAR operating system. This latest release of STAR builds upon the first phase of the system, which was rolled out in September 2012 and supports the WCIRB’s unit statistical report (USR) collection and experience rating functions. Phase 2 gives the WCIRB new policy data management tools, which will enable electronic policy data reporting for insurers. It also includes the initial release of STAR Online – a new online service for insurers to manage USR data submissions, correspondence and more.

With this deployment, the WCIRB can begin decommissioning its mainframe system and, in conjunction with the online services provided via STAR Online, will be positioned to provide new operational efficiencies for member insurers and new products and services for all WCIRB stakeholders.

Phase 2 of STAR will be deployed over the weekend of July 19-21. In the days preceding the cutover, the WCIRB will resolve as many open policy inquiries as possible. On July 12, the WCIRB will process its last policy submission in its mainframe and, between July 15 and July 22, no new policies will be processed. During this period, the WCIRB will continue to process USRs and publish experience ratings and classification inspection reports. For additional information concerning the rollout of STAR phase 2, refer to WCIRB Bulletin 2013-11.

The initial release of STAR Online provides insurers access to their USRs, experience rating worksheets, an online queue for managing and resolving USR audit errors, and various tools for benchmarking and managing USR submissions. Later in 2013, STAR Online will expand to provide insurers access to their policy data, classification inspection reports and test audit results. It will also provide licensed agents and brokers with access to experience modifications and classification information.

Insurer enrollment for the STAR Online system has begun. For details about the new STAR Online system or to learn how to begin the enrollment process, see the STAR Online Brochure or visit the STAR Online Enrollment page on www.wcirb.com.

When fully deployed, STAR Online will completely replace the services provided by WCIRBonline.org; however, WCIRBonline.org is not impacted by the first release of STAR Online and will continue to operate normally. Until STAR Online is completely deployed later in 2013, insurers may find it necessary to have a STAR Online and a WCIRBonline.org user account.

For STAR Online enrollment information, contact marketing@wcirb.com.

For general questions regarding the STAR system or the cutover process, please contact the WCIRB Customer Service department at customerservice@wcirb.com or by calling 888.229.2472.

Surveillance video from a San Francisco Muni bus has exonerated a Southern California tourist accused of assaulting the bus driver, who received more than a year’s worth of workers compensation for injuries he falsely claimed he received from the tourist. According to the CBS San Francisco story, the passenger, 25-year-old Victorville resident Matthew Lopez was found not guilty Tuesday of felony battery on the claimant, unidentified 64-year-old Muni driver in November of 2010. Lopez was in jail for three months before trial.

Lopez had boarded the 49 Mission bus while on crutches and with a broken leg, accompanied by his girlfriend, according to San Francisco Public Defender Jeff Adachi. Lopez got into a confrontation with the driver after an argument with another passenger who apparently had been bumped by Lopez’ girlfriend. The driver’s 55-year-old sister – a passenger on the bus – also confronted Lopez’s girlfriend, which let to a fistfight between the two women, according to Adachi. As the women fought, Lopez pleaded with the driver to open the bus doors, said Adachi. Lopez then reached over the driver to press the button releasing the doors, prompting a scuffle between Lopez and the driver, said Adachi.

During the four-day trial, the Muni driver testified Lopez went into a rage, punched him in the face, bashed his head on the fare box and tried to break the doors off the bus. However, the surveillance video from the bus showed none of the things the driver claimed and instead showed Lopez acting in self-defense, according to Lopez’s attorney, Deputy Public Defender Seth Meisels. “The video clearly showed that the passenger fell on his own,” Meisels said. “It was the driver and his sister who escalated the situation and turned an accident into a fistfight.”

The Muni driver collected worker’s compensation for 14 months after saying he had lost three teeth and torn his rotator cuff in the incident, said Adachi. But during the trial, Meisels produced dental records showing the driver was missing 12 teeth due to advanced periodontal disease before the incident, including two of the three he claimed were knocked out. The driver admitted on the stand his rotator cuff was originally torn in a fight with another passenger in 2009, said Adachi. On the surveillance footage, Lopez is heard telling the driver, “You know what you did. Your camera will show it. Your camera will show everything.”

There is no word yet whether the unidentified Muni driver will face any sanctions. San Francisco Municipal Transportation Agency spokesman Paul Rose said told CBS San Francisco the agency was made aware of the ruling Wednesday, “but it would not be appropriate to comment any further at this time.”