Farewell. The Flying Pig Has Left The Building.

Steve Hynd, August 16, 2012

After four years on the Typepad site, eight years total blogging, Newshoggers is closing it's doors today. We've been coasting the last year or so, with many of us moving on to bigger projects (Hey, Eric!) or simply running out of blogging enthusiasm, and it's time to give the old flying pig a rest.

We've done okay over those eight years, although never being quite PC enough to gain wider acceptance from the partisan "party right or wrong" crowds. We like to think we moved political conversations a little, on the ever-present wish to rush to war with Iran, on the need for a real Left that isn't licking corporatist Dem boots every cycle, on America's foreign misadventures in Afghanistan and Iraq. We like to think we made a small difference while writing under that flying pig banner. We did pretty good for a bunch with no ties to big-party apparatuses or think tanks.

Those eight years of blogging will still exist. Because we're ending this typepad account, we've been archiving the typepad blog here. And the original blogger archive is still here. There will still be new content from the old 'hoggers crew too. Ron writes for The Moderate Voice, I post at The Agonist and Eric Martin's lucid foreign policy thoughts can be read at Democracy Arsenal.

I'd like to thank all our regular commenters, readers and the other bloggers who regularly linked to our posts over the years to agree or disagree. You all made writing for 'hoggers an amazingly fun and stimulating experience.

Thank you very much.

Note: This is an archive copy of Newshoggers. Most of the pictures are gone but the words are all here. There may be some occasional new content, John may do some posts and Ron will cross post some of his contributions to The Moderate Voice so check back.


Saturday, April 7, 2012

HCR -- Workers Comp Ticking Bomb

By John Ballard

When the notion of health care reform came up I was very aware as a manager that workers compensation expenses are a serious part of any business. And the more employees you have, and the more opportunities they have to get hurt, the more is at stake. Improvements in health care will benefit those with a medical problem, of course, but there is a secondary benefit for everyone, including the well population, as one of the major expenses of all goods and services is brought under better control. 

The most expensive single claim of the place where I worked started with nothing more than a cut finger. The story I got later was that as someone made arrangements to take the employee to the doctor, the employee was left briefly alone. During that time he fainted at the sight of blood, fell against something and bumped his head, resulting in a concussion that was not discovered until too late. He resumed consciousness and received appropriate treatment for his cut, but no one paid attention to the bump on his head. Hours later, as the result of undiagnosed slow internal bleeding, his brain sustained irreversible damage, the result of which caused him to need special assistance for the rest of his life. 

Despite a national conversation about American medicine, I almost never hear anything about how work related diseases or injuries are addressed. Anyone who thinks health insurance will ever be replaced by some national health care delivery scheme is not living in the real world. Third-party risk management, both liability and workers compensation, is a essential to any business as competent legal and accounting resources. For that reason, work-related medical problems are of concern to everyone in ways that most consumers of products or services never think about. 

Joe Paduda, whom I have linked in the past (I called him the Oprah Winfrey of managed care) points to another large and growing expense plaguing the workers compensation sector.

Is your hair on fire yet?

The single biggest crisis facing workers comp is NOT the market cycle, employment, rate adequacy, or regulatory changes.

It is opioids. As Gary Franklin MD, Washington state fund's Medical Director says, this is a "hair on fire" issue.

I'm not talking about the $1.4 billion employers spend on these drugs, nor am I referring to the other medical costs incurred by claimants on opioids or the dollars wasted on diverted drugs or the hundreds of claimants dead from opioids prescribed for their injury; not even the disastrous personal impact on claimants and their families.

It's what opioids do to disability duration - that's what's going to drive up rates, kill off carriers, and jack up employer's premiums.

Claimants on opioids are NOT going back to work; not to their original job, a new job, any job. They can't drive, operate machinery, think clearly, function physically. Most employers can't or won't re-employ opioid-taking claimants out of concern for their safety and additional liability. Can't blame them either.

The issue is this - the industry has not accounted for the financial impact of the explosive growth in opioid usage among long-term lost time claimants. Sure, a couple of big insurers have figured this out and are moving very fast (and very quietly) to assess the risk and try to mitigate the impact, but the vast majority of carriers, employers, reinsurers, actuaries, and regulators have yet to catch on.

While some are beginning to implement programs in an attempt to reduce the initial use of opioids for injuries, that's closing the proverbial barn door after the herd is long gone. These programs are often pretty ineffective as well; even if the medical director/case manager/guidelines recommend against approving opioids, adjusters usually approve them anyway. That's not really the adjuster's fault; they just don't have the experience/education/training/support to make the right call.

The real killer is the claim backlog, those old-dog, legacy claims where the claimant has been on OxyContin, Fentora, Actiq, hydrocodone and god knows what else for five years, where the doses have been escalating, there's been no drug testing for compliance, and the treating doc has no long term plan other than 'more'.

What does this mean for you?

If you aren't already deep into a financial analysis of the real impact of opioids on claim closure, disability duration, indemnity and medical expense, start immediately. Not this afternoon, not tomorrow, not after next month's planning call.


And don't settle for platitudes, for "not to worry we've got that figured out" statements. Demand projections based on actual experience backed up by real data. And be prepared for some very, very bad news.

But better to get that news now then a couple years down the road from your favorite rating agency. While they haven't figured this out yet, you can be sure they will.


  1. By all means,lets join the hysteria to be sure that real pain is under medicated and that patients suffer because crusaders and lawyers have terrified doctors out of prescribing adequate pain medication to those who need it.

  2. Actually, I think he is more concerned with substance abuse following the use of opiates than the appropriate use of them as part of a treatment regimen. He points out that [t]hese programs are often pretty ineffective as well; even if the medical director/case manager/guidelines recommend against approving opioids, adjusters usually approve them anyway. He points specifically to cases where the doses have been escalating, there's been no drug testing for compliance, and the treating doc has no long term plan other than 'more'.
    I know as an employer how harsh the penalties for a company are in Georgia when a former employee fails to return to work as the result of a WC claim.
    In a personal case, not job-related, my wife went through four different orthopedic practices, all of which went with some painful combination of PT and drugs, before she finally went to a specialist willing to recommend back surgery. This was about twenty-five years ago and the referral was to a neuro-surgeon (not orthopedic). Without that intervention I feel sure she would have been on years of drugs instead of (or perhaps in addition to) any recommended daily exercises and lifestyle changes.