WCRI Study Identifies Medical Benchmarks for Texas

WCRI Study Identifies Medical Benchmarks for Texas

Medical payments per workers’ compensation claim changed little in Texas during the five-year period between 2016 and 2021, according to a report from the Workers Compensation Research Institute.

The report analyzes payment trends and utilization of services in the workers’ compensation system in 17 states, including Texas. It found that after medical costs per claim in Texas increased 4% from 2017-2019, they have fallen 6% annually in the years since.

Payments per claim for nonhospital care in Texas declined 4% per year between 2019 and 2022. According to the report, most nonhospital providers in Texas experienced recent decreases in payments per claim, mainly due to a decline in utilization for all nonhospital providers and for most nonhospital services. Utilization of nonhospital care has decreased in many states since 2019/2020, especially in 2021/2022, when the decrease in Texas (11%) was larger than in all but one state in the study.

Payments per claim for hospital outpatient care in Texas grew 5% per year from 2019 to 2021. Payments per service increased 8% per year in the period, partly offset by a decrease in services per claim. The recent increase in hospital outpatient payments per claim was mostly driven by treating/operating/recovery room services. There were increases in payments per service for most outpatient services, especially for treatment/operating/recovery room, which grew 12% per year from 2019 to 2021.

The average hospital payment per inpatient episode increased 24% from 2017 to 2018 for claims at 12 months of experience and remained at that higher level through 2020, followed by a 10% rise in 2021. The 2018 increase was a key factor in the growth in Texas medical payments per claim from 2017/2019 to 2019/2020. The percentage of claims with inpatient care has fluctuated since 2016 but decreased about 1% from 2019 to 2021, a phenomenon also observed in other study states.

The report is free to WCRI members. Information for nonmembers interested in purchasing the report is available here.

OSHA Extends Comment Period for Proposed Rule on Employee Walkaround Designate During Inspections

Deaths on the job from drug overdoses have increased 536% since 2011 and overdoses now cause one in every 11 workplace fatalities, according to the National Safety Council (NSC), which has launched a new workplace safety program, Respond Ready Workplace, designed to increase awareness of the need for naloxone in workplaces and ensure people are trained to use it.

Recent FDA approval of naloxone nasal sprays for over-the-counter use gives workplaces a new lifesaving tool to prevent these deaths. Naloxone is a drug that can temporarily stop many of the life-threatening effects of opioid overdose. The National Safety Council says including naloxone in a workplace first aid kit or elsewhere on-site, and training employees to use it, is a critical component of emergency response to help save a life. Through Respond Ready Workplace, NSC aims to reduce overdose deaths in worksites by supporting the availability of naloxone, related training, and support resources in workplaces.

Key highlights of the Respond Ready Workplace initiative include:

Advocacy and Education: Most employers do not understand the tragic data on the increasing fatalities in the workplace. NSC will provide educational materials to raise awareness about the opioid crisis and the importance of naloxone in mitigating its impact.

Employee Training: NSC will provide comprehensive training resources to educate employees on the proper administration of naloxone, empowering all workers to respond swiftly and effectively in emergency situations.

Naloxone Distribution: The program will guide employers on how to obtain and incorporate medications like naloxone into their workplace first aid kits or other accessible locations.

More information about the Respond Ready Workplace program and how organizations can get involved is available here.

National Safety Council Announces Program to Prevent Workplace Overdoses

Deaths on the job from drug overdoses have increased 536% since 2011 and overdoses now cause one in every 11 workplace fatalities, according to the National Safety Council (NSC), which has launched a new workplace safety program, Respond Ready Workplace, designed to increase awareness of the need for naloxone in workplaces and ensure people are trained to use it.

Recent FDA approval of naloxone nasal sprays for over-the-counter use gives workplaces a new lifesaving tool to prevent these deaths. Naloxone is a drug that can temporarily stop many of the life-threatening effects of opioid overdose. The National Safety Council says including naloxone in a workplace first aid kit or elsewhere on-site, and training employees to use it, is a critical component of emergency response to help save a life. Through Respond Ready Workplace, NSC aims to reduce overdose deaths in worksites by supporting the availability of naloxone, related training, and support resources in workplaces.

Key highlights of the Respond Ready Workplace initiative include:

Advocacy and Education: Most employers do not understand the tragic data on the increasing fatalities in the workplace. NSC will provide educational materials to raise awareness about the opioid crisis and the importance of naloxone in mitigating its impact.

Employee Training: NSC will provide comprehensive training resources to educate employees on the proper administration of naloxone, empowering all workers to respond swiftly and effectively in emergency situations.

Naloxone Distribution: The program will guide employers on how to obtain and incorporate medications like naloxone into their workplace first aid kits or other accessible locations.

More information about the Respond Ready Workplace program and how organizations can get involved is available here.

Department of Labor Adopts Government Shutdown Contingency Plan for OSHA

A government shutdown would limit Occupational Safety and Health Administration (OSHA) safety inspections to those representing ‘imminent danger’ only, according to a contingency plan adopted by the U.S. Department of Labor.

Congress has until Nov. 17 to reach a decision on continued funding for the federal government, including OSHA. If talks fail and the government shuts down, OSHA would furlough 926 of its 2,106 employees (44%) and suspend most of its compliance assistance, outreach, training and regulatory activities, according to the contingency plan.

OSHA Administrator Doug Parker told a congressional panel in September that in the event of a shutdown the agency would respond to a worker fatality, injury or complaint, but would not do proactive inspections.

According to the contingency plan, OSHA would still be able to review whistleblower complaints received during a shutdown about potential problems that pose an imminent threat to the safety of human life or the protection of property, thus requiring an immediate response.

OSHA would also continue to conduct follow-up inspections of establishments with high-gravity, serious violations and no abatement.

The DOL contingency plan for a shutdown is available here.

Survey: Workers Say Culture Drives Productivity

Nearly three-fourths of U.S. workers (73%) say the culture at their workplace impacts their ability to do their best work, and 72% indicate that culture drives their productivity and efficiency, according to a new survey. Some 65% of employees say culture impacts their ability to best serve customers.

These findings are from the 2023 Eagle Hill Consulting Culture Survey conducted by Ipsos from July 25-28, 2023. The survey included 1,315 respondents from a random sample of employees across the U.S.

When asked about the most important elements of the ideal organizational culture, workers say it’s respect (74%), integrity (57%), stability (55%), ethical treatment (53%) and employee well-being (51%).

Other findings include the following:

When queried about who impacts organizational culture, 86% say it’s their colleagues, 79% say it’s their boss, 75% say it is human resources leaders, and 69% say it is executive leadership.

Suggested actions employers could take to create a healthy workplace include investing in improving employee well-being (51%), holding workers accountable for bad behavior (46%), and leadership development (42%).

Only 30% of workers say their company has increased its focus on employee well-being during the past year. Fifty-four percent say the focus on employee well-being remained steady, and 17% percent say there is less of a focus.

When asked who they trust in their workplace, 45% of workers say they trust their colleagues, 42% trust their boss, and only 13% trust executive leadership.

Thirty-nine percent of workers say their organizational culture is better than most organizations, and 10% say it is worse. Fifty-one percent say their culture is about the same as other organizations’.

Eighteen percent of employees say they have reported unethical behavior observed in their workplace.

More information about the survey is available here.

Study Shows Diversity, Equity and Inclusion Is Important When Workers Consider Company for Employment

A recent survey reveals 53% of U.S. workers say diversity, equity and inclusion (DEI) is a key factor when considering a company for employment, especially among younger workers, with Gen Z at 77% and Millennials at 63%.

Other findings include:

During the recruitment process, workers say it is important to hear that employee perspectives are valued (85%), employees feel safe bringing their authentic self to work (80%), leadership has transparent decision making (80%), and the company has a collaborative culture (75%).

When considering a new job, employees say it is important that there are employees they identify with (63%), leaders they identify with (59%), and that DEI is a priority for the CEO (52%).

Factors that employees say are important when choosing an employer include meaningful work (61%), confidence in the company (53%), identifying with company values (41%), and enthusiasm about the mission (41%).

When considering a new job, employees say it is important to hear that the company promotes work-life balance (87%), workers feel respected (87%), employees are recognized for their work (86%), and workers feel connected to their colleagues (77%).

More than half of employees (55%) indicate that the ability to advance their compensation is important when considering a new job, as is career advancement potential (49%), career training (47%), relationships for career advice (41%), and equitable career advancement opportunities (35%).

The 2023 Eagle Hill Consulting Diversity, Equity and Inclusion Survey was conducted by Ipsos from July 7-12, 2023, and included 1,395 respondents from a random sample of employees across the United States.

EEOC Proposes New Guidance on Workplace Harassment

The U.S. Equal Employment Opportunity Commission (EEOC) is proposing its first new guidance on workplace harassment in nearly 25 years, with new guidance on trans rights, women’s reproductive decisions, and social media, among others.

If approved, the guidance would not have the effect of law, however; it would be a resource for employers to understand what EEOC considers workplace harassment.

Among the major points addressed:

  • Intentionally or repeatedly misusing an individual’s preferred name or pronoun or denying access to a bathroom consistent with an individual’s gender identity would be considered sex harassment. Sex-based harassment would include actions based on a woman’s reproductive decisions, such as contraception or abortion.
  • Employers could be held liable for their employees’ personal activity outside of the workplace, including over social media. According to the EEOC, conduct that happens outside the workplace can still create a hostile work environment if it has consequences in the workplace. It cited as an example a Black woman who alleged she was the subject of co-workers’ harassing conduct at work that culminated in an offensive race-based Instagram post. According to EEOC, the combined conduct, including the social media post, is sufficient to create a hostile work environment.
  • The new guidance also clarifies what it expects employers to include in their anti-harassment policies, stating that an effective anti-harassment policy should be “comprehensible to workers, including those who the employer has reason to believe might have barriers to comprehension” (e.g., limited English proficiency), and should include: a definition of the prohibited conduct; a requirement that supervisors report harassment; a statement that clearly identifies accessible points of contact for reporting purposes, including contact information; and explain the complaint process, including anti-retaliation and confidentiality protections.

The proposed guidance is available here.

Workers’ Concern About Financial Well-Being Grows

A trio of recent surveys find workers exceedingly worried about their financial well-being and whether they can save enough for retirement.

According to a recent survey commissioned by Human Interest and conducted by OnePoll of 1,000 salaried and 1,000 hourly employed workers, roughly one-third of hourly employees say they are “winging it” when it comes to retirement; they are also less confident that they will retire comfortably compared to salaried workers (53% vs. 63%). Those results are similar to those of a recent survey from Bankrate of 2,527 U.S. adults, of whom 1,301 are working full time, part time, or are temporarily unemployed. The Bankrate survey of retirement goals shows 56% of working Americans feel behind their goal, including 37% who feel significantly behind. Some 22% of workers surveyed say they did not make contributions to their retirement savings last year and won’t be doing so this year either.

The third survey, the 2023 Workplace Wellness Survey, a joint project of Greenwald Research and the Employee Benefit Research Institute, finds a majority of workers are worried employers will reduce hours and benefits, cut wages, and lay workers off. More than half of workers (57%) do not feel financially prepared for reduced hours or temporary unemployment.

According to the survey, 51% of workers are satisfied with their current jobs, down from 59% last year. A similar number say they are likely to stay with their current employer for the next two years.

Nearly eight in 10 workers are at least somewhat satisfied with their employee benefits package, similar to last year. More than half of employees (54%) say a greater financial contribution from their employer would be a valuable improvement to benefits programs – up from 42% last year.

The Human Interest survey is available here.

The Bankrate survey is available here.

The 2023 Workplace Wellness Survey is available here.

Software Tool Measures Workers’ Job Satisfaction and Happiness

Workers are unhappier today than they were during the middle of the COVID-19 shutdown, with employee happiness dropping 8% from 2020, according to a new report.

HR software platform BambooHR analyzed data from almost 60,000 employees at more than 1,600 companies worldwide between January 2020 and June 2023 to measure job satisfaction and happiness. Its findings are based on what BambooHR calls an eNPS (employer Net Promoter Score), which is derived from a numeric rating of how likely employees are to recommend the organization as a place to work, and an open-ended question about their reasoning.

Additionally, the report analyzed volatility by tracking the total movement of eNPS over time, calculated using the percentage difference between each month’s average eNPS. High volatility reflects more dramatic highs and lows within a time period, while low volatility denotes consistency.

The report found that employees appear resigned to low morale.

“Employees aren’t experiencing highs or lows — instead, they are expressing a sense of resignation or even apathy,” according to the report. “Most simply accept that morale is getting worse.”

According to the report, happiness spiked to an all-time high (45 eNPS) in April 2020 as the initial shock of lockdowns faded and more information about the COVID virus — and relief plans — emerged.

Both 2021 and 2022 began with high levels of happiness and gradually tapered off throughout the summer months before rebounding slightly as the winter holidays approached. However, employee happiness reached a low point in June 2023, with an eNPS of 37.

The report is available here.

The Challenge of Topical Compound Drugs in Workers’ Compensation
By Ron Carter - RxBridge

Compound drugs are medications created by compounding pharmacies that combine two or more individual drug ingredients to meet the specific needs of a patient. These customized medications can be beneficial when standard, off-the-shelf drugs do not work for a patient or are unavailable due to allergies or other reasons. While compound drugs can offer benefits in certain situations, they also pose several challenges for claims payers. Topical compounds can be dispensed for injured employees. In light of this, it’s important to have a program in place to review and assess compound topicals for clinical effectiveness to help ensure patient safety and, secondarily, cost-effectiveness.

Topical medications are a common choice for treating various ailments. These preparations are applied directly to the skin, offering relief from conditions ranging from skin infections to muscle pain. While topicals can be prescribed responsibly, there are instances where alternatives can prove more cost-effective.

Commercially available topicals have FDA approval and offer tried-and-true treatments. However, even within this category, cost disparities can arise. Consider the Lidocaine 5% patch, a prescription-only option costing approximately $200 for a 30-patch supply. In contrast, the over-the-counter (OTC) 4% patch costs around $50, meriting the question of whether the 5% patch is really needed. Similarly, prescription diclofenac topicals can be pricier than their OTC counterparts, providing an opportunity to explore more cost-effective options.

Designer topicals, often dispensed exclusively through physicians, claim to offer unique formulations and appealing qualities, such as nongreasy textures or better adhesion. While they may tout slight differences in potency compared to OTC alternatives, their costs can be significantly higher. For instance, Terocin lotion, with 10% menthol, 0.025% capsaicin, and 25% methyl salicylate, can run around $480-$500 for a 4-oz. tube. A similar OTC product like Ziks arthritis cream, with 1% menthol, 0.025% Capsaicin, and 12.5% methyl salicylate, costs just $9.99. The allure of designer topicals should be weighed against their substantial price tags.

Compound topicals are unique, as they are not commercially available and are crafted by pharmacists based on a doctor’s prescription. These preparations often contain multiple ingredients and can be quite costly. It’s crucial to note that if even one ingredient in a compound topical lacks FDA approval for topical use, the entire preparation loses FDA approval.

One prevalent example involves the incorporation of gabapentin, an anticonvulsant, into topical compounds. While some may advocate for its effectiveness in topical form, there is no substantial evidence to support this claim. Consequently, gabapentin is not FDA approved for topical use, rendering the entire compound non-FDA approved. Such instances raise concerns about the safety and efficacy of compound topicals in the workers’ compensation context.

The use of topical medications in workers’ compensation presents a complex landscape. While these treatments can offer relief, there are notable issues surrounding cost, efficacy, and FDA approval. It’s essential for stakeholders to critically evaluate the choice of topicals, considering both the well-being of injured workers and the financial implications. Identifying more clinically efficacious and cost-effective alternatives and ensuring the FDA’s stamp of approval for compound topicals are steps toward addressing these challenges.

Challenges with topicals include:

  1. Lack of Regulation and Standardization: Unlike FDA-approved medications, compound drugs are not subjected to the same rigorous testing and quality control standards. This can lead to variations in potency, safety, and effectiveness, making it difficult to predict how a particular compound drug will affect a patient.
  2. Cost Inflation: Compound drugs can be significantly more expensive than their commercially available counterparts. The high cost may incentivize overutilization, which can drive up overall workers’ compensation expenses.
  3. Potential for Fraud and Abuse: The complexity and lack of oversight in the compounding industry have created opportunities for fraud and abuse. Some providers may overprescribe compound drugs or collude with compounding pharmacies to maximize their profits.
  4. Limited Scientific Evidence: Unlike standard medications, compound drugs often lack robust scientific evidence to support their efficacy and safety. This makes it challenging for claims professionals to make informed decisions about their use. In some cases, injured workers may be subjected to treatments with uncertain benefits and potential risks.
  5. Delayed Recovery: Inconsistent or ineffective compound drugs can lead to delayed recovery for injured workers. Workers may experience prolonged pain and suffering, extended periods of disability, and difficulties returning to work. These delays not only impact the workers’ quality of life but also increase the financial burden for claims payers.

Texas News

Insurance Business
Texas Mutal Announces Dual Promotions
Workers’ compensation provider Texas Mutual Insurance Company has announced the promotion of two employees to vice president. Click here for full article.

State News

Delaware Public Media
Workers’ Compensation Insurance Rates In Delaware Drop For A 7th Straight Year
“Back in 2016 workers compensation insurance premiums were higher in Delaware than almost every other state in the country. And the Markell administration had seen this as a significant challenge for business owners here in Delaware. In fact, some were moving to our surrounding states because these premiums for workers’ comp were so high,” explained Delaware Insurance Commissioner Trinidad Navarro. Click here for full article. 

Insurance Journal
Kentucky Approves 18th-straight Decrease in Workers’ Comp Loss Costs
Kentucky’s Insurance Commissioner has approved a 6.4% decrease in average workers’ compensation loss costs for the state, making it the 18th consecutive drop in costs for most Kentucky employers. Click here for full article.

WTKR
Abby Zwerner Lawsuit: Judge Holds Off Ruling On Former Newport News Teacher’s Compensation Claims
A Newport News judge said he will wait to decide if a former Richneck Elementary teacher shot by a student is covered under workers’ compensation, or if her $40 million lawsuit goes to trial. Click here for full article.

AP News
A Teacher Was Shot By Her 6-year-old Student. Is Workers’ Compensation Enough?
A heated debate has emerged about the once-unimaginable shooting of a Virginia teacher by her 6-year-old student: How should the school district take care of the teacher? Click here for full article.

KXLY
Local Firefighter With Cander Doesn’t Qualify For Worker’s Compensation
“You want to help them because you might have a neat day, but the people that you’re trying to help are having the worst day in the world. And, you want to try to make that a little better,” Ron Cato, a former local Spokane County firefighter said. Click here for full article.

The Black Chronicle
Business Leaders Protest Washington’s Workers’ Comp Rate Hike Plan
Three out of four people on Thursday morning testified against the Washington State Department of Labor & Industries’ proposal for an overall average rate increase of 4.9% in workers’ compensation, which it says will ensure adequate premiums to cover expected costs in 2024 claims. Click here for full article.

General News

Forbes
Mental Health Issues Soar To Number 1 Workplace Injury
As October 10th recognizes World Mental Health Day, chronic stress and burnout continue to sweep through the workplace, and workplace anxiety has become a top occupational hazard. Click here for full article.

The Insurer 
The Hartford: Workers’ Comp Remains “Steady” Despite Growing Loss Cost Concerns
The Hartford’s CEO Chris Swift has expressed optimism on workers’ comp pricing and loss cost trends, despite some increasing concerns that claims costs are rising. Click here for full article.

Lockton
Beyond Analytics: Unlocking savings from Workers’ Compensation
As economic uncertainty and a hard insurance market persist, companies continue to seek cost reductions. Workers’ compensation is typically the largest controllable expense for an organization, but traditional cost control efforts aren’t always effective. Click here for full article.

Property Casualty 360
Technology Transformation In Workers’ Compensation
Whether you are a risk manager, physician, attorney, claims manager, payer, or service provider, the evolution of technology modernization in workers’ compensation affects everyone. Click here for full article.

Jonathan Perkins – Injury Lawyers
How Pre-Existing Conditions Can Impact Your Workers’ Compensation Claim
or most people, a long-term physical condition, such as achy joints or a back issue, does not mean they cannot work. However, you may wonder, “What if my job aggravates the condition or makes it worse?” Click here for full article.

Medscape
6% of Workers’ Comp Cases Are for Long COVID, But Many Can’t Collect
Long COVID cases now account for 6% of all workers’ compensation claims, according to a new study released by the Workers Compensation Research Institute (WCRI), a nonprofit research and trade group. Click here for full article.

WorkersCompensation.com
Report Highlights Loss of Experienced Workers in Healthcare
Although the pandemic has passed, the cost of caring for patients has continued to rise. According to an April report from the American Hospital Association, average drug costs per patient increased 31.6 percent from 2021 to 2022. Click here for full article.

Statista
Directo Costs Of The Top 10 Most Disabling U.S. Workplace Injuries in 2023
In terms of cost, falls on the same level were the second most disabling workplace injury in the United States in 2023. The direct costs for this type of injury that year stood at some 8.98 billion U.S. dollars. Click here for full article.

NBC News
People Who’ve Had COVID At Least 5 Times Describe How The Illness Changed With Each Reinfection
Nearly four years after Covid’s emergence, plenty of people have tested positive at least twice. But an unlucky group has been hit with reinfection after reinfection. Click here for full article.

The New York Times
Feeling Terrible After Your Covid Shot? Then It’s Probably Working
Fever, chills and fatigue may all be signs of vigorous antibody production, a new study finds. Click here for full article.

The Washington Post
1 Percent Of Children Had Long COVID Through Last Year, CDC Says
In a new survey conducted by the National Center for Health Statistics (NCHS), the CDC found that 1.3 percent of children had long COVID in 2022 and 0.5 percent now have it. Click here for full article.

NPR
The CDC Will No Longer Issue COVID-19 Vaccination Cards
The CDC will no longer be issuing COVID-19 vaccination cards, the agency said in guidance updated on Wednesday. It will also not be keeping records of people’s vaccinations, as there is no national vaccine registry. Click here for full article.

Yale Medicine
Comparing the COVID-19 Vaccines: How Are They Different?
COVID-19 is now in its fourth year, and the Omicron variant and its subvariants are still driving infections in cases in the United States. The good news is that vaccines are still expected to be effective at preventing severe disease, hospitalization, and death from COVID. Click here for full article.

The New York Times
Am I Still Contagious?
As you begin to feel better, the amount of virus in your body drops quickly, and it’s generally safe to assume that you’re no longer very contagious after Day 3. Click here for full article.

NBC News
Sore Throat, Then Congestion: Common COVID Symptoms Follow A Pattern Now, Doctors Say
Doctors say they’re finding it increasingly difficult to distinguish Covid from allergies or the common cold, even as hospitalizations tick up. Click here for full article.