Monday, December 17, 2012

Florida Medical Association: Predictable, but Still Disappointing

The Florida Medical Association (FMA) has decided, according to Florida State Senator Alan Hays, to oppose forthcoming legislation intended to remove the economic incentive for physicians to dispense medication.  The language of the bill is likely to mirror the language found in SB 668 from this past year's legislative session. 

The bill will not, in fact, restrict the rights of physicians to dispense medications but rather will focus on eliminating egregious billing practices by forcing physicians to essentially mirror the state fee schedule when they do choose to dispense medications to patients.  Given that we've seen virtually no evidence that such restrictions have resulted in either access or compliance issues for patients, this seems like something that should enjoy broad support.

While the FMA has refused public comment, Senator Hays indicated that FMA's opposition is based on the organization receiving "a significant number of emails objecting to the bill and saying it would diminish doctors' ability to dispense drugs." 

Maybe the FMA should read SB 668.  Or wait until Senator Hays submits his bill for the forthcoming legislative session.  And then maybe the FMA could help facilitate progress by educating its membership on the language of the legislation and helping doctors to understand that, by exploiting loopholes and artificially inflating drug prices, they are not doing themselves any favors.  Perhaps FMA could act strategically by helping doctors understand that the short-term economic windfall they are experiencing may not be in the best interests of the patient.

On the other hand, the FMA could stake out premature and thoughtless positions driven by what I hope is an uninformed minority of its membership. 

Senator Hays thinks he has the votes either way, so let's do what we can to help him.

On Twitter @PRIUM1

Thursday, December 13, 2012

Opioids and Cancer: Adding Risks to the List

As if we needed additional reasons to help injured workers avoid the detrimental effects of long term opioid use... we can now add cancer to the list.

A study published in the journal Anesthesiology and led by University of Chicago researcher Patrick Singleton has shown that opioids can enhance the malignant tendencies of cancer cells.  The study suggests that the same mu receptor cells that enable the powerful pain relieving effects of opioids are also present in cancer cells and, when opioids are present, can influence the progression and spread of cancer. 

Interestingly, this is good news in the oncology community.  The article states: "In a series of labortaory studies, Drs. Singleton and Moss found that drugs which blocked the mu opioid receptors reduced cancer growth in animals and helped prevent further invasion and spread of cancer cells.  Further, tumors did not grow in mice that lacked the mu opioid receptor."

Of course, I can't help but think about the inverse.  How many injured workers might (emphasis on might) experience more rapid cancer growth due to the abundance of opioids being taken? 

Granted, the studies thus far are all bench science - no human trials have been conducted.  But the body of evidence continues to grow regarding the dangers inherent in long term opioid use. 

On Twitter @PRIUM1

Tuesday, December 4, 2012

Managing the Managers Who Manage Managed Care

That's not a typo.  That's the challenge of contemporary workers' compensation claims management.  Part of the cynicism and frustration in workers' comp today is driven by the backward incentives and cumbersome statutory constraints of the system.  But another important driver of frustration is the rather complicated managed care infrastructure we've created for ourselves (albeit unintentionally).  As an artifact of the regulatory process in most states, work comp is now rife with the time lines and technicalities of MPNs, UR, BR, PPOs, IMEs, WCJs, ALJs, ADLs, AOE/COE, DOIs, MMIs, and lots of other acronyms that make injured workers and payers alike crazy. 

Commercial and government health plans grapple with some of these constraints, but work comp is a universe all its own when it comes to navigating a claim from start to finish (if, in fact, getting to a proverbial "finish line" is possible).  Others far more experienced than I could probably walk through the detailed history of the development of all of this, but I've simplified it (mostly so I can understand it) to the following: The grand bargain of work comp (a.k.a. the exclusive remedy) is not static.  In fact, it is dynamic and its evolution is marked by legislative and regulatory measures designed to rebalance the bargain when economic realities demand it.

When a state engages in "work comp reform", what that state is essentially doing is "rebalancing the bargain" because the economics of the current system are, in some material way, out of whack.  This is incredibly difficult to do given the micro and macro economic forces at work both within and outside of the work comp system and the special interests that attempt to influence the outcome of the effort.  Sometimes, the bargain tips too far toward the payer/employer... sometimes it tips too far toward the injured worker. 

Regardless of which direction the scale tips, there is no panacea for claims management.  On the other hand, the level of cynicism in work comp is creating blind spots in the claims management process that lead to missed opportunities for positive outcomes.  I find too many assumptions about bad doctors, unmotivated claimants, greedy lawyers, and ineffectual judicial processes.  All of these exist, no doubt.  But opportunities for progress are missed when we assume that engagement and discussion won't move the needle.

Let's engage the participants in the system not in new ways, but rather the old fashioned way.  Let's take the processes, time lines, and technicalities of managed care and call those "Plan B" (they have a place and we need to use those tools when necessary).  And let's develop a "Plan A" that's focused on simply communicating with each other about the best path forward to achieve the clinical and financial outcomes we all want. 

We've forgotten how to talk with each other. 

On Twitter @PRIUM1