kevin walsh m.d
DESCRIPTION
Kevin Walsh M.D. Partner: Industrial Medical Associates Staff Anesthesiologist University Hospital Member of Medical Advisory Committee to Chairperson of WCB. Background. Family Practice Emergency Medicine Occupational Health (IMA) Anesthesiology Interventional Pain Management. - PowerPoint PPT PresentationTRANSCRIPT
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Kevin Walsh M.D.
Partner: Industrial Medical AssociatesStaff Anesthesiologist University Hospital
Member of Medical Advisory Committee to Chairperson of WCB
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Background
• Family Practice• Emergency Medicine• Occupational Health (IMA)• Anesthesiology• Interventional Pain Management
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Today's Objective
• Review WC in context of 2006• Illustrate how the system is
dysfunctional• Identify three pivotal cost drivers
– How they may be better managed
• Case management illustration
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Are Workers Compensation Costs Important?
• Business council of NYS– Major obstacles for recruitment &
retention of jobs in New York State• Tax Structure• WC Costs• Energy Costs
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History of New York’s WC System
• Created by the Legislature around time of WWI
• Legal framework to protect injured workers and employers.
• Orderly litigation, predictable outcome
• Medical sciences were in their infancy, medical costs were irrelevant.
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1980’s Conditions
• Relationship between worker, family, and employers• Health benefits were comprehensive and improving.• Providers preferred to care for injuries under BC/BS -
employees didn’t object.• Fewer MD’s• Fewer paramedical professionals
PT - OT - Chiropractic - Massage Therapy• Few diagnostic tools
Cat scans new to scene• Sparse legal interest locally• Pharmacy costs irrelevant• Biomedical engineering costs were non existent.
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WC - The Players
• The Legislature• Lawyers• WCB • Injured worker• Employer• Physicians & Paraprofessional
Providers• Insurance Carriers
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2006 Conditions
• Workers feel disenfranchised.• No loyalty between worker/employer.• Erosion or absence of benefits.• Private health insurers actively push cases to WC.• Patients and physicians see WC as default
insurance.• Full force of best pharmaceutical marketing
machine in the world with no constraints.• Biomedical engineering research funding.• Proliferation of medical providers and advanced
technologies.• Lifetime medical care.• Inability to close cases.
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Problem
• Modern medical practice & Antiquated WC systemSquare peg / Round hole
• Trying to treat medical problems in a political versus market driven environment
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The (Paradox/Dilemma) in WC Care
• Medical technology abundant• Diagnostic capabilities much improved• Supply of medical and paramedical
specialties abundant
Why is the severity of WC cases escalating rapidly and outcomes of care
are so poor?
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Three Pivotal Cost Drivers
• Nature & Severity of the injury.• Interface between the worker and
employer.• Dynamic between the injured worker
and medical providers.
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Employer / Injured Worker Interface
• Visceral response• Negative • Adversarial
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Injured Worker / Medical Care Dynamic
• Review in detail what happens through the course of long term workers comp case.
• The Human condition + behavior and their implications
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Workers Comp: Low back injury case review
Day 1 - “I really hurt my back”Day 7 - “Feeling a little better thank you”
4 Weeks Later…Feeling Worse
“The Pain Is Awful!”
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Pain
Pain
Nociceptive Pain SufferingAlienation at Work
Fear of Job Loss
Disability
Financial Stress
Family Problems
Too much emphasis on investigating and treating pain.
Suffering is often the dominant factor and it is ignored
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WC Care Walk-through cont’d
6 weeks• In physical therapy
Request CT or MRI scan 10 - 12 weeks
• The pain is worse• Abnormal MRI scan
Request Pain Blocks / EMG study 4 - 6 months
• The pain is worse• Failure of conservative therapy
Request authorization for surgery
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Request for Surgery
• Based on abnormal MRI & report of persistent of pain.
• The most common cause of poor surgical outcomes is not bad surgeons.– It is operating for the wrong reason.
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Pain
Pain
Nociceptive Pain SufferingAlienation at Work
Fear of Job Loss
Disability
Financial Stress
Family Problems
Too much emphasis on investigating and treating pain.
Suffering is often the dominant factor and it is ignored
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Case Continued
6 months plus• Post operative visit
– Still have pain Repeat pain blocks & rehab
• Chronic medication requirement– Including narcotics
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Workers Compensation Cost Cascade
In house health resource$
Off site health resource$$
Hospital based care - Emergency dept.$$$
Specialist consultation - Orthopedic$$$$
Imaging studies - CT, MRI, Pet Scans, EMG$$$$$
OT, PT, Chiro Massage therapy$$$$$$
Surgical Intervention Surgical fee $$$$$$$ Facility fee
More rehab - Pain ManagementNerve blocks $$$$$$$$ Pharmaceuticals
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Managing the Cost Drivers-Nature & Severity-
• Safety training• Safety culture• Ergonomics• Engineering
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Managing the Cost Drivers-Employer / Injured Worker Interface-
• Be positive and supportive.• Treat like a valuable athlete.• How can I help you recover?• You are important to the success of our
business.• Maintain regular personal contact.• Facilitate timely medical care.• Make sure compensation checks arrive
on time.• Make return to work pathway easy.
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Managing the Cost Drivers-Dynamic between Injured Worker & Medical Provider-
• This is really a triad:• Worker• Employer• Medical Provider
• More Complex• Requires persistent effort• When I do right nobody remembers,
when I do wrong nobody forgets.
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Managing the Cost Drivers-Dynamic between Injured Worker & Medical Provider-
• Keep it simple.• Engage with “problem solver”
medical providers / systems.• Attentive patient management.• Mechanisms to resolve disputes
quickly.• Utilization review.• Encourage early return to work.
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Workers Compensation Cost Cascade
In house health resource$
Off site health resource$$
Hospital based care - Emergency dept.$$$
Specialist consultation - Orthopedic$$$$
Imaging studies - CT, MRI, Pet Scans, EMG$$$$$
OT, PT, Chiro Massage therapy$$$$$$
Surgical Intervention Surgical fee $$$$$$$ Facility fee
More rehab - Pain ManagementNerve blocks $$$$$$$$ Pharmaceuticals
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Workers Compensation Reform
• Changes in law will never keep up with changing business environment.
• Employers who manage the process and human behavior can effectively reduce losses regardless of reforms.
• Reform efforts should address:• Direction of care.• Appropriate utilization of medical services.• Timely resolution of all disputes.
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Employer Influence
• Employers can influence the length of the disability more than they realize.
• Manage the process.• Develop relationships/programs with
medical community.
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Wrap Up
• Preemptive efforts:• Invest in the Recruitment Process• Invest in Safety & Training
– Make it important part of culture• Patient Care management:
• When accident or injury occurs don’t pass it off. Be involved in care management from day 1.
• Medical management: Have a “Friend In The Business”• Safety person• Occupational health nurse• Contracted service offsite• Physicians
• Positive ongoing relationship with Employee:• Treat like valuable asset• Frequent in person relationship• Facilitate medical care• Make sure compensation checks arrive on time• Make return to work pathway easy
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Contact Information
Kevin Walsh M.D.Industrial Medical Associates
IMA: (315) 478-1977Digital Pager: (315) 441-1324