Top Medical Cost Drivers 2013 NCSI Annual Meeting

Report
2013 NCSI Annual Meeting
May 19-22, 2013
Rancho Bernardo Inn
San Diego
Presented by:
Kevin Glennon, RN, BSN, CDMS, CWCP, QRP
Vice President Home Health & Complex Care Services
MSC Care Management-A One Call Care Management Company
Disclosure Statement
Kevin T. Glennon, RN, BSN, CDMS, CWCP, QRP works for MSC Care Management-A
One Call Care Management Company as their Vice President of Home Health
and Complex Care Services. A provider of Home Health, Infusion Therapy,
Complex Care Coordination, Medical Equipment, Devices and Supplies and
Assistive Technology Products and Services in the Workers’ Compensation
Industry.
Off label use of certain medications may be discussed during this presentation
along with Nursing considerations.
Discussions related to urine drug testing companies may be discussed during this
presentation .
Additionally no financial relationships exist with any commercial party.
Objectives
 Review case studies to learn to expect the unexpected
 Identify the needs of the aged worker, the
obese/overweight worker and the injured worker with
significant co-morbidities
 Discuss the level of medical care and treatment needed,
the increased costs associated and how co-morbidities
adversely affect recovery and indemnity benefits
 Understand increased recovery times for better return to
work planning based on injury, age and adverse factors
The Current Trend
NCCI’s latest review indicates:
 Overall claim frequency has increased for the first
time since 1997 (3%). Prior years trend -4.3%
 Indemnity decreased by 3% and Medical
increased by 2%
 Workers compensation medical costs per claim
average more than $6,000 and soar to nearly
$25,000 for lost-time claims
 Prescription drug (Rx) use, a medical expense
that makes up 19% of all workers compensation
(WC) medical costs
Complex Injuries and Complicating Factors
Head Injuries
Spinal Cord Injuries
Amputations
Spinal Fusion Surgeries
Multiple Fractures
Pelvic Fractures
Crush Injuries
Burns
Upper & Lower
Extremity Injuries
Diabetes
Obesity
Circulatory Disorders
Cardiac Conditions
Hypertension
Neurological
Abnormalities
Age
Infection
Home Environmentort
OBESITY - ICD 9 278
Obese claims are 2.8
times more expensive
than non-obese claims at
the 12-month maturity
This cost difference
climbs to a factor of 4.5
at the three year
maturity and to 5.3 at the
five year maturity
The cost difference (at
the five year maturity) is
less for females than for
males
Obesity Supersizing Workers’ Compensation
Costs
$78.5 Billion/1998
$147 Billion/2008
46.6% Increase
27% of increased medical costs directly related to
obesity
Medical 29%-117% greater than normal weight
Approximately 1/3 of all Americans are obese (>72
million)
$62.7 billion direct costs (medical)
$56.3 billion indirect costs (includes lost work days)
Obesity Statistics
Obesity Related Co-Morbidities
 Hypertension
 Dyslipidemia
 Diabetes
 Coronary Heart
Disease
 Stroke
 Gall bladder
Disease
Osteoarthritis
Orthopedic
Problems
Impaired Mobility
Peripheral Vascular
Disease
Kidney Failure
Sleep Apnea
Osteoarthritis is the most common joint disorder
affecting
Hands
Hips
Knees
Neck
Back
10 extra pounds of weight increases the force on
the knee by 30-60 pounds with each step
Body Composition
Know Your Weight Limits
Know Your Weight Limits
Rising obesity will cost U.S. health care $344 billion a year
If Americans continue to pack on pounds, obesity will
cost the USA about $344 billion in medical-related
expenses by 2018, eating up about 21% of healthcare spending, says the first analysis to estimate the
future medical costs of excess weight.
"Obesity is going to be a leading driver in rising
health-care costs," says Kenneth Thorpe, chairman of
the department of health policy and management at
Emory University in Atlanta
The Aging Workforce
The Generation Gap
 Traditionalists (born 1927-1945) - Typically loyal,
hardworking with the best collective work ethic
 Baby Boomers (born 1946-1964) 73 mil- Typically
competitive, political, hardworking, and entrepreneurial
 Generation X (born 1965-1981) 49 mil- Typically
entrepreneurial, independent, looking to improve skill set
 Millennials‘ (born 1982 - 2000)80 mil - they're trustworthy,
loyal, helpful, friendly, courteous, kind, obedient, cheerful,
thrifty, brave, clean, and reverent
The Aging Workforce
This increase does not just reflect the aging of the baby-boom
population, since none had yet reached age 65
BLS expects the growth in employment to continue
During the period 2006-2016
Workers age 55-64 are expected to climb by 36.5%
Workers between the ages of 65 and 74 and those aged 75
and up are predicted to soar by more than 80%
The Risk
Older workers pose an increased risk for fatal work injuries
Require more time to return to work following an injury or
illness
And are less likely to receive training as their jobs change
With many employees staying in the workforce past
retirement age, there is growing concern for aging worker
safety
There are many challenges that face this group of people that,
if not appropriately addressed, could lead to serious, longterm injury in the workplace with little or no hope of recovery
to a normal life
Managing Safety for the Aging Workforce
 Many employers have shifted their focus to wellness and
prevention as a means to address the healthcare costs of an
aging workforce, with an emphasis placed on such services
as smoking cessation and weight management in addition
to addressing the current physical demands of jobs
 Risk Management Shift to Job Modification for current
employees
 What needs to be done to keep the aging workforce safe in
the current work environment
Managing Safety for the Aging Workforce
 Specific safety concerns for older workers:
 Shorter memory
 More easily distracted, e.g., by environmental
noise
 Slower reaction time
 Declining vision and hearing
 Poorer sense of balance
 Denial of decreasing abilities, which can lead to
employees trying to work past their new limits
Managing Safety for the Aging Workforce

These physical limitations lead to the following injury types for older workers:
 Falls caused by poor balance, slowed reaction time, visual problems, or
distractions
 Sprains and strains from loss of strength, endurance, and flexibility
 Cardiopulmonary overexertion in heat or cold, at heights, using
respirators, or in confined spaces
 Health- or disease-related illnesses, such as diabetes, cancer,
osteoporosis, coronary artery disease, or hypertension
 Accumulation injuries from years of doing the same task, e.g., truck
drivers who experience loss of hearing in left ear from road noise with cab
window open
Challenges
 Equipment needs change
 Potential for additional surgery
 Medications may be contraindicated or no longer effective
 Liver and Kidney issues
 Loss of family caregiver/support
 Are all these changes related
 Is anyone monitoring who is prescribing what medications
Mitigating Risk
With varying perspectives on what constitutes an older
worker, there is no set definition. The Age Discrimination
in Employment Act of 1967 (ADEA) applies to individuals
aged 40 and over
The majority of workers in their 50s work full-time
regardless of health status.3 These workers are often
affected by health conditions that can limit their ability to
work. For example, more than one-third (35%) of workers
in their 50s who report being in fair to poor health
indicated that a health condition limits the type or amount
of work they can do
Proportion of workers age 51-59 with work
limitations, by health status
Managing Safety for the Aging Workforce
 Look for these signs that older workers may need accommodations:
 Physical signs, such as fatigue, tripping
 Psychological or emotional signs, such as loss of patience, irritability
 Feedback from supervisors or co-workers on declining performance
 Numbers and patterns of sick day
 History of minor injuries or near misses
Antibiotic Resistant Infections
Increased Risk
Infectious diseases continue to be a leading cause of
death worldwide
It is the third leading cause of death in the United
States
 Emergence of new infectious diseases
 Re-emergence of old infectious diseases
 Persistence of intractable infectious diseases
Increased Risk
 The Institute of Medicine estimates that the annual
cost of treating antibiotic resistant infections in the
United States may be as high as $90 billion
 Doctors currently prescribe antibiotics for outpatients
approximately 150 million times a year
 CDC estimates that approximately 50% of all antibiotic
prescriptions are unnecessary
A Classic Example
 The literature on the management of ankle fractures in patients with diabetes has
shown outcomes to be generally poor
 42.3 % incidence of complications in patients with diabetes compared to people
without (McCormick and Leith)
 Conservative management may be preferable to surgical treatment
 32 % higher infection rate found in people with diabetes ( Flynn, et. al.)
 Those patients with diabetes who were treated conservatively had a greater tendency
to become infected over those who treat with open reduction internal fixation (ORIF)
 People with diabetes who are poorly controlled and had evidence of neuropathy were
shown to be very difficult to manage
Prolonged Recovery
04-29-1997
06-30-1997
A Cost Comparison
Claimant A
130 lbs with post-op infection
Needs cubic in 5mg/Kg/Q24 59Kg @ 5mg/Kg = 295 mg/day
Cost @ $1.19/mg x 295mg = $351.64/day
Claimant B
330 lbs with post-op infection
Needs cubic in 5mg/Kg/Q24 150Kg @ 5mg/Kg = 750 mg/day
Cost @ $1.19/mg x 750mg = $892.50/day
NCCI Reports
Pharmacy costs are
19% of total medical
spending in Worker’s
Compensation
Drug Deaths now outnumber
Traffic Fatalities in US
Approximately 38,000 deaths
annually
1 death every 14 minutes
Death toll has doubled over
the last decade
Prescription Drugs now cause
more deaths than Heroin &
Cocaine Combined
OxyContin Habit can run twice
as much as a Heroin Addiction
 Most commonly
abused Drugs

OxyContin

Fentanyl

Actique

Vicodin

Xanax

Soma
TOP 50 DRUGS
OXYCONTIN®
LIDODERM®
HYDROCODONE-ACETAMINOPHEN LYRICA®
CELEBREX®
GABAPENTIN
SKELAXIN®
CYMBALTA®
MELOXICAM
CYCLOBENZAPRINE HCL
TRAMADOL HCL
OMEPRAZOLE
FENTANYL
FLECTOR®
OXYCODONE HCL
ULTRAM® ER
OXYCODONE HCL-ACETAMINOPHEN
CARISOPRODOL
NAPROXEN
KADIAN®
ZOLPIDEM TARTRATE
OPANA® ER
AMRIX®
TIZANIDINE HCL
AMBIEN CR®
PERCOCET®
IBUPROFEN
NAPROXEN SODIUM
OXYCODONE-ACETAMINOPHEN
ACTIQ®
ENDOCET®
AVINZA®
LUNESTA®
DURAGESIC®
NEXIUM®
LOVENOX®
FENTANYL CITRATE
MORPHINE SULFATE
EFFEXOR XR®
DENDRACIN, NEURODENDRAXIN®
TOPIRAMATE
TOPAMAX®
DICLOFENAC SODIUM
PROPOXYPHENE NAP-ACETAMINOPHEN
ETODOLAC
NABUMETONE
PROVIGIL®
LEXAPRO®
ZANAFLEX®
SEROQUEL®
Adherence/Efficacy
All individuals are different:
Slow
Metabolizers
Fast
Metabolizers
NON
Metabolizers
Based on adherence studies…
Less than 30% of claimants take their medications as
prescribed
More than 30% fill their medications but do not take
them
More than 30% take additional medications and/or
substances that can reduce or eliminate the efficacy
of the prescribed medications
Economic Impact
 For every dollar Medicare spends on medications, it costs $1.33 to manage the
complications of those medications
 Medication-related problems account for $88.2 billion/annually
 Infectious Disease is the third leading cause of death in the United States
 The Institute of Medicine estimates that the annual cost of treating antibiotic
resistant infections in the United States may be as high as $90 billion
 Doctors currently prescribe antibiotics for outpatients approximately 150
million times a year
 CDC estimates that approximately 50% of all antibiotic prescriptions are
unnecessary
Learn to Expect the Unexpected

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