In a nutshell
Much
has been said about the cost of Schedule II pain medications in Workers’
Compensation. Rebecca Shafer, JD recently summarized the stunning financial
impact in this way: “The average lost time work comp claim in the U.S. without
the use of opioids cost $13,000. When an employee is prescribed a short-acting
opioid like Percocet, the average lost time claim cost triples to $39,000. When
an employee is prescribed a long-acting opioid like oxycontin, the average lost
time claim costs explodes to $117,000, an increase of 900% over the average
lost time work comp claim without the use of any opioids.”[1]
Do nothing
Obviously,
doing nothing about this problem is not an option. Moreover, cost is not the
only issue. The lives of injured workers, their families, and fellow workers
are affected by long term use of Opioids used in the treatment of pain. The probability
of return to pre-injury status after long term treatment with Opioids is meager. Analyze prescription practices
The first step in solving or mitigating the problem is to analyze the data to profile medical doctor prescribing history. Those who continually prescribe Opioids of any type, and particularly those who prescribe long acting Opioids should not be a part of any medical provider network. A proactive strategy should be used to eliminate such doctors from the network and direct injured workers to best practice doctors.
The best doctor solution
Direct injured workers to best
practice providers. Avoiding over-prescribing doctors will solve the problem. Pretty simple.
Automatic trigger
Nevertheless,
in situations where avoiding the perpetrators is impossible or they are unknown,
another approach is available. Ms. Shafer recommends, “If you do not have a
nurse case manager assigned to all of your lost time claims, the issuance of a
prescription to the injured employee for any narcotic should be an automatic
trigger to assign the nurse case manager.”[2]
The catch
The
catch is, what is an automatic trigger or how is the information about
prescriptions conveyed to nurse case managers?
The
most expedient way to spot Opioid prescriptions and impending disaster is through
concurrent electronic data monitoring.
Proactive medical management
The
trick is to always know when a narcotic is ordered and to monitor the type and
subsequent prescriptions. Manual monitoring is time consuming and costly. It is
also inaccurate as important information is easily missed. Instead, apply the
power of technology through concurrent electronic data monitoring. Deliver
automatic alerts to nurse case managers. The nurse will take it from there to
discuss the treatment plan with the doctor, provide the doctor with evidence of
poor results with continued Opioid use, and refer to peer review when the
doctor is resistant.
Responsible Opioid use
The
question might be posed, “Should Opioids ever be prescribed for pain?” The
answer is yes. Opioids, can be very effective pain relievers and injured
workers deserve relief from acute pain. However, responsible prescribing and monitoring
prescriptions is essential to avoiding the disaster of addiction.
Data made a
work-in-progress information tool
Systems designed and to monitor
prescriptions and automatically alert the appropriate person when Opioids are
prescribed are available. Alerts can be adjusted to the number and type of prescriptions,
thereby establishing consistent standards of care. Read more about how to make
data a work-in-progress information tool for proactive computer-intensified
medical management How to Optimizethe Nurse Case Management Advantage.
Karen Wolfe is President and CEO of MedMetrics®, LLC, an online Workers’ Compensation analytics company.
MedMetrics analyzes data to score provider medical performance and provides “apps”
for quick look-up of best practice providers by medical specialty and geo-zip,.
MedMetrics also monitors concurrent integrated data to detect potentially high
risk or high cost events in claims and automatically alert the appropriate
persons.
