Heart Disease Treatment, Associated Lost Productivity Costs Rising at Alarming Rate

The cost to treat heart disease will triple by 2030, and lost productivity costs alone will increase by an estimated 61 percent, according to a policy statement issued this week by an American Heart Association (AHA) expert panel.

For the study, productivity losses are defined as days missed from home or work tasks because of illness and potential lost earnings because of premature death.

The panel said effective prevention strategies are needed to limit the growing burden of cardiovascular disease, the leading cause of death in the United States that accounts for 17 percent of overall national health expenditures.

“Unhealthy behaviors and unhealthy environments have contributed to a tidal wave of risk factors among many Americans,” said AHA CEO Nancy Brown. “Early intervention and evidence-based public policies are absolute musts to significantly reduce alarming rates of obesity, hypertension, tobacco use and cholesterol levels.”

About the Findings

To prepare for future cardiovascular care needs, the AHA developed methodology to project future costs of care for hypertension, coronary heart disease, heart failure, stroke and all other cardiovascular diseases (CVDs) from 2010 to 2030. Projected costs are based on current rates of disease and census data to adjust for anticipated population shifts in age and race. The methodology avoided double counting of costs for patients with multiple cardiovascular conditions.

“Despite the successes in reducing and treating heart disease over the last half century, even if we just maintain our current rates, we will have an enormous financial burden on top of the disease itself,” said Paul Heidenreich, M.D., chair of the AHA panel that issued the statement. “These estimates don’t assume that we will continue to make new discoveries to reduce heart disease. If our ability to prevent and treat heart disease stays where we are right now, costs will triple in 20 years just through demographic changes in the population.”

Currently, 1 in 3 Americans (36.9 percent) have some form of heart disease. By 2030, approximately 116 million people in the United States (40.5 percent) will have some form of cardiovascular disease, the panel said. The largest increases are anticipated in stroke (up 25 percent) and heart failure (up 25 percent).

Between 2010-30, the cost of medical care for heart disease (in 2008 dollar values) will rise from $273 billion to $818 billion, the authors predicted. 

“We were all surprised at the remarkable increase in costs that are expected in the next two decades,” Dr. Heidenreich said. “We need to continue to invest resources in the prevention of disease, the treatment of risk factors and early treatment of existing disease to reduce that burden.”

References

Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement From the American Heart Association; Circulation, January 2011.

http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820a55f5v1?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Paul+Heidenreich+2011&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

In Another Study...

Heart Attack Major Source of Costs

Meanwhile, employees with myocardial infarction (heart attack) and other types of acute coronary syndrome (ACS) were found to be a major source of direct and indirect health costs in a study published in the January edition of the Journal of Occupational and Environmental Medicine.

The findings show that ACS is even more costly than other conditions common in working-age adults, such as asthma, high blood pressure and diabetes.

Medical insurance claims were used to estimate costs: Direct costs for workers with ACS were $40,000 higher, on average, than for other workers. Initial hospitalization accounted for about half of the costs; 30% of workers with ACS had at least one more heart disease hospitalization within a year of the first.

ACS also is associated with higher indirect short-term disability costs: about $1,000 per case/year. While costs associated with work absence did not significantly increase, those findings were based on a small number of cases.

PureSafety Acquires Occupational Health Research/SYSTOC®

Those of you who have been around this industry for awhile are aware that only a handful of companies produce occupational health-specific software products - and that number has dwindled over the years.

 

The number shrank again today with the acquisition of Maine-based Occupational Health Research (best known for its SYSTOC® software platform) by PureSafety, a leading provider of workforce safety and health software, information management and training solutions. Both companies are members of the NAOHP's Vendor Program.

 

Founded by Dr. Bill Newkirk, OHR/SYSTOC reports it supports employee and occupational health information systems in more than 800 hospitals, clinics and worksite-based programs nationwide. The company is widely recognized for its customer support and comprehensive capabilities.

A Little History
In 1977, a charitable health care trust serving rural Maine sought ways to control workers' compensation costs and improve injured worker treatment and care management. They called on Dr. Newkirk for assistance, recognizing the value of his medical training and work using mathematical models to predict patient outcomes. Dr. Newkirk subsequently developed SYSTOC, which became the first commercially successful occupational health software for personal computers. 

SYSTOC entered clinical trials at a Maine hospital in 1982, and by the end of 1985 was installed at 10 hospitals. OHR was incorporated to support technical development and provide a core organization for network members. The network has been expanding ever since.

In 2002, OHR shook things up a bit when it acquired The Stolas Group, producer of StolaSystem occupational health software. Under the direction of Dr. Steven Schumann, StolaSystem was originally designed to support his independently owned occupational medicine practice in California.

 

Meanwhile, in 1997, Thompson Machinery Commerce Corporation, a Tennessee-based heavy equipment dealer, suffered its first and only work-related fatality. In response, senior management helped develop a safety training safety solution, which transitioned into PureSafety in April 1999.

In 2006, PureSafety acquired PerDatum to expand its safety and case management tools. Two years later it acquired Unique Software Solutions, Inc. and its Occupational Health Manager^® (OHM) software suite. Launched in 1986, OHM was one of the first modular software packages to integrate detailed tracking and reporting tools for occupational health, medical and safety management, with a focus on workplace applications.

 

Fast forward to 2011

Given the history, the acquisition is really a marriage of multiple existing and former businesses that promises to offer a powerful approach to occupational health and safety work-flow management.

 

"The combination of the two businesses creates the clear market leader in the occupational and employee health market," company officials said in a joint press release issued today.

 

In the press release, Bill Grana, president and chief executive officer of PureSafety, noted:

 

“From its development nearly 30 years ago, OHR pioneered best-in-class tools for the employee health market and has always been a market leader and respected competitor. PureSafety is driven by a similar vision to offer the industry’s most complete suite of solutions to manage all facets of occupational safety and health. Adding SYSTOC to our existing software suite creates a total solution that is unmatched in the industry. 

 

"We are extremely excited to welcome OHR and its employees to PureSafety and look forward to providing their clients with the technology and services they trust, but with the added benefit of a larger, more broad-reaching enterprise to support their success.”

 

Dr. Newkirk, a true visionary who will serve as PureSafety's medical director, said:

 

“Building this company has been a labor of love for me. To see it reach this level of success and join forces with PureSafety is thrilling. I think that this acquisition will be a transformative event in the field of occupational medicine and employee health.”

 

Stay tuned.

Fixing the Workers' Comp System

Mark Walls, assistant vice president-claims at Safety National and the moderator of a Linked-In Workers' Compensation Analysis Group, is asking: "What changes would you make to improve the workers' compensation system?"

"Keep in mind that in order for this to work, it must be fair to all parties involved (employers, workers, etc)," he says. "Suggestions such as 'raising' or 'lowering' benefits gets us nowhere. Workers' compensation is a compromise that must protect the interests of everyone involved."

In a response posted today, Jamie Stark, Ph.D., who analyzes outcome data for payers, suggests creating a platform for true data sharing. "There are two realities going on here - the medical process and the business process," she writes. "You cannot take business process data and force fit a model of what happened medically.... bad data means we try to manage a process we don't even have an understanding of. No one would expect to navigate the back hills of the Carolinas with a map of Kansas, but in WC we do it every day and wonder why we're lost." 

Post your comments here and we will pass them on to the Work Comp Analysis Group. Members of the group would benefit from hearing the medical provider perspective.

Workers’ Compensation Insurance Market a Moving Target

Workers’ compensation insurance is “in play,” says Preston Diamond, managing director and co-founder of the Institute of WorkComp Professionals, Asheville, NC: www.workcompprofessionals.com

Economic conditions, low interest rates and decreased demand have created a buyer’s market and put pressure on workers’ compensation insurers to remain competitive. Meanwhile, governmental agencies, employers and health care providers continue to take a close look at insurance products and other strategies in an effort to control workers’ compensation costs, Diamond reports.

While 94 percent of executives in the property/casualty industry expect an improvement in profitability in 2011, they are not optimistic about the prospects for workers’ compensation insurance, according to a poll taken this week at the Insurance Information Institute Property/Casualty Insurance Joint Industry Forum.

Broken down by lines of insurance, 86 percent of respondents said they do not expect an improvement in workers’ compensation and 76 percent do not expect an improvement in commercial lines.

Propertycasualty360.com, a national underwriter website, reported today that the poll results are consistent with recent comments from industry executives: http://www.propertycasualty360.com

For example:

• At the forum, Liam McGee, chairman, president and CEO of The Hartford Financial Services, said middle-market commercial insurance pricing “is not rational right now.” 
• Kristian Moor, president and CEO of Chartis, reported workers’ compensation is under-priced and that the company was getting out of the market. 
• In November, Liberty Mutual CEO Edmund “Ted” Kelly reportedly called workers’ compensation insurance a “time bomb on the balance sheet of the industry.”

According to 2010 data from the National Council on Compensation Insurance, the workers’ compensation market has experienced 23 consecutive quarters of rate decreases, starting in early 2003.  

Marsh,in its U.S. Insurance Market Report 2010, Third Quarter Update: Insureds Net Benefits as Downward Rate Pressures Persist 

reports that workers’ compensation rates have declined an average of 5.3 percent: http://www.insurancemarketreport.com/LinkClick.aspx?fileticket=TziR0Ua5iYI%3D&tabid=8002

On the other hand, some industry experts now warn employers that while the soft market is predicted to continue in 2011, proposed and approved rate increases in some states suggest the beginning of a gradual shift toward a harder market.

Experience shows such things tend to be cyclical.

Characteristics of Better-Performing Practices

“Better Performers” who responded to the Medical Group Management Association’s annual Cost Survey Report demonstrate certain behaviors that may be the key to their financial success, the MGMA reported this week. 

For example, the data show better-performing medical practices:

• Use formal patient satisfaction surveys. More than 30 percent benchmark results to other practices and more than 60 percent educate physicians about behavior.

*Note: The NAOHP plans to introduce a patient satisfaction benchmarking program for occupational heath providers in 2011.

• Spent more on information technology operating expenses than their counterparts (with the exception of multi-specialty practices).
• Report  less bad debt to fee-for-service activity per full-time-equivalent (FTE) physician.
• Report lower total operating costs as a percentage of total medical revenue.
• Consistently note more procedures per FTE physician.  
• Have a lower percentage of total A/R in the 120-plus-day category than their counterparts, indicating that strong cash flow is crucial to the success of any practice.

Meanwhile, organizations deemed “better-performing medical practices” by the MGMA's Performance and Practices of Successful Medical Groups: 2010 Report Based on 2009 Data excelled in four categories. 

1. profitability and cost management;
2. productivity, capacity and staffing;
3. accounts receivable and collections; and
4. patient satisfaction. 

And their performance was at least 10 percentage points better than their peers in numerous other categories.

The data is based on responses from 544 practices that responded to the MGMA 2010 Cost Survey and a supplemental questionnaire that assessed practices and procedures. 

http://www.mgma.com/pm/article.aspx?id=9198

GINA Nuances Clarified

We have had a number of inquiries about the applicability of Title II of the Genetic Information Non-Discrimination Act (GINA) to occupational medicine practice this week.

To clarify, the regulation includes this footnote: “GINA is not intended to limit the collection of family medical history by health care professionals for diagnostic or treatment purposes.” 

In addition, under the regulations, an employer may request family medical information to substantiate the need for family or medical leave. The regulations, which went into effect Monday, also allow family medical history questions as part of a wellness assessment as long as the questions are clearly identified as voluntary in nature.

The GINA prohibition on acquisition of genetic information, including family medical history, applies to medical examinations related to employment. For example, an employer must tell health care providers NOT to collect genetic information as part of an examination intended to determine the ability to perform a job.

Refer to http://www.federalregister.gov/articles/2010/11/09/2010-28011/regulations-under-the-genetic-information-nondiscrimination-act-of-2008.

Employers Take Cues from Guide to High-Value Physicians

The director of a hospital-affiliated occupational health program told the NAOHP today that employers in her California market are starting to pay attention to advice contained in A Guide to High-Value Physician Services in Workers’ Compensation: How to Find the Best Available Care for Your Injured Workers. 

Which means that she and the program's clinical staff also are paying attention to employers' expectations.

While acknowledging that the physician workforce in the U.S. is not evenly distributed, the Guide advises employers to find the best available doctors by following these steps:

1. Identify potential candidates.
 
2. Determine which physicians meet criteria for basic suitability in terms of access, credentials and proficiency.
 
3. Look for high-value signals by learning all you can about a physician’s practice style and outcome metrics, if available.

According to the Guide, physicians who provide high-value services in workers’ compensation meet a basic set of criteria. For example, they:

• are accessible when needed.
• have appropriate credentials, relevant professional experience and necessary proficiencies.
• practice medicine in a high-quality manner by coordinating care and making wise use of evidence-based treatment methods, diagnostic tests, procedures and specialist services.
• focus on patients’ functional recovery, minimize needless life disruption and work disability, and produce positive overall outcomes in a timely manner.
• satisfy the needs of key parties in workers’ compensation cases (workers, employers, payers and others who may become involved) by providing guidance without bias and with good communication skills.

The Guide is a product of the American College of Occupational and Environmental Medicine (ACOEM) in partnership with the International Association of Industrial Accident Boards and Commissions (IAIABC).

“Most participants in the workers’ compensation system want to direct workers to high-quality medical care, but rarely have access to accurate and comprehensive data about physician practice patterns,” said ACOEM Executive Director Barry Eisenberg. “This Guide provides a practical alternative – a methodical approach that helps them ask the right questions and find the information they need to ensure excellent care.”

“It is our hope that resources such as this Guide will encourage workers, employers, insurers and others to increasingly seek out the physicians who are most likely to deliver the best care outcomes, and in the process help drive overall improvement in the workers’ compensation system,” said IAIABC Executive Director Greg Krohm.

The Guide may be downloaded for free at  http://www.acoem.org/uploadedFiles/Policies_And_Position_Statements/Guidelines/Library_and_Reference_Material/A%20Guide%20to%20High%20Value%20Physician%20Services.pdf

Genetic Information Rule Enforcement Begins Today

Final rules for enforcement of Title II of the Genetic Information Non-discrimination Act (GINA) go into effect today.

Attorneys say occupational medicine providers must be cautious when responding to requests for medical information from employers who are trying to manage family or medical leave and job accommodation situations. Meanwhile, some providers are removing family medical history questions from medical forms filled out by patients in an effort to comply with the law.

Title II prohibits employment discrimination based on genetic information. It is the first legislative expansion of the Equal Employment Opportunity Commission’s (EEOC) jurisdiction since the Americans with Disabilities Act of 1990 (ADA) was enacted.

In other provisions relevant to occupational medicine practice, the EEOC rules interpret the law with regard to voluntary workplace wellness programs. (Refer to 75 Fed. Reg. 68912 at http://edocket.access.gpo.gov/2010/pdf/2010-28011.pdf). GINA allows employers to obtain genetic information in connection with a wellness program only under circumstances delineated in the regulations.

GINA prohibits employers from requesting genetic information about an employee, job applicant or family member. A request is broadly defined as asking for information about an individual’s health status in a way that is likely to result in obtaining genetic information, conducting an internet search, actively listening to third-party conversations and searching an individual’s personal effects to obtain genetic information.

Prior to issuing the final rules, the EEOC received a significant number of comments from employers who cited concerns about not having control over the information they receive from medical providers. Consequently, the final regulations include provisions protecting employers from liability and recommended language for standard medical request forms:

“(GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information.” 

In the law, genetic information includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services and genetic information about a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving reproductive services.

Our Medicated Society

Some occupational medicine physicians go out of their way to avoid prescribing narcotic medications, and when their use is justified, they only recommend a limited course. However, data show this is not always the case.

In a brief released this week, the National Council on Compensation Insurance sheds light on pharmacy costs based on an updated analysis of 2008 data. (Refer to Workers’ Compensation Prescription Drug Study: 2010 Update: https://www.ncci.com/documents/2010_ncci_research_rxdrug_study.pdf)

Among key findings:

1. Prescription drugs represented 18 percent of total medical costs in the study year.
2. Physician-dispensed drug costs rose dramatically in almost every state.
3. Three-fourths of workers’ compensation re-packaged drug costs originated from physicians.
4. Costs for repackaged drugs have grown out of proportion to the number of prescriptions written because of re-pricing practices.
5. Utilization has overtaken price as the leading factor affecting per-claim workers’ compensation drug cost increases.
6. Physicians often dispense more than one drug at the same time.
7. Claimants frequently continue to receive physician-dispensed drugs for extended periods. 
8. Oxycontin® led the pack in terms of costs in 2008.

Meanwhile, PMSI’s 2010 Annual Drug Trends Report features findings from a 2009 analysis of millions of retail and mail-order pharmacy transactions.  (Refer to http://www.pmsionline.com/knowledge-center). According the report, while the use of narcotic analgesics for the treatment of new work-related injuries decreased 7.8 percent, average pharmacy spend per injured worker increased by 6.5 percent.

In addition:

• Growth in total spend was attributed to increases in prescription price of 4.7 percent and net change in utilization of 1.7 percent.
• There was a 2.2 percent increase in the days of supply per prescription from 27.6 days in 2008 to 28.2 days in 2009.

These data support the use of a multi-faceted approach that includes cost management through the use of fee schedules, generic medications and appropriate formularies; utilization review and reductions in concurrent use of medications; and clinicians working with claimants to develop alternative interventions for chronic pain patients.

Reversing the Downward Spiral

The frequent occurrence of work-related musculoskeletal (MSDs) disorders and chronic pain syndromes is a common and costly problem for medical providers, employers, patients and workers’ compensation insurers.

Many occupational medicine specialists believe that early detection of the potential for delayed recovery and a multi-disciplinary approach to the treatment of painful MSDs can help prevent disability, promote return to function and reduce costs. A return to function means an injured worker has reached maximum medical improvement and is able to engage in gainful employment.

However, according to findings from a newly released study, the Musculoskeletal Disorders and Chronic Pain Survey, while 43 percent of responding practitioners use guidelines and evidence-based medicine in the treatment of MSDs and chronic pain, only 12 percent report using early intervention and a bio-psychosocial and/or multi-disciplinary approach.

In addition, according to physicians and other practitioners who responded to the survey (N=486):   

• 22 percent plan to implement, or are considering, early intervention, bio-psychosocial, multidisciplinary, evidence-based medicine services, and 15 percent are implementing/considering controlled narcotic/non-pharmaceutical alternatives/services.

• Guideline compliance, inter-professional communication and education (patient/provider/employer) are viewed as the most significant obstacles to developing policies for effective MSD management.

• The need for research evidence on clinical interventions/strategies for preventing disability, followed by practical approaches for addressing those at risk for disability, are considered high priorities.

The survey results are being used to develop the curriculum for a Musculoskeletal Disorders and Chronic Pain Conference co-sponsored by the American College of Occupational and Environmental Medicine and the Canadian Institute for the Relief of Pain and Disability (Feb.10-12 in Los Angeles). Planners say a focus of the conference is the identification of high-quality research evidence that - if implemented into policy and practice - would improve clinical outcomes and prevent disability for adults with MSDs and chronic pain.

Click here to read the full Executive Summary of the Survey

Welcome to the new National Association of Occupational Health Professionals' blog, On the Beam. The site is intended to encourage interaction and information exchange. Your comments are welcome!

It's cold outside, but temperatures (and tempers) are already rising in Washington as Republicans in the House prepare for a Jan. 12 vote to roll back health reform. Meanwhile, a new survey from the Midwest Business Group on Health (MBGH) and co-sponsors suggests employers are edgy about reform impacts.

Anticipating Increased Costs

As occupational health professionals are aware, many employers are voluntarily expanding coverage of preventive services to better manage chronic disease and associated absence. The MBGH survey shows that nearly 60 percent of employers plan to leverage incentives allowed under the reform law to expand wellness programs. (The Sept/Oct 2010 edition of VISIONS - the NAOHP's 24-page periodical - features a cover story on incentives. To request a copy contact me via this site or write to info@naohp.com.)
 
A majority of employers believe the Patient Protection and Affordable Care Act will increase their benefit costs and that changes are needed in the law to improve quality, reduce expenses and reward health system performance, according to the survey findings released Jan. 3. 
  
The survey also found:

• Of the 65 percent of respondents who reported they have done some modeling on how health reform will impact benefit costs, 25 percent forecast increases of 2 to 5 percent and 15 percent found increases of 6 to 10 percent.
• 86 percent believe it is unlikely reforms will reduce the rate of health care cost increase and 74 percent believe it’s likely health reform will boost costs even more than if the legislation was not passed.

In response, Andrew Webber, president and CEO of the National Business Coalition on Health, commented: 
 
“The survey results reflect employer frustration that cost containment, as their priority goal for health care reform legislation, is not, at present, being realized. While there appears to be strong support for the legislative provisions related to payment reform, value-based insurance design, medical homes and accountable care organizations, I think employers are signaling the Obama Administration that these delivery reform and value-based purchasing strategies need to be fast-tracked. Cost containment cannot wait.”
 
And Larry Boress, MBGH president and CEO, said: 
 
“There remains a great deal of uncertainty among employers about how health reform will ultimately impact their efforts to provide health benefits for their employees. However, it’s clear that keeping workers healthy is a key focus. In fact, employers are already implementing strategic health management approaches and these are quickly evolving into viable cost reduction strategies.”
 
The online survey, co-sponsored by the National Business Coalition on Health Business Insurance and Workforce Management, was conducted from late November to mid-December 2010. Among the 430 respondents, 43 percent represented employers with more than 500 employees. Visit http://www.nbch.org/News for a summary of the findings.