Category Archives: New Jersey

Nursing: One Of The Most Dangerous Jobs In America

 

Kicked, pummeled, taken hostage, stabbed and sexually assaulted … would you want a job that included these risks? In One of America’s Most Dangerous Jobs, the Washington Post’s Petula Dvorak shines a spotlight on the dangers in the nursing profession, specifically around the violence nurses encounter on the job. Citing a recent GAO report on violence in the healthcare profession, the article notes that, “the rates of workplace violence in health care and social assistance settings are five to 12 times higher than the estimated rates for workers overall.”

Here’s one excerpt from the article:

“In Massachusetts, Elise’s Law, which is named for the nurse who was attacked in June, is already on the fast track to set state standards for workplace protection. Legislators were working on this months before Wilson was stabbed.

Nurses in Massachusetts were attacked more frequently than police or prison guards. When association members testified about the violence epidemic this spring, they said nurses had been threatened with scissors, pencils or pens, knives, guns, medical equipment and furniture in the past two years alone, according to the Massachusetts Nurses Association.”

OSHA reports that in surveys conducted by various nursing and healthcare groups:

  • 21% of nurses and nursing students reported being physically assaulted and over 50% verbally abused in a 12-month period
  • 12% of emergency department nurses experienced physical violence and 59% experienced verbal abuse during a seven-day period
  • 13% of employees in Veterans Health Administration hospitals reported being assaulted in a year

New Jersey is one of 26 states that have safety standards aimed at combating violence in health care facilities. The “Violence Prevention in Health Care Facilities Act,” enacted in 2008, lays out detailed requirements for hospitals (including psychiatric hospitals) and nursing homes. However, with more than 2,000 hospitals, nursing homes and health care facilities in New Jersey, there is ample opportunity for workplace violence to occur.

Notwithstanding the Act, at Work Comp Psych Net, our clinicians are asked  to treat healthcare workers who are victims of workplace violence or abuse. The mental health complications of these injuries can leave lasting damage, which, if untreated, will only worsen over time. We advise claims adjusters and nurse case managers to pay particular attention to the possibility of a mental health comorbidity complicating a workplace violence injury.

NIOSH worked with various partners – including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. – to develop a free on-line course aimed at training nurses in recognizing and preventing workplace violence. The course has 13 units that take approximately 15 minutes each to complete and includes “resume-where-you-left-off” technology. Learn more about the courses at Free On-line Violence Prevention Training for Nurses, and the actual course can be accessed here: Workplace Violence Prevention for Nurses CDC Course No. WB1865

Related

Workers’ Compensation and SSDI Dual Eligibility: Costly Changes Coming?

In 2014, workers’ compensation loss costs (indemnity wage replacement plus medical benefits) totalled $62.3 billion, nationally, while Social Security Disability Insurance (SSDI) paid $141.5 billion in wage replacement benefits to disabled persons and their dependents. In the same year, 10.3  1.3* million disabled workers qualified for both workers’ compensation and SSDI wage replacement. They are dually eligible for both programs given their on the job injuries.

If a worker becomes eligible for both SSDI and workers’ compensation cash benefits, one or both programs will reduce benefits to avoid making excessive payments relative to the worker’s past earnings. Social Security amendments passed in 1965 require SSDI benefits to be reduced so the combined total of payments does not exceed 80% of the injured worker’s pre-injury wages.

However, prior to the 1965 amendments, fifteen states, including New Jersey, had passed what are called “reverse offset” laws, which required that it is the workers’ compensation benefits, rather than SSDI’s, which are reduced to stay under the 80% cap. The reverse offset laws were grandfathered into the 1965 amendments. This produces millions of dollars in savings per year for insurers and employers.

A bristly fly has just done a swan dive into the reverse offset ointment. President Trump’s proposed budget calls for eliminating the reverse offset law. If this provision makes it into the final budget proposal, New Jersey employers would face the prospect of not insignificant increases in total loss costs. Thousands of injured workers in the state are dually eligible for workers’ compensation and SSDI benefits. No one knows for sure the exact number, because Social Security doesn’t have a good verification program. The president’s budget estimates eliminating the reverse offset law would save $164 million over ten years, all of which would come from the 15 states that would lose the reverse offset advantage.

If you’d like to know more about the reverse offset inside baseball game, the National Academy of Social Insurance has an excellent description on page 48 of its October, 2016, workers’ compensation annual report.

Thanks to Work Comp Central’s Elaine Goodman for a story on this issue (subscription required).

*Thanks to Mathematica’s Yonatan Ben-Shalom for catching this typographical error.

News Of Note

 

Bit of a dreary day here in the northeast, so why not get yourself a good mug of tea, sit for a moment, put your feet up and dive into the latest health care news. If you want insights from people who really understand what’s happening – from across the political spectrum – Health Wonk Review is the must-read.

Steve Anderson at HealthInsurance.org hosts this month’s edition – and what a health care month it has been.

Among the posts are Charles Gaba’s view of Congress’s Keystone Cops act at Trump, Ryan, McConnell & Price will owe my family $2,000 next year. Pay up, jerkweeds. Title pretty much says it all.

Louise Norris’s How Would the BCRA Impact Deductibles and Out-of-Pocket Costs? tells us why the Better Care Reconciliation Act is a double whammy.

And Kelley Beloff, a medical office manager, offers her insights about two healthcare systems, and two very different outcomes, with A Tale of Two Health Systems.

Lots more. Thanks to Steve for hosting.

And for more reading close to the New Jersey homefires, this morning’s Work Comp Central told the story of a North Jersey doctor who authorities accuse of providing oxycodone and Xanax to a group of South Jersey drug dealers. Dr. Craig Gialanella, 53, of North Caldwell was arrested last week along with 17 members of the alleged drug ring.

From Work Comp Central’s story (subscription required):

Gialanella is accused of writing prescriptions to the members of the drug ring run by Douglas Patterson, 53, of Egg Harbor Township; his ex-wife, Mary Connolly, 54; and her three children, Michael, 33, Robert, 31, and Lauren, 28, prosecutors say.

Patterson and Connolly allegedly ran the drug ring’s supply and distribution activities, while Lauren Connolly allegedly served as an intermediary among her mother, ex-stepfather and the street dealers.

New Jersey’s prescription monitoring program showed that in 2016 alone, Gialanella wrote 413 prescriptions for oxycodone to 30 people from the Atlantic County area, which is more than 100 miles away from his office, prosecutors say.

Those 413 prescriptions contained roughly 50,000 30-milligram pills, which the alleged Patterson-Connolly ring referred to as “blues” and sold for between $18-$25 each. Gialanella also allegedly provided Xanax prescriptions to members of the drug ring, who sold the anti-anxiety pills for $5 each.

The New Jersey Attorney General’s office detailed the charges here.

Workers’ Compensation’s Costly Psychosocial Issues (2)

Yesterday, we described the challenges confronting claims adjusters and injured workers when psychosocial issues are present in a workers’ compensation claim. These issues impede recovery and exacerbate costs. Whistling a happy tune, we  picked up our saw and confidently walked out on the proverbial limb to suggest this thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful and does not focus enough on speedy return to work. There is a critical need for a more systemic approach as well as an integrated coterie of clinicians and practitioners, trained in workers’ compensation, whose goals are to provide compassionate treatment with a steady return to work trajectory. 

Taking a large gulp after writing this, we listed the serious factors that make finding a solution to this looming crisis tremendously difficult.

But early in 2015 in New Jersey two Neuropsychologists, Mary Ann Kezmarsky and Richard Filippone, had an idea. Over a couple of decades, they’d treated a number of workers’ compensation claimants and had been appalled by what appeared to be the lack of a coherent system to deal with the issues they saw in their patients. They weren’t exactly sure what to do about it – they didn’t know much about workers’ compensation – but they saw it as a business opportunity. Well, they are “we,” and here’s what we did with that idea.

We contacted Tom Lynch, of Lynch Ryan, a nationally recognized consultancy in workers’ compensation, and over the next year and a half created a company, Work Comp Psych Net (WCPN), and built a systemically organized and integrated specialty network of workers’ compensation clinicians and therapists to treat injured workers in New Jersey who might have behavioral health issues delaying recovery. With Tom’s help, here’s how we did it:

  1. During the the last half of 2015, we recruited, credentialled and vetted 44 mental health professionals covering 55 offices throughout New Jersey’s 21 counties. Providers within WCPN’s network include psychologists and neuropsychologists, as well as cognitive rehabilitation and biofeedback specialists. All of the clinicians and therapists gave up a weekend to attend Lynch Ryan training in workers’ compensation. They learned about the New Jersey law, as well as the way workers’ compensation works – how a premium is constructed and  what indemnity and medical benefits are. They now understand experience modification, maximum medical improvement and the law regarding injuries “arising out of and in the course of employment.” Further, they have been educated regarding early return to work and have agreed to work with employers, adjusters and nurses to effectuate modified duty wherever possible.
  2. We built (with difficulty, because it wasn’t easy) the nation’s first electronic Claimant Intake & Referral Portal that allows claims adjusters, nurse case managers and attorneys to refer a claimant instantly. The paperless portal’s referral system is geographically and specialty based, meaning that referrers are assured that claimants will not have to travel far to reach their assigned clinician. In the past, referrals and appointments took weeks, even months, to arrange, but now they can be finalized within minutes. In Beta Testing from May through October, 2016, the longest time from referral to Provider scheduled appointment was 27 minutes.
  3. We built (with even more difficulty) the nation’s first mental health Electronic Health Record system for workers’ compensation. The EHR is set up as a roadmap for all WCPN clinicians to follow, meaning reports have a consistently structured form. The EHR is paperless, HIPPA-compliant and cloud-based. Initial Psychological Evaluations and subsequent treatment reports reach claims adjusters in pdf form within five business days.
  4. Our clinicians are all highly qualified and experienced; they know how to treat workers with mental health issues delaying recovery. But to make the system work we needed to understand the needs of adjusters and defense attorneys who would be referring the injured workers the clinicians would treat. Consequently, we conferred with experienced adjusters and defense attorneys. After doing so we decided that every referral would begin with a thorough Initial Psychological Evaluation (IPE), which, although not technically an IME, would be done at the IME level (we priced the IPE at $450, and, since nobody’s complained, we now think that’s too low, but we’re sticking with it). If the Initial Psychological Evaluation determines the presence of one or more mental health issues which are deemed to be work-related and requiring treatment, the treatment prescribed is initially authorized for up to 12 sessions unless medically justified, extraordinary circumstances are present. Additional treatment requires the approval of the referring party.

We officially launched in November, 2016. Over the intervening three months  we’ve learned two things (among a lot of others): First, our solution works extremely well; referrers have been highly receptive and pleased. They appreciate the ease of referral, the EHR reports and the fact that claimants do not have to travel far to see a qualified clinician. Even more, they appreciate that our clinicians and therapists have been trained in workers’ compensation.  Second, this could be a national solution.

So, our solution is working in New Jersey, but every state workers’ compensation system is grappling with how to deal with psychosocial issues that frequently hobble recovery. This may be work comp’s final frontier. Time will tell whether our template and software could help others. Regardless, we will continue to improve our solution at Work Comp Psych Net, as well as report on our outcomes.

It’s taken us nearly two years to get to this point, but, for the sake of the many injured workers suffering psychosocial comorbidities, as well as the claims adjusters who work tirelessly to help them, we think it’s been worth it.

The Oregon Bellwether Bi-Annual Study’s Conclusion: Workers’ Comp Is REALLY Expensive in New Jersey!

Every two years, Oregon’s Department of Consumer and Business Services publishes its Workers’ Compensation Premium Rate Ranking Summary. Last week, the state issued its 2016 Study Summary. Just before the Study was released, Workers’ Comp Insider published a Primer on how to interpret it. This from that post:

The executive summary of this year’s study is due to be released in the next few days, and the findings are closely watched in quite a few states. Unlike the National Academy of Social Insurance report, issued last week, the Oregon study takes the comparison beyond simple averages. Instead, Oregon derives average rates for what a hypothetical set of comparable employers would pay, thus factoring out much of the difference in states’ risk profiles.

Oregon’s Premium Ranking Study looks at premium rates for a set of the most common job classifications, establishes a single index rate for each state based on the job classification rates and then compares those index rates among all the states.

California, the state which, if it were a country, would have the world’s fifth leading GDP, is always in its own universe in studies like this. However, after discounting California, the state with the highest index ranking in the nation at $2.92 per hundred dollars of payroll is (drum roll): New Jersey. The New Jersey index rate is 158% higher than the median rate for all states.

New York and Connecticut are right behind New Jersey in cost, with index rates of $2.83 and $2.74, respectively.

There is no medical fee schedule in New Jersey, which is one of the reasons for the high costs. Fee schedules do exist in New York and Connecticut, but they’re quite high. On the other hand, Massachusetts also has a fee schedule, one of the lowest in the nation, and it’s index rate reflects that. Massachusetts’s index rate of $1.29, which is 70% of the median, makes it the sixth lowest cost state in the country.

At Work Comp Psych Net we are highly sensitive to the high costs within New Jersey, because head injuries and psychosocial issues impact those costs in a significant manner. According to the New Jersey ‘ Compensation Rating & Inspection Bureau, total incurred costs (paid plus reserved) for all head injuries for the 5-year period from 2009 through 2013 were $1.72 billion. And that’s just for insured companies. It does not include self-insureds, which means that total state costs are more than likely near $3 billion for the period.

Clearly, carriers and third-party administrators representing insured and self-insured employers need all the help they can get. Early evaluation and intervention in claims that may contain mental health components delaying recovery is a proven way to eat into the high costs that so bedevil workers’ compensation professionals in New Jersey. That’s why we’re here with solutions that are: Sooner, Faster, Smarter.

New Jersey Self-Insurers’ Association Spring Conference and Vendor Fair: Key Takeaways

First, congratulations to the Staff and Members of the association for an informative and entertaining conference at Harrah’s Resort and Casino in Atlantic City.

A couple of shout-outs are in order: Donna Wrobel, the Association’s President and Assistant Director for the Archdiocese of Newark, and Regina Lamptey, ABM’s Regional Risk Manager and the Conference Program Chairperson, did an outstanding job organizing the event and making sure it ran with professional efficiency. Kudos to both ladies.

The presenters were interesting and, in many cases, thought provoking. A special mention of Dr. Tom Dwyer, who, as he did at the recent Millennial Seminar organized by Capehart & Scatchard Attorney John Geaney, delivered an exceptional presentation focusing on the intersection between workers’ compensation and orthopedic medicine.

There was an interesting panel on Utilizing Social Media to Schedule Strategic Surveillance. Another panel that caught everyone’s attention, moderated by Ann DeBellis, Esq., of New Jersey Manufacturers Insurance Company, discussed Pain Management, Medical Marijuana and Interventional Spine Techniques. No free Cannabis samples, though.

It was also a big couple of days for us at Work Comp Psych Net. In addition learning a lot, making many new friends and even managing to leave Harrah’s without contributing much to the casino’s profits, we had a highly successful launch of our venture.

While we were happy to meet so many of New Jersey’s key workers’ compensation players, we were even more gratified for their deep interest in how we might help them deal with the many thorny mental health issues that crop up from time to time.

One of the things that seemed to impress the conference attendees was the breadth of our geographic coverage. We built a county coverage map to illustrate it.

20160428_110750

Another thing that seemed to hit home was the responsiveness of the system. Work Comp Psych Net’s online referral portal allows instantaneous referral, saving adjusters and attorneys considerable time and effort. The last thing these extremely busy professionals want is to have to spend hours, days or even weeks tracking down the help they need. Our first-in-the-nation online referral system eliminates that.

One final congratulation is in order: As the conference was scheduled for the first day of the NFL draft, the organizers chose the theme, “Drafting The Right Workers’ Compensation Team.” All vendors competed for the prize for the best display illustrating that theme. So, we salute Team Kirshner, of the Kirshner Spine Institute, for its historic win (although, with our superb Pittsburgh Steeler Display, we have to say, “We wuz robbed!”).

20160427_160024

Tomorrow Is Official Launch Day!

Well, here it is. After more than a year of building, Work Comp Psych Net Launches tomorrow.

In what seems to come right out of Star Wars’s opening line – Long ago in a galaxy far away – Richard Filippone and Mary Ann Kezmarsky had a vision, a dream of doing something never before done anywhere in America. They realized that the workers’ compensation system in New Jersey for dealing with mental and behavioral health issues was an afterthought, at best, resulting in high costs for employers, frustration for insurers and angst for injured workers. Claims adjusters did not want to “buy a psych claim,” because of the fear that doing so sent the claim into a psychological black hole and created a lifetime annuity for some PhD.

Richard and Mary Ann, PhDs of the first order, themselves, knew there had to be a better way.

And thus was born a dream that becomes reality tomorrow.

At Work Comp Psych Net you’ll find a network of Psychologists and Neuropsychologists, as well as Cognitive Behavioral Health and Biofeedback experts. The network covers all of New Jersey’s 21 counties, from Sussex in the north to Cape May in the south. All members of the network have been highly trained in New Jersey’s workers’ compensation system. They have learned what employers go through every time a worker is injured and misses time away from work. They’ve learned about experience modification and modified duty and how premiums are built. They know how important is the concept of MMI, Maximum Medical Improvement. And they’ve learned all this without checking their expertise and compassion at the door.

But that’s not all. In addition to building this unique network, Richard and Mary Ann have built the nation’s first totally electronic claimant referral portal and electronic health record system. Richard had another vision – no paper. This means that a referral can happen in a matter of minutes, saving claims adjusters hours, even days of time in finding the proper person to see a claimant.

So, tomorrow, at the New Jersey Self-Insurers Association annual conference, we launch. We couldn’t be happier

 

The John Geaney Seminar

John Geaney is a renowned New Jersey attorney focusing on workers’ compensation. He heads the workers’ compensation practice for Capehart Scatchard, and is a good friend of Work Comp Psych Net.

John is the author of “Geaney’s New Jersey Workers’ Compensation Manual for Practitioners, Adjusters, and Employers,” and updates it annually. If you have anything to do with workers’ compensation in New Jersey, you need to have John Geaney’s Manual.

In addition to representing a great number of New Jersey’s foremost employers, writing a Lexis Nexis Top Blog and creating the aforementioned Manual, John, teaming with Millennium Seminars, puts on three seminars each year for New Jersey professionals specializing in workers’ compensation. The seminars are always full. Attendees keep coming back, which is a testament to the high regard employers and insurers have for John.

As I write this, Work Comp Psych Net founders Mary Ann Kezmarsky and Richard Filippone are attending and exhibiting at one of John’s seminars in Mount Laurel, New Jersey.  There are more than 100 work comp pros here.

20160414_092212

They’ll also be exhibiting at the upcoming Annual Conference of the New Jersey Self-Insurers Association in Atlantic City at the end of the month where attendees will number nearly 300.

20160414_083309

Work Comp Psych Net, with trained and certified workers’ compensation psychology professionals throughout New Jersey,  as well as an online claimant referral portal and electronic health record system, is gathering steam. We’ve been Beta Testing for a couple of months. Our official company launch is only two weeks away. To say we are excited doesn’t begin to describe it.