Medical Changes Impacting Workers’ Compensation

At the 2017 WCIRB Annual Conference, a session discussed the how changes in medical science are impacting workers compensation. The speakers were:

• Roman Kownacki, M.D., Chief Medical Director, Occupational Health, Kaiser Permanente
• Linda Radler, WCIRB Managing Director, Medical Analytics

Opioids

California is working to develop a prescription drug formulary and the expectation is that will lead to a reduction in opioid use. Other states that have adopted formularies have experienced this impact.

Currently the top 1% of physicians in California are prescribing 33% of all opioids in the workers’ compensation system. This means 90 physicians are having this significant impact. This is onto going away any time soon as these physicians do not seem inclined to change their prescribing patterns. It is hoped the formulary will address this however this will ultimately depend on how it is structured and what exceptions it contains.

Marijuana

Medical marijuana is a reality that we are going to be seeing in workers’ compensation in the near future. Six states now have allowed medical marijuana in workers’ compensation and New Mexico added this to their fee schedule. Six states have expressly forbidden reimbursement for medical marijuana by insurance and workers’ compensation. It has been “observed” that states with medical marijuana have lower opioid prescribing rates. However, there have not been any studies to establish a definitive link in this area.

A recent National Academy of Science study found “there is substantial evidence that cannabis is an effective treatment for chronic pain in adults.” This area needs more study, in particular whether the canniboids in marijuana can be separated from what causes the “high” effect leading to something that relieves pain but does not cause impairment.

With marijuana still classified as a Schedule 1 (illegal) drug by the FDA, marijuana cannot be paid for using the banking system which is governed by federal law. This means medical marijuana must be purchased with cash by the injured worker who is then reimbursed by the carrier.

Integrated Advances in Medicine

• Because of advances in medical treatment, people between the ages of 20 and 40 who have major disabling conditions can reasonably expect to live a normal life expectancy. Years ago such injuries led to significantly reduced life expectancies. This change in life expectancies is dramatically increasing the costs on such claims.
• More and more people are realizing the impact that the mind has on the body, and the importance of mental health on overall health. Expect to see more of an emphasis on mental health in the future.
• The use of devices for tracking exercise, sleep, exertion, etc can have an impact on the overall health of the workforce. There are privacy concerns around such information and it remains to be seen if carriers could require injured workers to utilize such devices.
• Prosthetic technology is advancing rapidly enabling better function for injured workers with amputations. Unfortunately, this new technology tends to be expensive which again can lead to significantly higher claim costs on such cases.
• 3-D medical printing shows the ability to create extremely customized prosthetics. 3-D printing has a wide variety of other medical applications including assisting in training physicians for complicated procedures.
• Genomics can allow for very customized medical care and the cost of genome sequencing is now less than $1,000. The consistency and accuracy of this testing is still an issue. There are significant ethical issues around this concept. A recent court case in CA allowed for apportionment of permanency based on genetic conditions.
• Stem cell research shows promise to regenerate heart tissue and reverse some damage from a heart attack. There is research into how stem cells could possibly impact spinal cord and brain injuries.