Injured Workers Pharmacy: News

State of the States October 7, 2022

Written by Jayne Kresac Esq. | Oct 10, 2022 12:30:00 PM



The NCCI addresses how the great reshuffle affects workplace injury frequency

New report from NCCI shows the effects of the "great reshuffle" on work injury frequency. Quitting rates remain high in the workforce, at approximately 50 million quits a year which is 10 million more than pre-pandemic averages. This era of the great reshuffle is placing heavy numbers of workers in new workplaces where they are potentially unfamiliar with their work surroundings. NCCI researchers found that short-tenured workers, those in the first couple years of their job, are twice as likely to be injured compared to longer-tenured employees in most economic sectors. Industries such as construction, manufacturing, and wholesale trade saw injury rates among short-tenured employees at the highest frequencies. Despite high injury risks among short-tenured employees, NCCI says the influx of new workers to new workplaces due to the great reshuffle is unique to itself and that with time such injury risk to newer employees will likely have a lesser impact on long-term injury frequency.

 

New data confirms that heat increases risk of injury

Confirming previous studies, a new report shows that heat increases the risk of injury for workers. Analyzing 92,000 accepted workers' compensation claims, researchers found that the injury rate increased 4 percent when the heat index was above 75 degrees. For industries such as farming and construction, the injury rate is 14 percent higher when the heat index exceeds 75 degrees. On rare occasions where the heat index exceeds 115, the overall injury rate among all industries saw an 11 percent uptick. Currently, the Occupational Safety and Health Administration (OSHA) is in the process of creating heat workplace rules to mitigate the risk of injury and provide states with formal guidelines.

 

A new WCRI study indicates that medical payments per claim have grown moderately in the state

A new Workers’ Compensation Research Institute (WCRI) study indicates that medical payments per claim in the Sunshine state grew moderately from 2016 to 2019 at approximately 4 to 5 percent. However, this metric decreased 5 percent for non-covid related injuries from 2020 to 2021, likely attributed to the affects of the pandemic. Medical payments per claim are fairly typical with other states and is attributed to lower payments per claim for nonhospital professional services offsetting higher payments per claim for ASC facility and hospital services. Prices paid for nonhospital professional services were lower than most states, however prescription payments per claim saw increases. The average payment per prescription increased in four of the 18 states surveyed including Florida.

 

Several injured workers are speaking out after their state reported over 13,000 backlogged worker’s compensation cases

Several injured workers involved in the 13,842 workers' compensation cases backlogged in the state are speaking out regarding their state's broken system. Injured workers say that while reforms to claims processes by the state are welcome, more systemic issues must be addressed. Currently, injured workers can only file a complaint to the Department of Industrial Relations when insurers or third party administrators (TPAS’) don't handle their claims appropriately or don't respond. To better ensure accountability, injured workers would like the state to allow them the ability to seek civil remedies such as punitive damages against unresponsive stakeholders. Many injured workers say more options for recourse are necessary after having to take on health care expenses alone while also being unable to work. 

 

WCRI says that medical payments per claim in the state decreased 5 percent since 2020

The Workers’ Compensation Research Institute’s (WCRI) newest report demonstrates that medical payments per claim in Pennsylvania decreased 5 percent in 2020 and 2021. Declines in the average payment per claim are attributed to telemedicine as well as state action to suspend nonemergency treatment and procedures during the pandemic. Prices paid for professional services have been stable since 2015 with a 3 percent decrease observed in 2020/2021. In all, medical payments per claim were approximately 9 percent higher than the most states from 2018 to 2021. Higher payments are tied to higher payments per claim for hospital outpatient services and hospital payments per inpatient episode. Prescriptions in the state saw increases ranging from 8 to 16 percent per year since 2018 with the average payment higher than most other states.

 

The DWC says that in-network claims in workers’ compensation save money, receive services more quickly and result in better return to work outcomes

The Division of Workers' Compensation says that in-network claims in workers' compensation save money, receive non-hospital medical services more quickly, and result in improved return to work outcomes. However, the average medical cost six months post-injury in 2022 for in-network services is recorded at $2,886, while the non-network average is only slightly higher at $2,897. Of new claims, 53 percent utilized out-of-network services, while 47 percent used in-network services. Overall, out-of-network service use increased 2 percent since last year.

 

  • New findings from the Workers’ Compensation Research Institute (WCRI) found that the state saw a 5 percent decrease in medical payments per claim since 2019. The decrease is associated with a smaller segment of high-cost inpatient cases, decline in utilization of medical care and an increased use in telemedicine services. Overall medical payments per claim were lower than the typical state. For prescriptions Texas saw a higher percentage of claims with prescriptions and a higher number of prescriptions per claim. Despite high numbers of prescriptions, the average payment per prescription in the Lone Star states is seen as typical to most states.

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