‘Wired for addiction’

Addiction specialist addresses work comp health symposium

By Tony Gottschlich, BWC Public Information Officer

Many believe drug addicts are weak-willed people of diminished moral character who choose drugs, getting high and even criminal behavior over a proper, law-abiding life.

And they would be wrong, a longtime psychiatrist and addiction specialist said Friday morning at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

“Addiction is not about the drugs or the behavior, it’s all about the brain,” said Dr. Susan K. Blank, co-founder and chief medical officer for The Atlanta Healing Center, an outpatient treatment recovery program. “This is a genetically inherited brain disease.”

Blank, speaking to a capacity audience at the Greater Columbus Convention Center, spoke for an hour on the topic, “The Perfect Storm: Pathophysiology of Controlled Substance Misuse and Addiction.” Her presentation was the first continuing education session on the final day of the two-day symposium for health care professionals.

Blank explained there are three key forces behind addiction, and choice has little, if anything, to do with it. They include:

  • Genetics. Our brains are hardwired for addiction because of our genes. Some of us inherit malfunctioning “dopamine feedback loops.” When we experience pleasure, whether from food, drugs or sex, it’s because our brains are releasing the feel-good neurotransmitter dopamine. In addicts, that feedback mechanism doesn’t shut down and they just want more and more, regardless of the consequences. “It’s never enough,” Blank said. This is particularly hard to overcome if the addiction started in one’s youth. That’s because drug and alcohol abuse can damage the prefrontal cortex, our brain’s impulse-control center, which is still developing into our mid 20s.

Worried your children might be future addicts? Look for the thrill-seeking child who thrives on adrenaline, the child who’s the first to take a dare. These are behaviors that demonstrate he or she is seeking a dopamine release, Blank said.

  • Exposure. Growing up around addicts increases the likelihood of addiction.
  • Environment. There must be an environmental trigger or stressor – loss of a job or loved one, for instance – that keeps the addiction cycle going.

“You have to have all three legs of that stool for addiction to manifest itself in your life,” said Blank, who is also president of the Georgia Society of Addiction Medicine. Genes alone won’t doom you.

Addictions often start through prescription drugs, she said, and can’t stop without outside help. They lead to brain changes that can’t be undone. “Our rational brain is gone.”

Drug overdose is the leading cause of accidental death in the United States in recent years, fueled by powerful opioids, heroin especially. Ohio is the nation’s overdose death capital, with 3,050 OD deaths in 2015, or more than eight per day, according to state-by-state statistics compiled by the Henry J. Kaiser Family Foundation.

Blank noted that addictions aren’t limited to painkillers and street drugs, of course. People can be addicted to sugar, sex, tobacco and other dopamine triggers, too. It’s all about the dopamine. (Surprising fact to nonsmokers: “Nicotine is better than food, sex and morphine,” Blank said.)

Blank provided a number of sobering facts and statistics, including this one: “This is a chronic disease and there is no cure.”

But there is hope, she said. Addictions can be managed, and many addicts go on to live long, productive and healthy lives. Nationwide, opioid prescriptions are falling and there’s a growing awareness and understanding that addiction is a disease.

She concluded her remarks with a warning: “If you can’t escape addiction, choose yours carefully.”

The health symposium concluded Friday. It was held in conjunction with the 2017 Ohio Safety Congress & Expo, the Ohio Bureau of Workers’ Compensation’s annual safety, health and workers’ compensation conference.

Comprehensive care for injured workers, innovative employers highlight busy day 2 at #OSC17 and #BWCmhs, much more to come

Welcome back to the Columbus Convention Center, home of the Ohio Safety Congress & Expo and the Ohio Workers’ Compensation Medical & Health Symposium!

We have a lot in store before we bid farewell this afternoon but first, here’s a rundown of yesterday’s activities.

The second day of OSC17 was the first day of the Medical & Health Symposium. This is the second year of the symposium, which filled to capacity weeks ago. BWC sponsors this conference for health-care professionals who treat Ohio injured workers to hear from leading national and state experts. This year, our theme is “Comprehensive care for the injured worker.”

BWC Medical Director Dr. Stephen Woods welcomed participants and kicked off the event. The day featured several intriguing sessions on various topics related to the care of injured workers. One session covered how the aging workforce challenges the workers’ comp industry. Read a detailed blog on that topic here.

Over at OSC17, we got the day started with the Safety Innovation Awards. ICP Adhesives from the Akron area took first place, and Holloway, Henderson & Martin LLC of Pickerington snagged the People’s Choice Award.

All of the finalists were impressive!  Here’s the final list of award winners along with links to videos highlighting their innovations:

  • 1st place ($6,000 award): ICP Adhesives and Sealants, Norton (Video )
  • 2nd place ($4,000 award): C&K Industrial Services Inc., Cleveland (Video)
  • 3rd place ($3,000 award): Holloway, Henderson & Martin LLC, Pickerington (Video)
  • Honorable Mention ($1,500 award): Suburban Steel Supply Company, Gahanna (Video)
  • Honorable Mention ($1,500 award): Ames Arboreal Group, Columbus (Video)

And our very own Dr. Abe Tarawneh, superintendent of the BWC Division of Safety and Hygiene delivered a presentation on the role of safety leaders in building and executing strategic direction for occupational safety and health programs. Abe advised attendees that the mission of a safety leader is simple: elevate safety as a core value for the organization. If it is not a core value, make it one.

We’re not done yet! Our final day will feature more informative sessions at OSC and the symposium.

See OSC17 and symposium schedules here, in the event guide or on the mobile app. Follow @OhioBWC on Twitter and keep an eye on hashtags #OSC17 and
#BWCmhs for coverage.

Stay tuned for a wrap of the day as we bring the curtain down on another successful OSC17 and M&HS.

Aging workforce challenges work comp industry

By Tony Gottschlich, BWC Public Information Officer

Americans are living longer and they’re working longer, which presents a particular set of health care challenges for the injured worker, as well as economic challenges for the workers’ compensation industry, a longtime nurse and work comp veteran said Thursday morning at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

“Many of us don’t want to retire or we can’t retire, and that’s changing how we look at individuals in the workforce before they have an injury and how we manage their care after an injury,” said Kevin T. Glennon, vice president of clinical services for One Call Care Management in Jacksonville, Florida.

Glennon, speaking to a capacity audience at the Greater Columbus Convention Center, spoke for roughly 50 minutes on the topic, “Managing the Changing Needs of the Aging Injured Worker.” The session was one of 13 continuing education classes offered at the two-day symposium for health care professionals. The symposium continues Friday in conjunction with the 2017 Ohio Safety Congress & Expo, the Ohio Bureau of Workers’ Compensation annual safety, health and workers’ compensation conference.

Glennon pointed to U.S. Bureau of Labor Statistics indicating that older workers are less likely to get injured on the job, but when they do, it’s almost always worse than when a younger person is injured.

“When a 25-year-old worker falls on the job, she might get a bruise, but for a 75-year-old worker, it’s a broken hip,” he said.

While applauding people who want to work past the typical retirement age, Glennon noted the risks for doing so. Older workers typically have decreasing strength, endurance and reflexes, as well as diminished vision, hearing and mental acuity. And when injured, their recovery might be compromised by other existing health problems, such as diabetes, as well as medications that are contraindicated and an increasing susceptibility to infectious diseases.

The list goes on. All of which becomes even more complicated and costly if injured, aging workers have no family at home to help with their recovery.

Glennon told the audience to be proactive in managing work comp cases involving the elderly, even for cases where the worker was injured decades ago.

“I have one patient who is 80 who was injured at 22,” he said. “I’m a firm believer that when you have these older injuries, check up on these patients at least once a year.”

In any case involving the elderly, Glennon said to make sure the patient’s needs are being met, that they’re receiving proper vaccinations and routine medical checkups. Look for red flags —untreated wounds, recent ER visits — that could lead to a downward spiral of health problems. “And whatever we can do to keep the respiratory system healthy is money well spent,” he said.

Glennon added that technology, while expensive, can be more cost effective in the long run for the aging patient. Self-operated lifts to help the patient get out of bed, for example, or a wheelchair that helps a patient stand upright is likely cheaper than the costs of a home health aide over months and years.

As he wrapped up his presentation, Glennon said the aging workforce has caused employers to adjust their approach to risk management and workplace health and safety. Today the focus is on wellness and prevention — smoking cessation and weight management, for example — as well as modifying job tasks to better suit the worker.

Ohio prescription drug monitoring program showing positive outcomes

By Nick Trego, BWC Clinical Operations Manager

Established in 2006, the Ohio Automated RX Reporting System (OARRS) is Ohio’s state wide prescription drug monitoring program. OARRS collects information on all controlled substance prescriptions written by Ohio licensed prescribers and dispensed by pharmacies across the state.

The OARRS data base can be accessed by pharmacists, prescribers and law enforcement. Pharmacists use the database to review all controlled substance prescriptions being taken by a patient. OARRS allows the pharmacist to see the details of those prescriptions for an individual patient.

Prescribers access the database to ensure the appropriate treatment for patients and to assess compliance with prescribed medication regimens.

Law enforcement officials can review OARRS reports when legal issues emerge surrounding controlled substance use.

The OARRS database promotes the use of best practices when prescribing opioids, benzodiazepines and other medications that can have dangerous side effects if used inappropriately.

A recent report published by the Ohio Board of Pharmacy on opioid prescribing between 2012 and 2016 shows encouraging outcomes including:

  • 4% (162 million dose) decrease in the total number of opioids doses dispensed
  • 20% (2.5 million) decrease in number of opioid prescriptions
  • 5% (43 million) decrease in the total number of benzodiazepine doses dispensed
  • 2% decrease in the number of individuals who see multiple prescribers to obtain controlled substances illicitly (“doctor shopping”)
  • 11 million requests for OARRS reports in 2016

Ohio BWC statistics, likewise, show a decline in opioid prescribing over the same time period. During this period BWC has encouraged the use of best clinical practice guidelines and a state of the art closed formulary to provide medication management. Ohio BWC is the first state agency to establish a prior authorization (PA) process where clinical nursing staff reviews each medication request. The successes of the closed formulary, best practice guidelines and clinical nursing staff PA processes are listed below:

  • 5% decrease in opioid doses achieved by BWC
  • With less than 1% of the opioids receiving population in Ohio, BWC accounted for 9% of the reported decline in doses dispensed

These statistics leave no doubt that the OARRS database is having a positive influence on prescribing and dispensing controlled substances. Increased safety to patients in the state of Ohio and reducing the chances for opioid/benzodiazepine abuse and misuse are valuable benefits provided by OARRS.

Opioid education: the dangers of addiction and dependence

By Nick Trego, BWC Clinical Operations Manager

Opioid analgesics are potent pain relieving medications that can cause numerous side effects that range from itching to chronic constipation to hormone deficiencies.

The United States Drug Enforcement Administration (DEA) considers opioid analgesics to be dangerous drugs with a high potential for abuse and with use potentially leading to severe psychological or physical dependence.

Prior to initiating therapy with opioid analgesics, patient education surrounding the risks and benefits of these medications is essential to understanding and developing realistic expectations of treatment outcomes.

Due to the addictive nature of these medications, the Ohio BWC is also taking additional steps to prevent addiction, including collaborating with other organizations to develop fact sheets to help providers, employers and injured workers better understand the potential risks of excessive opioid use.

A few statistics show the importance of understanding the impact opioids are having in Ohio and across the United States:

  • Prescription opioids are associated with more fatal overdoses than any other prescription or illegal drug including cocaine and heroin.1
  • In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.2
  • Unintentional drug overdose continued to be the leading cause of injury-related death in Ohio in 2015, ahead of motor vehicle traffic crashes – a trend which began in 2007.3
  • Unintentional drug overdoses caused the deaths of 3,050 Ohio residents in 2015, the highest number on record, compared to 2,531 in 2014. The number of overdose deaths increased 20.5 percent from 2014 to 2015, which is similar to the increase from 2013 to 2014.4

Increased understanding of the safety and risks associated with the use of opioids will benefit those seeking the best possible medical treatment without facing the consequences of dependence or addiction.

We invite you to review these new educational materials and share them with your colleagues, family and friends.

The fact sheets can be found on BWC’s website:

BWC’s medical director, Dr. Stephen Woods, addressed the importance of balancing short term pain management and the longer term risk of addiction in an earlier blog post

For more information, email Pharmacy.Benefits@bwc.state.oh.us.

 

1 Ohio’s Opiate Epidemic, Mental Health & Recovery Board – Erie and Ottawa Counties, Alcohol and Other Drugs (AOD) Committee

2 CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016

3, 4  2015 Ohio Drug Overdose Data: General Findings, Governor’s Cabinet Opioid Action Team

Keep Riding the Wave!

By Noori Butt, Technical Medical Specialist, Reimbursement and Coding Policy Department

A famous shark attack survivor once said, “I’ve learned life is a lot like surfing. When you get caught in the impact zone, you need to get right back up, because you never know what’s over the next wave… and if you have faith, anything is possible, anything at all.” – Bethany Hamilton

Bethany is an amputee who has proven time and time again that with a solid support system, motivation, and grit that anything can be possible. You may have seen her story in the movie, Soul Surfer (2011) 1, that highlights Hamilton’s 2003 shark attack survival and her ultimate return to a victorious professional surfing career.

Stories like Bethany’s really hit home. At BWC, the Reimbursement and Coding Policy Department works with injured worker amputees to ensure they receive quality care and services. We collaborate with managed care organizations (MCOs), prosthetic vendors and BWC staff to work toward an efficient, timely, and simplistic process for delivering prosthetic services to Ohio’s injured workers.

This collaboration has resulted in the creation of the BWC Prosthetics Workgroup. This group is tasked with the responsibility to assist in developing standards for the billing and reimbursement of prosthetic devices. Our goal is to use the standardization to create a more efficient and cost effective approach to purchasing high-end, computerized prosthetics. We hope to reduce the overall lag time from physician prescription to the time the injured worker receives his or her fitted, programmed prosthesis. Our workgroup members have gained valuable insight into the prosthetics and orthotics industry as a whole, as well as an appreciation of relevant BWC polices.

In addition to the workgroup, Medical Services recently published a Prosthetic Policy Alert. The alert was published in an effort to assist MCOs with inconsistencies related to the new Prosthetic Pricing Methodology that was implemented in the beginning of 2016. BWC worked to collect input from both MCOs and prosthetic vendors to
include in the alert. The Prosthetic Alert provides details to clarify procedures involved in dispensing of devices in an efficient and consistent manner.

We remain positive as we continue our efforts of further improving prosthetic and orthotic protocols and procedures to best serve Ohio’s injured workers.

As Hamilton enthusiastically implied in her quote – just keep riding the wave!


1
McNamara, S. (Director). (2011) Soul Surfer [film]. Hawaii, USA: Island Film Group.

Five things you need to know about BWC’s provider fee schedules

By Yvette Christopher, Technical Medical Manager, Medical Policy

The Ohio Bureau of Workers’ Compensation (BWC) relies on a network of medical professionals to care for Ohioans injured on the job so they can return to work as quickly as possible. Competitive fees are essential to maintaining an excellent network of providers to deliver hands-on, quality care.

A fee schedule lists the maximum cost for which BWC will pay for services rendered. A fee schedule should provide a reasonable reimbursement for services rendered, while still maintaining a forum for the provision of cost effective, medically necessary services.

The Reimbursement and Coding Department within BWC’s Medical Services’ Division is responsible for development of fee schedules. The department partners with our providers and provider associations to develop appropriate methodologies to reimburse for services provided to Ohio’s injured workers.

Here are five things you need to know about BWC’s provider fee schedules:

  1. BWC has five fee schedules: The Professional Provider Fee Schedule, Outpatient Hospital, Inpatient Hospital Fee Schedule, Ambulatory Surgical Center Fee Schedule and the Vocational Rehabilitation Provider Fee Schedule.
  2. The fee schedules are implemented and changes are applied through the Ohio Administrative Code rule-making process annually. Rules applicable to the BWC fee schedules can be found on the BWC Web at www.bwc.ohio.gov.
  3. The fee schedules are modeled using the Centers for Medicare and Medicaid as a basis. BWC inflates the Medicare fee schedule by a set percentage often referred to as a Payment Adjustment Factor (PAF). The professional provider fee schedule PAF is between 125% and 220% of Medicare, depending on the procedure code.  The Ambulatory Surgical Center PAF is between 100-112%, depending on the procedure code. For February 2017, the inpatient PAF will be 112.7% for MS-DRG and DGME and 175.4% for outliers. Also proposed for May 2017, the outpatient PAF for children’s hospitals will be 266.9% and for non-children’s hospitals, 152.9%.
  4. BWC accepts stakeholder comments related to the annual implementation of the fee schedule. The proposed annual updates are published on the BWC web and comments are accepted for two weeks. The typical timeframe is approximately five months prior to the annual effective date of the rule. Stakeholders can request to be on the notification mailing list by contacting BWC at feedback.medical@bwc.state.oh.us.
  5. Each fee schedule has an annual rule effective date. The professional provider fee schedule is effective January 1 of each year. The outpatient hospital fee schedule and inpatient hospital fee schedules are effective May 1 and February 1, respectively. The ambulatory surgical center fee schedule is effective May 1. The vocational rehabilitation fee schedule is reviewed, but may not be updated annually.

Our network of medical professionals serves as the foundation for Ohio’s workers’ comp system. We’ll continue to regularly review our fee schedules so that Ohio’s injured workers have access to a variety of excellent providers who can put them on the road to recovery and a return to work.