The document summarizes the key points from a panel discussion on solving America's workers' compensation crisis. The panel identified four main changes needed: 1) Eliminate unproven therapies in favor of accurate diagnosis and evidence-based treatment; 2) Identify at-risk workers early and invest in wellness programs; 3) Embrace innovative treatment solutions currently not covered by insurance; and 4) Advocate for changes to public policy to alleviate financial motivations that drive up costs. The panel agreed comprehensive reform is needed across the entire workers' compensation system to improve outcomes and reduce costs.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
At the 2014 HFMA National Institute, PYA Principal and Chief Medical Officer of PYA Analytics, Kent Bottles, MD, spoke about the strategies that hospitals and health systems are using to decrease per-capita cost, while increasing quality. In the session, “Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians and Administrators,” Bottles offered tactics for engagement.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
At the 2014 HFMA National Institute, PYA Principal and Chief Medical Officer of PYA Analytics, Kent Bottles, MD, spoke about the strategies that hospitals and health systems are using to decrease per-capita cost, while increasing quality. In the session, “Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians and Administrators,” Bottles offered tactics for engagement.
The Gathering Storm; The Breaking Dawn - Newport Beach, CALouis Cady, MD
In this lecture, presented February 8, 2014, Dr. Cady reviews the current state of medical economics in the US, highlighting both dangers as well as opportunities to improve American's health. He also reviews the Pharmanex BioPhotonic Scanner, the science of antioxidants and carotenoids, and the advantages of supplementation with a balanced multivitamin and multimineral supplement with fish oil. Numerous studies are cited correlating optimal nutrition and supplementation with normalization/optimization of thyroid function, blood sugar, brain function, minimization of brain shrinkage and cognitive decline, and avoidance of sexual dysfunction.
The Gathering Storm; The Breaking Dawn - Newport Beach, CALouis Cady, MD
In this lecture, presented February 8, 2014, Dr. Cady reviews the current state of medical economics in the US, highlighting both dangers as well as opportunities to improve American's health. He also reviews the Pharmanex BioPhotonic Scanner, the science of antioxidants and carotenoids, and the advantages of supplementation with a balanced multivitamin and multimineral supplement with fish oil. Numerous studies are cited correlating optimal nutrition and supplementation with normalization/optimization of thyroid function, blood sugar, brain function, minimization of brain shrinkage and cognitive decline, and avoidance of sexual dysfunction.
Discipline is not a punishment as most of us think. Through effective discipline children can get to learn how to cooperate with others and how to manage their own behavior.
Study and survey results indicate that digital can best be deployed by healthcare and life sciences/pharmaceuticals practitioners and companies to offer "warm" treatment that encourages and empowers patients in order to yield excellent health outcomes and operational efficiencies.
Disaster Contact a disaster preparedness person at either a loca.docxlynettearnold46882
Disaster
Contact a disaster preparedness person at either a local hospital, or local city or county emergency services agency. NORTHEAST OHIO
1. Blackout 2003
2. Chardon Highschool shooting 2012
3. Great blizzard 1978
Interview your contact, asking the following questions:
1) "What do you consider to be the top three disasters for which you prepare?"
2) "What would you say are your top three lessons learned about managing a disaster?"
What Would the Best Future for Health Care Look Like?
Introduction
The one thing the debate over reforming health care taught us all is that there are as many opinions as there are interested groups, and all of them differ in meaningful ways. To look at the views on improving the systems of care delivery, it is important to note where they have points of agreement and where they differ. They are all driven by the values and principles of the constituencies and what they hope to achieve from changes in the delivery system. This module will explore points of agreement and differences between important groups that will influence the direction health care will go in the next decade.
Patients
It is an interesting point that all constituencies, in their public statements, emphasize that a strong health care system should focus on getting the best outcomes for patients. What would that be, from the perspective of patients? Typically, patients relate that they want top quality in their care and the latest technology, along with immediate and unrestricted access to care, at the lowest possible cost. This triad has become the stumbling block of change initiatives, since to date, no one has figured out how to deliver all three. However, when patients' views are explored and probed, some interesting facts emerge. When patients say they want top quality care, in general, they tend to define that as achieving a cure or return to health. They certainly do not want to leave the system feeling worse than when they came in. Patients have been heavily lobbied in the media by pharmaceutical and medical technology companies to convince them that the latest (and most expensive) technology will deliver the desired outcomes. However, very little real research on the true effectiveness of treatments and technology makes its way to most patients, and patients in general do not shop for their medical care as carefully as they would if they were purchasing new cars, for example. The language of research and medicine is difficult for patients to understand and is frequently not well-explained by providers.
So, the nuances of top quality care in terms of being able to deliver a cure or return to health are not well understood by the constituency with the most at risk. What patients do understand is whether they feel better or see improvement in their health and whether care was rendered without errors and in a compassionate way. The best health care system, from a patient's point of view, is one that can consistently deliver the good.
Running head McVeigh– Defensive Medicine Essay 1 1 .docxcowinhelen
Running head: McVeigh– Defensive Medicine Essay 1
1
It has been said that the fear of medical liability drives healthcare providers, particularly
physicians, to unnecessarily order diagnostic tests and to perform treatments and procedures
that may not be necessary, simply to ensure that nothing is left undone. Is this in fact the case?
Defend position on this premise using literature.
Langley McVeigh, MHA, FACHE
May 23, 2017
McVeigh - Defensive Medicine 2
Yes, defensive medicine is practiced in the United States. However, it is important to
understand: (1) what impact it has on healthcare expenditures (2) to what degree does it occur
(prevalence) and (3) if so, what can be done to prevent it?
As an emergency services administrator for a Level 1 trauma center, experience has led
me to understand the dynamic influencing physicians in their clinical decision making process.
Ideally, this process should be void of non-clinical bias or influence. However, this is not the
case in many circumstances. Physicians are considering risk and liability when ordering tests
and procedures. This risk management, or risk mis-management, phenomenon is called
defensive medicine. By definition, these occurrences are medical practices intended to
exonerate practitioners from liability with limited or without medical benefit to the patient
(Sethi et al, 2012). Physicians have been directed by health policy to provide value based care,
but defensive medicine practice works against this care model.
There have been studies conducted measuring physician attitudes towards tort reform
and defensive medicine practices. While studies show physicians, especially high risk medical
specialists, regularly practicing defensive medicine, the cost implications are unclear.
Furthermore, proposed reforms to the medical tort system must be investigated. Some have
proposed to completely do away with the medical tort litigation and insurance system,
replacing it with a system similar to workman’s compensation models. While it may be a reflex
mechanism to use cost as a metric to measure results of defensive medicine practices, patient
outcomes and quality of life implications must also be measured. The patient is the one who is
being subjected to additional and unwarranted procedures.
McVeigh - Defensive Medicince 3
According to a survey of 2000 orthopedic surgeons in 2010 (Sethi et al, 2012), of the
1214 respondents, 96% admitted to have practiced defensive medicine by ordering labs,
imaging studies, specialist referrals, and inpatient admissions. Many surgeons confided this was
done to avoid malpractice claims. These prescriptions offered little no benefit to patient
outcomes, and contrary to the current posture of value based practice in our health care
system. This additional intervention is costly, at an inconvenience to the patient, and may carry
additional health risk. As a reflex, one may think of ...
In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.
Human Resources Debbies DilemmaFor this assignment, review t.docxadampcarr67227
Human Resources: Debbie's Dilemma
For this assignment, review the Debbie's Dilemma case study and complete the interactive module in Section 12.4 of your course text. Then, thoroughly address the following points in your paper:
· Use Herzberg’s two factor theory to explain Debbie’s level of motivation.
· Use Adams’ equity theory to explain Debbie’s decision to look for work elsewhere.
· Use Vroom’s expectancy theory to explain this situation.
· If you were advising the three physicians in the organization, what would you tell them they should have done when confronted by the two LPNs? Defend your advice.
Your assignment must be one to two pages in length (excluding title and reference pages). Utilize your course textbook and at least one additional scholarly source to support your conclusions and responses to the questions. Your paper and all sources must be formatted according to APA style as outlined in the Ashford Writing Center.
7.3 Organizational Change and Redesign
Organizational Design and Change
For many years, the world of business has experienced an increasing rate of change, as was predicted by Alvin Toffler (1970) nearly half a century ago. This trend has accelerated in healthcare. Toffler noted that people exhibit a natural tendency to resist change. In this section, drivers or forces that lead to change are examined first, followed by a discussion of resistance to change. Then, methods of implementing changes are described, and the impact of change on employees and managers, particularly as it relates to organizational design and healthcare, is discussed.
Drivers of Change
Two major sets of forces drive change in both profit-seeking and nonprofit organizations: internal drivers and external drivers. Each factor appears in the management of healthcare organizations.
Internal Forces
Many times, the feature that creates the greatest need for change originates from within the organization. These factors come from diverse sources, including organizational growth, a crisis, or an opportunity.
CASE
Combining Assets and Activities
The community of Tampa, Florida, has a diverse population, with healthcare being provided to persons with low incomes, extremely wealthy individuals, and a strong middle class. Three well-established physicians—an obstetrician, a gynecologist, and a urology specialist—decided that they should combine their practices into a unique new organization. They believed that numerous patients would be attracted to these separate, but interrelated, medical practices.
The three physicians worked together to create a plan. They decided that each physician would have privileges, or authority to practice, in more than one organization. Beyond their individual practices, the doctors would perform surgeries and provide additional medical care in several local area hospitals. In the new practice, their days would be divided into times in which they tend to routine examinations, to patients with medical problems.
4Seeking an Effective Care ContinuumLearning Objective.docxblondellchancy
4
Seeking an Effective Care Continuum
Learning Objectives
After reading this chapter, you should be able to:
• Identify programs that address the health issues surrounding workplace accidents.
• Assess the need for a continuum of care that comprises a comprehensive approach to
health care for vulnerable populations.
• Identify the preventive care services available to vulnerable populations.
• Examine the treatment services available to vulnerable populations.
• Explain the options that vulnerable populations have for accessing long-term care.
Courtesy of Kurhan/Fotolia
bur25613_04_c04_111-148.indd 111 11/26/12 10:30 AM
CHAPTER 4
Critical Thinking
OSHA provides many programs to ensure workers’ health and safety. Is there a similar program for
health care elsewhere? If not, could OSHA be used as a model to create or redesign existing programs?
Introduction
Introduction
Workplace injuries, deaths, and work-related illnesses cost the United States approximately $693.5 billion a year (National Safety Council, 2009). The Occu-pational Safety and Health Administration (OSHA), established in 1970,
ensures safe and healthy working conditions for men and women by setting standards
and providing training, outreach, and education. In other words, OSHA focuses on the
prevention of injuries by regulating the workplace.
In contrast, workers’ compensation programs, which are administered through the
Department of Labor, help workers who have already sustained a work-related injury or
an occupational disease. These programs focus on wage replacement, medical treatment,
and rehabilitation services coverage. Employers pay into the workers’ compensation
programs through companies that work to mitigate costs to insurance companies, called
insurance underwriters, or government programs to help cover these expenses. Although
paying into the national workers’ compensation program represents a significant expense
for employers, lost employee productivity is more costly. To minimize workers’ compen-
sation and lost productivity expenses, many employers have preventive workplace safety
programs that include educational sessions on safety and even posters with images and
safety messages to remind workers of best practices for safety. These preventive programs
aim to minimize risks both to the workers and the employers. Some of these programs
are available through OSHA, the national programs for workers’ compensation, or their
company insurance or liability underwriter.
Workplace safety programs and workers’ compensation programs provide a continuum
to address the health issues surrounding workplace accidents. From prevention to treat-
ment to rehabilitation to return-to-work, workplace safety and workers’ compensation
programs address the specific health care needs of America’s working population. This is
one example of the way a continuum of care works and how programs can work together
to create a continuum of care. E ...
how does malpractice affect quality of healthcare service What are .pdfDhanrajsolanki2091
how does malpractice affect quality of healthcare service? What are two options of malpractice
reform?
Solution
Any sort of unskilled or negligent treatment on the part of healthcare providers, be it a doctor,
dentist, nurse, even the hospital or any other professional of the domain, towards the patients can
be treated as \'malpractice\'. And it can have several adverse effects on the patients as well as
doctors. Following lists a few of them:
The most obvious effect is the reluctance among patients to seek medical help at the hour of
need. This is as a result of the lack of trust in the patients for the whole system of treatment,
which ultimately affects the basis of doctor and patient relationship.
Malpractice claims can also affect the cost of treatment, ultimately making them exorbitantly
high for the patients to be able to afford it. Easy access to helathcare by patients can also become
difficult due to a rise in the insurance premiums.
Claims of negligence by the patients can also lead to a potential threat amongst the doctors. This
results in the latter becoming more conscious or defensive in choosing their line of treatment,
where they end up prescribing all sorts of additional diagnostic tests. The ultimately results in
excess cost incurred in the part of the patients, who then find it increasinly difficult to afford it.
As for the doctors, they could be involved in lawsuits and that can jeopardise their career, induce
stress, and in extreme scenarios, when the cost of malpractice insurance becomes too high, they
can even look for alternative careers.
The most common type of malpractice reform is the traditional tort reform, that can be both
direct as well as indirect. The direct reform puts a cap of the costs incurred in the hospital but it
generally doesnot impact the quality of healthcare that is provided to the potential patient.
Indirect reforms, on the other hand, puts a cap on the liability cost, such as attorney\'s fees in
case of a lawsuit. This as well has no effect on the quality of treatment. The traditional tort
reform can however reduce the occurance of defensive medication. According to Daniel Kessler,
there is a need for a more aggressive reform system that can address issues such as errors on the
part of healthcare provides, transactional costs incurred in the system, and the slow
compensation rate for the injured patients. And in turn he proposed the \"administrative
compensation system\". According to this system, there are two models to be followed for
reforms, the health court and the no fault models..
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sam in health ecosystem
1. Innovation and Change: The 4 Keys
To Solving America’s Workers’
Compensation Crisis
Written by George K. Lewis Jr., PhD
Chief Executive Officer and President, ZetrOZ, Inc.
Manufactured by:
2. The workers’ compensation system in
America has become so ineffective and
plagued with questionable practices that
some experts have deemed it “broken.”
The medical community, insurers, employers,
and patients alike complain of feeling trapped
in a system where costly, catastrophic cases
dominate, becoming unmitigated “train
wrecks,” which often could have been more
simply resolved.
This sad reality has stakeholders scratching
their heads in confusion. How did a system
that was originally intended to protect the
health and safety of American workers become
so intractable, and how can we solve what has
become a multi-billion-dollar workers’ comp
crisis?
A panel of experts with deep experience in
workplace injury, health care, insurance,
and pain management tackled the question
in a comprehensive discussion of the state
of workers’ compensation today. The panel
members agreed upon directions that, if
adopted, could improve treatment and
healing for injured workers while also keeping
long-term costs in check for employers and
insurers.
All agreed, however, that addressing
the worker’s compensation crisis will
require innovative approaches, a deeper
understanding of diagnosis and worker
lifestyle, and a willingness to challenge public
policy.
The panel discussion was moderated by
Michael Shor, MPH, Managing Director at Best
Doctors Occupational Health Institute, and
included: Dr. Ralph Ortiz, who is on the Board
of Directors and a Founding member of the
New York State Pain Society and Founder and
Director of Medical Pain Consultants; Robert
Woods, Senior Vice President of Energi, Inc,
a company that provides risk management
and insurance programs; David Cohen,
Executive Vice President at Standard Oil of
Connecticut, Inc; and Dr. Gerard Malanga, a
Rutgers University Clinical Professor of Physical
Medicine and Rehabilitation and Medical
Director of Horizon Casualty Services, Inc., a
subsidiary of Horizon Healthcare Services, Inc.
The resulting insights, summarized in this
paper, can be translated into solutions that
have the potential to bring the workers’
compensation system back on track, reducing
costs and helping patients return to work
safely and more quickly. In nothing short of
a total paradigm shift, stakeholders in the
system must embrace four essential changes
to return America’s workers’ comp system to
what it was intended to be -- a system that
helps injured workers return to work safely.
The panel’s recommendations are as follows.
Innovation and Change: The 4 Keys
To Solving America’s Workers’
Compensation Crisis
3. 1
Eliminate unproven therapies in favor
of accurate diagnosis followed by
evidence-based treatment.
It’s my opinion that the classic model is not successful due to outdated modes of thinking. The
current model of treatment consists of using lots of non-steroidal anti-inflammatories (which
are meager in efficacy to begin with), referral to physical therapy that is often perfunctory,
with a reliance on passive physical therapy (instead of active physical therapy). For persistent
complaints, patients are often provided repeated cortisone injections, which are well known
to inhibit tissue healing, rather than trying to regenerate tissue. When these treatments fail,
patients then often undergo surgery, with various surgical procedures that have become
embedded in classic traditional orthopedic treatment, such as partial meniscectomies
(removal of a piece of cartilage in your knee that cushions and stabilizes the joint), and spinal
fusion procedures. The current medical literature has demonstrated that in many patients,
partial meniscectomy is no better than physical therapy or even sham meniscal surgery. And
yet 700,000 partial meniscectomies are performed every year.
-- Dr. Gerard Malanga
Proper diagnosis is closely linked to proper
treatment, and providers need to focus
more heavily on accurate diagnosis to deliver
appropriate care. Yet some 30 percent of
patients are misdiagnosed: in the worst cases,
what could have been an injury that might
heal within weeks with proper treatment
can, if improperly diagnosed and treated,
snowball into a life-altering, permanent injury
that prevents that worker from ever going
back to work. Too often, providers choose a
conservative intervention in the beginning of
a workers’ compensation case, usually due to
its low cost. But when applied in the wrong
circumstances, conservative treatment can
cost more in the long run, as later, more costly
treatment is required.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis
30%of patients are
misdiagnosed
4. 2When we’re dealing with a work-related injury we’re dealing with a very specific population –
they make a living pushing, pulling & lifting. In our research, it’s a high school education or
less. They’re very ill equipped to really understand how to access the medical system, never
mind judge what is good care from bad care, so that places a huge burden on what [the
insurance company and company] do, in terms of trying to help that injured worker through
that process.
-- Michael Shor
Identify at-risk workers early, and invest
in wellness as well as sickness.
At the same time, preventing patients from
spiraling downward at the onset of injury is
crucial. Panelist Robert Woods, Jr., Senior Vice
President, Claims Energi, Inc. has discussed
his company’s demonstrable success with
use of nurse case managers (NCMs) for those
entering the workers’ comp system. Energi
assigns NCMs to every patient, providing
services from filing the claim, helping to
guide treatment and care, and accompanying
patients to doctor visits.
Energi retained Risk Navigation Group, LLC
(Risk Navigation) to conduct an analysis
of medical management outcomes in two
samples of claims. Risk Navigation examined
incurred losses to determine if there was a
distinction in the disability duration outcomes
between two programs, one using NCMs
for all claims and the other using NCMs in
less than 40 percent of claims. Use of NCMs
demonstrated a materially and financially
advantageous effect on both overall medical
management and, more particularly, a
diminution of disability duration in similar
claims. Specifically, “days of disability” were
reduced from 316.9 to 85.65 when NCMs were
activated from “day one.” According to Woods,
“Though some companies consider it an extra
cost, nurse case managers have been known to
help close workers’ compensation cases at 70
percent of what they would normally cost.”
Another example of a company investing in
wellness is Horizon Casualty’s innovative Pain
Management Medical Home. Anecdotally
speaking, patients with an unhealthy lifestyle
(e.g. smokers, overweight/obese, etc.)
combined with the psycho-social aspects of
negative relationships at work or at home
tend to be more likely to have a negative post-
injury experience. Strategic new initiatives
such as the Pain Management Medical Home
approach put people on the best therapeutic
course early in their care by implementing a
care team approach. The care team consists of
a diverse set of healthcare providers, including
a Physical Medicine and Rehabilitation
physician, a functional rehabilitation provider,
and a psychologist. This holistic approach to
5. the patient’s care applies a biopsychosocial
model to health care. Early studies show that
patients treated under the Horizon Casualty
Services Pain Management Medical Home
program, using evidence based medical
guidelines, had significantly improved medical
outcomes. In addition, there was a statistically
significant 50% reduction in medical and wage
replacement costs. Variables contributing to
lower costs were: fewer steroid injections,
fewer physical therapy treatments and no
patients discharged on opioid narcotics.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis
6. 3What is evidence-based medicine? It’s the publications and the journals, but it’s also the his-
tory and knowledge of the physician with the different techniques, and the history and goals
and desires of the patient. That’s evidence-based medicine.
--Dr. Ralph Ortiz
Embrace innovative
treatment solutions.
The panelists agreed that the physician
“quiver” is short on “arrows” when it comes
to treating musculo-skeletal pain, the most
common form of workplace injury. Today,
treatments offered may be limited to what’s
reimbursable rather than what might work
best for the patient. According to Dr. Ralph
Ortiz, “Pills, passive physical therapy and
injections only mask the pain – there are
newer therapies available, showing real patient
improvement - let’s get rid of the red tape, be
the innovators and try them.”
Dr. Ortiz is mainly speaking of innovative,
new treatments currently available, but
not yet considered part of the generally
accepted standard treatment protocol (and
thus unlikely to be covered) by the insurance
industry. However, more progressive workers’
compensation insurers such as Energi are
thinking more flexibly. Such companies are
allowing patients in some individual cases to
have access to new and innovative treatment
options where the treatment appears to most
likely be successful given the patient’s medical
circumstances because they view each injured
worker as an individual, and not just another
claimant.
Some of the novel therapies that may be
useful in some circumstances that were
discussed by the Panel include four distinct
therapeutics that enhance the human body’s
natural healing processes. Although well-
supported and researched in the medical
community, they are today largely “not
covered” by insurance carriers:
7. Prolotherapy
Widely considered the progenitor of each of the following
treatments, it is also called proliferation therapy or
regenerative injection therapy, a treatment of tissue with the
injection of an irritant solution into a joint space, weakened
ligament, or tendon insertion to relieve pain.
Platelet-Rich Plasma (PRP) Injections
An in-office procedure that uses the body’s own healing
mechanisms by injecting the patient at the site of injury with a
sample of their own blood enriched for platelets as a means to
promote the healing of injured soft tissues.
Sustained Acoustic Medicine (sam®)
A portable, wearable FDA cleared medical device that delivers
long duration, low-intensity therapeutic ultrasonic energy
to relieve pain and muscle spasms, and to increase local
circulation that will accelerate the natural healing processes.
Stem Cell Therapy
An in-office procedure using the unique capability of stem
cells to differentiate and proliferate into distinct cell types
throughout the body; the harvesting of stem cells from bone
marrow for reinjecting into the injury site aids the natural
repair process for damaged or degenerated tissues and joints.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis
8. The Affordable Care Act had one key
change that, intentionally or not, had major
ramifications for the workers’ compensation
industry. Historically, group health and
workers’ compensation were billed as “fee
for service,” meaning health care providers
were reimbursed based on the services
provided for a patient (including diagnostics,
procedures, office visits, etc.) But post-ACA,
workers’ compensation remains fee for service
while group health is evolving toward more
focus on capitation, in which doctors are
reimbursed a lump sum per patient based
on their diagnosis and thus must manage the
patient’s healthcare within a fixed budget. The
result: for patients with chronic degenerative
conditions – a bad knee, a bad shoulder, a bad
back -- it’s more efficient and more financially
sound for insurance and medical professionals
if patients can be classified under workers’
compensation because the patient’s cost of
care is not capped.
While the primary goal of all stakeholders
should be to ensure quality patient care,
the financial motivations (where can a
provider make the most money) and budget
considerations (how can a payer save the most
4When group health squeezes the financial balloon, it’s workers comp that makes up
the difference.
--Michael Shor
Advocate for a paradigm shift that alleviates
the implications of current public policy.
money) are real. Says panel participant and
employer, David Cohen, “What all involved
must keep in mind is, getting a patient back to
good health – and work - faster, will always be
the ultimate money saver.”
Reversing this trend requires the collaborative
efforts of key stakeholders: workers’
compensation insurance carriers, workers’
compensation preferred provider medical
networks, employers, and providers. Through
productive and transparent collaboration,
evidence-based medical care strategies can
be established to support diagnostic and
therapeutic products and services that deliver
high-quality health outcomes. This represents
a shift in the workers’ compensation industry
from current practice to focus on referring
claimants to medical providers that work in
collaboration with likeminded providers within
metrics based programs that consistently
achieve improved medical outcomes at
lower cost. Ultimately, this trend may result
in a shift from “fee-for-service” to “pay for
performance,” in which financial rewards
are only realized upon production of quality
health outcomes.
9. Where does the industry go from here?
According to the most recent findings from
the NCCI (National Council on Compensation
Insurance), although claim frequency has
generally declined over the last two decades,
the severity of claims has continued to
increase. And although recent increases
in the average medical costs have been
more modest than before, the underlying
drivers of medical costs “are still present and
remain a concern,” the NCCI says.
Beating back those “underlying drivers of
medical costs” is in large part the answer
to realizing lasting, meaningful reduction in
workers’ compensation claims, according
to Dr. George K. Lewis, whose progressive
medical device company, ZetrOZ, sponsored
the panel.
“Insurers, healthcare professionals,
employers and medical innovators have
to put aside dollars and differences and
be open to exploring a combination of
therapies - from the tried and true to the
new and innovative - that better prevent and
treat workplace injury,” Lewis said.
What’s more, the industry must move
beyond the comfort zone of treating
patients according to old patterns, Lewis and
other panelists agreed. All players should
take a fresh and unbiased look at evidence-
based medicine and adopt a more open
attitude to promising new therapies. Taken
together, these recommendations have the
potential to unlock a bright new future for
all who are involved in America’s workers’
compensation system.
Innovation and Change:
The 4 Keys To Solving America’s Workers’ Compensation Crisis
10. About ZetrOZ, Inc.
ZetrOZ develops wearable bio-regenerative devices for the delivery of sustained
acoustic medicine, a new treatment form. sam® is an FDA cleared device
which provides ultrasonic waves that penetrate 5 cm into the tissue, increasing
circulation, oxygen and nutrient delivery, and the removal of waste products, such
as lactic acid, from the site of a musculoskeletal injury accelerating the natural
healing cascade.
Built on a proprietary miniaturized platform designed for the treatment of acute
and chronic musculoskeletal conditions, ZetrOZ devices are clinically proven to
enhance tissue recovery, accelerate the body’s natural healing processes, and
relieve pain. Since the company’s founding in 2009, ZetrOZ has successfully
applied this innovative technology to the development of two products now
available on the market: sam®, an FDA approved device, and UltrOZ™ Elite for the
maintenance and rehabilitation of equine athletes. For more information, visit
www.zetroz.com.