The News You Need for April 24

Florida shuns heat safety, AI continues to be a force in healthcare, and what can organization do for case management? We cover it at WorkersCompensation.com

Climate & Comp: DeSantis Signs Bill Prohibiting Cities from Enacting Workplace Heat Protections

Liz Carey

Tallahassee, FL (WorkersCompensation.com ) – On April 18, Florida Gov. Ron DeSantis signed legislation that would prohibit municipalities in that state from implementing strict workplace heat protections.

The law, H.B. 433, will prevent local governments from establishing, or requiring employers to establish, heat protections that are not otherwise required by state or federal law. The law comes at a time when states and municipalities are scrambling to pass worker protections from climate change-related heat.

Between 2011 and 2022, the U.S. Bureau of Labor Statistics said, an estimated 436 work-related deaths due to environmental heat exposure were recorded. Officials expected to see more heat-related workplace death as record-shattering heat become more common.

The bill DeSantis signed would limit the powers of a local government to require heat and water breaks for outdoor workers. It was a direct response, DeSantis said, to Miami-Dade County’s effort to require shade and water for outdoor workers, such as construction and farm workers.

Officials estimate that more than 325,000 workers in Miami-Dade County work in the construction and farming industries. Critics of the bill called it an attack on workers.

“Florida is known as the Sunshine State — and the governor just signed a law to ensure the outdoor workers can’t escape the sun,” Torres said in a written statement. “Outdoor workers are all around us — working on construction sites, repairing and paving roads, picking fruit and vegetables on farms, and more. They’re just trying to make a living for their families — and instead of putting protections in place to ensure businesses are prioritizing their workers’ health and well-being from record-setting temperatures, we tied the hands of proactive local governments to do so.”

DeSantis said the bill was an issue raised by Miami-Dade County lawmakers.

“It really wasn’t anything that was coming from me. There was a lot of concern out of one county — Miami-Dade,” DeSantis said. “They were pursuing what was going to cause a lot of problems down there.”

Worker protections affected under the ban include employee monitoring, water consumption, cooling measures, acclimation and recovery periods or practices, informational notice posting, heat exposure training, first-aid measures, and reporting and recordkeeping requirements. The law is scheduled to take effect on July 1.

The bill follows similar measures in Texas last year.

In June of last year, as temperatures were soaring past the 100 degree mark, Texas Gov. Gregg Abbott signed a bill that prohibited municipal officials from implementing worker protections from the heat. Republicans introduced the bill on the grounds that “progressive municipal officials and agencies have made Texas small businesses jump through contradictory and confusing hoops.”

The move garnered national attention, earning the moniker the “Death Star” bill from the White House, and criticism from President Joe Biden.

“The idea that you can’t have mandatory water breaks when you’re working on a construction? I mean, what are we doing here?” Biden said during a White House event last summer in response to the bill.

Austin and Dallas were the only cities in Texas where those heat-related protections existed. Those ordinances required 10-minute breaks ever four hours for construction workers outside on sites.

Just before the bill was signed, in Lakewood, Texas, Eugene Gates, 66, a postal worker, died from what his wife said was heat-related exposure. Gates had been working on his usual route when a resident noticed that he had passed out on his lawn. The resident administered CPR until first responders arrived.

Gates was taken to a hospital where he later died. Officials determined in September that Gates died of the heat and heart disease. When Gates arrived at the hospital, his internal body temperature was 104.6. The high temperature in Dallas that day was 98 degrees, with a heat index of 115, according to the National Weather Service.

A photo taken by the president of the branch of the National Association of Letter Carriers that represented Gates, shows that two days prior to Gates’ death, a thermometer measured the temperature inside another USPS truck in the Dallas area was almost 140 degrees.

Not long after Abbott signed the bill, a 35-year-old lineman, Justin Cory Foster, was working to restore power in Marshall, Texas after storms took out electricity lines. Foster died after exhibiting signs and symptoms of heat illness. The heat index that day was 100. Officials said Foster had been working with his crew in the heat on June 20 and told other crew members he wasn’t feeling well when they returned to their hotel. He received medical attention and a shower to cool down, but later other crew members found him collapsed on the floor of his hotel. His death was determined to be heat-related.

Also in June in Bexar County, Texas, the mother of Gabriel Infante, a 24-year-old construction worker, sued his employer, B Comm Constructors, for creating “an extreme degree of risk” for workers.

In June 2022, Gabriel Infante, was reportedly dazed and sweating on a job site installing fiber optic cables in San Antonio. It was his fifth day on the job and the temperatures were over 100 degrees. Late in the afternoon, he lunged at another coworker in a fit of delirium, alleging that his coworkers were going to kill him, then fell and hit his head. His supervisor demanded someone call the police and that he be drug tested – even after EMTs arrived and said he was showing signs of heat stroke.

Infante later died in the hospital. His mother alleges in her lawsuit that B Comm Constructors lacked first aid procedures, failed to provide shaded rest areas and did not change work hours to adapt for the heat.

“All of these deaths are preventable,” Kristie Ebi, a professor of environmental and occupational health at the 美国华盛顿大学 , told the Guardian.

Officials said Infante’s internal body temperature was nearly 110F. Heatstroke can occur when the body reaches temperatures above 103F.

“If somebody had been paying attention, if they’d had the proper precautions on the construction site, he would have had water, he would have had access to shade, he would have taken a break. His core body temperature wouldn’t have gotten so high and he wouldn’t have died,” Ebi said.

In other states – California, Colorado, Minnesota, Oregon and Washington – regulations exist to protect outdoor workers from extreme heat. At least five states – Nevada, Maryland, Texas, New York and Massachusetts - have legislation under development, as of November of last year. However, there is no federal law that guarantees water breaks, rest or shade. In 2021, the Biden Administration ordered OSHA to produce heat safety standards, but they have not yet been issues. Officials said it could take up to 10 years for OSHA to finalize those rules and standards.

In Texas, Houston and San Antonio sued the state of Texas over the Death Star law, arguing that the legislation would limit cities autonomy and exemplified state overreach. That lawsuit is still pending.

Case Management Focus: Setting Realistic Expectations in a Challenging Healthcare System

Anne Llewellyn MS, BCPA, RN, CMGT-BC, CRRN, BCPA, FCM

Sarasota, FL (WorkersCompensation.com ) -- One of the most important things nurse case managers can do when working with injured workers and their families is to help them set realistic expectations of the healthcare system.

Before people enter the healthcare system, they think it is organized and coordinated and works for them. The reality is that the healthcare system works for the healthcare system and not the people who use it.

When people realize this, they can be demoralized and can lose hope. The role of the nurse case manager is to help their patients learn how to set realistic expectations so they can navigate the system and meet their needs.

Here are some tips you can use to educate and empower the injured worker you work with to become their best advocate.

Be organized: Help your patients understand that much information will come to them. This can be overwhelming, especially when they do not feel well. Recommend they get a copybook to list names, dates, and what was done at each entry. Note if they have to have a test done, go to therapy, or follow up with their doctor. Having things written down will keep them organized. Mark appointment dates on a calendar so they can keep appointments organized.

Prepare for appointments – Use the patient portal. Help them prepare for their appointment. Write down why they are attending the appointment and what they want to walk away with. A tool that will help them participate in their care is to sign up and utilize their patient portal. If they have lab work, x-rays, or saw a specialist, check to see if the reports are in their patient portal so they can make sure the doctor they are seeing has them and can review them at the appointment. Most portals allow the patient to print off the notes and test results. Having this documentation enables the appointment to be meaningful. Don’t assume the paperwork will be at your appointment. Check to be sure or bring the reports with you.

Write down questions and things you want to tell your doctor: Attending any doctor's appointment is hectic. The more organized the patient is, the more productive the appointment will be. Questions such as: How am I doing? What are the next steps in my plan of care? If the patient is taking a new medication, let the doctor know if there are any side effects. Ask if the medication is working. Is the patient’s pain relieved? Has the lab work normalized? Were there any challenges getting the medication, such as cost or access to it? Medications are costly – can the patient afford them? If not, investigate if there is a prescription assistance program to help with the costs. How does the patient feel about taking the medications? If they are having any issues, let the doctor know. Doctors and nurses want to help their patients but cannot do this unless the patient shares their concerns. Encourage the injured worker to Speak up!

Talk to the members of your healthcare team: Recommend that injured workers talk to all members of their healthcare team, including therapists, pharmacists, nurses, social workers, support staff members, the adjustor, and their insurance companies. Sharing concerns with their team members allows them to get various views and recommendations regarding resources that could help them.

Talk to the claims adjustor: Bring issues to the claims adjustor and work with them to devise solutions for your patients.

Read your member insurance handbook: Injured workers can have challenges not part of the workers' compensation case. In these situations, using their medical insurance is needed. When they have questions regarding their insurance coverage, they should read their member handbook that explains the policy. Many answers can be found in the member handbook. If they still have questions, have them call member services. As a nurse case manager, I sometimes make calls with them to ask direct questions and help the customer service people understand what the patient is asking.

I hope these tips help you help your patients set realistic expectations and learn how to be their own best advocate. If you are an onsite case manager, you can do many of these things in real time. If you are telephonic, it is not as easy – so touch base with your patient prior to any appointments and in between therapy sessions so you can help the injured worker as things happen. Have them report back to you so you know how things went and can follow up as needed.

Recent Study Suggests AI Could Improve Risk Adjustment Payment Accuracy?

FJ Thomas

Sarasota, FL (WorkersCompensation.com ) – Value based care and alternative payment models have been quite the experiment for healthcare the last few years. Used primarily by commercial, federal and state payers, payments using diagnosis-based risk adjustments accounted for more than $850 billion of healthcare payments in 2021. According a recent study published earlier this month in JAMA Network Open , new algorithms could be the key to more accurate calculations of risk adjusted payments.?

Hierarchical condition categories (HCCs), created in 2004 by CMS, are used to assign risk scores that are utilized in calculating payments. Critics of HCCs state that the categories have changed little since 2015 when the implementation of ICD-10 began, bringing about more meticulous diagnosis information. The critics state that the HCCs don’t account for the large data sets now available due to technology advancements. Additionally, the vulnerability of up-coding, and fraud have been arguments used by those calling for an overhaul of HCCs and risk adjustment calculations.

Researchers from the University of Kentucky argue that current HCCs models that predict healthcare spending and other outcomes are used by the majority of payers to manage and issue provider payments despite well documented flaws and inconsistencies in the methodology. To address these concerns, the researchers tested whether a machine learning algorithm could be used to create risk adjustment models that take into account clinical logic while addressing potential up-coding incentives and predicting cost of care better than the current federal HCC models. Using Diagnostic Item (DXI) categories and Diagnostic Cost Group (DCG) methods, clinical and claims data for commercial enrollees aged 64 and younger from the Merative MarketScan Commercial Claims and Encounters Database was reviewed and compared to HCC models from the US Department of Health and Human Services (HHS).

DXIs were grouped into disease hierarchies with an assigned Appropriateness to Include (ATI) score to identify vague conditions and up-coding opportunities. The ATI scores were then used as predictors where the DXI was clinically mapped to the most serious level of disease, even in rare disease cases.?

The researchers contend that considering current value based care models, new methods that can utilize and model over 70,000 diagnoses without creating invalid opportunities for up-coding is greatly needed. Usual models that estimate risk adjustment draw from repeated sampling of less than 1 million data sets, and classify with pre-specified sets of predictors. The researchers argue that such models are not accurate in predicting costs associated with rare conditions that may be outliers.?

While the methodology eliminated vague diagnosis classifications and up-coding incentive opportunities, researchers found that the model dramatically reduced HCC underpayments for rare conditions when compared to HHS models. Additionally, the researchers found that while predictive models work well in healthy populations, or in cases where there are only a few diseases, the ability for standard risk models to accurately predict costs decreases as there are more morbidity factors. In these cases, the researchers believe that traditional risk models cannot calculate the cumulative effect of multiple diseases in a single patient. While the test algorithm was similar to the HHS model, the researchers found the test model was better at differentiating rare, higher-cost conditions and had greater overall predictive power.