#PewPerspectives - Week of Mar 26

Following are the stories that I posted on LinkedIn during this week in case you missed them, along with my additional editorial comments in bold. View counts are as of 10:00am ET on April 6.

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Progress? (10,541 views)

This picture was provided to me by a colleague who had a friend visiting their #WorkComp doctor last week (I redacted the physician's name). Setting aside all of the misspellings and the passive-aggressive tone, having patients see this on the wall before seeing the doctor shows progress. At the very least, it sets expectations and should spark a conversation. Based on the number of views (10,541) and comments (43) this ended up being a provocative and controversial post. The comments included speculation about the doctor ("The tone of the statement sounds childish and lacks any nuance" and "This was obviously a physician who was part of the problem"), concerns about the change ("Please advise a slower tapering schedule!!" and "That is not a way to detox!"), and concerns about the patients ("This is how they end up on heroin or in MAT" and "There must be a plan in place to support the patients, not abandon them."). But this particular comment best fit my takeway - "Not sure a 'one size fits all' approach is the right answer, but posting this makes total sense if the goal is to create dialogue between the MD and patient on the issue." Given how polarizing the opioid epidemic has become, and how difficult it will be to "fix" it, conversation is required. If nothing else, notices like this should be a spark for a dialogue between the patient and physician, or the patient with family members, or using a resource like drugs.com to best understand the risks and benefits. The status quo on prescribing is no longer acceptable. How we move to a "new normal" will be difficult. But necessary.

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Change (1,907 views)

Thanks to Don McLaughlin for this concept yesterday -- It's often said that people hate change, but that's not entirely accurate. People hate loss (real or perceived). Change that makes things better is great, but maybe a "losing" change is the best thing that can ever happen to you -- So what do YOU need to change (and maybe lose) to advance forward? Change happens, whether it's solicited or unsolicited. How you respond to change can often determine whether it is "good" or "bad." Is it the fear of loss or the fear of the unknown? Or is it just the fear of discomfort that change often brings? Whatever the cause or the result, growth often only comes because of change.

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Boston Prediction Panel 2018 (1,237 views)

And speaking of change ... This panel at WCRI last Friday affirmed that change is coming, and those that are not prepared (regardless of whether predictions are accurate or not) will "lose." There were ideological differences (glass half full vs. half empty, socialism vs. capitalism) that made for a captivating dialogue as I sat in the audience. Ultimately, it came down to something that David Langham said (that he did not include in this blogpost) - choices will determine the future. By choosing to use Uber/Lyft instead of hailing a cab, we choose technology. By choosing to order groceries on an app for delivery vs. walking thru the aisles, we choose technology. By choosing to use the restaurant kiosk vs. going to the counter for a person to take our order, we choose technology. Most people make decisions that are in their own best self-interest, and by so choosing we select one (and potentially doom the other). As fast as technology is advancing, the implications to the workforce AND workplace are upon us. And our choices will determine winners and losers. The one thing everyone on the panel agreed upon was that change is inevitable. Whether in Work Comp, in society, or in personal lives, change is the one constant. As stated above, change can be "good" or can be "bad," but those that are adaptable have the best chance of growing because of it.

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Dealing with the Workplace Opioid Crisis (1,131 views)

Thanks to Chikita Mann for originally sharing this article from the Georgia Employers' Association. Considering myself an educator, I'm obviously a believer in education. The facts outlined in this article show astounding (not willful) ignorance .. still ... on behalf of employers, physicians and patients. And a tremendous impact on the workplace. Even if an employer doesn't reside in GA, there are some important tools included in their free "employer kit". Every employer should. I signed up for the kit and found an excellent online aggregation of National Safety Council resources. The highlights were:

• Develop a Workplace Policy (Learn about the issue, Update your drug-free workplace program, Structure benefits to address opioid misuse)
• Share Resources with Staff (Share the facts, Survivor advocate stories, Educate employees)

If you are on the management team of an employer (C-Suite, risk manager, H/R manager, middle management), this is something you should access and utilize.

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Indiana moves forward on a Work Comp drug formulary (1,841 views)

BREAKING: Indiana Gov. Eric Holcomb signed SB 369 into law on Mar 25 that establishes a Work Comp drug formulary, based on ODG. Excluding "medical emergencies" it is effective on 1/1/19 (for all claims) with an extension to 1/1/20 (if a 'N' drug's use starts before 7/1/18 and use continues after 1/1/19). A dispute resolution process is established as well. Lots of dates and more details than typical in legislation so it will be interesting to see how the regulations evolve. Regardless, now is the time to start evaluating the use of 'N' drugs in Indiana and starting the transition process (to 'Y' drugs ... or maybe no drugs #BioPsychoSocial). Hat tip to WorkCompCentral (subscription required). Seven states have implemented a drug formulary prior to this year, four states have / are implementing in 2018, and Indiana is now scheduled for 2019. That makes 12 total states that decided a drug formulary is a good idea. Other states continue to consider adoption. Is a drug formulary the solution (a "silver bullet") to the overuse of opioids in Work Comp? No. Can they be part of the multi-layered strategy? Yes. But if you've seen one drug formulary, you've seen one drug formulary.

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919,400 people aren’t working because of opioid use (1,788 views)

Excellent article from Joe Paduda on opioids. I wanted to add my perspective ...

• Opioid Use Disorder (DSM 5 definition for OUD) is indeed a huge issue for society, healthcare and workplaces. 919,400 people aren’t working, $40B cost to the economy.
• I believe a majority of injured workers using opioids do not have OUD (which implies addiction). They are using them appropriately, become tolerant (same dosage doesn't work as well over time) or dependent (will incur withdrawal is discontinued). But they are not addicted / have OUD.
• Medication Assisted Treatment (MAT) is indeed a key component of recovery from OUD / addiction (not as key for those that are tolerant or dependent) to address relapse. The concept has been strongly advocated for by the federal government since 2015 and most agree there is not enough treatment available.
• I have spoken with a number of providers of detox / FRP (functional restoration program) / recovery around the US. Every single one says they have "empty beds." In other words, they have room for patients. They agree the problem is two-fold - payers aren't paying and patients aren't going. So it's not just about access but motivation. To seek treatment. It's not happening as frequently as it should.

These statistics, issues and solutions are often difficult to fully digest. It is complicated and complex. The answer is likewise complicated and complex. But highly individualized. It requires people to recognize the need for treatment, and once that epiphany occurs for payers need to find and pay for the most appropriate treatment. The idiom "it takes two to tango" ("more than one person or other entity are paired in an inextricably-related and active manner") has never been more appropriate.

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In addition, I published two blogposts:

• "#PewPerspectives - Week of Mar 12" on March 27
• "#PewPerspectives - Week of Mar 19" on March 29

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

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