Once again, the CWC & Risk Conference organizers, exhibitors and presenters made good on their promise to deliver a conference that was packed and stacked with information. The venue was the St. Regis in Dana Point and the meetings ran pretty much from 8:00 in the morning 17:00 in the evening every day for three days.
I attended as I have for the past several years to educate both my readers and myself on the workers compensation system and to keep abreast on changes that affect the injured worker and the employer. This year’s conference didn’t disappoint.
I arrived too late in the day on Wednesday for the wonderful breakfast, but in time to attend a session that I thought might prove interesting. The session entitled “MSA Cost Mitigation: Strategies to Reduce Future Medical Exposure” was eye opening and helped shed light on how the defense side of Workers Compensation “thinks” when it comes to providing treatment to and for the injured worker.
MSA or Medicare Set Asides need to be calculated in many Workers’ Compensation cases, especially in those cases where the injured worker is already a Medicare beneficiary or will become Medicare beneficiaries within 30 months or where the injured worker is eligible or receiving Social Security Disability Insurance benefits (SSDI). Since this can have an impact on yours truly, needless to say I listened with rapt interest.
The speaker provided us with many examples of how an employer could control medical costs, however as a nurse I thought that some of these cost-saving measures came at the expense of the injured worker. The speaker gave the example of Gabapentin versus Neurontin. Gabapentin as with generics cost much less than the brand name medication Neurontin. She explained that by switching to the generic the employer could save as much as 2,124.30 a year on a claim. She went on to explain that even more money can be saved depending on the number of pills ordered based on milligrams; for example if the physician ordered one 800 mg pill a day an even greater cost saving can be realized if the following combination was ordered two 300mg pills (at a cost of .03 cents/pill) and two 100mg pills (at a cost of .02 cents/pill). The cost then goes from $85.80 to $3.00 a month. Of course this means that the injured worker must take a total of four pills a day instead of one pill a day, but hey what a cost savings!
The speaker explained that to make such adjustments the client must be a willing participant and that other conditions such as generic must already be available on the marketplace and that the client must already be using the generic. She suggested that if the employer took the long view and was in a position to anticipate when the generic of a specific medication would become available on the marketplace then it might serve the employer well to delay the MSA until the generic was available so the cost of the generic could be included instead of the brand name, once again providing a cost saving to the employer.
And while I am very much in favor of saving, I think it’s critical that the injured worker be truly part of the decision making process. Though the speaker made a point of using the term willing participant to refer to the injured worker I think there’s a fine line between willing and coerced.