FDA Approves Two New Opioids

The FDA recently approved Olinvyk (oliceridine) injections for intravenous (IV) use for the management of patients with acute pain severe enough to require an IV opioid analgesic and for whom alternative treatments are inadequate.

According to the FDA-approved drug label, dosing should be based on severity of pain, patient response, prior analgesic experience, and risk factors for addiction, abuse, and misuse. The lowest effective dose for the shortage duration consistent with individualized patient treatment goals should be used.

In related news, the FDA also approved Qdolo (tramadol hydrochloride) oral solution for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

At this time, only a letter of approval has been published by the FDA, and the drug label with more detailed information is still pending.

However, like all other opioids, Olinvyk and Qdolo expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Patient risk should be assessed prior to prescribing, with regular monitoring for the development of concerning behaviors or conditions. Serious life-threatening or fatal respiratory depression may occur, which prescribers should monitor for.

Concomitant use of any opioids, including Olinvyk or Qdolo, with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

Tags: FDA, product approval, approval, opioid, Olinvyk, Qdolo, oliceridine, tramadol

Side Effects: COVID-19-Related Healthcare and Pharmacy Trends

The COVID-19 pandemic has had a profound impact on the American healthcare system, causing disruptions and driving rapid adaptations in how care is delivered.

These developments are impacting workers’ comp in multiple ways, including patient access to care, medication adherences, and behavioral health issues. Employers and insurers can help to mitigate adverse effects on injured workers.

This white paper addresses:

  • Hindered access to care
  • The use of telemedicine
  • Easier access to prescription drugs
  • Other pharmacy impacts such as drug shortages, physician dispensing, and prescription medication delivery

Click here to download our white paper.

Tags: Healthesystems, white paper, COVID-19, prescription, access to care, telemedicine

WCRI Issues Report on Physical Therapy

The Workers’ Compensation Research Institute (WCRI) recently published a new report titled The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation?

With an increasing number of workers receiving physical therapy, this study seeks to understand the impact of the physical therapy (PT) treatment pattern on the utilization of other medical resources and outcomes. Specifically, this study examines how the timing of PT impacts:

  • MRI utilization
  • Opioid utilization
  • Pain management injection utilization
  • Lumbar surgery
  • Overall medical cost per claim
  • Number of weeks of temporary disability benefits per claim

This study takes data from 26,000 low-back-pain only (LBP-only) claims from 27 states with injuries arising between October 1, 2015 and March 31, 2017, with detailed medical transactions for the first year of treatment. The 27 states included represent two-thirds of workers’ comp medical benefits in the U.S. and 37-72% of workers’ comp claims in each state.

Data is broken down into five groups, arranged by the timing of PT, as follows:

  • PT within 3 days after injury
  • PT within 4-7 days post-injury
  • PT within 8-14 days post-injury
  • PT within 15-30 days post-injury
  • PT delivered 30+ days post-injury

Overall, this study concludes that for workers with LBP-only injuries for which PT is indicated, early PT within 14 days is likely to be beneficial, associated with a lower utilization of medical services, lower overall medical costs, and shorter temporary disability duration.

“There is a tremendous opportunity for continued analysis of physical therapy effectiveness and its appropriate utilization within workers’ comp,” comments Tate Rice, PT, DPT, MBA and Director of Clinical Services for Healthesystems’ Ancillary Benefits Management Program. “In addition to the impact of timing outlined in this analysis, other factors to consider are frequency, duration and intensity of visits. Are patients receiving the right mix of passive vs active modalities based on where they’ve progressed in their recovery? Are they going often enough, or too often?”

Among workers who started PT more than 30 days after injury, utilization and cost of medical services were significantly higher than earlier PT treatment. In this group, workers were 46% more likely to receive MRI and 46% more likely to receive opioid prescriptions, compared with those who had PT treatment initiated within 3 days after injury.

Average payment per claim for all medical services during the first year of treatment was lower with early PT initiation – average medical cost per claim for workers with PT after 30 days was 24-28% higher than those who had PT within 3 days of injury.

Later initiation of PT is associated with longer temporary disability (TD) duration. The average number of TD weeks per claim when PT is initiated more than 30-days after injury was 58-69% higher when compared to those who initiated PT within 3 days post injury.

Tags: WCRI, physical therapy, disability, initiation, timing

U.S. Executive Order Signed for Telemedicine

On August 3rd, President Trump signed an executive order written to make temporary telehealth changes that were enacted in response to COVID-19 more permanent, while also expanding telemedicine further for rural communities.

This order is meant to allow for new flexibility regarding what services may be provided via telehealth, who may provide them, and in what circumstances.

Internal analysis from the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) saw telehealth visits jump significantly after initial temporary changes were made due to the COVID-19 pandemic. Pre-COVID-19, roughly 14,000 virtual visits were conducted, while in the last week of April, approximately 1.7 million virtual visits were conducted.

Within 30 days of the signing of this order, the following provisions must be met:

  1. HHS will announce a new model to test payment mechanisms to ensure that rural healthcare providers are able to provide the necessary level and quality of care. This model should give rural providers flexibility from existing Medicare rules, establish predictable financial payments, and encourage movement into high-quality, value-based care.

    The HHS has since released an extensive Rural Action Plan, which contains a four-point strategy to transform rural health and human services, including:

    • Building a sustainable health and human services model for rural communities
    • Leveraging technology and innovation
    • Focusing on preventing disease and mortality
    • Increasing rural access to care
  2. HHS and the Department of Agriculture will work with the FCC and other executive departments to develop and implement a strategy to improve communications healthcare infrastructure available to rural Americans.

    The FCC, HHS, and Department of Agriculture have since released a short Memorandum of Understanding which establishes how these organizations plans to work together in their shared goal.

  3. HHS will submit a report on policy initiatives tied to eliminating regulatory burden that limit availability of clinical professionals, improving mental health in rural communities, and more.

The report of policy initiatives is included within the Rural Action Plan.

Within 60 days, the HHS shall review the temporary policies put in place due to the pandemic and propose regulation to extend them. This includes policies related to the additional telehealth services offered to Medicare beneficiaries and the services, reporting, staffing, and supervision of flexibilities offered to Medicare providers in rural areas.

Tags: Telemedicine, telehealth, rural, provider, Federal, national, U.S., President, Executive Order, HHS

Florida COVID-19 Report

The Florida Division of Workers’ Compensation (DWC) published their August 2020 COVID-19 Report, which utilizes claim data up through July 31, 2020. The data in this report is organized by Claim Frequency, Claim Costs & Characteristics, Coverage Information, and Telemedicine.

According to the report, by the end of July, 11,872 COVID-19 claims were filed, and of those claims 5,144 were denied. COVID-19 claims accounted for 26.2% of all indemnity claims in the Florida workers’ comp system. A total of $13,120,059 was paid to COVID-19 claims, making up 5.3% of total paid benefits.

The report breaks down claim frequency and benefits paid across all 67 Florida counties, as well as by industry, gender, and age. Of note:

  • Dade County had the most claims and benefits paid, with 4,092 claims, paying $4.96 million in benefits
  • Protective services workers (including first responders) made up 36.6% of COVID-19 claims, totaling 4,345 claims, which accounted for 40.5% of COVID-19 benefits paid, for a total of $5.3 million
  • Healthcare workers made up 28.9% of COVID-19 claims, totaling 3,432 claims, which accounted for 34.8% of COVID-19 benefits paid out, for a total of $4.56 million
  • Service workers made up 24.4% of COVID-19 claims, totaling 2,897 claims, which accounted for 8.8% of COVID-19 benefits paid, for a total of $1.15 million
  • More COVID-19 claims were filed for women than men

In regard to telemedicine, 27,867 telemedicine bills have been submitted since the beginning of the year, dwarfing the total 1,672 bills submitted for the entirety of 2019. Of note:

  • Only 336 telemedicine bills were submitted in February, but a peak number of 10,968 were submitted in April, steadily reducing in the following months
  • 13,346 telemedicine bills, or 48% of them, were submitted by medical doctors, with $1.4 million paid
  • 7,170 telemedicine bills, or 26% of them, were submitted by physical therapists, with $838,000 paid

Tags: Florida, COVID-19, report, industry, claims, first responders, healthcare workers, telemedicine

Workers’ Comp Industry Insights Survey

2020 has brought with it changing dynamics in healthcare that have significantly impacted the workers’ compensation experience for injured worker patients, claims professionals and many other stakeholders.

Healthesystems, in partnership with Risk & Insurance®, is asking industry experts to weigh in on the major disruptors that will likely have a lasting impact on our industry.

We are curious about your thoughts on:

  • COVID-19
  • Mental/Behavioral Health
  • Psychosocial Factors
  • Artificial Intelligence
  • Opioids
  • Mobile Technology
  • Access to Care
  • Interoperability Between Disparate Systems/Processes
  • Telehealth
  • New and/or Expensive Medical Treatments

Click here to respond to our 5-minute survey!

Tags: Healthesystems, Risk & Insurance, survey, industry, insights