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Protect Outdoor Workers from Extreme Cold

During this winter’s extreme cold spells, caused by a polar vortex creating frigid temperatures, workers are at added risk of cold stress. Increased wind speeds can cause air temperature to feel even colder. This increases the risk of cold stress for those working outdoors—including snow cleanup crews, construction workers, postal workers, police officers, recreational workers, firefighters, miners, baggage handlers, landscapers and support workers for the oil and gas industry.

The U.S. Department of Labor notes that what constitutes extreme cold and its effects can vary across the country. In regions that are not used to winter weather, for example, near freezing temperatures are considered “extreme cold.” Because a cold environment forces the body to work harder to maintain its temperature, as temperatures drop below normal and wind speeds increase, heat can leave the body more rapidly.

Wind chill is the temperature felt by the body when air temperature and wind speed are combined. For example, when the air temperature is 40°F, and the wind speed is 35 mph, the effect on exposed skin like an air temperature of 28°F.

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Cold stress can occur when the skin temperature goes down and the internal body temperature (core temperature) drops. This can lead to serious health problems and also cause tissue damage and possibly death. Exposed workers are vulnerable to hypothermia, frostbite and trench foot, the DOL said.

Some risk factors that contribute to cold stress are:

  • Wetness and dampness, dressing improperly and exhaustion
  • Predisposing health conditions such as hypertension, hypothyroidism and diabetes
  • Poor physical conditioning

The DOL recommends that employees working in frigid temperatures avoid alcohol, smoking and some medications to help minimize risks.

The best way to avoid cold stress is by wearing proper clothing. The type of fabric makes a difference as well. For example, cotton loses its insulation value when it becomes wet, while wool, silk and most synthetics retain their insulation even when wet.

Here are some clothing tips for workers in cold environments:

• For better insulation wear at least three layers of clothing: An inner layer of wool, silk or synthetic to wick moisture away from the body; a middle layer of wool or synthetic to provide insulation even when wet; and an outer wind and rain protection layer that allows some ventilation to prevent overheating.  Avoid tight fitting clothing.

• Wear a hat or hood to help keep the entire body warm.

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Hats reduce the amount of body heat that escapes from the head.

• Wear insulated boots or other appropriate footwear.

• Keep extra clothing (including underwear) handy in case clothing gets wet.

• Do not underestimate the wetting effects of perspiration. Venting of the body’s sweat and heat can be more important than protection from rain or snow, according to the DOL.

The Occupational Safety and Health Administration (OSHA) also issues guidelines. For example, because it is easy to become dehydrated in cold weather, employers can provide warm sweetened liquids to workers. Additionally:

• If possible, schedule heavy work for the warmer part of the day. Assign workers to tasks in pairs so that they can monitor each other for signs of cold stress.

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• Allow workers to interrupt their work if they are extremely uncomfortable.

• Give workers frequent breaks in warm areas.

• Acclimatize new workers and those returning after time away from work by gradually increasing their workload. Also allow more frequent breaks in warm areas to help them build tolerance for working in the cold environment.

These and other safety measures should be incorporated into the organization’s health and safety plan.

Workers Compensation Issues to Watch in 2014

With 2013 behind us, here are my thoughts on some workers compensation issues to watch for in 2014:

Rates Continue to Climb

In most of the U.S., rates for workers compensation insurance continue to rise. Rates are being driven by rising medical costs, the low interest rate environment, and the general unprofitability of the line of business.

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Potential Expiration of TRIPRA

Unless Congress takes action, the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) will expire on Dec. 31, 2014. Companies with high employee concentrations in certain cities are already seeing fewer options, with some carriers scaling back their writings to reduce their exposure to a potential terrorism event.

Impact of the Affordable Health Care Act (AHCA)

There has been much speculation about the potential impact the AHCA will have on workers compensation. With a finite number of medical providers available to handle the increased utilization, it is imperative that workers compensation payers identify the providers who deliver the best clinical outcomes for injured workers.

Integrated Disability Management

More employers are realizing that the impact of federal employment laws, like the Americans with Disabilities Act and the Family and Medical Leave Act, must be considered on workers compensation claims. Companies are also recognizing the value of managing non-occupational disability so that valued employees can get back to the workplace and be productive. Integrated disability management programs are the next generation of claims-handling and will expand in the future.

State Legislative Issues

Several states that passed significant reform legislation in the last two years are working to implement those reforms. Passing a law is only the first step, as the rules, regulations, and implementation of those laws determine if they will achieve their intended purpose. The most significant states to watch are in California, New York, and Oklahoma.

When California passed SB 863 in 2012, the expectation from the state’s legislature was that it would increase benefits to injured workers, while lowering costs for employers in the state. Litigation and unanticipated consequences of the bill have resulted in increased complexity and continually rising insurance rates. There is currently talk of potential clean-up legislation to go along with continued efforts at implementation. We will know by the end of the year whether SB 863 will be able to produce the promised cost savings.

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New York streamlined its assessment process, resulting in a significant reduction of the assessment rate for most employers. Since these rates are adjusted annually, it remains to be seen if these assessment savings will continue into the future.

The big news in Oklahoma is the bill that allowed employers to opt-out of workers compensation starting in February 2014. There have been delays in developing the rules and regulations supporting the opt-out plans, and this has in turn delayed carriers’ development of policies to cover new benefit plans. It appears unlikely that everything will be in place in time for employers to opt out beginning in February.

Vendor consolidation

In the last few years, there has been significant vendor consolidation in the workers compensation industry. First on the third-party administrator side and most recently in medical management. All this consolidation is making buyers of these services uneasy.

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They question how this will impact the quality of the services they receive and wonder how their goals of reducing costs align with the vendors’ goals of increasing revenues.

Analytics

Despite the huge amount of premium, exposure and claims data produced by the workers compensation industry, many complain about the lack of actionable information. As an industry, we will see a continued focus on the use of more meaningful analytics that can assist in identifying savings opportunities, formulating action plans, and measuring the impact of change.

Assessing ROI for Medical Cost Management Efforts

Programs including bill review, utilization review, and nurse case-management are all necessary components of any successful workers compensation program. It is important, however, that these programs are constantly monitored to ensure they are being used appropriately.

Please join me Jan. 15, for a webinar discussing these issues and other potential legislative developments to watch in 2014.  Click here to register

Industry Comments on CMS SMART Act Implementation

On September 19, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (IFR) addressing implementation of the SMART Act (otherwise known as the Strengthening Medicare and Repaying Taxpayers Act) , and specifically Section 201 of the Act, which requires CMS to develop a final conditional payment process that would take 120 days from beginning to end. The IFR issued by CMS would significantly extend this process beyond the 120-day deadline, and likely undermine the SMART Act’s intended improvements of the Medicare Secondary Payer (MSP) process. Several industry groups took the opportunity to express their disappointment in CMS’s efforts.

The Risk and Insurance Management Society (RIMS) called on CMS to rescind the IFR and reissue a proposed rule:

“While we commend the Centers for Medicare and Medicaid Services for initiating the SMART Act implementation process, we are disappointed that it chose to issue an IFR rather than promulgating a rule through the regular notice and comment process. We have serious concerns that CMS failed to comply with statutory requirements to implement a final conditional payment process by October 2013, and that the process it has chosen to implement in the interim rule allows for over twice the statutory 120-day period to obtain a final payment amount. We urge CMS to rescind its IFR and to re-issue a new proposed rule through the regular comment process.”

An American Insurance Association (AIA) task force also found the IFR severely lacking:

“AIA’s Task Force does not support the method, manner and time frames contained within the IFC for obtaining final conditional payment amounts via a web portal. The main purposes of the SMART Act are to allow the parties to resolve claims in a timely manner, with finality, to streamline compliance and make it more practical, while ensuring that CMS receives reimbursement for conditional payments quickly. The IFC as written undermines these goals, imposes impediments to prompt claim resolution, allows CMS to delay providing necessary information to beneficiaries and insurers and will not accomplish these goals. The IFC states it specifies the process and timeline for expanding CMS’ existing MSP web portal to conform to the SMART Act. Unfortunately, the provisions of the IFC do not comport with the SMART Act and in many instances go well beyond the purposes and provisions of the terms of the Act.”

The Medicare Advocacy and Recovery Coalition (MARC), a group created in 2008 by various stakeholders and beneficiaries to advocate for the improvement of the Medicare secondary payer system, stated that the IFR is in clear violation of Section 201:

“The IFR is in direct violation of Section 201, which explicitly required CMS to develop a portal process that, from beginning to end, took 120 days. The statutory language could not be more clear: ‘In the case of a payment made by the Secretary pursuant to clause (i) for items and services provided to the claimant, the claimant or applicable plan (as defined in paragraph (8)(F)) may at any time beginning 120 days before the reasonably expected date of a settlement, judgment, award, or other payment, notify the Secretary that a payment is reasonably expected and the expected date of such payment.’ The language of Section 201 is unambiguous; the entire process – from beginning to end – is to take 120 days, which is triggered by the notice, and which includes the 65 day response period within the 120 day period in which the Secretary is to provide the final number.”

An interim final rule differs from typical proposed rules and regulations in that it is in effect even as the public is still commenting on the proposal. The comment deadline for this IFR was November 19. It remains to be seen what, if any, changes CMS will make in response to the comments.

Minimizing the Dangers for Hospital Nurses

Nurses in Emergency Room

In “Bad Medicine,” from the December issue of Risk Management magazine, Alan H. Rosenstein wrote about managing the risk of disruptive behaviors in health care settings, which he defined as “any inappropriate behavior, confrontation or conflict, ranging from verbal abuse to physical or sexual harassment, that can negatively impact patient care.
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” More than half of respondents in one survey felt these events led to medical errors and compromises in patient safety and quality of care, Rosenstein reported.

But the risks nurses face do not just come from within the staff—simply doing their jobs presents a minefield of potential danger to physical and mental health. According to the Occupational Safety and Health Administration, those who work in nursing are the most likely to face violence on the job. Over 54% of emergency room nurses report experiencing physical violence or or verbal abuse on the job, of whom 41% report they have been punched or slapped at work and almost 28% report being pushed, shoved or thrown.

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Nearly 98% of physically violent incidents against nurses are perpetrated by patients, who are also responsible for 92.

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3% of verbal abuse in the health care setting.

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Check out the infographic below for more details on the risks nurses face, and some preventative best practices to minimize risk for hospital workers:
The Dark Side of Nursing
Source: TopRNtoBSN.com