Submission vs Non-Submission (Opt-out)
The pros and cons of CMS review were debated by a diverse panel of experts during the second day of the conference. The panel included attorneys Robert Sagrillo, President and Chief Legal Officer of NuQuest, Jennifer Jordan, Chief Legal Officer and founder of MedVal and John Cattie, Jr, head of the MSP compliance group for the Garretson Resolution Group. Rita Wilson, CEO of Tower MSA Partners, Melinda R. Petit, Director of Claims Operations at Chesapeake Employers Insurance Group and Mark Sidney, VP of Claims at Midwest Employers Casualty Company balanced the panel out. Mark Walls, VP of Communications and Strategic Analysis at Safety National, kept the audience engaged with his questions.
The session began with an overview of CMS’ guidance on submission and the oftentimes inaccurate interpretation of the guidance by workers’ compensation judges in certain jurisdictions such as Maryland and Nebraska. One of the main reasons cited for CMS submission in those jurisdictions and a few others was that “the judges make you do it”. Proposed solutions included the parties challenging the workers’ compensation judges’ authority to push for submission as well as increased efforts by the industry to provide accurate MSP compliance training for the judges in the affected jurisdictions.
The discussion then turned to the panelists’ own views on the merits of CMS submission. CMS submission proponents cited the improvement in CMS’ review turnaround times and an aversion to risk as the main reasons for CMS submission. Opponents of CMS submission cited CMS’ inability to objectively assess future care given their inherent bias towards overfunding the MSA as the main reason to avoid CMS review. When our experts were presented with the question of “should you submit to CMS?” Sagrillo, Jordan and Cattie replied with a resounding “never”. Sidney preferred submission given his aversion to risk, while Wilson and Petit’s answers depended on the facts of the case. The audience’s show of hands suggested a close split between “never” and “depends” with very few opting for submission at all times.
An Rx for Prescription Drug Costs: Mitigating Costs While Providing Quality Care
Friday’s session began with a somber look at the opioid epidemic that is facing our nation. Attorney Amy Bilton, moderated a panel that included Mark Pew, Senior VP of PRIUM and Amy Lee of the Texas Department of Insurance, Division of Workers’ Compensation. Rear Admiral Assistant Surgeon General and Chief Pharmacist Officer United States Public Health Service (PHS) Pamela Schweitzer joined the panel via video-conference.
Pew began the discussion by reporting on the arrival of counterfeit fentanyl that has recently entered the market. It is mixed with Carfentanil, an elephant tranquilizer, and has made its appearance in oxycodone and roxicodone. Although naloxone is an effective antidote to traditional opioids, it is much less effective in reviving an individual who is over sedated from tainted opioids. The increased dangers from the counterfeit opioids further support the need to limit the use of opioids. The ethical dilemma of providing addicts with an antidote that may lull them into a false sense of security was also discussed.
Amy Lee then followed with an explanation of the development of the Texas drug formulary and its effectiveness in limiting opioid use in Texas. The status of California’s drug formulary and future implementation was also reviewed by the panel. Rear Admiral Schweitzer finished up the session by outlining the U. S Surgeon General’s “Turn the Tide: Rx” campaign that focuses on changing the way physicians prescribe opioids. She also indicated that numerous government agencies are working together to collect data and develop coordinated policies that will support a halt to the opioid epidemic. New policies may be implemented within the next year or two. The panelists also discussed the viability of medical marijuana for pain control as an alternative to opioids along with the risks posed by marijuana.
As the MSP compliance industry ages, compliance issues are becoming more nuanced and complex. These issues will require a multi-disciplinary approach that includes nurses, pharmacists, attorneys and claims in decision making. Both of these sessions served to highlight the evolving nature of the industry and will surely be further discussed in future NAMSAP meetings.