California Business Property Insurance Brief

It’s a pop quiz style risk roundup this week where you can match wits with the riskmeisters. The Notwithstanding Blog hosts the Cavalcade of Risk #149: Single Best Answer edition.

In other matters, we will use this week’s roundup here at Workers Comp Insider to highlight some useful gizmos and gadgets that have been accumulating in our bookmarks folder: a grab bag of work-related mobile apps and calculators that we hope you’ll find useful!

There’s an app for that

DOL data apps – Backed by prize money, last summer the Department of Labor issued an Occupational Employment Statistics challenge to developers to use DOL data in innovative, creative, and useful ways that would empower job seekers and consumers. Winning apps were recently announced – they include job trackers and occupational wage watchers – but our favorite is Eat Shop Sleep, an app that allows you to geographically shop for hotels and restaurants, and to narrow your results based on health and labor violations, as well as local reviews.

The DOL itself offers a few mobile apps – a labor statistics tool, a timesheet, and an OSHA heat safety tool. See the full menu of USA.gov features various mobile apps – a few that look particularly helpful include PTSD Coach, MedlinePlus Mobile, and U.S. Federal per-diem rates. And we can’t resist pointing out the MEanderthal, a Smithsonian app that allows you to upload a photo and morph into a neanderthal – not particularly work-related, unless you want to create an unusual portrait bulletin board for your work team. (See a fun video of MEanderthal in action).

Accessibility App – Another app development challenge sponsored by the Knight Foundation and the Federal Communications Commission yields a tool with great potential for people with disabilities. Access Together, is a crowd-sourced Foursquare-style app, which incorporates user information about accessibility of various locations. All answers will be saved and become part of a searchable dataset, map and open API to be used by people with and without disabilities.

Distracted Driving – DriveSafe.ly is a mobile application that reads text (SMS) messages and emails aloud in real time and automatically responds without drivers touching the mobile phone. DriveSafe.ly bills itself as “the solution to texting while driving.” It’s available in either a personal or a business/enterprise edition.

Calculators

Push Pull Carry Calculator – Canada’s WorkSafeBC is a great source of quality health and safety resources. Check out the Push Pull Carry Calculator, a tool designed to help prevent musculo-skeletal injuries.

Ergonomics Cost Benefit Calculator – The Puget Sound Chapter of the Human Factors and Ergonomics Society has developed an Ergonomics cost-benefit calculator that helps you to estimate ROI by comparing three intervention options that offer estimates of benefits and payback periods.

Diabetes cost – The Agency for Healthcare Research and Quality (AHRQ) has created Diabetes Cost Calculator for Employers, an evidence-based tool that employers can use to estimate how much diabetes costs them and the potential savings that would result from better management of diabetes. In a similar vein, see Blueprint for health, a free web-based tool for making value-based decisions for health and productivity management. This tool was developed by the Health as Human Capital Foundation in collaboration with ACOEM, and the National Business Coalition on Health (NBCH).

R.O.I. – Wellness Return on Investment Calculators are designed to help you to estimate the effect that a good wellness programs can have on health care costs, absenteeism, and presenteeism. For another tool variation on the theme of wellness program ROI, see the Calculate your Savings.

The cost of doing nothing – Quantifying the Cost of Physical Inactivity Calculator estimates the financial cost of physically inactive people to a particular community, city, state or business. The site also provides companion resources and information to re-allocate resources and plan for healthier workplaces and communities that are more supportive of physical activity.

Yesterday the New York Sunday Times ran a fascinating piece on the manufacturing of iPhones. The making of 200 million phones is taking place in the far east, mostly in China. When President Obama asked Steve Jobs “why can’t that work come home?” Jobs replied: “Those jobs aren’t coming back.” The article, written by Charles Duhigg and Keith Bradsher, describes the reasons why this work will never come back home (and why we wouldn’t want them anyway).

In the months prior to the release of the iPhone, Steve Jobs carried a prototype in his pocket. He discovered that the plastic screen was easily scratched by the keys and loose change that people often have in their pockets. He informed his engineers that this was not acceptable and insisted – at the last minute – that they redesign the phone with a scratch- and break-resistant glass. Corning Glass was able to do this.

Corning (made in America!) shipped the new parts to China, where they arrived around midnight. Supervisors at the assembly plant woke up some 8,000 workers sleeping in company dorms, gave them tea and a biscuit and set them to work in 12 hour shifts installing the glass into bevelled frames. The plant churned out 10,000 phones per day.

It is impossible to envision an American workforce positioned to perform this kind of work under these conditions. We do not house our workers in dorms (except migrant farm workers). We do not suddenly change work schedules to begin at midnight. Even in the Republican dream of a post-union workforce, it is inconceivable that American workers would accept this kind of pressure – and be paid $17 per day or less.

iPhones and Pyramids
Nearly seven years ago we blogged the emerging issue of worker rights in China. While there is a bare-bones structure of rights, these are arbitrarily enforced and easily avoided. China is a single party state, run with ruthless efficiency by the Communist Party. Opposition is not tolerated; dissent is brutally suppressed; and workers are at the mercy of their employers. To enforce rights, you need a constitution and an infrastructure of laws and regulations. And you need lawyers to argue on behalf of workers. China has none of these crucial elements and, truth be told, no real interest in developing them. And that is why everything is made in China: quality is high, working conditions are whatever management wants them to be, and labor costs are low.

While technically not slaves, production workers in China labor under appalling conditions that do not and cannot exist in most western cultures. They may be paid better than the slaves who built the pyramids, but they are paid less – while working harder – than any comparable workforce in developed countries.

So the late Steve Jobs was correct: the jobs involved in assembling essential electronic devices will remain off shore. These jobs are never coming home, unless, of course, the economy collapses totally and our workers are reduced to accepting virtually any working conditions. Which leads to questions beyond the scope of a workers comp blog: what manufacturing jobs will remain domestic? What will happen to the millions of production workers in America who no longer have jobs? As the American middle class declines, how will the economy function? Who will buy the goods that drive the engine of capitalism?

Epilogue
I drove my American assembled Japanese car to the Verizon store yesterday and picked up my black 16 gig iPhone, designed by indisputable geniuses in America and assembled by an underclass in China. It’s awesome. I can’t imagine life without it.

I have seen this situation many times when reviewing employers’ Workers Compensation situation. The cost of Workers Comp is a budget item that is in the overhead cost (cost of doing business) section of their budget. I would never infer that an employer, whether self -insured or not, should just change their company’s budget to make Workers Comp a controllable variable cost.

Including Workers Comp as a variable cost will usually result in three changes/improvements:

• Workers Comp costs will be examined more by Senior Management. If Workers Comp is viewed as a fixed cost, little attention will be paid to a possible silent budget killer. If a Risk Manager or CFO presents the costs as variable, Senior Management or the owners will be much more accepting of an in-depth analysis.

• Forecasting your future Workers Comp budget will be more accurate. If your company had 500 employees, and now has 350 due to the economy, why would you pay the same amount on the upfront policy with a 30% drop in employees and payroll? The same can be said for the budgeting of a self-insured. If Workers Comp costs are seen as overhead, then forecasting is usually not even attempted overall.

• Now that Workers Comp is a variable cost, the budget responsibilities can be broken down, for instance, each department, plant, location, etc. One of the quickest ways to lower a Mod is to delegate responsibility for their portion of the Mod down to the smallest groups possible. Lag time on reporting injuries are usually cut very quickly and substantially when lag time is looked at by management or the Risk Manager.

There are many other advantages to looking at Workers Comp as a variable cost.

We’re delighted to be hosting Health Wonk Review this month. In looking for a potential theme, we turned to “the Googles” to see if January was noteworthy for any special commemorations beyond Martin Luther King day. Well buckle down because it looks like we will all be very busy. January is apparently train-your-dog month, radon awareness month, “get organized” month, crime-stoppers month, budget month, cervical health awareness month, closet organization month, mentor month, beer month, pet registration month, anti-human trafficking month, tuna month, pork month, and more – we’re sure we’ve missed some and we’re exhausted already.

We’ve decided to go with beer month (as we wrote this last night) and a turn to the classics: January is named after Janus, the ancient Roman god of the doorway. Janus is generally depicted as a two faced god, with one face looking to the past and one to the future. Here on Health Wonk Review, our last issue included some recaps of the prior year, so in this issue, we are looking to the future and what the coming year might hold for healthcare.

Reading the tea leaves
Since our last issue, several of our intrepid wonks have proffered prognostications for the coming year. First up is Joe Paduda at Managed Care Matters who offers his workers’ comp predictions, which are expansive enough to encompass not one post, nor two, but but three – and if he is right, it looks like it will be a busy year in the occupational medicine arena.

At The New Health Dialogue Blog, Joe Colucci notes that the countdown to the SCOTUS ruling on the Affordable Care Act has begun, and weighs in with prognostications about how the constitutionality challenges are likely to fare.

At InsureBlog, Bob Vineyard looks ahead at the future of healthcare, finding some things you won’t get on the 6 o’clock news.

The devil-some details
While some of our posters are looking at the broad trends, others are looking under the hood. As the saying goes, the devil is in the details.

At Health Affairs Blog, Timothy Jost examines the first set of Supreme Court briefs filed in the challenge to the ACA, including the U.S. government brief defending the constitutionality of the minimum coverage requirement, aka individual mandate.

At Health Care Renewal, Dr. Roy Poses takes a bipartisan look at the presidential candidates and their financial relationships with large health care organizations, wondering whether any of them would be inclined to advocate for health reform measures that might threaten the interests of these organizations. He notes that some of these relationships appear significant enough to be called conflicts of interest in arenas other than the political one, yet none of the candidates has made a point of disclosing these relationships as potential conflicts.

Louise Norris of Colorado Health Insurance Insider examines some of the potential reasons why claims expenses in Colorado’s new high risk pool are double the national average. She points out that, “pre-existing condition exclusion riders have all but disappeared in the individual health insurance market in Colorado. Nearly all carriers now use underwriting rate increases instead.”

On the eponymously named John Goodman’s Health Policy Blog, John examines barriers that physicians face in pricing and packaging their services in a post entitled How Doctors are Trapped.

David Williams of Health Business Blog looks at Medicaid expansion and questions if we will we get our money’s worth. He notes that as more diabetics are added to the rolls, their out of pocket costs will fall. But overall costs will rise steeply and it’s unclear whether outcomes will improve.

Healthcare Economist Jason Shafrin investigates how Medicare’s physician value-based purchasing scheme will work. He notes some of the challenges involved in evaluating physicians for quality and cost.

Brad Wright is looking sharp at his newly designed blog, Wright on Health, where he offers an overview of the Independent Payment Advisory Board, the mechanism created by the Affordable Care Act to deal with growing Medicare spending. He looks at how it works, as well as what it can and cannot do.

Gary Schwitzer looks at senior health care policies from another perspective. He earns his Health News Watchdog blog name as he digs up the truth about a dishonest health care hoax intended to scare seniors which has recently been making the rounds, including airtime on a national radio call-in show.

And for another angle on senior care, at Health AGEnda, Marcus Escobedo looks at the issue of life expectancy and whether it should affect treatment. His post discusses a new evidence-based website for predicting life expectancy among older patients, ePrognosis.org, and the debate surrounding its use.

On the technology front…
Primary care physician Jaan Sidorov believes the digitization of health care information will commoditize primary care. At Disease Management Care Blog, he examines the transport of information and the likelihood that, when it comes to routine medical problems, patients won’t need to be seen by a physician in a traditional face-to-face visit.

Also on the healthcare technology front, Dr. Michael Koriwchak has a post a Healthcare Talent Transformation where he takes a closer look at the “enthusiasm gap” between Health IT startup companies and physicians and opines about some of the reasons for barriers to adoption.

Closing thoughts…
At Corporate Wellness Insights, Kat Haselkorn reminds us that wellness can be a good investment with a good ROI, and that ignoring workplace wellness is as risky as gambling because no employee is immune to illness or injury.

Here at Workers Comp Insider, we point you to our piece on How Doctors Die, recounting a thoughtful article by a physician who notes that, “What’s unusual about them is not how much treatment they get compared to most Americans, but how little.”

Next up: Our next edition of Health Wonk Review will be hosted by Louise Norris at Colorado Long Term Care Insider on February 2!