The looming physician shortage, coupled with expanded health insurance coverage under the Affordable Care Act, an aging population and other pressures on the U.S. healthcare system are driving some occupational medicine providers to reposition themselves to take on primary care.
Work-related stress can kill.
I used to give weekly depositions on the status of patients who were referred to me for the resolution of contested workers’ compensation cases.
Prior to the Supreme Court’s decision on the Patient Protection and Affordable Care Act (ACA), I wrote “You Be the Judge: Predicting the Supreme Court Ruling on the Affordable Care Act.” My analysis included an exercise for readers to learn more about this controversial case by reviewing the fundamental issues and reaching their own conclusions on the likely ruling.
In my last blog, I discussed the background and main issues regarding The Affordable Care Act, which may be the most significant event in the history of employee health since the creation of OSHA.
In late June, the United States Supreme Court is expected to rule on the constitutional challenge to the Affordable Care Act (ACA). This ruling may be the most significant event in the history of employee health since President Nixon signed the act creating the Occupational Safety and Health Administration (OSHA) in 1970.
When I was a senior medical student, I became obsessed with finding the reason why certain of my professors and fellow students were so much better at medical diagnosis than I was. My search for the answer led me to the mathematics of probability theory. I continued my research when I was a surgery resident and created a mathematical probability model to diagnose appendicitis. I sent my research to the prestigious British medical journal, The Lancet. They promptly rejected it. My efforts did win a low-level award from the American College of Surgeons. When I presented my theories to a roomful of surgeons after winning the award, one replied with a smirk: “Dr. Newkirk, you’re saying that we’re going to have to have a computer in every emergency department.” Several other surgeons nodded dismissively at the preposterous nature of this assumption. I left the podium defeated. It was 1976. I was 25 years old. A few weeks later, Steve Jobs and Steve Wozniak released the Apple 1 computer. The medical world was going to change. I re-directed my models to use these new computers and created tools for the prediction and treatment of work-related injuries. Thirty-five years after my lecture to the surgeons, these tools are used by approximately half of the occupational medicine providers in the United States and by hundreds of thousands of employers.
On November 9, 2011, the U.S. Department of Labor's Bureau of Labor Statistics released data showing that the 2010 incidence of nonfatal occupational injuries and illnesses requiring days away from work was 2 ½ times higher in health care support workers than in the population as a whole. And the rate is increasing: musculoskeletal disorder cases with days away from work for nursing aides, orderlies and attendants increased 10 percent from the previous year.
When he delivered the keynote address at PureSafety’s 2011 User Conference in Nashville, former Tennessee Governor Philip Bredesen presented a well-reasoned critique of President Obama’s health care reform plan contained in the Patient Protection and Affordable Care Act of 2010. Because he is a Democrat and has extensive health care experience in both the public and private sectors, Bredesen is an influential voice in the health care debate. His recent book, Fresh Medicine: How to Fix Reform and Build a Sustainable Health Care System, lays out his detailed analysis of the issues. On October 21, 2010, the Wall Street Journal published Bredesen’s essay, “ObamaCare's Incentive to Drop Insurance”, in which he describes how Tennessee could reduce its health care costs $146 million under the proposed health care reform rules by shifting the responsibility for state health care to the federal government. Bredesen writes: “For an entrepreneur wanting a lean, employee-oriented company, it's a natural position to take: ‘We don't provide company housing, we don't provide company cars, we don't provide company insurance. Our approach is to put your compensation in your paycheck and let you decide how to spend it.’”
Trang Nguyen MD, PhD and her colleagues from the University of Cincinnati, using their own money to avoid funding bias, conducted an important study to determine whether lumbar fusion was a useful treatment for workers’ compensation patients with herniated or degenerating lumbar discs. Since the FDA approved the use of interbody cages in 1996, the rates of lumbar fusion surgery have increased dramatically. With an average cost per procedure of greater than $60,000, physicians and hospitals have a strong economic incentive to perform the procedure.