2018 | ISSUE 1

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Supporting anInjured Worker’s RecoveryToo often, we hear the bad workers’ compensation news, such as fraud, unsafe work conditions or rising prescription costs. These are real problems that people in both the insurance and medical world are working to combat. But that is only part of the story.

If you’ve worked with injured workers for long, you know that the goal is to help them recover from their injuries and get them back to their normal lives, both at work and at home. And the truth is, together we really do accomplish that goal for most patients. In fact, around 80 percent of our injured workers recover so quickly that they never even meet the threshold for lost wages, which in most states is a week or less of time off work. (We call those cases medical-only claims.)

Great safety and return-to-work programs in companies across the country are the driving forces behind this success. As a physician, you probably can’t influence a company’s safety culture, but you can do a lot to support an employer’s return-to-work program. Here are a few of the top ways companies depend on you to help get their employees back to their normal work routines.

Realistic expectationsInjured workers are often overwhelmed by their situations and sometimes have unrealistic ideas about how their own recovery will progress. Many also trust your expertise and will listen to your opinion. Helping them understand when they can expect to return to work with restrictions, and then fully recover, goes a long way toward easing their minds. It also offers support to employers who may be requesting that they return to work in some form of transitional duty.

Clear restrictionsOne of the things that many injured workers fear is that they may hinder their recovery by working. They are

afraid that their employers may ask them to do something that will cause a relapse or even a new injury. By offering specific guidance on what they can and cannot do, you are not only helping protect their recovery, you’re offering critical evidence to show their employers. This way, if they are asked to do something inappropriate to their medical condition, they can confidently decline, knowing that Summit’s adjustors will back them up.

Ongoing encouragementAttitude is everything, especially for your longer-term patients. As we mentioned, most workers recover quickly and jump right back into work. There are also those with more serious injuries or comorbid conditions, and the process can seem to drag. Helping your patients keep their spirits up is an important factor in the recovery process because it helps ward off depression and motivates them to keep working at it.

At Summit, we’re committed to helping our injured workers return to work. If you have a patient who needs more information on returning to work or who would like us to facilitate a discussion with his or her employer, feel free to give us a call. We’re always ready to help someone get back on the job. ■

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Technology and medicine go hand in hand, and in this issue, we’re highlighting some medical tech designed to offer better treatment, and even save lives. You will find useful tips on opioid overdose management and some helpful information

on how we’re using data analysis to solve some of our everyday medical questions. Here, however, I’d like to discuss one of the topics you’ll often hear whenever new medical innovations are up for discussion. Regenerative medicine is making the news more and more, and whether it has potential for treating injured workers is a perennial question we hear from providers. The National Institutes of Health defines regenerative medicine as “the process of creating living, functional tissues to repair or replace tissue or organ function lost due to age, disease, damage, or congenital defects.”1

In some ways, it’s an exciting new field, but truthfully, regenerative medicine has been around much longer than many people think. The Mayo Clinic points out that “the first bone marrow and solid-organ transplants were done decades ago.”2 In fact, we have documented cases of bone, soft tissue and cornea transplant attempts during the early 20th century, and the first successful kidney transplant was completed in 1954. By the 1980s, kidney, pancreas, liver, heart and lung transplants, in various combinations, were becoming available across the nation.3 Transplant technologies changed the landscape of patient treatment when they debuted, and have saved countless lives since their introductions.

Today, stem cell therapies are widely considered to be the next step forward in regenerative medicine. As you probably know, stem cells have the ability to develop into many different types of cells, which creates tremendous opportunities to treat a wide gamut of conditions, including rheumatoid arthritis, spinal injury, degenerative joint disease, autoimmune disorders, cerebral palsy, diabetes, heart failure, multiple sclerosis and many others.4

Stem cell research is an expansive field with promise not only for treatment, but also for profit. Because of this, it’s important to consider your information sources carefully when it comes to stem cells. The allure of financial success can tempt some research centers to cut corners and conduct sloppy studies in their race for results.5

So how do stem cells fit in with workers’ comp? The truth is, we’re not really sure yet. A tremendous amount of research is in progress but, in many cases, stem cell therapies are still considered highly experimental, with some not yet to human trials. In those studies that have made it to clinical trials, there are often questions regarding patient safety. Treatments have generally proven safe in the short-term studies we’ve seen so far, but long-term potential for carcinogenic effects is a concern. In addition, stem cells aren’t actually considered drugs, which creates questions about approval jurisdiction.6

One specific treatment protocol that crops up often in the workers’ comp treatment literature is stem cell autologous transplantation. As the name implies, this procedure involves harvesting adult stem cells from the patient (usually from bone marrow, fat or peripheral blood), purifying them, and then reintroducing them back into the patient. The Official Disability Guidelines7 explains, “According to the theory, stem cells isolated from a patient have the ability to become different cell types, and they are capable of ‘homing in’ on and repairing damaged tissue.”8

While ODG doesn’t yet recommend stem cell autologous treatment due to its experimental nature, it does offer some information on hopeful research. There are a

MDSpeak: Regenerative MedicineBy Summit Medical Director, Karen Olson, MD M.S.P.H.

Today, stem cell therapies are widely considered to be the next step forward in regenerative medicine.

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handful of studies available regarding treatment for low back and rotator cuff injuries that show some promise, but research in both areas is in the very preliminary stages.9

No doubt in the months and years to come, we’ll see more opportunities for workers’ comp treatments arise from the mountain of stem cell research underway. As new options

become available, we hope to work with you as always to bring the latest, and safest, treatment options to the injured workers you treat. If you have questions about the role of regenerative medicine or stem cells in workers’ comp, or if you have a specific question about the treatment of any patient, feel free to contact our office. ■

Protecting Your Patients from the Opioid CrisisAs you will remember, last October, the opioid epidemic was declared a public health emergency.10 And it’s no wonder. According to the last Centers for Disease Control provisional estimate, there were more than 65,000 drug overdoses between April 2016 and April 2017. That’s a 17.7 percent increase over the April 2016 number. Even more frightening are some of the state-by-state numbers. Florida, for example, saw a 43.8 percent increase from 2016 to 2017.11

The crisis is so pronounced that it’s cropping up in the mainstream news cycle on a regular basis, and this may not be the first time you’ve seen those statistics. If you haven’t made a plan for how your practice will handle opioids, now is the time. There are dozens of factors to consider, but we hope you’ll include these key points in your plan.

Daily morphine equivalentsMany medications can include opiates, and if you’re not sure of everything your patient is taking, please take the time to ask. Once you have a complete list of medications for a patient, you can use the simple tool on our website to calculate his or her total daily morphine equivalent dose. To access the calculator, click on Provider Resources, then Opioid Dosage Calculator.

Remember the following guidelines from the CDC:12

• Use caution when prescribing opioids at any dosage and prescribe the lowest effective dose.

• Use extra precautions when increasing to greater than or equal to 50 MME [morphine milligram equivalents] per day, such as:

■ Monitor and assess pain and function more frequently. ■ Discuss reducing dose or tapering and discontinuing opioids if benefits do not outweigh harms. ■ Consider offering naloxone.• Avoid or carefully justify increasing dosage to

greater than or equal to 90 MME per day.

At Summit, we want to help you in this process, so you may periodically receive a notice from us about your patient’s total daily morphine equivalent. We know it’s hard to keep track of this information for all patients, especially if they see more than one doctor. That’s why we will send you a heads-up if we notice a patient with a high daily morphine equivalent.

Test and follow upIn today’s environment, it’s more important than ever to have a consistent testing program in place for your patients who take narcotic medications. Summit has contracted with several toxicology testing services for our injured workers, and we are happy to connect you with these companies. We encourage a testing program for all patients with an opioid prescription.

Knowing whether your patient is taking his or her medications as prescribed is important in making treatment decisions and can open communications about any struggles or fears they may have. Some patients take less than prescribed out of a fear of addiction. And there is, of course, the potential for drug diversion. Those who take too much could be at risk for addiction. And occasionally, you may find unexpected drugs on a toxicology report. In each case, we hope you’ll take the needed steps to get your patients the help they need, knowing we’re here to offer support as well.

Talk about naloxoneThis drug (sold under the brand names Narcan and Evzio) counteracts the life-threatening effects of opioid overdose,13 and is available in several forms. Standard injections are available for trained first responders, and EpiPen-style auto-injectors can be used by those without formal training. A Narcan nasal spray is now available at many retailers, as well. In fact, Walgreens announced last October that it will carry the nasal spray in each of its more than 8,000 stores nationwide, and it has so far received approval to sell the drug without a prescription in 45 states.14

If you have a patient who you feel may be at risk for an opioid overdose, we hope you will encourage them, or a caregiver, to keep this potentially life-saving medication on hand. You’ll need to remind them, though, that naloxone is not a substitute for medical care.

While the opioid crisis is a bigger problem than any of us can resolve on our own, we believe that together we can step in and make a difference for the patients under our care. We know you place patient safety as a top priority, and we hope you know that we do as well. If we can help with any specific case, please feel free to give us a call. ■

According to the last Centers for Disease Control provisional estimate, there were more than 65,000 drug overdoses between April 2016 and April 2017.

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Now in Alabama

Retailers Casualty Insurance Company, a Summit-managed insurer/payor, has expanded to Alabama!

Summit has grown a lot over the years, and we know it can be a bit confusing. Here’s a list of Summit managed companies that you might see on a check, invoice or letter. All of these companies have access to the Heritage provider network:

• Bridgefield Casualty Insurance Company• Bridgefield Employers Insurance Company• Retailers Casualty Insurance Company*• RetailFirst Insurance Company*• BusinessFirst Insurance Company*

In addition, the City of Plant City is a self-insured Summit-managed client that has access to the network.

If you have any questions, please give us a call and ask to speak with a network representative.

You can also visit the Provider Resources section of our website and click on State-specific Payors. ■

*Not affiliated with Summit

Who Is Summit?With 40 years of experience, Summit is a leading provider of workers’ compensation insurance products and services to employers throughout the southeastern United States. Summit includes Summit Consulting LLC and its subsidiary, Heritage Summit HealthCare LLC. Summit is also the managing general agent of Bridgefield Casualty Insurance Company, Bridgefield Employers Insurance Company, BusinessFirst Insurance Company, RetailFirst Insurance Company and Retailers Casualty Insurance Company.

For a full listing of the workers’ compensation payor customers who lease and have access to the Heritage Summit HealthCare LLC preferred provider network, visit the Provider Resources section of our website and click on State-specific Payors.

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The information presented in this publication is intended to provide guidance and is not intended as a legal interpretation of any federal, state or local laws, rules or regulations applicable to your business. Heritage Summit HealthCare LLC has used its best efforts to select information for this publication from reliable sources, but cannot warrant that it is complete or accurate. Heritage does not assume and hereby disclaims any liability to any person for loss or damages caused by error or omission. Please check with your attorney for details about the laws as they may affect your specific business situation.

©2018 Heritage Summit HealthCare LLC, PO Box 988, Lakeland, FL 33802

How to Contact UsHeritage Summit HealthCare

PO Box 3623Lakeland, FL 33802-3623

1-800-282-7644

Summit Claims CenterPO Box 2928

Lakeland, FL 33806-29281-800-282-7644

24-hour injury reporting1-800-762-7811

www.summitholdings.com

References For a full list of all references used in this newsletter, please visit our website, www.summitholdings.com,and click on Provider Resources. You will find references, as well as current and past issues of The Heritage News.

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Working with Workers’ Comp: FAQsThere are a handful of questions we hear fairly often from providers, and so we would like to offer a quick rundown of answers for those of you who may be new to our network.

Do you offer prepayment options?As you may remember from your agreement with us, we do not allow prepayment for services. Because you have a contracted agreement with Heritage Summit HealthCare, any money due to your office will be paid according to that agreement. Prepayments can cause glitches in our system and can actually slow down the bill-payment process, so it’s really in your best interest to follow our standard payment procedure.

Are there any prescription limitations?Many prescriptions for your patients are automatically processed when the injured worker has them filled at a retail pharmacy through our pharmacy benefits manager. However, certain medications will not be approved without prior authorization. These include compound

medications, medical foods, non-FDA-approved drugs and prescription topical analgesics. Keep in mind, however, that we are happy to cover over-the-counter topical analgesics at no out-of-pocket cost to your patient if you write the prescription on a standard prescription pad.

What about physician-dispensed medications?You may dispense a 72-hour supply of medication at the initial visit to your patients; otherwise, physician-dispensed medications require pre-authorization. Every injured worker you see who is covered through a Summit-managed program has access to our pharmacy network, so filling a prescription should never be a problem. Injured workers can print a temporary ID card and a first prescription fill letter from our website if their card doesn’t arrive in the mail quickly enough. They can also find a nearby pharmacy by clicking on Find a Medical Provider and then Find a Pharmacy. And, of course, our adjustors are happy to help any patient with prescription questions or concerns. ■