WCRI Webinar Looks into Providers, Cost, Heat in Florida

Webinar Wrap Up

What's going on in Florida workers' compensation?

A recent WCRI webinar covered trends, costs, and, as you might expect for the Sunshine State, the role of hot temperatures in workplace injuries.

Medical Workforce

Addressing the trend of decreasing physicians and increasing demand for them, WCRI CEO Ramona Tanabe explored who's providing care.

"The average number of physicians per person has decreased, and there is increasing demand because of population growth and aging," Tanabe said.

This has led to predictions that there will be a shortage of as many as 124,000 physicians by 2034 and a shortage of up to 450,000 registered nurses as soon as this year.

How has this trend shown up in Florida?

According to Tanabe, it has to do with whom an injured worker sees for care.

"Florida almost doubled in number of injured workers seen by advanced practitioners on first visit between 2013 and 2022," Tanabe said. "What we saw was a shift in who's providing the care."

What about Costs?

According to WCRI Senior Policy Analyst Dr. Rebecca Yang, total costs per claim have grown in recent years in Florida, matching a trend seen across the country.

A Florida-specific trend has been medical stability, driven by fee schedule changes. Notably, hospital payments per claim fell 11% in 2023 and utilization remained stable.

What are those fee schedule changes, which went into effect during 2023?

Hospital Inpatient. Per diem fee schedule (removing the stop-loss threshold).

Hospital Outpatient. Fixed-amount fee schedule (as about to the previous fixed-amount or charge-based fee schedule).

Ambulatory Surgery Center. Fixed-amount fee schedule (as about to the previous fixed-amount or charge-based fee schedule).

Prescription Trends

Yang also examined prescription payments per medical claim between 2015 and 2023, pointing to a decrease from $102 to $67 during that time. Currently, dermatologicals and NSAIDs lead the pack on driving costs with increases that have matched the decreasing prescriptions of opioids and compounds.

"We saw an especially large increase between 2018 and 2021 and stabilizing since then," Yang said. "Dermatological agents remain the top driver of prescription costs."

Heat Hurts

In a topic especially relevant to Florida, Tanabe explained that days with excessive heat, or when the temperature is above 90 degrees, are becoming more frequent, and Florida is no stranger to that trend.

Heat is the leading cause of death among hazardous weather conditions, with the Bureau of Labor Statistics estimating 33,890 heat-related work injuries and 479 deaths from 2011 to 2020.

As if those numbers aren't bad enough, Tanabe said they are likely "vastly underestimated" due to a lack of national heat safety standards and underreporting.

Tanabe also pointed out two different types of injuries from the heat:

(1) Heat-related illnesses of a physiological nature, known as HRIs. These include heat stroke, heat exhaustion, syncope, cramps, rash, rhabdomyolysis, and acute kidney injury.

(2) Injuries occurring when heat impairs the perceptual, motor, or cognitive abilities of workers, leading to accidents. For example, when someone falls off a ladder on a hot day.

Some workers are at a high risk for HRIs, including:

+ Workers in southern states.

+ Outdoor workers, with construction workers representing 21% of HRI claims).

+ Younger workers.

+ Men.

+ Newly hired workers with 0-2 months on th ejob.

"Newly hired workers tend to have less training and less experience handling the heat," Tanabe said. "That's why OSHA has acclimatization training for new workers."

Challenges for addressing HRIs are that there are no national heat safety standards apart from a proposed rule that OSHA published in 2024. At the state level, only seven states have heat safety rules, while 19 have proposed standards.

For states that have adopted rules, the best practice emerging seems to be to follow OSHA's 2024 proposed guidelines.

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