Carlos Luna

The agriculture industry recently came together for AgSafe's Innovation Virtual Conference. During the conference's two-day track on state and federal regulatory compliance, dignitaries from various government agencies echoed one another in vocalizing high praise for America’s agriculture community amid the height of the COVID-19 pandemic. Here is a recap of the event's highlights.

Throughout my career, I’ve learned to lean on a couple of very rudimentary, yet highly effective, elements to help keep me focused and composed in times of high anxiety and uncertainty. I hope this column edifies and helps you cope with the ongoing COVID-19 crisis and its effects on many aspects of our society.

On September 24, the Comp Laude® Awards and Gala featured eight industry leaders as part of the People’s Choice Awards, which is quickly becoming the signature event of the conference. This group of individuals represented the legal, medical management, client services, and marketing business verticals in workers’ comp.

The nation’s largest workers’ compensation community came together recently in Dana Point, California to attend one of the country’s more prominent trade conferences. To kick off the event, a panel of work comp subject matter experts, representing system stakeholders and employers, was assembled to address issues ranging from California’s chief public official’s appetite to tamper with seemingly sound system reforms to automation and technology’s role in workers’ compensation.

California's Assembly Insurance Committee is having a public hearing on AB 1107 on Wednesday April 24th. Is the bill a step in the right direction in promoting prompt, adequate medical treatment for injured workers in the State of California? Fortunately, we have a material amount of data to help inform the answer to this question.

Irrespective of overwhelmingly positive data published on appropriate UR decisions, the UR process becomes a target of criticism. Largely driven by a lack of understanding, a push to unravel this layer of protection for injured workers persists. The over-utilization of unnecessary medical care is not a benefit, it is a risk. These are my thoughts on how the King case may motivate this movement come next year’s legislative session.

Tragedy has a way of spurring unexpected outcomes bringing people from all walks of life and disciplines. These are my observations on important paradigm shifts happening throughout workers’ compensation partly due to the global tragedy that is the opioid epidemic.

Another important July 1st deadline has come and gone for the California workers’ compensation community. As of mid-June, nearly half of California’s Utilization Review Organizations had yet to complete the accreditation process required by newly modified Labor Code section 4610(g)(4). Is the crawl to compliance due to a complacent system culture or a costly and complex accreditation process?

The crux of the opioid crisis is in unchecked, inappropriate prescribing habits. Absent of comprehensive medically responsible prescribing standards, today’s opioid issue has the potential to evolve into another prescription drug crisis. Are narrow legislative bills enough to keep injured workers safe and encourage a paradigm shift among prescribers?

The U.S. House of Representatives has held numerous information-gathering meetings. The divide that exists between state and federal government has never been more clear as the feds turn their focus on the success that state workers’ compensation systems are having in the war on opioid abuse. But, are all aspects of the crisis being considered?

Pennsylvania, who is hosting one of the fiercest battles in the war on opioids, will not adopt a nationally recognized evidence-based medicine drug formulary. Is this the outcome of Pennsylvania politics, the right move to preserve the doctor to patient relationship?

The importance of the National Guideline Clearinghouse™ (NGC) cannot be validated by someone continuing its work. Its importance was established in 2008 by U.S. Congress. Without appropriate oversight in the development of this content, anything might be called "quality" imperiling the well-being of injured workers. Here is my take on why "WorkComp Needs Quality Measures for Clinical Practice Guidelines".

The national Workers' Compensation community is at risk of losing the plot of the opioid epidemic. The aggressive assault against opioid abuse may be relying too much on over-simplified medicine. It is essential to expand the conversation to emphasize the importance of the overall care of a patient and improve the tracking of health outcomes. The discussion can no longer be just about drugs and potential savings.

The workers’ compensation industry gets a bad rap for surviving off of people’s accidents and injuries, but there’s something that you have to know. First things first, someone has to do it. Second of all, many of the leaders in this industry only possess good intentions and are fighting for a bigger, more positive cause.

A good example of the latter? Carlos Luna.

As the Director of Government Affairs at Reed Group and Medical Issues Committee Member of IAIABC, he is constantly… Show more

The workers’ compensation industry gets a bad rap for surviving off of people’s accidents and injuries, but there’s something that you have to know. First things first, someone has to do it. Second of all, many of the leaders in this industry only possess good intentions and are fighting for a bigger, more positive cause.

A good example of the latter? Carlos Luna.

As the Director of Government Affairs at Reed Group and Medical Issues Committee Member of IAIABC, he is constantly on the hunt for learning and sharing newfound knowledge in this industry. He’s been personally affected by a close family member who had to go through a workers’ compensation accident, so his fight for what’s right is all too real. Show less

Regulating the use of evidence-based medicine standards by state jurisdictions tends to polarize workers’ compensation stakeholders – sometimes for good reason. However, an important attribute that is evident in a well-developed medically responsible EBM standard can be easily overlooked: EBM guidance may not always be unequivocal.

The data is clear. The impact that EBM has on improved health outcomes in workers’ compensation is overwhelmingly positive. Continue reading to get my take… Show more

Regulating the use of evidence-based medicine standards by state jurisdictions tends to polarize workers’ compensation stakeholders – sometimes for good reason. However, an important attribute that is evident in a well-developed medically responsible EBM standard can be easily overlooked: EBM guidance may not always be unequivocal.

The data is clear. The impact that EBM has on improved health outcomes in workers’ compensation is overwhelmingly positive. Continue reading to get my take on why it is counter-productive to use the content out of context. Show less

The call to increase patient engagement to inform the development of standards and policies is gaining traction. Efforts to consistently collect and incorporate patient perspectives into the scientific process is becoming a priority for many. This is welcome news to all patients and patient advocates!

In the Workers’ Compensation system, variances from one state to another seem endless. The source of variability is often the disparity in resources available to state regulators across jurisdictions. Is it reasonable to suggest that the varying availability of resources from state-to-state presents limitations for regulators in their pursuit to appropriately research prospective public policy that will improve system outcomes? Would establishing national standards help level the playing field… Show more

In the Workers’ Compensation system, variances from one state to another seem endless. The source of variability is often the disparity in resources available to state regulators across jurisdictions. Is it reasonable to suggest that the varying availability of resources from state-to-state presents limitations for regulators in their pursuit to appropriately research prospective public policy that will improve system outcomes? Would establishing national standards help level the playing field for states having to make due with less available resources? Show less

The addition of the California ACOEM-based drug formulary, in concert with the impending updates to various treatment guidelines (following the new expedited process set forth in SB 1160), in MTUS will improve the system by increasing the use of evidence-based care administered to patients, thereby reducing the inappropriate prescription of dangerous drugs and inappropriate medical treatment, and reducing system friction by providing a common standard to base medical decisions for injured… Show more

The addition of the California ACOEM-based drug formulary, in concert with the impending updates to various treatment guidelines (following the new expedited process set forth in SB 1160), in MTUS will improve the system by increasing the use of evidence-based care administered to patients, thereby reducing the inappropriate prescription of dangerous drugs and inappropriate medical treatment, and reducing system friction by providing a common standard to base medical decisions for injured workers at every step in the care and claim continuum. Show less

The US market loses serious dollars in lost productivity due to health-related conditions – more than $225 billion, according to a report by Carlos Luna, director of government affairs for MDGuidelines. In response, Luna says employers are looking for alternatives that would deliver the “best medical results at the best prices” for workers on the mend.

Be sure and read my latest Guest Post published in the Louisiana Comp Blog where I explain how comparing the Texas Worker's Compensation system to Louisiana’s system is like comparing apples to oranges. The expectations for similar outcomes using the same Drug Formulary is a stretch at best. If Representative Kirk Talbot's HB 592 passes, the Louisiana formulary experiment will take place at the expense of injured workers. What are your thoughts on how Louisiana can improve the quality of care… Show more

Be sure and read my latest Guest Post published in the Louisiana Comp Blog where I explain how comparing the Texas Worker's Compensation system to Louisiana’s system is like comparing apples to oranges. The expectations for similar outcomes using the same Drug Formulary is a stretch at best. If Representative Kirk Talbot's HB 592 passes, the Louisiana formulary experiment will take place at the expense of injured workers. What are your thoughts on how Louisiana can improve the quality of care provided to injured workers while addressing the opioid crisis? Show less

In the following guest post, Carlos Luna, Director of Government Affairs for Reed Group’s MDGuidelines, explores the National Guideline Clearinghouse and whether or not it performs its function – assessing the quality of medical guidelines and improving transparency in the guideline industry.

As the Louisiana Legislature is soon to begin its Regular Session on April 10th and workers’ comp officials anticipate a bill to incorporate the ODG formulary in Louisiana’s system, read on to get… Show more

In the following guest post, Carlos Luna, Director of Government Affairs for Reed Group’s MDGuidelines, explores the National Guideline Clearinghouse and whether or not it performs its function – assessing the quality of medical guidelines and improving transparency in the guideline industry.

As the Louisiana Legislature is soon to begin its Regular Session on April 10th and workers’ comp officials anticipate a bill to incorporate the ODG formulary in Louisiana’s system, read on to get Luna’s take on how the National Guideline Clearinghouse could benefit stakeholders across the board. Show less

With the total annual cost of lost productivity attributable to health-related conditions exceeding $225 billion in the United States, employers are looking for ways to get the best medical results at the best prices for injured workers. More than 40 percent of employers are considering implementing value-based plan designs or high-performing networks in the coming year. Worker’s compensation providers who don’t adopt a value-based care model may find themselves left out of narrow networks in… Show more

With the total annual cost of lost productivity attributable to health-related conditions exceeding $225 billion in the United States, employers are looking for ways to get the best medical results at the best prices for injured workers. More than 40 percent of employers are considering implementing value-based plan designs or high-performing networks in the coming year. Worker’s compensation providers who don’t adopt a value-based care model may find themselves left out of narrow networks in the not too distant future. Show less

As discussions about adopting #evidencebasedmedicine guidelines and #drugformularies become more common place throughout the country, it is imperative that the workers' compensation industry have a good working knowledge of traits present in #trustworthy #EBM - not all guidelines are created equal.

Misconceptions exist about the content, and the tools it powers, and who it benefits most. EBM is not primarily for cost containment, it is not a license to deny needed care to patients, and… Show more

As discussions about adopting #evidencebasedmedicine guidelines and #drugformularies become more common place throughout the country, it is imperative that the workers' compensation industry have a good working knowledge of traits present in #trustworthy #EBM - not all guidelines are created equal.

Misconceptions exist about the content, and the tools it powers, and who it benefits most. EBM is not primarily for cost containment, it is not a license to deny needed care to patients, and it is not one-size-fits all medicine. Let me know your thoughts on how EBM can be better leveraged to improve the quality of care to #injuredworkers. Show less

Keeping workers employed while they’re recovering from a work-related injury or illness is just one approach to rethinking the role of return-to-work guidelines, a hot topic of discussion several recent conferences, and the main focal point of the webinar presentation “Changing Perceptions About Return to Work Confirmation,” hosted by the International Association of Industrial Accident Boards and Commissions in conjunction with the National Institute for Occupational Safety and Health’s Center… Show more

Keeping workers employed while they’re recovering from a work-related injury or illness is just one approach to rethinking the role of return-to-work guidelines, a hot topic of discussion several recent conferences, and the main focal point of the webinar presentation “Changing Perceptions About Return to Work Confirmation,” hosted by the International Association of Industrial Accident Boards and Commissions in conjunction with the National Institute for Occupational Safety and Health’s Center for Workers’ Compensation Studies (CWCS). Show less

In 2016, Louisiana Governor John Bel Edwards’ administration installed, the election of a new President, several high profile reports criticizing state workers’ comp systems, and numerous regulatory and rule changes. Louisiana Comp Blog reached out to local and national voices in the comp arena to ask: What was the biggest story of 2016?

Return to work is a potent ally in preventing medical scenarios from becoming unnecessarily complex and causing long-term disability, while fostering over-utilization and over-consumption of treatment and medications. It can, and should, be used proactively as part of treatment regimens to ensure injured workers profit from the therapeutic benefits of the workplace.

The Department of Labor’s report on workers’ compensation "Does the Workers’ Compensation System Fulfill Its Obligations to Injured Workers?" is the subject of much discussion among stakeholders in the workers’ compensation industry. Does the key to much of what ails today’s workers’ compensation industry lie in the adoption of the value-based health care model?

Despite the insurance industry's focus on emerging issues such as opting out of state workers compensation systems and medical marijuana, the majority of workers comp bills introduced, as of May 2016, involve first responders, medical cost management and the definition of an employee.