We’ve done several blog posts about the negative health impact of junk food’s growing popularity and availability around the world. Junk food consumption has been at the root of increased obesity and diabetes rates all over the globe and India is finding itself  greatly impacted. The New York Times recently published an article examining why India is facing a potential diabetes epidemic — in part due to their genetics.

Scientific research has found that Indians are more prone to becoming diabetic as a result of weight gain than people from other regions. The article goes on to explain several factors that scientists believe could be to blame for Indians’ predisposition to diabetes including body type, women being malnourished during pregnancy, hormones, and the adjustment from food scarcity to the food availability that comes with rising affluence.

According to The Times, there is a proactive movement afoot to reduce new diabetes cases by improving access to healthy food for younger generations. As awareness of diabetes increases in India, so does the number of people working to ban junk foods from schools and from advertisements that target children — despite push back from companies such as Coca-Cola, PepsiCo, and Nestlé.

According to the CDC, about 17 percent of kids and teens in the U.S. are considered obese, a number that has tripled since the 1970s. One of the consequences of excess weight in children has been an increase in childhood cases of type 2 diabetes. It used to be that type 2 diabetes was called “adult-onset diabetes” because it would take years to develop. However, data shows that doctors are now diagnosing type 2 in young kids and even toddlers. An article in the Seattle Times features the new data and also gives five take-aways. One of the most important of these is the tremendous effects diabetes can have over time because “the earlier the disease starts, the more potential it has to do damage.”

As always, share your thoughts with us in the comments section.  

As a workers’ compensation (WC) claims professional, you deal with increasingly complex claims on a daily basis. At times, you may need clarity or greater certainty on specific aspects of a case. For example, what is the true cause of a claimant’s condition? Is this recommendation the best course of treatment? Does a degree of malingering or injury exaggeration exist? In other situations, the case can be complicated by other medical issues – such as diabetes, hypertension or depression – which can hinder recovery.

Faced with these challenges, you may request an independent medical examination (IME) to help determine the next step in the claim and injury management process. In general, there are four areas where an IME can provide useful information:

• Causation. Determine if the condition, pain or other symptoms experienced by the claimant are in fact caused by the work-related injury or another medical issue.
• Treatment. Confirm if the recommended treatment falls within occupational disability guidelines (ODG). For instance, you may want a second opinion on whether a certain procedure or surgery should be performed.
• Disability. Depending on the jurisdiction and the relevant nomenclature, you may want to ascertain if the injured worker has reached maximum medical improvement (MMI), or whether permanent or partial disability exists and, if so, what is the impairment rating?
• Return to Work (RTW). Find out when the injured worker is expected to recover and return to work or determine if there might be work restrictions. For example, can the injured worker return to light, modified or full duty?

In these situations, an IME serves as an outstanding tool to help make difficult decisions, while also providing significant benefits to both the employer and injured worker.

IME Quality Overrides IME Controversy

With complex cases, claimants may seek legal representation. In these situations, opposing sides may obtain IMEs to substantiate their respective opinions. As a result, a certain amount of contention and suspicion has come to surround the IME process, with some WC professionals feeling the exams further complicate a case. Rather than bringing about clarification, some say decisions get bogged down and stalled, and injured workers get caught in the middle – not receiving the care they need in a timely manner.

Due to these issues, the WC market has begun to demand an increased level of quality in the IME process. Quality ensures the original intent of these exams – which is to obtain an impartial, expert medical opinion that will help determine the next step in the case.

In this three-part series, we review best practices that must be followed to ensure a quality IME result. Currently, a quality divide exists in the industry. On the “leading” side of this divide are organizations striving to establish and consistently adhere to quality standards. On the “lagging” side are those unaware that such standards exist and, as a result, unknowingly end up with less than optimal IME results. To bridge this divide, we need greater awareness, understanding and support of the key factors contributing to quality.

Three Sides to a Quality IME Process

Currently, there are three stakeholders that play an integral role in producing a quality IME. Whether these parties are leaders or laggards is largely dependent on whether they acknowledge and support the quality criteria under their control.

• Claims staff – observe a quality approach to requesting IMEs
• IME vendor – envision, put forth and champion new standards of IME quality
• IME physician – perform a thorough exam, provide an expert opinion based on evidence, and clearly address the stated IME objective and questions

In Part 1, we look at the quality criteria championed by claims staff like yourself.

The Claims Perspective: Ensuring the Right Stuff

In workers’ compensation, injured workers may often receive or have an opinion about their condition, treatment or ability to return to work. This opinion may not be supported by existing medical evidence. In other words, it’s being called into question or at least needs to be confirmed. This opinion could be based solely on the injured worker’s perception, or it could be supported by the treating physician and/or an attorney representing the case.

Working on behalf of the employer and payer, the claims professional strives to fairly cover the injured worker’s medical care and time away from work, but you also want to guard against conditions not covered by WC, as well as inappropriate treatment and potential abuse of the system.
When opinions are in question, it’s time to seek an IME to provide a third-party perspective from an objective physician who’s an expert in the relevant field. Key criteria to take into account include:

1. Quality Providers. Be careful about requesting IMEs directly. If a claim is litigated, it’s vital that the IME is performed by a credible expert. Many times, you may not have transparency into all the information pertinent to ensuring the right doctor is selected. For example, do you know if certain physicians have sanctions against them, or if they’re board certified? If a vital component is missed in the provider selection process, the resulting IME could lose credibility. A simple way to avoid this problem is to use a quality IME vendor, which we’ll discuss in part two of this three-part series.

2. Timeliness. As soon as an opinion is in question, an IME should be promptly requested. For example, perhaps you are unsure about the cause of the injured worker’s pain. There have been situations where a claimant received WC benefits for years, but causation was never officially confirmed. If this step was appropriately taken, the claim might not have been accepted in the first place. However, once a case has started down a certain path, it’s difficult to make a significant change in direction. For example, if you suspect treatment is deviating from normal guidelines, it’s time to request an IME before the plan proceeds too far to be able to make a shift.

3. Clear Objective. To obtain a useful IME result, it’s imperative to provide the examining physician with a clear objective and any specific questions that should be addressed in the final report. This allows IME physicians to understand what they’re being asked to evaluate and what type of opinion they need to provide. Is the exam to determine if further care is needed, the level of permanent disability or another concern? At the same time, it’s also important to limit these inquiries so the IME physician can focus on evaluating just a few items during the examination.

4. Comprehensive Background. An IME physician should receive all relevant background, including a complete medical record, diagnostic test results, job descriptions and claimant statements — all well in advance of the exam. The records should provide a clear chronology and history, so the IME physician can accurately assess what’s going on. Is the condition improving? Is the patient fixed and stable? Does permanent disability exist? Also, it should be clear what conditions, if any, have already been medically accepted. For example, if there are four injuries, but only two have been accepted, this should be clearly indicated in the file.

When looking for a place to initiate quality in the IME process, it’s essential to start with the request itself. Are there ways you can improve this process? The practices outlined in Part 1 of our series will enable you to help enhance the quality factors under your control – and will contribute to bridging the divide, so your organization joins other leaders consistently achieving quality IME results and garnering the benefits therein.

Brian L. Grant MD
Founder and Medical Director, MCN

This op-ed piece in the New York Times, along with many of the reader comments, are well worth reading. Obesity is a global public health emergency, and likely has greater impact on the state of U.S. health than tobacco use has had at its worst. I find myself musing on the similarities between the public’s approach to obesity and global warming, another topic that many choose to doubt despite metrics that suggests its truth. Like the warming earth, the fact that as a society we are getting fatter should be impossible to deny. The causes for this growing obesity problem, or whether or not there even is a problem for individuals or society, however, are debated. Related steps to address the problem are also heavily argued. After all, the growth in our girths is a new normal, while folks rail against airline seats rather than confront those of us who can’t fit into them.

The writers of this article, a pediatrician and economist, have a number of suggestions heavy on public policy changes and government intervention. Suggested changes may be desirable, but to be sure, they will at minimum take time to implement and most likely be heavily fought by well-funded lobbies and public outcry. These policy changes will do too little and be too late for those currently afflicted. Unfortunately, the authors say virtually nothing about individual contributions to the problem (without doubt aided by the seduction of cheap and ample calories), and choices that we can and must make on behalf of ourselves and our families today. People can’t wait or hope for government to change how much and what we choose to eat.

As the cost of health care coverage has increased markedly in recent years, many plans have increased co-pays and other out-of-pocket expenses. This article sheds some light on pricing as a controversial subject for the insurance and pharmaceutical industries. 

 Many states are making efforts to introduce legislation to allow pharmacists the ability and right to tell customers that they could save money by paying in cash for prescription drugs instead of using their health insurance. Currently, some plan members are paying two to three times the amount for prescriptions using their insurance policy vs. what the cash price for the same medication would be. Because of contracts between pharmacists and some companies, some pharmacists must remain silent about price variations and are not allowed to educate customers on discrepancies in pricing based on how payment is made. 

 Steven F. Moore’s family owns Condo Pharmacy in Plattsburgh, New York. Moore says, “A consumer filling a prescription for a drug to treat diabetes or high blood pressure may owe $20 if he uses insurance coverage. By contrast, a consumer paying cash might have to pay $8 to $15” – the difference often going to the drug benefit managers. 

 States across the country are beginning to recognize this issue, and state legislatures are moving to pass new laws to cap ever-climbing prescription prices. Five states including North Dakota, Georgia, and North Carolina have made headway in changing laws so that pharmacists can suggest alternative ways for consumers to pay for their medication. 

While the number of health, fitness, and nutrition bloggers who send messages about life style habits, workout templates, and healthy recipes has skyrocketed in the US, the upward trend of obesity rates continues to climb un-phased. With all this and other research readily available, some wonder why we have not seen decreases in the amount of people gaining weight. In this article, Dr. James Krieger, clinical professor of medicine at the University of Washington and executive director of Healthy Food America, an advocacy group, says, “Most people know that being overweight or obese is unhealthy, and if you eat too much that contributes to being overweight. But just telling people there’s a problem doesn’t solve it.”

Experts credit lifestyle, genetics, and poor diets as factors for this. While all age groups have increasing percentages of obesity rates every year, the most surprising impacted age group is children 2 to 5 years old.

It is important for individuals to take control of their weight because obesity often leads to heart disease, diabetes, some cancers, and premature death. For examples of how you can change your diet read our previous blog post, Four Easy Steps to Limit Sugar.

Mexico’s once largely isolated economy shifted in the 90’s when the North America Free Trade Agreement was enacted, allowing American goods to be brought into Mexico without high tariffs. The expectation was an improved economy for both countries but the long term effects of the agreement haven’t all been good. A recent article in The New York Times takes a close look at the negative health effects that have resulted from free trade with the US as our processed food and fast food consumption has become a way of life in Mexico over the last three decades.

The Times reports that foreign agricultural investment displacing family farm workers into cities in combination with a flood of American fast food and convenience store businesses opening south of the border has led to Mexico’s current reliance on Western, processed food. This American style diet has resulted in some equally American style health problems like obesity, diabetes, and heart disease. The article goes on to explain that some Mexicans even see their weight gain as a point of pride because they are well fed- a sign of prosperity.

This story parallels others we highlighted on this blog last year regarding cultures that once thrived on whole natural foods such as Brazil and South Africa becoming reliant on an unhealthy American diet. Access to processed food often results in a reliance on it and as American fast food chains and processed foods become increasingly affordable in other countries it is inevitable that the consumption, and resulting obesity rates, will continue to rise.