artefact_admin, Author at Tower MSA

Anthony Segrich Promoted as Chief Technology Officer of Tower MSA Partners

July 29, 2015

Newly positioned as the Chief Technology Officer of Tower MSA Partners, Anthony Segrich will pilot all components of technology at Tower MSA. Segrich’s experience in the architecture of successful business process management systems serves as a huge asset for Tower’s commitment to innovative systems and practices.

Anthony Segrich brings his history of consulting, designing and implementing valuable process management systems to the table for Tower MSA Partners. He has performed extensive consulting and development for Fortune 25 companies, such as Cingular Wireless/AT&T, National Semiconductor, and Pepsi International. He holds a bachelor’s degree in Computer Science from Boston College. Before joining Tower, he developed major process management systems for institutions like Fannie Mae, while serving as the general manager for Foreclosure.com.

“Anthony’s previous experience designing business process management systems for Fortune 25 companies equipped him to use the latest BPM technologies in our Section 111 modules,” said Tower CEO Rita Wilson.

In 2012, Segrich partnered with Tower MSA to develop its custom MSP compliance tracking software. He also served as the lead architect for the Section 111 Reporting and data mapping for claims eligibility exchange.

“We can convert files into CMS-preferred formats and then back into client-preferred formats and overlay advanced business rules to make MSP compliance as simple and effective as possible,” Segrich said. “We can now achieve in weeks what takes legacy systems months.”

Segrich has played an intricate role in equipping Tower MSA Partners with the latest technology to deliver end-to-end visibility for their client’s MSAs while simultaneously creating straightforward integration with multiple claim system platforms.

Martin Petro Joins Tower MSA Partners

June 23, 2015

Petro delivers more than 20 years’ experience in business administration, utilization review, case management, and pharmaceutical management to the fast-growing Medicare secondary compliance and MSA company.

“Martin’s clinical proficiency and business acumen, along with his MSA background, position him to run with our business model,” said Tower CEO Rita Wilson.

Most recently Petro was general manager for BioScrip Infusion Partners in Melbourne, Florida. Responsibilities encompassed management and profit and loss results for all departments, including operations, pharmacy, nursing, and customer relations.

“Tower is dedicated to reducing unnecessary medical and pharmaceutical overutilization on claims, getting ahead of potential obstacles to settlements and resolving all issues prior to preparing MSAs,” Wilson added. “Martin understands these issues and shares Tower’s proactive philosophy.”

A registered nurse, with a Bachelor of Science degree in nursing from the University of Pittsburgh and a Master of Business Administration degree from Nova Southeastern University, Petro started his career in utilization management and nurse case management. Previous employers include Broadspire, Gould and Lamb, and Express Scripts.

The VA’s Proactive Move on Opioids

October 3, 2014

I don’t need to reiterate how big a problem prescription drugs continue to be not only in the work comp industry as well as society, but I just did anyway. Recently I wrote here about the rescheduling of hydrocodone combination products and how it was a long overdue move for the DEA to make. As a reminder, the reclassification goes into effect on October 6, and this was no doubt the reason that the Veterans Health Administration sent a letter to my dad yesterday.

As well deserved as the scrutiny against the V.A. has been in recent months, the letter that they sent my father was an absolutely needed step and one that hopefully represents the direction in which the disgraced organization is heading.

It was a simple letter and you can see it by clicking on the link below, but the VA decided to take decisive action and inform what appears to be all patients who have been prescribed hydrocodone combination products in the past about the DEA’s decision to reclassify. Furthermore, they took the time to explain to our veterans the changes to the typical process that they will experience.

There are two aspects of the letter that really stick out. First, it explains the reasoning behind the DEA’s decision in a simple, yet alarming way – one I which my dad really took notice to. The letter states:

The DEA did this because these medications were found to be highly abused, habit forming, and potentially deadly in overdoses and need stricter regulations to improve their safe use.

Simple yet effective. It reads a lot like a surgeon general warning on a pack of cigarettes. The second impressive aspect of the letter is the fact that my dad hasn’t had a prescription for any drug that fits this category since his neck surgery 4 years ago. And so who knows how far back the VA went in considering which vets to send this letter to, and perhaps it was everyone who has ever received a hydrocodone combination product. Whatever they did, from my perspective it was above and beyond and so kudos to the Department of Veteran Affairs for stepping up and being proactive.

VA Letter on HC Products

The DEA Finally Decides To Reschedule Hydrocodone

August 27, 2014

Last week the DEA released a final rule on the rescheduling of hydrocodone removing it from the schedule III controlled substances list in favor of a schedule II designation. To be clear, this decision specifically addresses hydrocodone combination products (i.e., hydrocodone-acetaminophen formulations such as Vicodin) as hydrocodone by itself has always been a schedule II drug.

The new parameters surrounding the prescribing of hydrocodone under the more restrictive schedule II classification will go into effect on October 6, but the decision by the DEA in conjunction with the Assistant Secretary for Health of the U.S. Department of Health and Human Services has been a long time coming. Hydrocodone combination products (HCP’s) have been schedule III since the Controlled Substances Act was passed in 1970 despite, as mentioned, the fact that hydrocodone itself has always been a schedule II drug. The thought initially was that by combining hydrocodone with another substance such as acetaminophen would diminish the abuse potential, but in the DEA’s final order they actually point to several different statistics that definitively portray just the opposite. Perhaps the most eye opening of these statistics tells us that high school aged children have actually abused Vicodin at twice the rate of Oxycontin, a more tightly controlled schedule II drug that has in the past, grabbed a lot more of the headlines.

Not surprisingly, there was a lot of pushback from the pharmaceutical community as well as some from the medical community throughout this process which has taken 15 years to come to fruition (the original petition was submitted by a physician in 1999). This dissent however, is misplaced and perhaps even irresponsible considering hydrocodone is the most prescribed drug in the United States. Last I checked, heart disease was the biggest killer in this country, not pain, yet hydrocodone is prescribed more than even ACE inhibitors (for hypertension) or statin drugs (to lower cholesterol). And if that is surprising to you try to wrap your head around this: the United States is comprised of about 4% of the world’s population yet we use 99% of the world’s hydrocodone.

The affect this will have on the workers compensation industry could prove to be significant. In terms of PBM’s who commonly push for mail order distribution, schedule II drugs have restrictive policies not conducive to this type of service. It would therefore be a good idea to check with your PBM to ensure that they are actively transitioning all applicable injured workers.

A second implication could be in regards to the widely utilized Official Disability Guidelines (ODG) which have long classified several HCP’s as Y drugs (recommended for first line treatment) within their workers compensation formulary. If changed to N drugs, those HCP’s would be subject to immediate utilization review in states such as Texas and Oklahoma that have instituted a closed formulary.

In my world of Medicare Secondary Payer compliance, it’s tough to say exactly where the effect of this rescheduling will be felt, but there are some trends that I hope we begin to see starting with less hydrocodone on MSA’s. It is easy to get caught up in cost drivers and how to mitigate unnecessary medical treatment in my line of work, and rightfully so when a prescription that was never meant to be maintained long term must be allocated for because it is part of the current treatment plan. But oftentimes, payers tend to overlook or not focus on HCP’s due to their relative low cost in comparison to some of their counterparts such as Oxycontin, Opana or Actiq. The result of that is we are consistently including long term use of hydrocodone-acetaminophen (for example) within MSA allocations in spite of the fact that no opioid has ever been recommended for long term use. This sort of tradeoff is unavoidable at times, but I will still hold out hope that the DEA’s most recent stance to reschedule hydrocodone combination products will prove to have a significant impact on the misuse and abuse of prescription painkillers, not just in our little world of work comp, but far reaching into our society as a whole.

Dangers of Tramadol Recognized

July 23, 2014

Recently, the DEA made the decision to reclassify Tramadol as a schedule IV controlled substance and the decision will officially go into effect on August 18th. Tramadol is an opioid analgesic and aside from its generic form it can also be found in brand names such as Ultram, ConZip and Ryzolt.

This is considerably important news for a number of reasons. First, Tramadol is one of the last commonly prescribed opioids to not be scheduled by the DEA. It has long been used by physicians as a “substitute” for other opioids perceived to be more dangerous. The prevailing thought has been that tramadol has a better safety profile and is not associated with dependence or other negative side effects as much as its headline grabbing brethren such as Oxycontin. In work comp and really in health care in general, it has been this type of thinking that has led to the frequent prescribing of Tramadol as a first line treatment even prior to recommending an NSAID.

The DEA however, has now realized that the data shows something different entirely. And because Tramadol was not scheduled upon FDA approval, it had been closely monitored since it hit the market in 1995 … that is until the steering committee tasked with monitoring dissipated in 2005 due to lack of response to their findings. And what they found was that Tramadol had a high incidence report as related to emergency room visits, a high potential for abuse and astonishingly atypical withdrawal symptoms both when the drug was titrated and stopped abruptly. There were 16,000 emergency room visits related to Tramadol in 2010 yet still 40 million prescriptions made it out of doctors’ offices in 2012.

It is unfortunate that it has taken the DEA this long to do what 10 states have already found necessary (states have the right to schedule differently than the feds), but at the very least this action has brought increased awareness to the dangers of all opioids – not just the typical headline grabbers. And to their credit, throughout their process the DEA was faced with pushback from a number of interest groups citing the potential for a new black-market to emerge, fear of criminal action by prescribing physicians and even the complaint that there is a never ending practice of drug-scheduling (give me a break); but through it all they held firm and got this done.

The WSJ Picks Up NAMSAP Press Release

April 22, 2013

Recently, one of the many but ongoing successes for Tower MSA has occurred. The Wall Street Journal and others covered CEO Rita Ayers’ discussion on pharmacy trends during NAMSAP’s Annual Meeting and Educational Conference on April 25. The Wall Street Journal was just one of many that put out a press release on the discussion. For More information check out the link below.

Tower MSA Partners CEO Rita Ayers Discusses Pharmacy Trends in MSAs at NAMSAP

Join Us In Vegas… Ask How Tower Triage Can Save Millions

October 29, 2012

Wednesday, Nov 7-9 Las Vegas Convention Center.

For 20 years, the National Workers’ Compensation and Disability Conference® & Expo has been the industry’s leading training event. And this year’s event is taking it to the next level – making it the best ever!

Key NWCD presentation tracks include the following:

A new full set of sessions will explore and deliver tangible, actionable solutions to the opioid crisis in workers compensation.
New ‘Regional Differences Sessions’ will each tackle the most challenging issues in a particular area of the country and provide you with practical strategies to overcome them.
New interactive ‘Think Tanks’ give attendees an opportunity to exchange innovative ideas with industry peers and leaders.
Enhanced legal track for attorneys and non-attorneys via partnership with LexisNexis.

Click here for more info on NWCD.

And for those who seek the latest in optimized settlement and Pre-MSA intervention strategies, stop by Booth #936 to learn more about the challenges of the current CMS review model and what Tower MSA Partners is doing to save clients millions.

Tower Triage enables employers and carriers to:

Mitigate CMS exposure
Optimize patient care
Expedite settlement

For more information , or to request a meeting with one of our executive team members, email us at info@towermsa.com.

Is an Illegal Immigrant Entitled to Workers’ Compensation Benefits?

Is an illegal immigrant working in this country entitled to benefits under the Workers’ Compensation statutes? This question was answered in the affirmative in the Delaware Superior Court case, Del. Valley Field Servs. V. Ramirez, No. 12A-01-007-JOH (Sept. 13, 2012).

Saul Ramirez began working as an independent contractor in April 2010, and then working as a regular employee an added to payroll in January 2011. Mr. Ramirez’s boss requested a Social Security number in order to include him on payroll. Responding to that request, Mr. Ramirez furnished a fake Social Security card.

Shortly after being converted to a full-time employee, Mr. Ramirez fell down some stairs and injured his back. The accident was witnessed by the company’s president and reported the accident. It was determined by the treating physician that Mr. Ramirez was totally disabled.

In February, the company was informed by the payroll service that Mr. Ramirez’s Social Security number was false and Mr. Ramirez was subsequently deported in March.

Employer argued that employee (Mr. Ramirez) was not entitled to Workers’ Compensation benefits because:

Employee’s “fraudulent inducement” in falsifying documents to gain employment;
Mr. Ramirez’s deportation suspended benefits;
If Mr. Ramirez could not be lawfully hired pursuant to federal immigration laws, the State’s workers’ compensation laws were preempted.

The Board rejected those arguments stating that despite Mr. Ramirez’s illegal status and falsifying documents, he still qualified as an “employee” under the Workers’ Compensation Act (“Act”). The information Mr. Ramirez falsified was not the type of information that would make him forfeit his rights as the falsification did not pertain to his health, work history, or prior injuries.

Next, the Board stated that federal law did not prohibit the award of benefits to an illegal alien. Also, the inability of Mr. Ramirez to return to the United States for treatment did not forfeit his right to benefits as he was not “refusing” treatment as defined in the Act.

The main issue in this case was not one of immigration law, it was labor law. Mr. Ramirez was hired by the company to perform work. He was injured on the job and required medical treatment. There was no dispute about the actual injury. The employer received the bargained-for benefit of the employment relationship. This case has been appealed to the Delaware Supreme Court.

When NOT to Authorize an Additional MRI

October 24, 2012

Additional MRI States that follow the Official Disability Guidelines (ODG) do not need to authorize an additional MRI
unless there are specific changes in pathology.
The ODG states that ³MRI¹s are test of choice for patients with prior back surgery,
but for uncomplicated low back pain, with radiculopathy, not recommended until after at least one month conservative therapy,
sooner if severe or progressive neurologic deficit. Repeat MRI is not routinely recommended,
and should be reserved for a significant change in symptoms and/or findings suggestive of significant pathology
(eg, tumor, infection, fracture, neurocompression, recurrent disc herniation).² (Bigos, 1999) (Mullin, 2000)
(ACR, 2000) (AAN, 1994) (Aetna, 2004) (Airaksinen, 2006) (Chou, 2007)

Things My Mother Taught Me

She taught me a LOT!

My mother taught me TO APPRECIATE A JOB WELL DONE.
³If you¹re going to kill each other, do it outside. I just finished cleaning.²

My mother taught me RELIGION.
³You better pray that will come out of the carpet.²

My mother taught me about TIME TRAVEL.
³If you don¹t straighten up, I¹m going to knock you into the middle of next week!²

My mother taught me LOGIC.
³Because I said so, that¹s why.²

My mother taught me MORE LOGIC.³If you fall out of that swing and break your neck, you¹re not going to the store with me.²

My mother taught me FORESIGHT.
³Make sure you wear clean underwear in case you¹re in an accident.²

My mother taught me IRONY.
³Keep crying, and I¹ll give you something to cry about!²

My mother taught me about the science of OSMOSIS.

³Shut your mouth and eat your supper.²

My mother taught me about CONTORTIONISTS.
³Will you look at that dirt on the back of your neck!²

My mother taught me about STAMINA.
³You¹ll sit there until all that spinach is gone.²

My mother taught me about WEATHER.
³This room of yours looks as if a tornado went through it.²

My mother taught me about HYPOCRISY.³If I told you once, I¹ve told you a million times, don¹t exaggerate!²

My mother taught me the CIRCLE OF LIFE.
³I brought you into this world, and I can take you out..²

My mother taught me about BEHAVIOR MODIFICATION.
³Stop acting like your father!²

My mother taught me about ENVY.
³There are millions of less fortunate children in this world who don¹t have wonderful parents like you do.²

My mother taught me about ANTICIPATION.

³Just wait until we get home.²

My mother taught me about RECEIVING.
³You are going to get it when you get home!²

My mother taught me MEDICAL SCIENCE.
³If you don¹t stop crossing your eyes, they are going to get stuck that way.²

My mother taught me ESP.
³Put your sweater on; don¹t you think I know when you are cold?²

My mother taught me HUMOR.³When that lawn mower cuts off your toes, don¹t come running to me.²

My mother taught me HOW TO BECOME AN ADULT.
³If you don¹t eat your vegetables, you¹ll never grow up.²

My mother taught me GENETICS.
³You¹re just like your father.²

My mother taught me about my ROOTS.
³Shut that door behind you. Do you think you were born in a barn?²

My mother taught me WISDOM.
³When you get to be my age, you¹ll understand.²

My mother taught me about JUSTICE.³One day you¹ll have kids, and I hope they turn out just like you!²