Opioids and the IAIABC's Need to Lead

Tuesday, February 26, 2013 | 0

The International Association of Industrial Accident Boards and Commissions is the trade group for workers' comp regulators, the folks who have assumed the responsibility of advancing the efficiency and effectiveness of workers' compensation systems.

By not approving model language for regulations/legislation addressing opioids, the IAIABC's Executive Committee failed to meet that responsibility.

This may seem like a very small issue, one scarcely deserving of attention or even note.

It is not.

Opioid overuse and abuse kills claimants. Ruins families. Destroys lives. Keeps claimants out of work far longer than they should be, while dramatically increasing employers and taxpayers costs. Everyone knows this, understands the implications and realizes that we must do everything we can, as fast as we can, to address the issue. Yet the model language, developed carefully and wisely in a structured process by a group of committed experts and dozens of stakeholders working hundreds of hours, over a year-long period, for reasons unfathomable, was not approved by the Executive Committee.

I asked the EC why. They told me via email that "the models would be overreaching on the part of the IAIABC … We believed the consequences of advancing this prescriptive approach could potentially harm jurisdictions more than help."

Frankly, I don't see the issue. Model language is just that: language that provides a basis, a framework, a starting point; but it is NOT the final word, the only way, the best practice. Each state takes that language, refines it, adapts it to meet their unique situation, environment, current laws and regulations, and does so in a process that works for them.

How model language could harm states is beyond me and everyone else I've spoken with. When I asked for specific reasons for their decision, the EC responded:

"Adopting model legislation and regulation would be too narrow and restrictive. We were concerned the models that were presented could unintentionally create conflict in jurisdictions that may be already taking steps to initiate regulations for appropriate guidelines."

What conflict? How? Someone in some state might ask, "Hey, how come our regs are different from IAIABC's model language?" As if this never occurs, and is somehow a problem? Would highly experienced, capable, intelligent, articulate regulators be stumped, unable to articulate a reasonable response, like "Things here in Texas/California/Mississippi/Maine/New York are different than the rest of the states; we already have regulations/our laws require a different process/we have to address the issue primarily via utilization review," or some other intelligent response?

I asked if this means the IAIABC will no longer promote model language, and got a nebulous response: This decision will not impact future decisions to promulgate models and standards when appropriate.

Well. If opioids are not appropriate, then what, pray tell, is?

If you get the sense that I'm holding back here, you're right. I along with many others who did a lot more work on the language than I did are frustrated, angry, disappointed. Yet I hold out hope that the EC will reconsider their decision, understand that this issue is far bigger than any individual concerns about how the model language may cause them a bit of stress, and approve the language.

The clock is ticking…

Joe Paduda is owner of Health Strategy Associates, a Connecticut-based employer consulting firm, and co-owner of CompPharma, a consortium of pharmacy benefit managers. This column was reprinted with his permission from his Managed Care Matters blog.