Oct
30

Good news Monday starts with this from the Economist, a beacon of objectivity (reformatted for clarity):

a steady stream of better-than-expected data has left analysts scrambling to lift their forecasts.

    • New orders for manufacturing firms reached their highest in nine months in July.
    • Retail sales were perky last month, too, with consumers splurging on everything from restaurant meals to online shopping and clothing to sporting goods.
    • The construction industry has also been buoyant, supported by a rebound in homebuilding.
    • the labour market… has remained hot, making it relatively easy for people to find work at decent wages.
    • The total number of jobs in America has been growing faster than the working-age population, helping to keep the unemployment rate at 3.5%, just shy of a five-decade low.

Oh, and those naysayers, remember they are the ones who’ve been doomsaying a recession is imminent…for more than two years.

“Eventually” that may happen – and “eventually” my granddaughter may have grandkids…

Oh, and our economy has far outperformed the rest of the developed world over the last few years.

One measure of a country is how it cares for the less fortunate…thanks to recent changes in Medicaid thousands of homeless people are now getting primary care, which is:

A) the right thing to do and

B) saves a boatload of dollars as these homeless folks are far less likely to go to the ER which costs a shipload more than getting basic primary care.

What does this mean for you?

Don’t get caught up in all the negativity…workers are doing better and better, jobs are plentiful, we are improving the lives of the less fortunate…and the US is leading the world.


Oct
27

Awful news Friday

I wrote the post below 4 years ago…and I’m heartbroken that it’s truer now than it was back then.

Our daughter went to school near Lewiston…I’m heartened that she graduated years ago and guilt-ridden that other parents and family are terrified their kids and family members may be the next victims.

It’s easy – and completely wrong – to say it’s all random.  It isn’t.

At all.

The epidemic of death by firearm is uniquely American.

Take responsibility.

  • Demand red flag warnings.
  • Demand assault weapon bans
  • Demand universal background checks. 

Or accept the blame.

Guns and public health

Guns are a major public health and safety problem. Guns are associated with tens of thousands of deaths every year, most preventable.

And we Americans are among the world leaders in death via firearm.

Before you make any assumptions – I own guns. I hunt – although I’m a pretty poor hunter.

My dad taught me to shoot, and handle firearms, and gun safety. Among the guns I own are his service rifle – a 1903 Springfield – from WW2 and the revolver he carried while flying in B-17s over Europe. They mean a lot to me, and one day I’ll pass them down to my kids.

A couple key factoids that are worth considering.

  1.  Most Americans – and most Republicans – want background checks and “red flag” laws.  And most Americans want stricter control of gun sales in general.

2. Firearms are used to commit far more suicides than homicides.

3.  People who attempt suicide with a gun are much more likely to die than those who use other means.

4. There’s a strong correlation between higher rates of gun ownership and higher suicide rates.

5.  Lastly, every day 65 people use guns to kill themselves.

Guns are a major public health concern, yet no other public health menace gets the same public support.  As a gun owner, I’m deeply troubled by the willingness of some to advocate positions that will get more guns into more hands – which will lead to more unnecessary tragedies.

What does this mean for you?

The data is clear – people want stricter gun laws – and for very good reason


Oct
26

COVID vaccines’ impact on newborns

If pregnant moms are vaccinated their babies were less likely to die, get very sick, or end up in the NICU (neonatal ICU) than unvaccinated mom’s babies…

That’s the findings from a very large Canadian study just published.

But wait…there’s more!

during their first 6 months (longer durations were not part of this initial study) babies from vaccinated moms were much less likely to get COVID than babies from unvaccinated mothers.

And, there was NO evidence that babies may have been adversely affected by the vaccinequoting one of the researchers:

The study “provides further reassurance on the safety of maternal mRNA COVID-19 vaccination during all trimesters of pregnancy for newborns and infants,”

Details on the study are here.

Maternal Covid-19 vaccination offers infants immunity for up to 6 months

 

What does this mean for you?

Yes, there are some potential limitations, but this is yet more evidence that vaccinations save lives.

If you want to challenge the study, provide credible citations to support your statements.  Anything from Robert Kennedy does not meet that standard.


Oct
25

Medical costs are going up because…

Wonder why that office visit/imaging study/minor surgery/diagnostic test costs twice what it did last year?

Partly/mostly because the physician practice was acquired by a health system or big hospital…which – under current Federal law – allows the new owner to upcharge for “facility fees.”

VERY briefly, way back in 1997 Congress passed the Balanced Budget Act, a giant bill that, among other things, allowed facilities to tack on a facility charge for services delivered in its facilities.

That oversight is a key reason health systems have been snapping up provider practices as fast as they can, paying gazillions for primary care, specialty care, imaging, PT, you name it. (another key reason is health systems want to own as much of the care delivery and referral process – and fees – as possible)

This from Health Services Research:

Medicare reimbursement for physician services would have been $114 000 higher per physician per year if a physician were integrated [part of a health system] compared to being non‐integrated.

The differential varied greatly by type of service…

The solution seems pretty simple…to quote Health Affairs,

Pay for common ambulatory services under the rates, codes and policies in the physician fee schedule regardless of location

There’s an effort underway to at least partially remedy this by moving to a site-neutral reimbursement…but as it will take Congressional action that is a heavy lift indeed…especially given the current House of Representatives.

What does this mean for you?

Two things…

  • Think through potential unintended consequences BEFORE its too late
  • Rethink network contracting strategies…lock in pricing with office-based practices.

Oct
24

Do not let the past repeat itself

The Triangle Shirtwaist Fire was the horrific result of unregulated capitalism. 146 people – mostly women -burned to death or were smashed on the pavement nine stories below the factory floor when fire raged through their Greenwich Village workplace.

The mind reels when contemplating the last moments of the victims, who moments before had been looking forward to a Saturday night with friends and family, and a Sunday (gasp!) off work. When the fire below burst through the stairwells and floor it found bins of dry cotton, wooden worktables, beams, walls and floors.  There was no escape – the owners had locked the exit doors. The conflagration exploded in seconds, and women and men young and old were gone in moments.

And yes, this was foreseen, and preventable. This from David Drehle:

Despite the New York City fire commissioner’s well-publicized prediction that a deadly blaze in a high-rise loft factory was inevitable — and despite multiple small fires during working hours at the Triangle — the owners ignored a consultant’s advice to perform regular fire drills to train workers for an emergency. And they declined to enforce their posted rule against smoking near the highly flammable cotton scraps their workers snipped by the ton.

Long ignored, for over a century there was no memorial, no permanent reminder of the tragedy, no tribute to the mostly-immigrant women who died that awful day. That ended when Mary Ann Trasciatti and others’ relentless effort culminated in this…the steel runs along the building, listing names and ages of the victims and quotes from survivors. It will be completed early next year.

Good friend and colleague Rick Sabetta reminded me of this, and I am indebted to him.

What does this mean for you?

We would be well-advised to learn a lesson from days past, a lesson seemingly ignored by those looking to employ young kids in dangerous jobs and downplay the very real dangers of heat exposure in agriculture and logistics.


Oct
18

more good jobs = more premium and more claims

Old coal-fired electric plants are being converted to manufacturing, residential, office, and recreational uses. These are massive undertakings involving dismantling giant buildings; taking down crumbling smokestacks; removing hundreds of tons of asbestos; shredding hundreds of tons of steel, copper and aluminum; and hauling hundreds of truckloads of debris.

photo credit Daniel Lozada, NYTimes

Then there’s site remediation to clean up hazardous and dangerous residues from decades of processing and burning coal.

Developers estimate around 20 coal-burning plants are candidates for this type of re-development; many others may be taken down as well. A quick scan indicates a plurality of plants are located in Michigan, Texas, Indiana and Tennessee. 

Once the demolition and remediation is done, it’s time to build – and not just commercial and residential projects. One of the main attributes of these plants is they are tied into the grid, making them prime locations for green energy production in the form of solar and wind farms.

From the NYT:

In Illinois alone, at least nine coal-burning plants are on track to become solar farms and battery storage facilities in the next three years. [emphasis added] Similar projects are taking shape in Nevada, New Mexico, Colorado, North Dakota, Nebraska, Minnesota and Maryland. In Massachusetts and New Jersey, two retired coal plants along the coast are being repurposed to connect offshore wind turbines to the regional electrical grids [emphasis added]

Building and operating renewable energy projects has long been cheaper than fossil fuel plants. The barrier “is not economics anymore,” said Joseph Rand, a scientist at the Lawrence Berkeley National Laboratory, which conducts research on behalf of the U.S. Department of Energy. “The hardest part is securing the interconnection and transmission access.” [which is not an issue when old coal plants are re-purposed]

Which all translates to lots and lots of very well-paid workers doing risky work for years.

What does this mean for you?

More workers’ comp premiums and claims.


Oct
13

Good news Friday (really)

Yeah…I know, this was a really awful week.

At times like these I retreat into the “control what you can control” mantra…Can’t do a darn thing about the Middle East or the incredibly dysfunctional House of Representatives…but we all can do something.

So, a couple thoughts.

Be outwardly cheerful and engaging, smile at everyone you see, say hello, and wish them well. Some will growl (looking at you, NYC pedestrians), some will smile back, others will wonder what’s wrong with you, but you’ll make things just a bit brighter for many.

It will also improve your mood…guaranteed!

Do something to build community – anything. Call someone you haven’t spoken to in a while, stop by a neighbor’s to just say hello, send a card to a distant friend or relative, maybe drop off cookies at a friend’s desk or home, get a few friends together for a walk, hike, ride…no agenda, just connecting.

At times like these we need each other more than ever.

And if you need something positive to talk about…inflation is moderating…sure it is still higher than the Fed’s 2% target, but things are improving.

And, when you unpack the latest inflation data, housing prices increased more than expected…further unpacking by ABC News found “unusual jump in housing prices in Los Angeles as accounting for much of last month’s housing inflation, which may not be sustained. ”

So, for those of us not looking for a place to live in LA, prices aren’t increasing nearly as much as they were just a few months ago.

What does this mean for you?

You’re all set to be the cheerful bright spot at the barbecue, tailgate, kid’s soccer game, or morning walk.

 

 

 

 


Oct
12

Work comp services – the commodity trap and avoidance thereof

Few would argue that work comp services is largely a commodity industry…“price” is the ultimate decision criterion in many most buying decisions. There are exceptions, but many are really service guarantees backed by financial penalties…another way for purchasers to demonstrate fiscal prudence.

aka, “strategy” often devolves to attempts to escape the commodity trap.

The first step is to understand what’s lost in the typical sales process is the “value” inherent in the service. 

Way back in 2009 I wrote this:

For several years bill review has been [and still is] a commodity.

Despite vendors’ best efforts to differentiate, most buyers place great emphasis on price. As a result, bill review vendors have worked hard to squeeze out cost…bill review vendors have lost sight of their reason for existence – to ensure their customers pay only what they legally are required to. Instead they compete on the basis of how cheaply they can write checks out of their customers’ checkbooks.

This is not entirely the bill review vendors’ fault. Their customers bear much of the responsibility for the situation, playing vendors off against each other in an effort to reduce the payer’s admin expense. And the payers have succeeded. That success has come at a cost which some payers are only recently beginning to grasp [and now, 14 years later, many payers still don’t].

This is NOT unique to bill review...lazy buyers and brokers/consultants usually commoditize claims, networks, clinical services, occupational medicine, Medicare Set Asides and other services.

Why?  Because it is easy, requires little effort, and, frankly, vendors fail to focus on value.  Rare indeed is the service company that really, really trains its sales folks, or invests in market research, or has any concept of branding. So, yeah, it’s on the vendors too.

Value starts with understanding how your customers define success…and by “customers” I mean the individuals who will make and influence the buying decision.

What does this mean for you?

Organizations don’t buy – people do. But if you do not KNOW what the buyer values, you can’t get out of the commodity trap.

More…

this from an excellent Harvard Business Review piece...

price does equal value in the eyes of a customer when all other strategic factors in the purchase decision are equal, which often occurs with commodities.

Many other products and services are customized rather than commoditized, and, in these cases, price doesn’t equal value. Steve, for example, is CEO of a kitchen design and installation company specializing in large and expensive homes. When his inquiries dropped, he leapt to the assumption that he was “too expensive.” So, he embarked on a round of price cutting. But was cost really the issue? To find out, we assisted by interviewing some of his clients who chose a competitor. A typical example was Jenna.

She’d sought three quotes for the kitchen of her large home. “They came in at different prices, naturally,” she said. “I could have bought a new car at the prices supplied.” She explained that the kitchen contractor she chose wasn’t the cheapest. More important to Jenna were four other factors: innovative design (she spent a lot of time with each contractor trying to find the best design solution), work quality (recommendations from previous customers about kitchen finishes), customer service (easy to deal with and good listening skills), and quality of inclusions (the brands of dishwasher, sink and taps recommended).

The final factor, she said, was “trust.” It was “very important because she wasn’t going to be there every day checking on the installation of plumbing and electrical fittings.”

Your position on the scale of commoditized vs. customized depends on how much unique value you contribute to your products

If you – the service provider – don’t fully understand what your customers value AND are able to clearly and crisply articulate how your company can deliver that value, you’re forever going to compete on price.

And in the highly mature, scale-centric, declining industry that is work comp services guarantees ever-lower prices and ever-lower profits.


Oct
11

Yay North Carolina!

The Tar Heel State is the latest to expand access to Medicaid, a move that will drastically improve the health of 600,000 (!!!) North Carolinians and financial stability of dozens of hospitals and hundreds of other care providers.

40 states have now expanded Medicaid under the Affordable Care Act (aka Obamacare)…holdouts include Florida, Texas, Mississippi, Alabama, Missouri…

Think this doesn’t impact workers comp?

Think again.

States where work comp facility costs have risen the most – courtesy WCRI.

This from Captain Obvious – Hospitals in states that failed to expand Medicaid are using workers’ comp as a financial lifeline.

What does this mean for you??

Failing to expand Medicaid is unconscionable.  It greatly improves the health of babies, moms, kids, and older folks – at very, very little cost to taxpayers. 

The blatant hypocrisy of politicians claiming to respect life while blocking Medicaid expansion is disgusting.


Oct
6

Good news Friday….

Ok, time to set aside the current clustermess in the House of Representatives… because…

there is REALLY good news about the economy!

Inflation is waaaay down…and has been trending that way for months.

Core inflation in August was darn close to the Fed’s 2 percent target, signaling things have vastly improved.

Wages are growing faster than inflation

which is one reason personal consumption (what people spend, not what businesses and governments spend) remains quite strong… (personal consumption is a major economic driver)

13 million new jobs have been created since mid-January 2021, meaning there are more people working now than…ever.

What does this mean for you?

Don’t let negativity drag you down…Reality is, we are in far better economic shape than we were a few years ago.

Even pre-COVID.