This biweek’s edition of Health Wonk Review comes to us courtesy of Jason Shafrin PhD…Jason ties each entry to a quote.

Somehow he’s able to channel Mahatma Gandhi, Churchill, and a host of other luminaries to health care. Impressive indeed – head on over for a read!

As many readers know, I have been running for County Legislator here in Onondaga County New York – yesterday was election day, and I lost.

Results are here.

In the immortal words of Yoda, “there is no try, there is only do.”

Despite a lot of support from friends and colleagues, a massive amount of work, a very, very good campaign manager and staff, and a good message, I lost.

The regret I have is not for the hundreds of hours I put in, or the fun forgone when I knocked on doors instead of visiting with family and friends, rowing or riding my bike. The regret is many of you supported our campaign in many ways, and I did not deliver the win. This campaign was never about me, it was about making a difference for the people here, and many of you bought into that and pitched in.

I deeply appreciate your support and encouragement, kind words expertise and advice. I cannot tell you how much that meant and means to me, and I am profoundly grateful.

For now, the Paduda family is headed to Sedona Arizona for a week of family time, mountain biking, hiking, too much good wine and lots of reading the stuff that’s been piling up on the nightstand for the last nine months.

Looking forward to seeing you in Las Vegas – and thanks.

The death rate for drug overdoses climbed 17 percent last year, killing more than 64,000 people in 2016

‘We have roughly two groups of Americans that are getting addicted,” Dr. [Andrew] Kolodny said. “We have an older group that is overdosing on pain medicine, and we have a younger group that is overdosing on black market opioids.”

For those interested in why this is happening, I urge you to read a “biography’ of the Sackler family, owners of Purdue Pharma of Oxycontin fame.

Here is one chilling excerpt:

[Sam Quinones, author of a book on the crisis talking about the] similarities he finds between the tactics of the unassuming, business-minded Mexican heroin peddlers, the so-called Xalisco boys, and the slick corporate sales force of Purdue. When the Xalisco boys arrived in a new town, they identified their market by seeking out the local methadone clinic. Purdue, using I.M.S. data, similarly targeted populations that were susceptible to its product.

My take is this just one of the many similarities between Purdue and the drug cartels – the one chief difference is Purdue et al dosen’t have to worry about law enforcement.

At least not so far.

The average California MSA includes almost $49,000 for drugs – about half of all future medical expenses.

69% of MSAs included funding for opioids.

But when researchers compared the MSAs to a

“case-matched control group of closed workers’ comp permanent disability claims for similar injuries, the authors found that the WCMSAs called for much stronger opioids, as average cumulative morphine milligram equivalents (MMEs) allocated to WCMSAs with opioids were 45 times the level used in the control group during the life of the claim.” [emphasis added]

Why?

Especially when the report goes on to say:

Federally mandated formulae to financially account for decades of sustained individual opioid use are at direct odds with a growing body of clinical evidence — and a widespread recognition — that opioids are often over-prescribed for the management of chronic, non-cancer pain.

The Feds want/require employers and insurers to pay for another 20 years of opioids, at relatively high doses, for claims that should not be getting opioids.

This is what makes all of us nuts; one hand of the government is pushing us to assertively reduce opioid use, while the other hand demands we pay for opioids for another two decades.

Worse still, many of the MSA patients are also taking hypnotics and/or muscle relaxants. 

[chart courtesy CWCI]

A couple thoughts…

The claims with MSAs may well be those that payers can’t resolve, where the patient, their attorney, or their provider just won’t cooperate in efforts to reduce opioid use. Thus, the MSA projections make sense.

Why are these patients being prescribed – and ostensibly consuming – a high volume of opioids for an extended time when clinical guidelines and best practice clearly contradict this practice, and other patients with similar conditions aren’t getting these drugs?

What does this mean for you?

We are making progress, but we have a very long way to go – and CMS isn’t helping.

Yesterday’s announcement that Concentra owner Select Medical is purchasing US Healthworks sent waves through the workers’ compensation world.  The “new” Concentra will:

• have 565 occ health clinics and on-site centers in about 40 states,
• handle around one out of every seven occupational injuries, and
• further cement Concentra’s position as the largest initial treatment provider in work comp.

The transaction valued USHW at $753 million, or about $3 million per location. Concentra is currently jointly owned by Select Medical and investment firms Welsh Carson, Cressey & Company (and several other firms). It looks like one goal of the deal was to buy out minority investors, a not-uncommon objective for this type of transaction.

So, what does this mean for workers’ comp?

1. Workers comp services is a very mature industry, where scale and buying power are critical. This is yet another indication that players in the industry recognize scale is critical.
2. This looks to be continued move on the part of Concentra to focus on occupational care and de-emphasize urgent care – which is focused on non-occupational conditions.
3. Concentra will have more bargaining power with work comp PPOs and payers. The giant provider can’t quite dictate terms today, but is certainly in a very strong position.
4. USHW has a reputation for over-prescribing physical therapy, a concern some have with Concentra as well.  Payers would be well-served to monitor this closely going forward.

What does this mean for you?

Consolidation can be beneficial for all parties.

It can also be a cause for concern for customers.