Wing of Zock (a great blog name and one you’ll have to click on to understand) has the last edition of the spring – or as I like to think of it, the first of the SUMMER!!
Jun
20
Insight, analysis & opinion from Joe Paduda
Category: General Insurance Issues
Jun
6
The next scam improvement in patient care and physician profits is…
in-office lab testing for drugs!!! I’m not talking qualitative testing (the cup version) but rather tests done on a machine in a physician’s office.
I received this email not once, but three times from a “consulting firm”. I responded twice, intrigued by the opportunity to improve patient care AND generate more dollars for docs. I’m SURE insurers would be deeee-lighted to pay docs more for such wonderful improvements to patient care.
So, here’s the full text of the email. Prepare to be amazed – there’s yet ANOTHER scam brewing in workers’ comp.
“We are a consulting firm that represents an innovative leader of in-clinic
drug screening solutions. Our client is seeking representation for its
toxicology offering for physicians who treat workers compensation patients.
Their testing options generate significant income for physicians and
representatives when testing workers compensation and commercial insurance
patients.
Like many ancillary offerings in medicine, Treatment Guidelines continually
evolve. Our client, unlike others, provides an automated portal into their
lab that is continually updated to keep physicians and related clinics
compliant. Their automated transactional software is considered best in
class in the industry and makes drug screening a snap. By providing
in-clinic testing solutions, physicians can now better manage patient
treatment regiments, generate significant additional revenue, mitigate
clinic liability and provide better patient care!
Our client is now reaching out to your organization to see if you are
perhaps interested in representing them in your local market. Our client
seeks reps that have direct/personal relationships with physicians.
— Reps now have the ability to add thousands of dollars per month to their
organization’s bottom line via these test offerings.
Benefits of Toxicology Testing for the Physician:
— Reduces Practice Liability.
— Prevents drug to drug interaction.
— Provides key information to better manage the treatment of patients.
— Generates additional clinic revenues with little to no out of pocket costs.
— Testing is simple, fast and easily compliments current daily clinic responsibilities.
The targeted Physician Practices/Clinics are:
— Any Physician that sees more than 10 or 15 new work comp patients per month
— Pain Management Centers
— Orthopedics
— Neuro Spine Surgeons
— Hand Surgeons
— Defense / Military suppliers
— Urgent Care
— Podiatry
— Specialists of Extremities
— Any Other Physician/Clinic that will benefit from administering toxicology testing.
If you are interested in representing this exciting best in class ancillary opportunity
in your local market, please call me or return by email your mailing address and
phone / fax number (or feel free to contact me directly). We are aggressively recruiting
reps in different local US markets and will immediately email you our client’s website
for your review. Please know that upon request, hard copy information can be sent
to you as well. We look forward to your response.”
What a great country. Gotta love that free market!
May
24
Brad Wright brings his sardonic flair to this week’s edition of Health Wonk Review; very funny and frightening at the same time.
To wit: “Austerity, in the economic sense, is the approach to balancing your household budget by spending less money and quitting your job.”
May
24
NCCI’s conference is perhaps the best-produced workers comp conference I’ve attended. Great support for speakers (thanks Mona Carter, Peter Burton, Lisa Lancelotti, Linda Simmonds et al), well run, tightly organized, and substantive as well.
Several single-state payers I spoke with at the conference said they attend NCCI, and other national conferences and affiliate with national trade groups (AIA) for a very good reason – they know it is important to keep abreast of national trends, share ideas with other payers, and avoid the perils of navel-gazing. Less insightful regional payers don’t see the value, and will regret their myopia.
The keynote – David Gergen – was excellent. Great to hear his perspective; Gergen is even-handed, deeply knowledgeable, and a good speaker. Posted on that elsewhere…
Aron Ralston’s talk (he of the 127 hours; he’s the guy trapped by a boulder in a canyon in Utah who had to chop his own arm off to escape) was compelling – to say the least. He talked little of the pain, the horror of near death by dehydration (reportedly one of the more awful ways to die), the personal misery – he didn’t ignore it but did not make that a main theme of the speech. One cannot imagine the terror, much less the physical misery he suffered while trapped for five days. He used the trauma to focus his attention – and the audience’s – on identifying the important things in life; Not your typical NCCI talk (but I’d rather listen to Ralston than Krauthammer any day). A risky choice for NCCI, and one that – by all accounts – was an excellent one.
I spoke on Thieves, Profiteers, and Enablers, a quick summary of physician dispensing, overprescribing of opioids, and the growth of compounded medications, physician-dispensed durable medical equipment and physician-office-based drug testing. Notice a common thread here? These are physician-centric…
Alas, I felt like I was preaching to the converted…
Attendance at the end-of-the-conference research discussion was high, proving that there is a large audience for the more analytical presentations. There was a lot of discussion, attendee input, and dialogue, with many relevant points, observations, and recommendations for refinement or methodological modifications.
A couple more posts to come on the annual confab, stay tuned!
May
17
David Chavern of the US Chamber of Commerce focused on manufacturing in his talk at NCCI, and his talk was one of the most important I’ve heard for we in the workers comp world.
Why? Because manufacturing jobs drive workers comp premium.
The manufacturing jobs we have lost are predominantly relatively low-skill level, low-tech, low-value-added sectors such as textiles, clothing. That said off-shoring of higher-level jobs such as semi-conductors has also been significant – but this off-shoring is now viewed as a mistake. We’ve lost the ability to innovate via rapid product evolution, by tapping into the knowledge and experience gained thru the manufacturing process companies that leads to continuous upgrades in products. If the folks on the floor are 8 thousand miles away, don’t speak the same language, and there’s no way to for the engineers and designers to interact with the folks who make the widgets, American companies can’t increase productivity, reduce waste, eliminate unnecessary parts or processes, or improve product quality.
That’s been changing for some years now as manufacturing jobs have been returning to our shores – and this “trend” will increase.
To drive manufacturing, education and training is critical – you can’t run a CNC machine if you can’t do math. There are 600,000 jobs open today for machinists, welders, technicians, and other higher-skill levels and many have been open for some months – there just aren’t enough trained people to meet the demand. Yet, as David Gergen noted earlier, we are failing to educate young people for the jobs that exist today; this has happened in my home town where the education budget is continually challenged as providing education on topics that voters didn’t have – and claim today’s kids don’t need. That’s precisely the kind of short-sighted non-thinking that got us in this mess, and will keep us stuck here.
Energy cost reductions will help bring these jobs back as well; our electricity rates are much lower than competitors in Europe and some Asian countries. Of course, energy production drives heavy industry jobs – another big driver of workers’ comp
The net – manufacturing drives workers’ comp, manufacturing is going to continue to grow. Many of these jobs are going to be higher-skilled and likely lower-risk, while others are going to be high risk – energy production and equipment manufacturing.
Again, no discussion of the impact of all this carbon production on climate change, and the impact climate change will have on the nation and the insurance industry. Another big miss.
Much to consider.
May
13
A new book reports on the impact of financial austerity measures on public health, suicide rates, hospital admissions, and other measures of morbidity and mortality. The news is striking – countries that adopted severe austerity measures have seen rapid deterioration of citizens’ health status, while those that dealt with financial trauma in a more measured way avoided those consequences. In a piece in today’s NYTimes, they contrast two recent financial disasters – Greece and Iceland – and the impact of their austerity programs on public health.
Lest you think this has nothing to do with we Americans, think “sequester”. More on that in a minute.
Severe austerity measures in Greece have produced similar consequences for public health –
“Greece[‘s] national health budget has been cut by 40 percent since 2008, partly to meet deficit-reduction targets set by the so-called troika — the International Monetary Fund, the European Commission and the European Central Bank — as part of a 2010 austerity package. Some 35,000 doctors, nurses and other health workers have lost their jobs. Hospital admissions have soared after Greeks avoided getting routine and preventive treatment because of long wait times and rising drug costs. Infant mortality rose by 40 percent. New H.I.V. infections more than doubled, a result of rising intravenous drug use — as the budget for needle-exchange programs was cut. After mosquito-spraying programs were slashed in southern Greece, malaria cases were reported in significant numbers for the first time since the early 1970s.”
While Iceland’s more measured approach has had little impact on their citizens’ health status –
“Iceland avoided a public health disaster even though it experienced, in 2008, the largest banking crisis in history, relative to the size of its economy. After three main commercial banks failed, total debt soared, unemployment increased ninefold, and the value of its currency, the krona, collapsed. Iceland became the first European country to seek an I.M.F. bailout since 1976. But instead of bailing out the banks and slashing budgets, as the I.M.F. demanded, Iceland’s politicians took a radical step: they put austerity to a vote. In two referendums, in 2010 and 2011, Icelanders voted overwhelmingly to pay off foreign creditors gradually, rather than all at once through austerity. Iceland’s economy has largely recovered, while Greece’s teeters on collapse. No one lost health care coverage or access to medication, even as the price of imported drugs rose. There was no significant increase in suicide. Last year, the first U.N. World Happiness Report ranked Iceland as one of the world’s happiest nations.”
Which brings us home to the US.
Sequestration’s impact on public health has been well-documented. What I find really troubling is how fast Congress and the President reacted to air traffic delays – it took them less than a week – compared to their total inactivity on Head Start, addiction treatment, inoculations, and staffing cuts.
Good to know we abide by the Golden Rule:
He who was the Gold, rules.
May
9
This biweekly edition of health Wonk Review covers the recent news that health care cost inflation has moderated, digs into various aspects of ACA implementation, and provides insights on a couple other timely topics. Read on!
Health care cost trends are slowing…
First up, Health Affairs’ just-released research indicates the decline in inflation could result in a reduction of $770 billion (yup, that’s “billion” with a B) in public program health care costs over ten years.
I can hear the cheering…
For those looking for a thoughtful and comprehensive consideration of the sustainability of this trend, consider this post from John Holahan and Stacy McMorrow of the Urban Institute; “All of these factors taken together suggest that a return to a high historic growth rates in health care spending may not materialize….we…are cautiously optimistic.”
John Roehrig is less optimistic, using research into economic cycles and related factors to come to a conclusion that “I don’t think either of these studies suggests that spending growth is likely to remain at the 4 percent levels seen over the past four years. [emphasis added] Some portion of the slowdown is permanent but some will be given back during a recovery.
I’ve reviewed these and several other reports, and my takeaway is guarded optimism. Sure, the economy reduced demand, but there’s no question there are fundamental changes occurring that are affecting care delivery, pricing, and reimbursement.
While drug costs are not top-of-mind these days, a group of oncologists is plenty cranky about the cost of specialty meds intended for cancer patients. David Williams gives us his take, quoting one section of the doctors’ opinion piece: ““In the US, prices represent the extreme end of high prices, a reflection of a “free market economy”.
One cannot talk drugs without talking marketing to docs; Gary Schwitzer has highlighted an innovative marketing approach involving Hooters… If you don’t follow Gary, you should.
One area that researchers are paying close attention to is facility costs; Brad Flansbaum’s entry; Brad discusses the problems inherent in reducing costs in the hospital environment – “Most providers employed by hospitals know the drill: increase throughput, implement regulatory changes, monitor hospital measurement and report cards, and of course, reduce costs. However, despite the growth of “hospital as laboratory” and rise of the inpatient practitioner, we must face facts. We receive our salary from the beast we wish to slay.” [emphasis added]
Sticking with hospitals, a recent WSJ opinion piece assaulted Medicare’s new hospital re-admissions reimbursement policy; the John Hartford Foundations’ Chris Langston presents a clear-eyed, point-by-point rebuttal that shows why the program is a necessary and important step to improving health care for older adults. The net? The reduction in reimbursement for re-admitted patients appears to be good policy and will likely drive improvements in patient care and quality.
Implementing reform
A big part of reform’s implementation involves exchanges; Louise Norris ofColorado health Insurance provides a brief overview of the progress his state has made: “Less than a year after the ACA was signed into law, Colorado began the – often contentious – process of creating the state’s exchange. They’ve been working on it pretty much constantly ever since. And the result is Colorado’s health insurance exchange is on track to open on time and provide all of the promised services: small business and individual sales platforms, with an option for employees to select from multiple plan options in the small business exchange. Jay hasn’t seen data from DC and the other 16 states that opted to run their own exchanges, but guesses they’re also faring relatively well,
Interestingly, the move to electronic health records (EHR) may well lead to higher costs, as providers get better at coding, payers end up paying for more stuff. That’s one takeaway from Jonena Relth’s submission on EHR and a recent teleconference on same.
The changes in delivery models may well lead to long-term cost reductions, however patient involvement will be key. Jason Shafrin’s contribution contemplates the issues inherent in informing Medicare patients they’ve been assigned to an ACO; many may not know…
Neil Versel has also contributed a piece on consumer awareness – or more accurately the lack thereof. His piece refers specifically to ignorance about telemedicine, and what the industry must do to reduce that ignorance
For those seeking more info on Medicare and the often-mind-numbingly-confusing array of programs, acronyms, and payment schemes, Joanne Conroy MD’s post offers a simple overview of the program.
Writing at healthinsurance.org, Wendell Potter doesn’t see the possible decision of some large insurers to avoid the exchanges as much of an issue; “The number of insurers that participate in the exchanges will vary from state to state, but there should be no shortage of affordable options available, especially when the subsidies – which will be available only for coverage purchased through the exchanges – are factored in.” Wendell cites Vermont as an example; there are only two likely participants but both have submitted rates that are quite competitive with current products.
Motivations and motivators
Then there’s the motivation of big health plans and their leaders – can you spell M-O-N-E-Y? I thought you could…The always-engaged Roy Poses MD has two posts; one discussing UnitedHealth’s CEO, his compensation, and UHG’s rather checkered recent past and issues of quality, physician oversight, and patient safety. Ouch. Similar concerns exist regarding Amgen’s executive compensation and their recent legal troubles.
An interesting perspective on the same issue comes from Jaan Sidorov MD MHSA; Jaan wonders if the policy of “no pay for readmissions” could translate into shoddy care for patients who, despite the best of care, still have to be readmitted; If you had to be readmitted through no fault of anyone, wouldn’t YOU want your doctors to be compensated for taking care of you?
Thanks to Maggie Mahar for her post on breast cancer awareness – an effort that I (and others) think has had some significant negative consequences. Maggie says: “Could it be that breast cancer arareness has become over-awareness? This isn’t happening in other countries. Then again, we are better at marketing fear than any other country in the world. And the pink ribbon campaign is all about marketing.”[emphasis added]
Side-bar note – I’ve long been a critic of the male version of breast cancer awareness; the prostate cancer scare, those who profit from it, and their well-intentioned but harm-causing supporters.
Research says…
John Goodman thinks a recent analysis of Oregon’s Medicaid program is a damning indictment of Obamacare; “a new study finds that (as far as physical health is concerned) there is no difference between being in Medicaid and being uninsured.”
Ezra Klein has a different take on that study; while there’s no question many health status measures did not differ between the Medicaid insureds and uninsured’s, depression was 30% lower among the insured group. More significantly Ezra notes a wealth of other research has found Medicaid coverage does tend to improve health status.
Thanks to Vince Kuraitis and Leslie Kelly Hall for their editorial on the “duty to share” patient information with the patient. In the US and the UK, providers have excessive incentives to “hoard” patient data and insufficient incentives to “share” it. Consistent with a recently released report in the UK, they authors recommend development of an explicit duty to share patient information and discuss barriers and implications.
from the Work Comp World
WorkCompInsider’s Jon Coppelman thinks Massachusetts’ Governor Deval Patrick’s idea to tax workers’ comp indemnity (wage replacement) benefits. This in a state where those benefits are already inadequate – at best.
Bad idea, Your Honor.
Mike Allen alerts workers’ compensation payers to the need to prepare for reform; while PPACA doesn’t specifically address workers’ comp, there are a host of implications – especially for tech platforms.
Today’s tech topic
David Harlow’s piece focuses on Massively Open Online Medicine, showing just how diverse – and informed – HWR contributors are. If health sensors and wearable devices do become prevalent, it will likely take a lot of time – and a lot of change by a lot of people and institutions.
May
6
I’ll admit it, I’ve been slacking…It’s now five days since Coventry released their last-ever earnings report, and I’m only now posting on it. Mea culpa; too darn much work. Here are a few quick takeaways followed by my perspective on the company and their results this quarter.
(and so much for my title for the Q4 earnings report as the “last ever…”)
- Very solid earnings – up 61% from the prior year quarter. Pretty impressive.
- Revenues were flat after some Medicare Advantage bookkeeping stuff
- Commercial membership – and revenues – are down again.
- Medical loss ratios (MLR) for Commercial risk and Medicaid are looking very good, improving substantially over the previous quarter; Part D is not.
- Workers’ comp revenue is down substantially.
Let’s start with work comp (sorry David Young). 2012 was a tough year – revenue decreased $26 million or 3.3 percent from the prior year. And Q1 was no improvement; revenues declined almost $8 million from the previous quarter; $16 million from the same quarter in 2012.
The main driver was likely pharmacy; the full impact of the loss of ESIS’ PBM business to Progressive was felt; the numbers may also reflect the USPS’ decision to change from Coventry’s FirstScript PBM to PMSI. Because ALL pharmacy revenue counts as “top line”, losing a PBM customer has a disproportionate impact on financials – just as winning one does (First Script won the Selective Insurance business recently).
I’ve said before – and will repeat again – Aetna is NOT going to dump the WC business. If anything, they’ll likely invest in the sector. There’s a bunch of reasons private equity is all over workers’ comp services these days: there’s lots of upside from automation; margins are very healthy; regulatory risk is minimal; and it is a good counterbalance to the group/public sector health plan business.
Overall, decent growth in Medicare Advantage and Part D revenues. Medicaid growth was negative, driven by exiting one market and increasing membership in two others. Overall, Coventry’s public-sector business continues to be the largest of the company’s three business segments – while commercial membership and revenues continue to sag.
This is why Aetna is buying Coventry – public sector expertise, market share, and membership. Mother Aetna has the commercial sector pretty much figured out (as much as anyone does in these pre-ACA-implementation days); they need help in the public-sector health plan markets.
Unless the world ends, this will REALLY be their last earnings report.
What does this mean for you?
Size matters in the post-ACA days – a lot. Expect more mergers and acquisitions, and some big ones too.
May
2
This from a vendor presenting at a recent specialty medical society meeting in California…
I’m not sure who did the graphics on this, but I especially like the quality of the artwork (reminiscent of Highlights!) and subtlety of the message.
What’s your take?
May
1
The second most popular post (6300+ readers )in the 8+ years of MCM was on Obamacare’s RFID chip – a fantasy of conspiracy nuts and the right-wing tinfoil hat crowd.
For those who don’t recall, these crazies believe anyone signing up for health insurance will be implanted with an RFID chip containing their medical and financial records. This is an intentional or ignorant mis-read of the PPACA’s Medical Device Registry language which calls for a database – NOT A CHIP – for tracking who’s got what stuck inside them.
Here are a few priceless comments…
- Placing a chip, for any reason, within your body is the work of the devil. Devices can be tracked in other ways besides a chip. Just register the person’s information in the database. You don’t need a chip to do that..
- Joe Palooka [naw, I’ve got no right hook] thinks we will believe him when he tells US that Obamacare isn’t planning on microchipping every one of US just like mutts in a kennel — he kisses NWObutt but it’s not going to do him any good WTSHTF
- hey guys, I believe in the Lord. Don’t get the chip or else you won’t have eternal life with God. Please don’t use it and tag #savetheworld cause I’m against it. Please help! SAVE THE WORLD
- I heard (actually not just heard but read on the “National Review’s” “Huffington Post” tribute section) that Joe Paduda is in fact a socialist, Nazi, fascist, communistic, capitalist, Keynesian, free-market, supply-sided, Reaganomic, Obamanomic, bipolar, schizophrenic, ADD/ADHD, hate-mongering compassionist. And frankly –from what I and that person who types their comments to Joe over a cup of morning coffee in their in their underwear know about Joe– that sounded about right to us … but what do we know.
- the Illuminati is in control of all major world Governments and they don’t change any laws too fast that anyone can notice a big change happening, but they change it so little that we never mind it at all! This RFID chip and the drafted laws are just perfectly a Illuminati proceeding
- Do a little research its all true abd very sad it used to be subliminal now it all hidden in plain sight but amazingly enough 60%of the citizens still think everything is peachy who can see chemtrails and forced inauculations with their head always in the tv,cell phone, or computer wake sheeple befor it too late
- i just wish i was in US i will have love it n perharps what it wrong of having i chip in forehead ? it just for u to get proper care n feel protected wherever u are in this world , so my brothers n sisters lets us support it Obama all the way