Amidst about a dozen meetings yesterday there was precious little time to catch up on the latest and greatest vendor offerings, greet old friends and colleagues, and sit down and learn from experts.
But I did pick up on a few things of note.
Excellent session on chronic pain led by Broadspire medical director Jake Lazarovic MD. Dr Jake discussed warning signs indicating potential risk for chronic pain that would trigger interventions, as well as the processes and tools (e.g. case management, peer review, referral to an addiction management provider) to address those claims. The tools/processes go under the overall title “Pain Central”, a catchy term that helps focus internal and prospect – attention on an integrated solution.
The award for most new booths goes to the surgical implant cost control business. There were several new entrants, as well as a featured spot within MSC’s booth for their new service line.
Examworks’ by-no-well-recognized huge booth was staffed by hordes of orange-clad folk extolling the benefits of awarding all your IME business to the big player. Meanwhile, competitor MCN had a much more visible presence at the show than is typical for them. Sources indicate MCN’s business is growing, rather significantly, despite, or perhaps in part because, of EXAM’s rapid expansion.
Lots of rumors floating around, including a report of ESIS leaving Coventry for another bill review vendor. This would be a rather substantial loss for the industry-dominator, so we’ll keep you posted.
I’m hoping conference boss Nancy Grover can convince the authorities to schedule the annual daylight savings time change to fall during the conference; the extra hour of sleep would be most welcome.
After I’ve recovered from the frenzy of the last three days I’ll post a more thoughtful and less random review.
For now, safe travels home from Vegas, and for many, see you next week at WCRI in Boston

So, what happened yesterday at the comp conference?
Lots. Two work comp execs agreed to sit in front of a couple thousand people while being grilled by an opinionated and occasionally-combative interviewer, an event about as rare as a Rick Perry-Mitt Romney group hug. And in a clear demonstration of his commitment to full financial transparency Sedgwick’s Dave North agreed to share his vendor contracts with customers.
Kudos to Dave for his bold stance.
Local Las Vegas attorneys got really mad at Chris Brigham for his involvement in impairment ratings and discussion of Nevada’s…”challenges”. Mad enough for conference organizers to hire security for Chris very-well-attended talk yesterday when threats to disrupt were made.
A much-needed and by all accounts well-done and even handed presentation on medical foods by Progressive’s Tron Emptage was interrupted by a rather belligerent representatative of Physician Therapeutics Inc., the firm behind much of the physician dispensing of medical foods in CA. Methinks the inciden confined the very point Tron was making; there are good and bad actors in the medical foods business; Tron singled out HSA client Primus as one of the good actors.
More later…

For what seems like years I’ve been reporting on Sandy Blunt’s case and his ongoing and till now fruitless effort to clear his name.
Today we got some good news.
Sandy has long contended the prosecutor, Cynthia Feland, withheld key information that proved he (sandy) did not commit a felony. Today, a North Dakota court agreed, stating:
” The Panel concludes Cynthia M. Feland did not disclose to Michael Hoffman, defense attorney for Charles Blunt, the Wahl memo, and other documents which were evidence or information known to the prosecutor that tended to negate the guilt of the accused…”
Feland, now a sitting elected judge, has had her attorney’s license suspended and has been ordered to pay court costs.
This is not the end of the story. Feland will undoubtedly appeal. But she may well find the more she tries to justify her actions the worse it gets for her.
Beyond this specific issue lies the complete failure of the North Dakota justice system and particularly the Supreme Court. That august body refused to grant Sandy a new trial even when it was confronted with the same evidence that he was wrongfully convicted.
One would hope they feel at least some small embarrassment, if not shame at their complete abdication of responsibility.
One would hope.

This morning’s edition of WorkCompCentral came with the welcome news that legislation has been introduced in the Florida state senate to cap the price of repackaged drugs at the original manufacturer’s AWP plus a dispensing fee.
The bill, which has strong backing from the Chamber of Commerce, insurers, and many employers, is an attempt to forestall a work comp premium increase driven in part by the added cost of repackaged drugs that have added 2.5 percent to employers’ premiums.
Repackaged drugs now account for over half of the drug spend in the Sunshine state, and the cost per script is more than three times what retail pharmacies would charge.
While there are powerful interests backing the bill, repackagers and companies such as AHCS are opening their wallets and unleashing their lobbyists in an attempt to forestall any action.
I don’t know what it will take legislators to pass the bill, and given Gov Rick Scott’s propensity for blind ignorance if not willfull cupidity on these matters he could well veto any bill.
In which case employers will be paying millions more to line the pockets of these repackagers and dispensing/”technology” firms.

The biggest national work comp get-together is – hard to believe it – coming up in two months. While I’m somewhat conflicted about the location (I like Chicago a LOT more than Vegas…) the event is always well worth the trip.
This year I’ll be on the podium helping to kick off the conference – along with Davidson Pattiz of Zenith and Dave North of Sedgwick, two gentlemen who don’t always agree with everything I say or write (shocking, I know). The idea is I get to pontificate upon talk about what will affect workers comp tomorrow, the condition of the industry today, and some of the problems I see, and then Davidson and Dave get to tell you where and how I’m wrong.
This will be fun.
Lest you fall for the pre-conference hype, the three of us have specifically agreed to foreswear violence, conduct ourselves with professionalism and respect each other’s opinions.
Except if we really disagree.

We dodged a bomb.
Here in New England, it always seems the greater the media coverage around weather events, the less dramatic the impact when the actual events hit. Fortunately Irene was no exception. That’s not to minimize the impact of Irene and especially the devastation in Vermont and upstate New York; reports indicate the damage far inland far exceeds what those of us on the coast experienced. While we are without power – and likely will be for another week or so – that’s a minor inconvenience in comparison.
The silver lining of Irene’s dark cloud is the impact on insurance markets. While irene’s bill won’t be large enough to turn the market harder, it’s likely to have more of an additive effect, coming as it did on top of the tornadoes, tsunami, and flooding earlier in the year. The sum of all these events will certainly help to firm up the P&C market and not just in property lines. Insurers are looking for any reason to increase rates and this latest event may well push a few more to tighten underwriting and raise premiums.
We would do well to remember we are nowhere near the end of hurricane season; Irene has relatives that may come calling this fall and they may be nastier still.

Managed Care Matters will be celebrating the nation’s independence this weekend; a new flag graces the flagpole out front, friends and family will be with us to watch the fireworks show off the Town beach; and I’m going to try to finish reading a biography of James Madison I’ve been working on for about a year.
Have a great holiday – and see you next week. If you’re working, that is

Remember the woman who sued McDonald’s and won millions ($2.9 million to be precise) after spilling hot coffee on herself? Like millions of others, you may have been outraged at the award for something so trivial.
There’s a film on HBO tonight that you should watch.
Hot Coffee is a documentary about Stella Liebeck, the elderly woman who spilled coffee on herself and sued McDonald’s, “while exploring how and why the case garnered so much media attention, who funded the effort and to what end.”
Like most, I read the headlines abut the suit back in 1992 and thought “jeez, this is ridiculous”.
Maybe not.
This from wikipedia:
“Stella Liebeck, a 79-year-old woman from Albuquerque, New Mexico, ordered a 49 cent cup of coffee from the drive-through window of a local McDonald’s restaurant. Liebeck was in the passenger’s seat of her Ford Probe, and her nephew Chris parked the car so that Liebeck could add cream and sugar to her coffee. Stella placed the coffee cup between her knees and pulled the far side of the lid toward her to remove it. In the process, she spilled the entire cup of coffee on her lap
Liebeck was wearing cotton sweatpants; they absorbed the [180 degree] coffee and held it against her skin, scalding her thighs, buttocks, and groin. Liebeck was taken to the hospital, where it was determined that she had suffered third-degree burns on six percent of her skin and lesser burns over sixteen percent. She remained in the hospital for eight days while she underwent skin grafting. During this period, Liebeck lost 20 pounds (9 kg, nearly 20% of her body weight), reducing her down to 83 pounds (38 kg). Two years of medical treatment followed.”
Without being too graphic, think about that. An entire cup of 180 degree coffee dumped in your crotch, causing third degree burns on an extremely sensitive area with millions of nerve endings. An anatomical region involved in rather essential physiological functions.
Disclosure – my wife’s family was involved in McDonald’s for decades, we still own stock in the company, and know many fine people at McDonald’s.

UPDATE – this story gets ever more bizarrre; Business Insurance had a piece describing how employees at the party were snorting salt.
Right, that was my reaction as well; wha…SALT?? UP THEIR NOSE??
what the heck were they thinking? And is it somehow better that the folks in the pictures were inhaling salt and squeezing limes into their eyes rather than snorting coke?
Jeez, I thought I’d seen sales folks do some dumb things but we Americans can’t hold a candle to the Germans!
For those interested in photo documentation, click here. Note – the photos are from a German tabloid, and their standards for what is suitable for publication may be different from what you’d expect…
several credible sources , including the company itself, indicate >HM Insurance rewarded their top sales personnel (men, I assume) with a night to remember in the Gellert Thermal Baths.
What made this so special was not only the setting; the Gellert Baths are one of the more historic sites in Budapest; or the cost, a reported 83,000 Euros; or the sponsor (an insurance company!!). No, what made this unique was the reward for those reps who consistently performed.

(photo credit to adventurouskate.com)
Twenty prostitutes were there to personally congratulate the top sales staff, conveniently positioned in four-poster beds located around the edge of the central pool.
I kid you not.
Here’s how one attendee remembered the soiree:
“Anyone could go to one of the beds with one of the ladies and do what he wanted. The ladies were marked with stamps on their forearms after each such meeting. So it was recorded how often each lady frequented.”
“The ladies wore red and yellow wrist bands. One group were there as hostesses, and the others were to fulfill any and every desire,” he added. “There were also ladies with white wrist bands. They were reserved for the board and the very best salesmen.”
So, not only were they idiots, they were misogynistic idiots.
What’s almost as amazing as the fact that this occurred at all is the somewhat blase’ way the company is addressing this now.
Then again, maybe that’s just brilliant PR.

I’ve written before about the problems caused by buyers – poor wording of questions, lack of decisiveness, failure to provide feedback, failure to make ANY decision, arrogance and churlish behavior.
But vendors aren’t without blame. I’ve reviewed a lot of proposals from service vendors in my fourteen years as an independent managed care consultant. In that time, I’ve put together a list of the most common, and most frustrating mistakes made by the folks who submit proposals. Here they are.
1. Read the damn thing.
Vendors often write an answer to the question they have in their response library, not the question asked by the buyer. Sure, it may be close, but close isn’t anywhere near close enough. If you’re going to take the time – and it takes a lot of time – to respond, then take the time to do it right. Read the question before you respond, and have someone else, someone knowledgeable with strong analytical and writing skills, review each and every answer before you send it in.
2. Don’t bloviate.
Answer the question quickly, concisely, and accurately. Remember the poor folks who have to read your response have to read several others, and if you get to the point with a minimum of chest thumping and preening, they’ll appreciate it.
3. If the question seems repetitive, or you think you’ve already answered it, answer it again.
Reviewers can be assigned a specific part fo the proposal response, and if they have to go hunting around for your response, it won’t help your cause. And, if you’ve already responded in another section, make darn sure that response was specific to that question and wasn’t salesspeak and puffery.
4. Requirements
If you don’t meet one of the requirements, either a) don’t respond to the RFP; or b) discuss ahead of time with the buyer to make sure you won’t get shot down and then note specifically why you don’t meet that requirement, why it’s not an issue, and what you’ll do to meet that demand (if you can or are willing to) post-award.
5. Write well
Run-on, poorly written sentences with bad grammar, changing tenses, and poor word selection make reading some responses a nightmare. If you don’t KNOW that it is well written, it probably isn’t. Good RFP responses are tight, light on the adjectives, focused and responsive to the question.
If you can’t write a good response, you may kill your chance to win the business.
6. Differentiate
There’s almost always a place where you can clearly and concisely tell the buyer why you’re better and different. This isn’t – ever – a slam on the competition. Instead it is a ‘this is why we do things the way we do, and how it’s the best answer’ statement. If there isn’t a question that offers that opportunity, do it in the cover letter.
7. Confidential information
Many vendors are cautious about providing financials and other information, well aware that it may eventually get out. If there’s information that is quite proprietary and vital, feel free to offer it only when you get to best and finals stage, or make some other offer that keeps it confidential while enabling the buyer to verify you are stable, or have some license or financial stability.
Oh, and write well. Or I’ll ding your response!