Hard to believe, but it’s been six-and-a-half years that I’ve been writing, and some of you have been reading, Managed Care Matters. In that time, I’ve done over two thousand posts, accumulated 2539 subscribers, 3920 (legitimate) comments, and now average about sixteen hundred visitors a weekday.
So, where to next?
Content
No plans to change what we talk about here – heavy on the workers comp area, good coverage of national health policy and doings in the group health and Medicare markets, and I’ll keep working to explain why national, global, economic, cultural, societal, and business ‘macrofactors’ influence and affect work comp.
With the coming battle over entitlement reform, there will be much to discuss and dissect, as pro- and op-ponents of various proposals engage in hyperbolic predictions of catastrophe, rodents falling from the sky, and other signs of doom if their particular version of reform isn’t made into law. Rest assured I’ll keep this fact-based and use lots of references to support my views.
Occasionally I take some nasty shots from anonymous individuals complaining that this blog is just a way to schmooze my consulting clients, that I slant stories or pick fights solely to benefit clients.
My response is two-fold; transparency and stature. Re transparency, I ALWAYS disclose when a company or individual is a client or partner.
Re stature, I’m fortunate in that I’ve got as much work as I can handle and don’t need to work for clients I don’t like, respect, and believe in. Of course I write positively about my clients; they are all good companies doing business the right way, looking to get better.
Presentation
It’s important to refresh the look every so often, and we’ll be doing that this summer. Don’t expect laser light shows and pop-ups, but do expect a new and bolder look.
Along with that, we’re going to be starting video blogging; every week or so I plan on doing a ‘live video’ comment/report on something of interest. We’ll work to keep bandwidth requirements low so those using smartphones aren’t frustrated. Don’t know how this will turn out, but looking forward to blog-casting from the Intergalactic Headquarters of Health Strategy Associates, LLC.
Ads
My several month experiment with ads is over, mostly due to my unwillingness to change the blog’s layout to drive more click-thrus. Turns out that putting the ads in the posts themselves, or just below or to your left increases click thrus dramatically. I didn’t like the way that looked as it chopped things up and put emphasis on the ads and not the content (which I suppose is why it works better). So, they’re gone.
Comment policy
You would not believe the spam comments I get – over a hundred a day, and sometimes two hundred. We’ve tried everything to ensure your comments get thru (even ones I take issue with) while blocking spam; for now I have to review all comments before they go thru. We’ve got to change that, so look for something new soon.
As always, rants and comments disagreeing with me will not be posted unless they are backed by sources. That’s not to say I won’t post different opinions; always have and always will.
MCM ‘attitude’
Every now and then I get myself into a bit of hot water (or more) over a post, a characterization within a post, or an honest mistake. I’ll continue to retract and apologize for errors. I will also continue to opine assertively when I think the issue merits assertive opining. When I hear something that’s newsworthy, I’ll post it (after verifying thru at least two sources). And of course you can always rely on MCM to debunk stories, press releases, and flat out BS, with the tone and histrionics directly in proportion to my level of outrage.
Finally, through the blog I’ve been introduced to many great people and terrific companies. Sandy Blunt is a man I truly admire and respect; he’s now working with me on several projects and his work is exemplary. The work done by Alex Swedlow and CWCI is just outstanding, as is their commitment to shining a very bright light on issues sorely needing that attention. Similarly, NCCI publishes studies and research that add perspective and depth to our understanding of the work comp world. Maggie Mahar is a great writer and strong advocate for her positions on health policy. Jason Shafrin remains one of the best health care economists I’ve come across. Roberto Ceniceros, Peter Rousmaniere, and Julie Ferguson have much to say and manage to say it economically and in ways that often makes one stop and think.
And then there’s you, dear reader! Thanks for reading, keeping me on the straight and narrow, and letting me know when there’s something worth writing about.
Thanks for reading, and keep those comments coming.

Some of you may remember that after I wrote about Automated Healthcare Solutions (AHCS) last September, I was sued for defamation. That case was dismissed by the Federal Judge.
AHCS has not forgotten, and I will not be surprised if AHCS corrects the issues with their initial suit and refiles it. I’ll let you know if that happens but, in the interest of accuracy, I want to summarize those events and to clarify a couple of statements from my September 2010 posts re AHCS.
On or about Thursday September 16, 2010, I received a letter from AHCS attorneys demanding a retraction of my “false statements.” I was traveling at the time, but sent an e-mail response on Monday, September 20th.
In my September 20th e-mail, I stated that I had tried to reach AHCS before my initial post, and had received no response, but that I would still write a correction if it was warranted. Ironically, I added in my closing paragraph that “… I’m looking forward to continued productive dialogue so as to establish the facts…” That was the extent of our dialogue. The following day AHCS filed its lawsuit; it has never responded to my September 20th e-mail.
As I mentioned above, there are two statements in my post of September 9, 2010 which I want to clarify. First, I wrote this:
“An audit of Miami-Dade County Public Schools’ workers comp program determined AHCS-affiliate Prescription Partners, LLC was paid over a quarter million dollars for drugs in 2008. That’s a lot of money, but even more striking is the average cost per script; Prescription Partners; average script was $423.25, by far the highest per script cost of any supplier. Miami-Dade’s PBM had an average cost of $188.52.”
The audit noted in the post referred to a document entitled “OIG Final Audit Report Re: Miami-Dade County Public Schools Workers’ Compensation Program, Ref. IG08-25SB” (OIG refers to Office of the Inspector General).
AHCS took exception to the inclusion of the $453.25 figure in the paragraph that began with the lead “An Audit…” The Final Audit Report included the OIG’s report as well as a response from Gallagher Bassett, the TPA for Miami-Dade Public Schools. While I did not specifically attribute the $423.25 figure to the OIG’s report (I didn’t even mention the OIG), I could have been more clear and noted Prescription Partners’ $423.25 average cost per script figure was provided by Gallagher Bassett in their response to the report (on page 8 of their response, to be precise).
Some may think this a minor detail, but it would have been more precise if I had noted that Prescription Partners’ average cost per script of $423.25 mentioned in the Final Audit Report was determined by Gallagher Bassett.
The second statement is:
“Gerald Glass advertises himself as a ‘medical doctor’. Which he isn’t. Glass, Founder and ‘Co-CEO’, claims he got a medical degree from Windsor University, a Caribbean academic institution. However, I found no evidence that Glass had ever been licensed as a physician in the US…”
I based that statement on a review of Mosby’s Medical Dictionary 8th ed.; American Heritage Medical Dictionary c 2007; Dorland’s Medical Dictionary for Health Consumers c 2007 – all include licensure as a requirement to be defined as a medical doctor (all sources redirect “medical doctor” to ‘physician’ for definition).
In AHCS’ original lawsuit, they stated “Dr Glass earned his medical degree from Windsor University, and he therefore carries the title of “medical doctor.”
In subsequent conversations with MDs, several opined that earning a medical degree enables one to use the title ‘medical doctor’. I respect their opinions that Glass is entitled to call himself a medical doctor as a result of graduation from Windsor University’s School of Medicine.
Finally, there were several other complaints in their original suit, complaints which I have attempted to discuss with them several times, to no avail.
As I’ve said numerous times, if I made a mistake, I’m more than happy to admit said mistake publicly. Well, happy may not be the correct-est word, but suffice it to say I’ll publish a retraction/correction/apology immediately after I determine I screwed up.
But that retraction/correction/apology can’t happen unless AHCS shows me where I made a mistake. I’ll keep you posted.

My annual April Fool’s entry has caused a good bit of agita for Anthem Wellpoint’s workers comp folks.
Wellpoint has been in the workers comp services business, and that business is still operating.
The post put up this morning has turned out to be less than funny; I regret the error in judgment and apologize for the confusion I created. This was my mistake, and my mistake alone.
The post has been deleted.

Glenn Laffel has put one what is probably one of the best editions of Health Wonk Review since we first started the thing five plus years ago.
He knows his baseball, and really, really knows his health blogs.
Thanks Glen – the bar is now raised.

From Workers’ Comp Insider comes this ‘wait, is it April Fools’ Day already’ post –
Morgan Fairchild is slated to star in a sitcom pilot to be titled – wait for it –
Workers Comp!!
I kid you not.
As Julie Ferguson noted; “That scintillating topic of workers getting injured on the job, there’s a hilarious premise: Fraud hijinks! Injury pratfalls! Wacky claims! Processing snafus! Can’t wait to see it!”

In what has to be the irony of ironies, my experiment with Google Ads has AHCS advertising on MCM.(it may not come up on your page as Google has some weird way of determining what you see)
Their ads even appear on my blog posts about the suit…
Yes, that’s the same AHCS, the AHCS that sued me last fall for defamation, libel, and a bunch of other awful things (case has since been thrown out of Federal court on a technicality; if they refile you’ll be the first to know…).
I’ve been a somewhat reluctant advertiser as the thought of making money because people click on ads on my site, ads that may bring them to companies like AHCS, makes me…uncomfortable?
I know, I can block them, but I think it’s kind of funny that AHCS will end up paying me when people click on their ads. Then again, they could always block my site…

This always seems like a good idea in January, looks like a not-well-thought-thru idea in July, and by December morphs into a well-it-coulda-been-worse idea.
But I’ve got a short memory, so here goes – in no particular order, predictions for the comp world in 2011.
1. Business will pick up – a lot. Hiring numbers are up, there’s considerable growth in high-frequency areas like logistics, construction, and health care, and frequency itself is trending higher. What’s been a looooong, cold winter in the work comp world is getting much brighter.
2. We’ll see several new comp writers enter the market – as things pick up, the capital that has been parked, waiting for a better, more promising opportunity, will start coming into comp, providing increased underwriting capacity in selected markets. I don’t see this as a flood, but more as selective entrance into specific markets.
3. Sedgwick will continue to snap up TPA operations, supply-chain pieces, and managed care vendors as it expands its leadership position. And there will be plenty from which to select, as a few TPAs are just barely holding on.
4. The exploding growth of opioid usage in narcotics in comp will become even more prominent, with several states seeking ways to attack the issue via regulation – or even legislation. NCCI and CWCI have done excellent work identifying the problem, now it’s time for regulators to give payers the tools they need to really impact overuse of opioids.
5. Obesity’s impact on work comp costs will gain more attention, as additional research will show significantly higher costs, longer disability durations, and lower RTW rates for the obese and morbidly obese. Employers will get tougher on new hires and existing employees alike, requiring both to meet and maintain body mass standards to get – and stay – hired.
6. Congress will not solve the Medicare physician reimbursement conundrum, choosing instead to kick the ever-growing deficit into 2012. As all comp provider fee schedules save one (California, for now) are based on Medicare’s RBRVS, there will be no change forced on states due to political possibilities in Washington.
7. Hospital and facility costs, both inpatient and out, are going to get a lot more attention in payers’ C suites. Look for a lot more action on the part of big payers and self-insured employers as they seek to hold the line on cost increases driven by declining discounts and exploding utilization; action that will take the form of network shopping, intensive specialty bill review, and, for the smarter and more data-driven payers, more assertive direction to lower cost facilities.
8. We’ll see more litigation around ‘silent PPOs’ in more states. As providers learn more about the layering/stacking/combining of multiple PPOs, more will decide to litigate, driven in part by the success of other efforts in states such as Illinois and Louisiana. This will be driven – in large part – by the legislative/judicial environment in specific jurisdictions, and in equal measure by outraged providers angry that they are giving discounts to patients who just happened to stumble into their practices.
I’ve saved the two biggest for last.
9. Social media is going to make its presence felt broadly and deeply in comp, in ways obvious and not, good and bad – The time-to-implementation for new and better ways of doing things, quick vetting of new ideas, and dissemination of best practices and alerts about new dangers/problems in the work comp world are all accelerating/improving as more and more of us use the myriad social networking tools. From the start of ‘social media’ in comp – which was probably marked by the publication of Workers Comp Insider more than seven years ago (!!) , through the explosive growth of Mark Walls’ Work Comp Analysis Group on LinkedIn, to Facebook, Twitter, photosharing sites and user groups, there are now dozens of ways to share, send, find, and uncover information that – back a mere eight years ago – was either never going to be found, or would have taken days if not weeks of digging, or was outright impossible to get without convening a few thousand WC pros in a room and asking them to respond to a question.
This is a powerful force for efficiency, a terrific tool for claims and underwriting and medical management and planning. It is also one fraught with danger – the danger of believing everything you read on the Internet just because it agrees with your mindset; the risk of taking action based on unsubstantiated rumors, the potential for privacy violation, and perhaps most common, the risk of embarrassment that comes from passing on ‘information’ to others before vetting it yourself (especially MCM’s annual April Fool’s posts…)
10. The impact of health reform on workers comp will happen in ways mostly subtle. The industry was served notice late last year of just how much reform is going to affect comp when Humana announced it was buying Concentra, the largest provider of primary occ injury care in the nation – for reasons completely unrelated to work comp. We can expect to see:
– consolidation in the health plan industry as size becomes even more important
– more vigorous enforcement of anti-trust regulations that may well block some of these deals
– providers getting increasingly hard-nosed in negotiations with comp networks
– changes to fee schedules as RBRVS changes flow thru the system
– changes in provider practice patterns and utilization as physicians adapt to reform initiatives
And, equally likely, not see other effects early on because they are very subtle and we aren’t even able to track them until they become blindingly obvious.
There you have it. What to watch for, where I think things are heading and what the impact will be. As sure as I am that I’m correct on a few/some of these, I’m just as sure there are some big ones I missed completely, and others I predicted that won’t happen at all.
But January always brings out the optimist in me!
Here’s to your New Year – may your positive predictions come true, and your negative ones not.

MCM will be off the virtual air till after Christmas, when I’ll revisit my predictions for 2010 and make a few for 2011.
We’re in Maine for Christmas, where it’s snowing and beautiful.
Have a wonderful weekend.

I’m reluctant to post this. There have been so many false starts and so much confusion around the issue of PBMs’ status in Texas that the latest ‘news’ sounds too good to be true.
I have heard from two credible sources that Texas’ Department of Work Comp will file emergency regulations permitting PBMs to continue operating until legislation addressing the issue around their status is passed in the next legislative session.
Unless DWC – or another entity intervenes, as of now – 7 am in Phoenix – PBMs will be out of business in Texas after 1/1/11 – they are considered ‘involuntary networks (well, at least they ‘appear’ to be considered involuntary networks, but some disagree…) which cannot operate after the first of the year.
While some are saying involuntary networks should continue as legislation will retroactively permit their operation, that’s a very – very – high stakes gamble – loss of license plus a $25 grand per day fine for transgressors.
For more on the history click here.