Insight, analysis & opinion from Joe Paduda
Carol Gentry of the Tampa Tribune has authored one of the more accessible pieces on the hows and whats of hospital price variation.
Carol’s piece illustrates two key issues – the data is available, and consumers aren’t using it.
Back and neck injuries account for a third of all workers comp claims costs. That’s no surprise to industry types, and is a further affirmation of how tough it can be to manage comp claims.
Back injuries can be notoriously difficult to resolve, expensive to treat and impossible to determine if a back injury was related to employment.
If you’re wondering why your company’s drug costs are going up, one likely contributor is the dramatic increase in the use of pain medications. Retail sales of five leading pain drugs jumped 90% from 1997 to 2005 led by oxycodone’s six-fold increase.
Texas just released workers comp medical payment data for 2005 and 2006. There’s some really great stuff here.
Obese people. 85% of those injured at a major manufacturer were overweight or obese.
Richard Eskow of Sentinel Effect reports on the latest revelations about a bit of book-cooking at the VA. Seems the VA has been a bit, or perhaps more than a bit, overly positive about its record.
More troubling than boosterism is the allegation that the VA selectively reported results, and even fabricated conclusions to make the system appear better than it actually is.
As a fan of the VA, I’m concerned about two things.
The largest health plan trade group wants to form a new agency to “compare the cost and effectiveness of medical treatments as part of a series of recommendations to reduce health care costs.” (California HealthLine from CongressDaily) At first blush that’s pretty similar to what the Agency for Health Care Research and Quality is doing today.
Jason Shafrin reports on the link between physician compensation mechanisms and surgery rates.
Here’s the “money quote” –
“When specialists are paid through a fee-for-system (FFS) methodology rather than a capitation or salaried basis, surgery rates increase 155%. There is suggestive evidence that surgery rates fall when primary care physicians are paid on a fee-for-service basis compared to capitation or salaried payments.”
Not addressed is the key question – is the rate of surgery appropriate under either compensation mechanism?
The state of Washington is a monopolistic workers comp state; unless an employer is large enough to be self-insured, it has to buy workers comp insurance from the state itself.
As a monopolistic state, the regulators have even more power than in the highly regulated but non-monopolistic states. One area of particular interest is how the state deals with the WC drug formulary, which specifically excludes Actiq and Lyrica.
Washington’s Health Dept. just released new guidelines on the use of narcotic opioids; the guidelines, their development process, and the impact of same should be watched carefully by regulators, insurers, managed care firms and most of all prescribing physicians.
URAC, the accreditation body that seems to be into every aspect of managed care, is now looking to certify PBMs. In a presentation at the PBMI conference in Phoenix last week, a representative provided an overview of the process, modules, timing and certification levels contemplated by URAC.
While the process is only for health lines today, URAC is seriously looking into accrediting WC PBMs…
Brace yourselves.
Continue reading URAC’s foray into pharmacy benefit management