Category: Uncategorized

Jun
28

Good news Friday – Opioid settlement rejected, lower drug costs, and a solid economy

Posted by Joe Paduda on Friday, June 28th, 2024 | Comments

A beautiful Friday morning here in New York’s Finger Lakes…here’s the good news from this week.

First, the Supreme Court rejected the Purdue Pharma opioid settlement agreement – thereby allowing victims to pursue legal action against the Sackler family. As one who’s been deeply involved in the opioid disaster for a decade and half, I have somewhat mixed feelings about this – but have to support the Court’s decision.

The settlement would have shielded the Sackler family – many of whom were top execs and owners of Purdue – from personal liability.

It’s not hyperbole to say the Sacklers were directly responsible for the deaths of tens of thousands of daughters, sons, moms and dads, husbands and wives, friends and neighbors.  The settlement would have allowed these killers to keep some of their billions while avoiding any potential criminal or civil liability.

The downside is the settlement would have provided hundreds of millions of dollars for treatment and recovery services for addicts…losing those dollars is a tragedy.

That said, its very likely the Sacklers and Purdue will still have to provide funds to victims…and some of the Sacklers will now face civil – and potentially criminal – prosecution.

Lower drug costs

From CNBC:

  • The Biden administration  will impose inflation penalties on 64 prescription drugs, lowering costs for certain older Americans enrolled in Medicare.
  • A provision of Biden’s Inflation Reduction Act requires drugmakers to pay rebates to Medicare if they hike the price of a medication faster than the rate of inflation.

Lastly…

The economy grew by 3.1% YoY last year…a really solid result!

What does this mean for you?

Sacklers don’t avoid prosecution and liability, drug costs will drop, and the economy is pretty darn solid. 

Reminder – switching to Substack shortly – this may look differently in your email!

Jun
14

Good news Friday…jobs and wages are up, inflation’s down.

Posted by Joe Paduda on Friday, June 14th, 2024 | Comments

Going to be a nice weekend in New York’s Finger Lakes…hope it’s just as nice wherever you are…

Here’s the good stuff that happened this week…

Jobs and increasing wages

The economy is booming…adding over a quarter million jobs in May, continuing 41 consecutive months of job gains.

Wages increased over 4% year over year, driven mostly by the service sector.

Inflation’s dropping

Fox news reported “inflation cools more than expected in May” yesterday…the producer price index fell 2/10ths of a point, the biggest drop since October. (Producer prices are inflation measures at the wholesale level – before it reaches consumers)

The biggest driver???

Gas prices plummeted 7.1%.

Medical debt

The Consumer Financial Protection Bureau (CFPB) proposed a rule that would remove as much as $49 billion of medical debts that unjustly lowers credit scores for 15 million Americans.

The rule will:

  • strip medical bills from most credit reports,
  • increase privacy protections,
  • help to increase credit scores and loan approvals, and
  • prevent debt collectors from using the credit reporting system to coerce people to pay.

The CFPB was created to help consumers, and it has been remarkably effective. Bookmark the site for help with bank issues, junk fees, mortgage problems, credit  card fees, auto loans…

What does this mean for you?

More dollars in families’ pockets and more jobs + better debt ratings = happier people.

 

Jun
13

Heat exposure – OSHA makes progress and a Simple Question.

Posted by Joe Paduda on Thursday, June 13th, 2024 | Comments

In a key step to help protect workers from excessive heat, OSHA’s Advisory Committee on Construction Safety and Health (ACCSH) met to review a draft rule’s initial regulatory framework.

While we wait for OSHA’s rule-making process to wend its way to fruition, inspections:

are happening under a National Emphasis Program intended to encourage “early interventions by employers to prevent illnesses and deaths among workers during high heat conditions…by adding an enforcement program targeting specific high-hazard industries or activities in workplaces where this hazard is prevalent during high heat conditions [emphasis added]

The OSHA instruction is here.

We all know increasing heat is endangering workers; more and more research demonstrates heat increases claims and can kill workers. While OSHA’s Rule will eventually be helpful it is unethical and immoral for us to wait on the Feds before we protect workers.

This is particularly timely as a massive heat wave slowly moves east…

Over the last couple of months I’ve made several attempts to get two of the industry’s better-known pundits – Bob Wilson and Mark Walls – to help encourage State and local government regulators and politicians to protect workers from increasing heat risks.

In the past Bob, Mark and I have worked together on issues including physician dispensing, TPA fee disclosure, opioid overuse, calling out politicians for really awful behavior, conference planning…lots of stuff.

Hoping Bob and Mark will lend their support to this effort – both are very influential and their advocacy would undoubtedly help save lives and prevent heat-related accidents.

In the meantime, local RIMS chapters and other industry groups should seriously consider adding heat to their agenda of work to be done.

What does this mean for you?

Depends…do we really want to protect workers and their families? 

Note – if you need proof this is bad and getting worse – there’s this.

May
29

Cost Doesn’t Equal Quality – Same Health System Edition

Posted by jay on Wednesday, May 29th, 2024 | Comments

Even when dealing with the same health system it is important to monitor the facilities you are directing care to.

In parts 1 and 2 of this series, we looked at two Florida facilities and showed the complete lack of correlation between the facility’s cost and the quality output.

Today, we look at three facilities ALL IN THE SAME HEALTH SYSTEM… IN THE SAME CITY… with differing costs and outputs.

Three HCA facilities: HCA Houston Healthcare Medical Center, HCA Houston Healthcare West, and HCA Houston Healthcare Northwest – all within 40 minutes of each other.

Based on data from Health Strategy Associate’s Facility Assessment Tool, HCA Houston Healthcare Medical Center is superior across the board when compared to HCA Houston Healthcare Northwest and equal to or better than HCA Houston Healthcare West.

Versus West and Northwest, the clinical outcomes from HCA Houston Healthcare Medical Center are more than 2x the other two. The patients… AKA your clients… are more than 2x as content with HCA Houston Healthcare Medical Center and you/your boss/your board/your shareholders will be too when you pay less for higher quality care.

Again, higher quality facility at a lower price.

Shop Around! This dynamic occurs all over the country – check your utilization and your network to make sure you know just what facilities you are using. 

May
20

What’s really going on with workers’ comp medical…

Posted by Joe Paduda on Monday, May 20th, 2024 | Comments

Medical inflation in workers’ comp is pretty much flat – as it has been for several years.  Why?

Four reasons.

  1. Claim counts continue to remain pretty flat with lost time claim frequency down yet again.
  2. Drug costs have plummeted over the last decade, and now account for about $2.2 to $2.5 billion or 7% – 8% of total medical spend…down from around $5 billion.
  3. Costs for professional services – docs, PTs/Ots/chiro – remain pretty low. WCRI’s latest publication (available for now cost at the link) shows very little inflation across 36 states. Kudos to WCRI for tracking this up through 2023 – that’s really fresh data.
  4. Facility costs are increasing, but have yet to reach the point where payers actually do anything material about cost control.
    A better way to say this is payers are lazy and complacent, waiting for the crisis to hit before actually doing anything.

What does this mean for you?

Focus on facilities. 

May
1

Cost Doesn’t Equal Quality

Posted by jay on Wednesday, May 1st, 2024 | Comments

In the ever-changing world of healthcare economics, one thing is becoming more of a norm – high hospital costs. Crazy facility fees coupled with hospital/health system consolidation are leading to higher prices for payers.

Facility fees, viewed by some as the latest gimmick to generate additional revenue for hospitals, help hospital costs to account for upwards of 40% of countrywide workers comp medical expenses.

Making matters worse is hospital/health system consolidation.  Consolidation often leads to higher prices – The Federal Trade Commission’s Director of the Bureau of Economics said that some consolidated hospitals have raised prices as much as 50%. Consolidation/M&A took a bit of a pause during COVID but has reemerged and is expected to keep going due to financial pressures and desire to gobble up market share.

Workers’ comp is already vulnerable due to its inability to rival group health’s scale along with unfavorable regulatory dynamics…

As the smallest payer in healthcare, it is critical for WC payers to make sure they are utilizing high quality facilities with reasonable costs.

Consider the following example:

In Jacksonville, Fl:

Two facilities. 21 minutes apart, same side of the city center, but different profiles. The Mayo Clinic – widely regarded as one of the best hospital systems in the world vs. an HCA hospital – Florida Memorial Hospital.

According to Health Strategy Associates’ proprietary Facility Assessment Tool ©, the Mayo Clinic scores the same on Patient Safety, but much higher on Clinical Outcomes, Person Satisfaction, and Efficiency all while being SIGNIFICANTLY less expensive than nearby Florida Memorial Hospital.

*Higher the grade the better*

Using data provided by CMS and state entities and HSA’s proprietary algorithm to best reflect the medical treatment of worker’s comp injuries, the Tool enables adjusters and case managers to ensure patients avoid poor quality facilities and employers pay a fair price for excellent care.

For a demonstration of the Facility Assessment Tool, email JStithATHealthStrategyAssocDOTcom.

Apr
19

Good news Friday…Springsteen.

Posted by Joe Paduda on Friday, April 19th, 2024 | Comments

Bruce Springsteen and the E Street Band have long been a favorite…last night I got to see them perform – and wow did they perform – at the JMA Dome in Syracuse.

The energy this 74 year old rocker has is amazing…of the 17 musicians on the stage, he was the only one that never took a break. Bruce is going through what a lot of us are – confronting mortality, watching friends pass, grieving and trying to push through….and in his music shares both his pain while treasuring the memories.

Oh, and there’s a shipload of flat out great rock & roll, incredible interactions with the audience (gave his harmonica to a 10 year old who was playing along with him), and Nils Lofgren on guitar is phenomenal – as is Little Stevie..

If you ever get the chance, you gotta see Bruce and the Band…here’s the tour info.

What does this mean for you?

Bring joy to your life.

Apr
10

What’s driving inflation?

Posted by Joe Paduda on Wednesday, April 10th, 2024 | Comments

There’s increasing evidence that higher corporate profits are driving inflation.

From the Hill:

Adjusted profits after taxes hit a record high of $2.8 trillion, beating the record of $2.7 trillion in the third quarter of 2022. Profits increased 3.9 percent on the quarter, above expectations of around 3.3 percent. [emphasis added]

This news preceded today’s announcement that inflation ticked up 0.4% in March, a number higher than expected. Annualized the rate is 3.5%, higher than wanted but much lower than this time last year.

Consumer goods prices have gone up much more than other goods and services, with prices for packaged foods and drinks noticeably higher.

So…corporate profits AND consumable prices are increasing, with both higher than expected.

The good news is wages are still trending higher than inflation, despite the profiteering of big corporations. 

What does this mean for you?

Wages are up – which means consumers are holding their own, but increases will affect WC premiums and indemnity expenses.

 

 

 

Mar
29

Good news…Friday!

Posted by Joe Paduda on Friday, March 29th, 2024 | Comments

First, it’s…Friday – reason enough to celebrate!

Second, the baseball season opened this week…although my beloved White Sox lost to Detroit, the Sox had very good pitching and defense. Yeah, they won’t be good this year but at least they’ll catch the ball…

Third, women’s NCAA hoops has been really fun. Watching Caitlin Clark – wow. That plus how much she inspires girls is making for the best championship in forever.

Fourth, the US economy is doing very well, with new data showing production increased more last month than previously reported, AND

business and household income jumped almost 5% in the last quarter of 2023 while core inflation dropped…

From Barron’s

Finally, in another win for consumers the Biden Administration’s effort to force a cap of $8 on late fees for credit card payments is making progress. That would be a big help for those who miss a deadline…the AVERAGE late fee is $30.

From Accountable USA

CFPB identified late fees as “the most significant fee assessed to cardholders in both dollar amount and frequency” and a major contributor to the more than $1 trillion in outstanding credit card debt in 2022.

What does this mean for you?

Things are getting better. Well, not including the White Sox’ chances of a winning season…

Mar
15

Good news Friday – fixing past mistakes, more progress on Medicaid, and lower drug prices

Posted by Joe Paduda on Friday, March 15th, 2024 | Comments

Medicaid

Checking in on Medicaid…41 states have expanded Medicaid, and by dribs and drabs some of the holdouts are moving to do the same.

Georgia may well be the next state to follow suit; a court recently ruled in favor of the Peach State’s approach.

Medicaid is one of those rare programs that delivers way more than it costs – economic impact is strongly positive, beneficiaries are much more likely to be healthy enough to work, clinical outcomes improve…

Oh, and uncompensated care costs drop – a LOT…so health systems and hospitals have less incentive to hoover dollars out of employers’ pockets.

Infrastructure investment – Billions of dollars will be invested to  improve infrastructure in places that need it most. From WaPo:

Earlier this week the White House unveiled $3.3 billion in federal grants to remove or retrofit highways that separate minority neighborhoods in many cities from jobs, entertainment centers, hospitals and other services.

In one of my adopted hometowns – Syracuse – the process is well underway. This rights a wrong done decades ago when politicians steamrolled poor folks in poor neighborhoods to build highways to suburbs.

Employment and long-term care

Yes, healthcare worker staffing is a big issue...the good news is much of the potential shortfall can be addressed by immigrants. 

Longterm care is particularly affected…three out of ten workers in long term care are adult immigrants.

What does this mean for you?

More opportunities, improved health, and more healthcare workers = a better place to live and work and raise a family.