Nov

How’s your PR?

Posted by Joe Paduda on Monday, November 21st, 2011 | Comments

Probably lousy, maybe okay, and just possibly pretty good.
Last week I received a PR email from a work comp services company that had me shaking my head. After I reattached my jaw.
I won’t get into the generalities, much less the details, but it was just not helpful to the company behind it.
Public relations is (pick one or more)
– grossly misunderstood,
– complicated and complex,
– overly involved and time-consuming,
– usually poorly done,
– not worth the money, and/or
– critically important.
My vote is “most of the above”, especially when we’re talking health care/work comp/health insurance.
Public relations deals with a couple areas – building brand and addressing problems. PR is MUCH more important for building brands than advertising – advertising claims aren’t credible, it’s much more expensive on a cost-per-impression basis, and no one believes advertising (especially when it’s from an entity you haven’t heard of or don’t have a solid brand impression of).
There’s a lot of attempted differentiation in the managed care space, but the differentiation exists mostly in the minds of the execs leading the vendors’ efforts. What they see as a definite, valuable, obvious difference their market either a) doesn’t see or b) doesn’t care.
I can’t remember all the times I’ve heard “the market just doesn’t get it” from a CEO lamenting their inability to break thru the clutter and get the market to understand just how great their product/service offering really is. But here’s the key – the CEOs are right, sort of: the market doesn’t get it because it hasn’t been explained to them in a way that will resonate and stick.
The way PR works in building brand is
– credible third party sources
– discuss, debate, define,
– an innovative product or service,
– in mass media, online vehicles, or public forums.
How that happens is the tough part. Press releases about relatively unexciting issues don’t work to build brand (they can have other uses); some press releases (such as the one mentioned in the lead) hurt the brand by confusing the reader, clouding the message, or because they’re just plain unprofessional.
What works is discussion of that brand, product or service by credible sources. But you can’t just get a reporter or writer to blather on about yet another predictive modeling approach, surveillance company, UR firm, disease management concept, network enhancement.
What reporters want to write about is stuff that’s new, different, exciting, fresh. They’re bored to tears writing up stuff they’ve written about countless times; they want something that’s really new, really different, really interesting.
So here’s the hard part, where most companies make a critical mistake. Writers and reporters don’t care what YOU think is new and innovative. It has to be really new and innovative, obviously so. And, except in rare circumstances, if it takes more than fifteen seconds to explain and they still don’t think it’s cool, you’re toast.
That’s where the hard work of PR comes in. Developing and refining your approach, critically thinking about positioning, getting past long-held ego-based self-held ideas about how great/important/innovative your company is, and instead looking in from outside, comparing what you do and how you do it to competitors, and paring down your message to its core.
What does this mean for you?
Most won’t be able to do this, as it can be painful. But those who can, and do, will be much more successful.

Nov

Workers comp hospital costs – perspective from Indiana and Virginia

Posted by Joe Paduda on Wednesday, November 16th, 2011 | Comments

After Dr Barth’s high level background we dove head first into the details of hospital costs and trends and management thereof.
Indiana’s Linda Hamilton shared insights into hospital cost regulation in IN, a state with a rather inadequate cost control history. Hamilton noted the substantial increase in providers appealing work comp payments for their services. A usual and customary state, IN has seen rather significant hospital cost growth, perhaps in part due to the lack of comparable hospital charge data on which to base “usual and customary”. Many of these were addressed by paying bills at the 80th percentile, However as there wasn’t adequate comparable data, the state didn’t really know on what to base payment.
As a result, the cost of inpatient care went up 93% from 2003-2007, and there is no real solution in sight.
Hamilton showed slides indicating wide variation in the cost for similar services within the state: neighboring states are seeing much lower costs. That’s one reason medical costs account for 75% of losses in the state.
If you are expecting a happy ending you’ll have to keep that patience cap on…However Hamilton did note that the state is working on a certified database to help address the difficulty in ascertaining an “appropriate” reimbursement.
Mike Paladino, a WC claim and management exec from a health care system in Richmond, then entertained the audience with a revealing view of the financials of his system.
75% of their revenue is government paid. Paladino asserted that Medicare and Medicaid both reimburse below the actual cost of providing those services; medicare at 80% of costs and Medicaid at 94%. Clearly the health system has to cover those shortfalls by getting private insurers – and workers comp – to pay way more than cost.

A thoughtful and knowledgeable speaker, Paladino noted the services provided by the system benefit society as a whole. He did not claim that the cost shifting that occurs at the system is good bad or indifferent, but it is absolutely clear that it occurs.
My takeaway?
This is a hidden tax on employers and burden on taxpayers and insurers.

Nov

WCRI’s opening talk – how we got here

Posted by Joe Paduda on Wednesday, November 16th, 2011 | Comments

The fall conference schedule comes to a close with this week’s annual WCRI meeting in Boston. I’ll be posting from my iPhone as the wifi access fee is $100(!) so watch out for typos…
Peter Barth began with a history of work comp, with particular emphasis on the societal issues that helped give rise to Wisconsin’s first in the nation state comp laws. (more accurately the first WC law that survived legal challenges) Barth noted that one county in PA had more than five hundred workplace fatalities one year in the early nineteen-hundreds.
The National Commission on WC and the impact thereof was discussed in some detail. For the non-work comp folks out there, the Commission led to rather remarkable changes in many state work comp systems by shining a very bright light on the differences among and between the various states. By developing and promulgating universal objectives, the Commission helped accelerate the pace of change and modernization in those states that had long lagged more progressive jurisdictions.
This being the anniversary of the passage of Wisconsin’s comp law, there have been many reviews of the history of comp; Barth’s presentation was one of the better ones. Perhaps the most revealing takeaway was the drastic change in medical benefits from the early days.
Barth reported that several states allowed claimants a maximum of fourteen days to obtain medical care, two states had rather brief medical benefits periods (Massachusetts with 14 days) as late as1940.
Next up for public consumption is a discussion of pharmacy costs – which is a subject near and dear indeed.
.

Nov

Opioids in work comp – problem solved!

Posted by Joe Paduda on Monday, November 7th, 2011 | Comments

I received a welcome email from a colleague Friday with the news that one company has solved a problem of monumental proportions that has bedeviled many a payer, regulator, employer and claimant – the rampant abuse of opioids.
Imagine my surprise and delight. The $1.4 billion catastrophe that has driven up costs for employers, kept many injured workers out of work for far too long, devastated families and led to addiction and diversion – is now fixed.
Talk about making my day!
I eagerly opened the email link, my fingers tripping over each other in my haste to discover who had achieved this epic success. As I waited for the link to open, my mind was filled with wonder at the achievement! Who could have done this? How could we reward them? For truly this wondrous accomplishment deserves all the recognition the industry can possibly confer!!!
At last (it was actually microseconds, but such was my excitement that it seemed like it took FOREVER) a window opened, and the screen filled!
It was none other than Integrated Prescription Solutions, formerly known as WorkCompRx.
Amazed. Stunned. Blown away. That was my reaction.
My bright hopes instantly burned to ashes as I read the screen. Imagine my pure, unadulterated shock; the bottomless pit of disappointment filled with crushed hope into which I fell as I discovered the party that had claimed this transcendental success.
For IPS/WorkComp Rx is the same company that, a mere two years ago, had taken my copyrighted work and without my permission, used it in a marketing presentation. Moreover, this company mischaracterized the work in such a way that it appeared I endorsed their approach and business model, if not them specifically.
Now, perhaps they had changed their ways, and had actually found the Holy Grail of opioid abuse prevention.
Alas, it was not to be. As I read their website, it became abundantly clear that while the name had changed, the company had not. In fact, I’m not sure they have progressed at all over the last two years.
There was precious little about opioids, and no “solution” I could find. Nope, same old marketing-speak claiming best-in-class this and industry-leading that. A mention here and there of opioids and utilization control but nothing new, insightful, innovative or even remotely promising.
There are no miracle solutions, no instant results. There is just hard work, careful analysis, thorough attention to detail, and persistent efforts. That’s what it will take to reduce the problem of opioids in workers comp.
Anyone who tells you they’ve “solved” the problem either a) doesn’t understand the problem – at all; or, b) doesn’t think you do.

Nov

Opioids in work comp – gaining visibility

Posted by Joe Paduda on Thursday, November 3rd, 2011 | Comments

Most workers’ comp executives have moved opioid abuse and overuse to the top of their “we’ve got to fix this now” list.
Those who haven’t, should.
Here’s why.
Employers and insurers will spend $1.4 billion on narcotics this year; the vast majority of those dollars will pay for opioids – OxyContin, Percoset, Actiq, Vicodin and the like.
In all likelihood, hundreds of claimants are dying every year as a direct result of opioid abuse.
There’s very little credible evidence that long term opioid use is appropriate treatment for work comp injuries. These are drugs primarily developed – and approved by the FDA for – treating end-stage cancer pain. Not much cancer in work comp.
There’s ample evidence that long term opioid use leads to longer claim duration, long term disability, higher costs and much more medical expense. And that’s on top of the damage it does to relationships, families, and society.
The insurance industry is beginning to focus on this as a critical problem, one that, although it is societal in nature, directly and dramatically affects employers and policyholders. Regulators and legislators are also keenly interested; I participated in an IAIABC webinar earlier this week along with Dr Kathryn Mueller, Medical Director for Colorado’s work comp system and Dr Gary Franklin, Medical Director for the Washington State Fund. There were more than 170 folks on the call, a clear indication of how important the issue is.
The big insurance trade groups are also addressing opioid use, driven by members looking for so-far elusive solutions to a problem costing their policyholders billions in added, unnecessary cost.
It is also going to be the subject of at least one session in next week’s workers comp conference and is on the agenda for WCRI later on this month as well.
This is long overdue but nonetheless very, very welcome.
To quote Gary Franklin MD, this is a “hair on fire” issue – and if your hair’s not on fire yet, you’re either a) bald or b) not paying attention.

Nov

The WCRI Conference – what to expect

Posted by Joe Paduda on Wednesday, November 2nd, 2011 | Comments

Following close on the heels of the National Work Comp Conference is the annual educational get-together put on by the Workers Comp Research Institute in Boston. This year marks the 28th (or perhaps 29th) edition; the agenda reflects how this industry has evolved over those three decades.
I caught up with WCRI Executive Director Rick Victor yesterday to discuss the conference and get a bit more detail on what’s going to be shared with attendees.
MCM – What are the goals of the conference?
Rick – We are focused on most important issues e.g. narcotics, use and cost of medications, and other cost drivers. We want attendees to come away with hard evidence of the nature of problem and information about solutions, including hard data on their effectiveness.
MCM – Any changes this year from past?
Rick – The format continues to evolve; it is a pretty robust mix of research and includes practitioners who don’t always agree with each other or with WCRI. We think it is important to not stack the deck.
MCM – The agenda has a strong focus on pharma – why and what’s driving it?
Rick – We try to align our research agenda with very important national issues like abuse and diversion of narcotics; as you know this far transcends WC and is a national public health crisis. Public policies about pharmaceuticals in WC are about 10 years behind medical policies and medical utilization, and this needs to change.
Some of the actions that public officials have taken about narcotics are not very well informed and not very sophisticated; there ought to be good opportunities to address this issue, if they have good info to make good decisions. Moreover, public decisions don’t make it easy for payers to get into they need to identify abuse and diversion; our research might help public officials to make better decision about what tools are appropriate.
MCM – There’s a session re hospital expense – what will we learn?
Rick – We see in WCRI’s CompScope(r) benchmarking that in a majority of states hospital costs are a bigger driver than non-hospital costs. Hospital price regulation is an area that is elusive for public officials and we would like to bring a bit more light to that. We’ve developed a new tool that will be unveiled at meeting, a hospital cost index, that will make meaningful and interesting comparisons among and between states.
MCM – I note there’s a surprise ending to this year’s conference – What’s the surprise?
Rick – It’s a big issue, an ‘elephant’. Elephants are big and can be nasty, and we want to help show how you might step out of the way when the charge is occurring. We will focus on an issue that is significantly under appreciated, hopefully to move it higher on the radar screen.
You can register for the Conference here.

Nov

The comp conference…

Posted by Joe Paduda on Tuesday, November 1st, 2011 | Comments

Is looking pretty busy. According to organizer Nancy Grover, this year’s industry get-together will have more folks in attendance than last year. The vendor list is long as well, which bodes well.
Here’s a few of the sessions that caught my eye.
Good friend and colleague Mark walls is moderating the General Session panel featuring many of the big names in comp: Maureen McCarthy of Liberty, Ken Martino of Broadspire, PMA’s Tina Preisig, and Eileen Auen of PMSI are just a few of the headliners.
Tron Emptage of Progressive Medical is speaking on medical foods Wednesday afternoon. Medical foods have gotten big press in California of late and look to be one of those areas ripe for abuse. However, there’s a lot more to this than you might think, and there’s very solid science behind some products, products that offer a much-needed and safer alternative to certain drugs.
Dr Jake Lazarovic, Broadspire’s Medical Director, and Dr Steven Feinberg of American Pain Solutions are leading a session Thursday am on Chronic Pain. These are two highly experienced and very knowledgeable experts who are certain to shed much-needed light on an issue that’s at the top of many an agenda.
A session Thursday afternoon on managing psychosocial issues in comp has a strong panel focused on what may be the knottiest problem in comp.
Of course there’s the usual menu of vendor entertainment options; the mail box has been flooded with invites for the past week. You west coast folks need to remember those of us from the east are three hours behind you; when you’re just getting going we’re nearing bedtime!

Oct

Physician dispensing – boy do we have a deal for you!

Posted by Joe Paduda on Friday, October 21st, 2011 | Comments

A friend who happens to be a practicing physician here in Connecticut was approached recently by physician dispensing firm Rx Development with a great offer. The physician could dispense medications right from his/her own office, at no cost and no obligation, and make buckets of money!
How much money?
Well, how about a 4443% markup on Soma’s generic?
Or 4330% on Mobic’s?
2060% on Ultram’s?
But wait. There’s more. The doc can pick her/his own drugs, negotiate for a bigger share of the margin, and Rx Development does all the work, provides all the drugs, handles all the billing, and trains the doc’s staff – all at NO CHARGE!
Of course, this only applies to work comp and auto accident patients.I guess increasing compliance, the avowed intent of physician dispensing, isn’t that important unless you can get paid huge dollars.

Oh well, one should do well if one is doing good! And if one can’t do well, what’s the point of doing good?
I’m hoping the State of Connecticut is aware of this, and takes prompt action to address this practice – which is nothing more than abusing the system to make outrageous profits at the expense of Connecticut’s employers. If you agree, please pass this on to the Connecticut Workers Compensation Commission Chair at
wcc.chairmansoffice@po.state.ct.us
We have GOT to stop this.
Here’s the letter received by the physician.
“Dr. Jenson,
Thanks for taking the time to speak with me this morning. We work with Offices in your area that see workmans comp [sic] patients and assist them with almost every aspect of the visit. Here is some information regarding what we were discussing and what we offer. Also here is a link to the Website. www.rxdevelopment.com
Our largest asset is In-Office Medication. What we do at Rx Development is store only the medications you would like in prepackaged (30,60,90,120 Count bottles) in a cabinet for your workman comp [sic] and auto accident patients. The medication is bar coded and electronically scanned through our web based dispensing system. There is absolutely no out of pocket cost to the Doctors or Patients. We handle everything for you: supplies, collections, set up and training, and tracking of inventory. Not only do your patients have the convenience of having their medical needs addressed in one location, you also capture the profit your [sic] passing onto local drugstores. [emphasis added]
We would love the opportunity to give you a free no obligation consultation to show you what makes us different and show you how easy and effective this really is!!
Here is more information from our Website:
Point-of-Care physician dispensing makes sense for both doctors and patients alike. From the convenience of having prescriptions on-site to the extra revenue doctors can easily generate, Rx Development offers unparalleled medication dispensing services that are above the rest.
In-office medication dispensing or point-of-care dispensing, gives physicians a greater success rate when it comes to managing the treatment process. While patients enjoy the convenience of having their medical needs addressed in one location, doctors achieve maximum medical improvement (MMI) for the injured, getting them back to work as soon as possible. Medication dispensing programs not only expedite Workers’ Compensation, personal injury, and automobile accident claims, but effortlessly yield supplemental revenue sources for the physicians.
· Obtaining Medications–It all begins with the convenience and availability of patient pharmaceuticals at your office. Rx Development will advance the amounts necessary to implement the program including medications that have been properly labeled and packaged in compliance with DEA and FDA regulations.
· Equipment and Supplies–Everything you need to properly dispense medication is at your fingertips. No out-of-pocket costs are necessary; all supplies are included as part of our management. This includes:
· Billing and Collections–Enjoy financial peace of mind while utilizing the Rx Development in-office medication dispensing program. A full suite of pharmaceutical A/R services is available so you don’t have to concern yourself with billing and collections. Rx Development advances the funds to purchase the medications and handles all insurance company reimbursements.
· Inventory Consulting–The Rx Development point-of-care dispensing program helps you maintain adequate inventory without incurring out-of-pocket costs.
· Comprehensive Training–Staff members will be completely trained in administering pharmaceuticals, accessing reports, processing patient requests, and more.
· Supplemental Income–Earn residuals as you provide a convenient service of dispensing pharmaceuticals to your patients without ever leaving your office.
· Industry Updates–Rx Development helps you stay abreast of current industry standards, as well as local, state, and federal regulations. Our knowledgeable advisors will keep your staff informed of the latest updates.”
I’m encouraging my friend to resist the temptation….

Oct

Opioids and work comp – the dialogue

Posted by Joe Paduda on Monday, October 17th, 2011 | Comments

There’s an excellent thread in Mark Walls’ LinkedIn group on the impact of opioid abuse on workers comp. Mark’s asked members to publicize the issue and among the fifty-plus comments are many thoughtful and well-considered responses, including several by physicians very knowledgeable about and engaged in the issue.
The dialogue is remarkable for its depth and detail; providers, attorneys, claims professionals, clinical managers, employers and
There’s also at least one provider opining that opioid abuse isn’t a problem and we should just let physicians do what they want because they went to medical school and we didn’t. His ignorance is stunning, but fortunately, his views are held by a minority of one.
The rest of the commenters are well aware of the dimension and impact of the problem, and several advance excellent, and pragmatic, approaches to addressing opioid overprescribing.
I think this social media thing just may take off…
Kudos to Safety National for encouraging Mark to engage in these issues. The impact he’s having is pretty impressive for someone who describes himself as “just a claims guy”.

Oct

Work comp fee schedule – a modest proposal

Posted by Joe Paduda on Wednesday, October 12th, 2011 | Comments

Here’s a modest suggestion re an alternative fee schedule methodology that deserves careful consideration by legislators and regulators alike –
From the medical fee schedule section of the Code of Hammurabi (1730 BCE):
215 If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
216. If the patient be a freed man, he receives five shekels.
217. If he be the slave of some one, his owner shall give the physician two shekels.
218. If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.
219. If a physician make a large incision in the slave of a freed man, and kill him, he shall replace the slave with another slave.
220. If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value.
221. If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
222. If he were a freed man he shall pay three shekels.
223. If he were a slave his owner shall pay the physician two shekels.
224. If a veterinary surgeon perform a serious operation on an ass or an ox, and cure it, the owner shall pay the surgeon one-sixth of a shekel as a fee.
225. If he perform a serious operation on an ass or ox, and kill it, he shall pay the owner one-fourth of its value.
Gary Anderburg of Broadspire was kind enough to forward this to my attention; he included the veterinary section just for comparison purposes. Gary says, and I agree, that we should give serious thought to reinstituting this, and go back to shekels.
That said, I’m wondering if Medata, Coventry, Mitchell, Stratacare, MCMC, and ACS/CompIQ can get this programmed…

Category: Workers Comp