Work comp claim frequency is down, but severity (claims costs) is up.
What to make of this?
Aug
13
Insight, analysis & opinion from Joe Paduda
Category: Workers Comp
Aug
10
The recent imposition of a work comp pharmacy fee schedule in New York has shaken the industry – and that’s not hyperbole. The latest news out of Albany is likely to intensify the aftershocks.
The preliminary guidance from the State is PBMs cannot charge more than the fee schedule, and cannot pay pharmacies more than the fee schedule.
Continue reading NY’s workers comp fee schedule – further developments
Aug
7
The adage goes something like – when the US sneezes, the world catches a cold, signifying just how much influence this country has on the rest of the world.
That’s analogous to Medicare’s impact on the health care sector. And Medicare is about to change the way it pays hospitals, a change that will have a dramatic effect on every private payer from HMO to individual carrier to workers comp insurer to self-insured employer.
Aug
6
The latest shot in the battle against drug costs comes from the Centers for Medicaid and Medicare Services, which is reported to be denying coverage for off-label use of drugs such as Actiq and Fentora.
Whenever CMS moves, the healthcare world shakes, and this is no exception. There are a host of possible ‘downstream implications’ in areas as diverse as workers comp, formulary management, and hospice.
Aug
2
Coventry closed the Concentra acquisition four months ago, and has been working diligently to merge this new acquisition and First Health. While it is still early, here’s what things look like after four months.
(sources are today’s earnings call and discussions with industry insiders)
Jul
31
Marsh has released a ‘report’ on managing workers comp claims. While it is undoubtedly a marketing piece, it doesn’t do the firm much good as it reflects a broad lack of understanding of the primacy of medical expenses as a cost driver in workers comp.
Continue reading Why are workers comp medical expenses going up so fast?
Jul
30
The workers comp insurance industry is booming – losses are down, profits are up, insurance rates are plummeting, and all is better-than-well.
Fooled ya!
Jul
18
New York’s new fee schedule for drugs dispensed to workers comp claimants is among the lowest in the nation.
How low?
Jul
17
The workers comp market is still soft, with rates continuing to decline. However, the rate of decline has leveled off somewhat, with the latest stats indicating a decrease of less than 2% in the second quarter.
While some think the tapering off is due to the effect of the California and Florida reforms tapering off, I’m not so sure.
Continue reading Will the soft market in workers comp persist?
Jul
12
The regulators in NY have decided that drugs for work comp claims will be reimbursed at the Medicaid fee schedule plus a dispensing fee.
That is a huge change from the prior reimbursement level of usual and customary, which in the Rx world is defined as the actual cash price in that pharmacy for that drug on that day.
Here’s the legal language.