Insight, analysis & opinion from Joe Paduda

Nov
7

CompScope is up…medical costs are not.

It’s that time of year…when the brilliant minds at WCRI release the latest CompScope report.

The top finding…is likely to surprise many…

Couple observations:

  • yes, this was during COVID….medical costs during COVID were LOWER, not higher than previous in previous years. Those who understand medical care delivery anticipated this, alas that is a very small group.
  • no, medical costs in comp are NOT increasing significantly. Haven’t been for years.
  • That’s because we’re still benefiting from the opioid hangover effect.

Warning – Medicaid disenrollment aka “screw the poor folks” will push facilities and healthcare systems in many states to look for revenue replacements.

And, because work comp is pathetically awful at controlling facility costs, we can expect facility costs to increase – which will increase medical costs.

You can register for WCRI’s  webinar highlighting findings from this year’s report here….tune in November 16, 2023 @ 2 pm eastern.

What does this mean for you?

It is long past time to start preparing for higher medical spend.


Nov
3

Here’s some of the good stuff happening these days…

The number of workers with paid sick leave has jumped…lowest-wage workers’ access to paid sick leave has nearly doubled from 20% to 39% since 2010 – driven by more states enacting paid sick leave laws, according to a new Economic Policy Institute report. Overall, almost 4 out of 5 U.S. private-sector workers have paid sick leave, up from 3 of 5 in 2010.

Home care workers’ pay is going up...almost every state has bumped up wages for home care workers, a long-needed change that might help ease the hone care staffing crisis.

Know those yellow pill bottles that have been around forever…and will be around almost forever? Almost 200 billion are added to landfills and trash every year… CabinetHealth is pioneering recyclable – and refillable – glass pill containers…a way better way to get your meds.

Ok, leaving aside the obvious positivity – this is definitely facepalm worthy…there’s this NEW THING among Gen Z’ers...a “silent walk”…aka going for a walk without your phone!!

Who woulda thunk it? Just…walking? And yes, a TikTok’er discovered this revolutionary new idea, and it is…trending!!!

Next up…Silent Walking athleisure wear, shoes, hats, and rain gear, maybe logo that says “don’t disturb – Silent walking”.


Oct
31

Work comp bill review – the state of the industry

Over the last two decades work comp bill review has A) changed a lot and B) remained stagnant.

Both things are true…

Here’s the top takeaways from our just-released Survey of Workers’ Comp Bill Review (public version is available here; respondents received a much more detailed version).

Top findings are as follows (scores are 1 – 5, with 5 being highest):

  1. The BR industry’s overall rating from 2018 hasn’t changed, with an overall average grade of 3.2.
  2. Today there’s almost no differentiation in ratings across the major vendors; scoring has become more compressed since 2018.
  3. Customer service is of utmost importance in establishing a successful BR relationship. It is the primary reason respondents gave for changing vendors.
  4. There is a noticeable difference between executives and front-line employees in the evaluation of their BR vendor’s customer service. Front-line employees’ average score was 3.6, while executives scored 4.2.
  5. Automation is a hot topic in the industry, with a focus on improving turnaround time, auto-adjudication, and quality. However, some respondents are still looking for their BR vendor to better handle basic tasks.
  6. E-billing is gaining popularity, particularly among larger respondents and those who handle BR internally.

Couple deeper dives.

As noted above the survey included both front-line staff and management respondents; it won’t surprise many readers to learn front-line folks are not as satisfied with their BR vendor as their titular superiors are...that’s because execs value “savings” (which are mostly ephemeral as they are just reductions below some arbitrary benchmark, not actual medical cost reductions) – while front-line workers value efficiency, simplicity, clarity and quick problem resolution. 

Since execs make buying decisions, vendors mostly focus on what I would argue are often meaningless metrics. (don’t get me started on reductions below billed charges…)

More broadly, since our first BR Survey way back in 2009:

  • there’s been major consolidation…there were more than 11 vendors back then (remember Stratacare?  CS Stars? CompReview? Ingenix?) and market share was pretty spread out. Today, the number of vendors hasn’t shrunk much, but market share is much more concentrated. 
  • BR vendors have yet to embrace real payment integrity tools. There’s way too much “we know what we are doing” and way too little “we can always get. better”. The arrogance of ignorance is nowhere more entrenched than among BR company execs (not all, but almost all).
    And that, dear reader, is because buyers aren’t pushing vendors hard enough.
    That is NOT to say some payment integrity vendors aren’t at fault; they are too rigid in their pricing or workflow requirements, just too hard to work with.

What does this mean for you?

Buyers – push harder.

BR companies – you can do better.  A LOT better.


Oct
30

Good news Monday starts with this from the Economist, a beacon of objectivity (reformatted for clarity):

a steady stream of better-than-expected data has left analysts scrambling to lift their forecasts.

    • New orders for manufacturing firms reached their highest in nine months in July.
    • Retail sales were perky last month, too, with consumers splurging on everything from restaurant meals to online shopping and clothing to sporting goods.
    • The construction industry has also been buoyant, supported by a rebound in homebuilding.
    • the labour market… has remained hot, making it relatively easy for people to find work at decent wages.
    • The total number of jobs in America has been growing faster than the working-age population, helping to keep the unemployment rate at 3.5%, just shy of a five-decade low.

Oh, and those naysayers, remember they are the ones who’ve been doomsaying a recession is imminent…for more than two years.

“Eventually” that may happen – and “eventually” my granddaughter may have grandkids…

Oh, and our economy has far outperformed the rest of the developed world over the last few years.

One measure of a country is how it cares for the less fortunate…thanks to recent changes in Medicaid thousands of homeless people are now getting primary care, which is:

A) the right thing to do and

B) saves a boatload of dollars as these homeless folks are far less likely to go to the ER which costs a shipload more than getting basic primary care.

What does this mean for you?

Don’t get caught up in all the negativity…workers are doing better and better, jobs are plentiful, we are improving the lives of the less fortunate…and the US is leading the world.


Oct
27

Awful news Friday

I wrote the post below 4 years ago…and I’m heartbroken that it’s truer now than it was back then.

Our daughter went to school near Lewiston…I’m heartened that she graduated years ago and guilt-ridden that other parents and family are terrified their kids and family members may be the next victims.

It’s easy – and completely wrong – to say it’s all random.  It isn’t.

At all.

The epidemic of death by firearm is uniquely American.

Take responsibility.

  • Demand red flag warnings.
  • Demand assault weapon bans
  • Demand universal background checks. 

Or accept the blame.

Guns and public health

Guns are a major public health and safety problem. Guns are associated with tens of thousands of deaths every year, most preventable.

And we Americans are among the world leaders in death via firearm.

Before you make any assumptions – I own guns. I hunt – although I’m a pretty poor hunter.

My dad taught me to shoot, and handle firearms, and gun safety. Among the guns I own are his service rifle – a 1903 Springfield – from WW2 and the revolver he carried while flying in B-17s over Europe. They mean a lot to me, and one day I’ll pass them down to my kids.

A couple key factoids that are worth considering.

  1.  Most Americans – and most Republicans – want background checks and “red flag” laws.  And most Americans want stricter control of gun sales in general.

2. Firearms are used to commit far more suicides than homicides.

3.  People who attempt suicide with a gun are much more likely to die than those who use other means.

4. There’s a strong correlation between higher rates of gun ownership and higher suicide rates.

5.  Lastly, every day 65 people use guns to kill themselves.

Guns are a major public health concern, yet no other public health menace gets the same public support.  As a gun owner, I’m deeply troubled by the willingness of some to advocate positions that will get more guns into more hands – which will lead to more unnecessary tragedies.

What does this mean for you?

The data is clear – people want stricter gun laws – and for very good reason


Oct
26

COVID vaccines’ impact on newborns

If pregnant moms are vaccinated their babies were less likely to die, get very sick, or end up in the NICU (neonatal ICU) than unvaccinated mom’s babies…

That’s the findings from a very large Canadian study just published.

But wait…there’s more!

during their first 6 months (longer durations were not part of this initial study) babies from vaccinated moms were much less likely to get COVID than babies from unvaccinated mothers.

And, there was NO evidence that babies may have been adversely affected by the vaccinequoting one of the researchers:

The study “provides further reassurance on the safety of maternal mRNA COVID-19 vaccination during all trimesters of pregnancy for newborns and infants,”

Details on the study are here.

Maternal Covid-19 vaccination offers infants immunity for up to 6 months

 

What does this mean for you?

Yes, there are some potential limitations, but this is yet more evidence that vaccinations save lives.

If you want to challenge the study, provide credible citations to support your statements.  Anything from Robert Kennedy does not meet that standard.


Oct
25

Medical costs are going up because…

Wonder why that office visit/imaging study/minor surgery/diagnostic test costs twice what it did last year?

Partly/mostly because the physician practice was acquired by a health system or big hospital…which – under current Federal law – allows the new owner to upcharge for “facility fees.”

VERY briefly, way back in 1997 Congress passed the Balanced Budget Act, a giant bill that, among other things, allowed facilities to tack on a facility charge for services delivered in its facilities.

That oversight is a key reason health systems have been snapping up provider practices as fast as they can, paying gazillions for primary care, specialty care, imaging, PT, you name it. (another key reason is health systems want to own as much of the care delivery and referral process – and fees – as possible)

This from Health Services Research:

Medicare reimbursement for physician services would have been $114 000 higher per physician per year if a physician were integrated [part of a health system] compared to being non‐integrated.

The differential varied greatly by type of service…

The solution seems pretty simple…to quote Health Affairs,

Pay for common ambulatory services under the rates, codes and policies in the physician fee schedule regardless of location

There’s an effort underway to at least partially remedy this by moving to a site-neutral reimbursement…but as it will take Congressional action that is a heavy lift indeed…especially given the current House of Representatives.

What does this mean for you?

Two things…

  • Think through potential unintended consequences BEFORE its too late
  • Rethink network contracting strategies…lock in pricing with office-based practices.

Oct
24

Do not let the past repeat itself

The Triangle Shirtwaist Fire was the horrific result of unregulated capitalism. 146 people – mostly women -burned to death or were smashed on the pavement nine stories below the factory floor when fire raged through their Greenwich Village workplace.

The mind reels when contemplating the last moments of the victims, who moments before had been looking forward to a Saturday night with friends and family, and a Sunday (gasp!) off work. When the fire below burst through the stairwells and floor it found bins of dry cotton, wooden worktables, beams, walls and floors.  There was no escape – the owners had locked the exit doors. The conflagration exploded in seconds, and women and men young and old were gone in moments.

And yes, this was foreseen, and preventable. This from David Drehle:

Despite the New York City fire commissioner’s well-publicized prediction that a deadly blaze in a high-rise loft factory was inevitable — and despite multiple small fires during working hours at the Triangle — the owners ignored a consultant’s advice to perform regular fire drills to train workers for an emergency. And they declined to enforce their posted rule against smoking near the highly flammable cotton scraps their workers snipped by the ton.

Long ignored, for over a century there was no memorial, no permanent reminder of the tragedy, no tribute to the mostly-immigrant women who died that awful day. That ended when Mary Ann Trasciatti and others’ relentless effort culminated in this…the steel runs along the building, listing names and ages of the victims and quotes from survivors. It will be completed early next year.

Good friend and colleague Rick Sabetta reminded me of this, and I am indebted to him.

What does this mean for you?

We would be well-advised to learn a lesson from days past, a lesson seemingly ignored by those looking to employ young kids in dangerous jobs and downplay the very real dangers of heat exposure in agriculture and logistics.


Oct
18

more good jobs = more premium and more claims

Old coal-fired electric plants are being converted to manufacturing, residential, office, and recreational uses. These are massive undertakings involving dismantling giant buildings; taking down crumbling smokestacks; removing hundreds of tons of asbestos; shredding hundreds of tons of steel, copper and aluminum; and hauling hundreds of truckloads of debris.

photo credit Daniel Lozada, NYTimes

Then there’s site remediation to clean up hazardous and dangerous residues from decades of processing and burning coal.

Developers estimate around 20 coal-burning plants are candidates for this type of re-development; many others may be taken down as well. A quick scan indicates a plurality of plants are located in Michigan, Texas, Indiana and Tennessee. 

Once the demolition and remediation is done, it’s time to build – and not just commercial and residential projects. One of the main attributes of these plants is they are tied into the grid, making them prime locations for green energy production in the form of solar and wind farms.

From the NYT:

In Illinois alone, at least nine coal-burning plants are on track to become solar farms and battery storage facilities in the next three years. [emphasis added] Similar projects are taking shape in Nevada, New Mexico, Colorado, North Dakota, Nebraska, Minnesota and Maryland. In Massachusetts and New Jersey, two retired coal plants along the coast are being repurposed to connect offshore wind turbines to the regional electrical grids [emphasis added]

Building and operating renewable energy projects has long been cheaper than fossil fuel plants. The barrier “is not economics anymore,” said Joseph Rand, a scientist at the Lawrence Berkeley National Laboratory, which conducts research on behalf of the U.S. Department of Energy. “The hardest part is securing the interconnection and transmission access.” [which is not an issue when old coal plants are re-purposed]

Which all translates to lots and lots of very well-paid workers doing risky work for years.

What does this mean for you?

More workers’ comp premiums and claims.


Oct
13

Good news Friday (really)

Yeah…I know, this was a really awful week.

At times like these I retreat into the “control what you can control” mantra…Can’t do a darn thing about the Middle East or the incredibly dysfunctional House of Representatives…but we all can do something.

So, a couple thoughts.

Be outwardly cheerful and engaging, smile at everyone you see, say hello, and wish them well. Some will growl (looking at you, NYC pedestrians), some will smile back, others will wonder what’s wrong with you, but you’ll make things just a bit brighter for many.

It will also improve your mood…guaranteed!

Do something to build community – anything. Call someone you haven’t spoken to in a while, stop by a neighbor’s to just say hello, send a card to a distant friend or relative, maybe drop off cookies at a friend’s desk or home, get a few friends together for a walk, hike, ride…no agenda, just connecting.

At times like these we need each other more than ever.

And if you need something positive to talk about…inflation is moderating…sure it is still higher than the Fed’s 2% target, but things are improving.

And, when you unpack the latest inflation data, housing prices increased more than expected…further unpacking by ABC News found “unusual jump in housing prices in Los Angeles as accounting for much of last month’s housing inflation, which may not be sustained. ”

So, for those of us not looking for a place to live in LA, prices aren’t increasing nearly as much as they were just a few months ago.

What does this mean for you?

You’re all set to be the cheerful bright spot at the barbecue, tailgate, kid’s soccer game, or morning walk.

 

 

 

 


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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