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…

I’ve never used MCM as a recruiting tool, but there’s a first time for everything.
An HSA consulting client is in the market for a managed care expert, specifically an RN with solid experience in workers comp medical case management/UR.
The client, an insurer in the midwest, is looking for an experienced, entrepreneurial and motivated nurse case management professional to manage the entire NCM function and support medical management in their workers comp claims operation. If you know someone who’s got deep experience in work comp medical management, is looking to make a difference, and wants to work with great people in a very solid organization, let them know there’s opportunity here. Or, if you’ve always wanted to help set up and run a nurse case management department, drive results and outcomes, and develop and manage relationships with NCM firms, you know this kid of opportunity doesn’t come along very often.
Shoot me an email – with resume – at infoAThealthstrategyassocDOTcom. I’ll pass it along to the client, and you’ll hear back from them.

Up until this week, it looked like this fall M&A in the work comp services sector was going to be at an all-time high. Now, with Greece in default, the Euro in serious trouble, and markets looking for yet another bottom, things may slow down – or perhaps even stop.
While some would think foreign debt problems wouldn’t have much to do with whether a private equity firm or larger rival buys a company, there’s no question those kind of macro factors have a significant influence. Its not unusual for a merger or outright purchase to include substantial funding from debt as the buyers seek to leverage their equity investment. While this can make for even better returns for the buyer, it can also saddle the target company with a significant debt burden that can hurt cash flow, hinder investment, and drag down results.
Perhaps its folks trying to make a splash at the comp conference in Las Vegas in early November. It could be the expiration of the Bush tax cuts at the end of 2012 is driving owners to sell before Uncle Sam’s take increases. Competitive pressures are also a factor; some owners are likely seeing some of these deals (OneCall buying RayTel, STOPS, Express Dental; MSC’s purchase of Integrated Health, Sedgwick’s continual pursuit of complementary businesses) as the big getting bigger, and figure they better sell before they can no longer compete with rivals who far outweigh them.
More sophisticated sellers likely realize the uptick in claims frequency we saw last year produced a nice bump in claims (and therefore business volume), a bump that has, in all likelihood, disappeared as the structural decline in frequency resumes it’s 19 year long decline. Of course this only helps the frequency-driven businesses, and has little if any effect on sectors that are more affected by severity.
Then there’s the impact of regulatory changes, with Illinois leading the charge (for now); ongoing cost pressures on traditional work comp services; and let’s not forget the desire on the part of some investors to pull money off the table.
Remember private equity firms have a portfolio of investments – some are doing well, others so so, and still others have tanked. Their investors are expecting outsized returns, so occasionally a private equity company has to sell off one of its stars to balance a portfolio laden with underperformers.
Finally, it’s become apparent to me that the level of involvement with and depth of knowledge about the work comp services space has grown significantly within the investment community. Sure, there’s still a lot of noobs out there who don’t know a claim from a claim, but the folks who’ve spent some time in this business are getting pretty good at spotting trends and opportunities.
Expect to see a few more deals announced before, during, or just after, the Vegas comp conference.

Safety National’s Mark Walls has started a great discussion about the use – and abuse – of opioids in workers comp on his LinkedIn Group.
I’m struck by the quality and volume of responses to his post – in a couple hours, Mark generated a couple dozen comments including one from MyMatrixx’s Phil Walls RPh, one of the most thoughtful individuals I know in the PBM space, and another from a psychologist, David Dietz, with a different perspective. Dr Deitz notes that there’s much more to this than just the drugs, and his views are well worth thoughtful consideration.
I applaud both – and (almost) everyone else – for engaging in the discussion.