Insight, analysis & opinion from Joe Paduda

Mar
24

Optum vs the Massachusetts Attorney General

Several weeks ago Massachusetts’ Attorney General’s office put out a press release noting work comp PBM Optum had settled a civil case by paying $5.8 million and agreeing to “implement additional procedures to prevent overcharges in the future under the workers’ compensation insurance system. Optum Rx has also agreed to cooperate with the AG’s Office regarding monitoring of future regulatory compliance.”

Several clients contacted me to get my take, and as I’m involved in audits of multiple pharmacy programs any insights into the issue might be helpful.

The net – Massachusetts’ work comp RX fee schedules’ regulations are ridiculously difficult/impossible to implement, and Optum was treated unfairly by the AG’s office.

[note I’ve spent way too much time digging into this, and it is entirely possible I don’t have the full story – largely because the AG’s office chose to be unhelpful.]

I reached out to the AG’s contact multiple times in an effort to better understand the issue; when I finally got a return call, it was, well, less than useful. The attorney told me he couldn’t say anything beyond the press release due to the involvement of a confidential informant. [that’s a pretty universal excuse for not engaging and one I found less than helpful; I wasn’t asking how the AG learned about this, but rather specifically what Optum allegedly did wrong]

here’s the key section of the AG’s press release:

The settlement, filed in Suffolk Superior Court, resolves allegations that Optum Rx, in some circumstances, failed to apply various regulatory benchmarks – like the Federal Upper Limit for Medicare and the Massachusetts Maximum Allowable Cost – to its pricing determinations for certain workers’ compensation insurance prescription drug charges.[emphasis added]

After some back and forth, in which I explained the release wasn’t clear, he informed me [paraphrasing here] that “anyone who knows the Mass work comp pharmacy fee schedule understands the significance of the ACA FUL and Mass MAC…”

I got a bit huffy with his borderline rude retort, and informed the gentleman that in fact:

  • A) I did “know” the Mass WC Rx fee schedule;
  • B) I have a pretty solid understanding of pharmacy fee schedules and reimbursement in general; and
  • C) if I couldn’t understand it, then I’m pretty sure most work comp payers and other stakeholders couldn’t either.

So, I called contacts at Optum to get their side of the story.

The net is, according to Optum – and other PBMs I’ve spoken with – the fee schedule wording is unclear, subject to interpretation, neigh on impossible to implement and therefore highly problematic.

From Optum:

  • Defining and Implementing the Commonwealth’s “Usual & Customary” definition – The provision as written is unclear and guidance on interpretation/implementation was not supplied in a manner that allowed all stakeholders to be successful.
    • 101 CMR 331.02  – “Usual and Customary Charge. The lowest price that a provider charges or accepts from any payer for the same quantity of a drug on the same date of service, in Massachusetts, including but not limited to the shelf price, sale price, or advertised price for any drug including an over-the-counter drug. If an insurer and the provider have a contract that specifies that the insurer will pay an average or similarly computed fixed amount for multiple therapeutic categories of drugs with different acquisition costs, the fixed amount will not be the provider’s usual and customary charge.”

      My take
      this is nonsensical and impossible to manage – for a whole host of reasons.
      Taking this literally, a PBM would have to A) know the amount accepted for reimbursement for B) each and every drug at C) each and every retail pharmacy. Note that the Commonwealth’s definition of U&C specifies the “lowest price that a provider…accepts from any payer…” As PBMs and other payers don’t instantly adjudicate claims and don’t know what amount a retail pharmacy ultimately “accepts” for a particular script, there is no way to comply with this requirement. [retail pharmacy bills are rarely paid on the day the script is dispensed, but paid in accordance with each PBM contract – it could be weekly, biweekly, monthly, or at another time.]Example – an Optum patient goes to Walgreens on Tuesday, gets her script for 30 tabs of 800mg ibuprofen. Did Walgreens know and transmit to Optum the lowest price it accepted for that drug on that day at that pharmacy?
      Of course not.

       

  • Understanding of contracts between the traditional triad of pharmacy/PBM/comp payor – The Commonwealth’s interpretation of how payment agreements (within the specific context of MGL c. 152, Section 13) should run between those entities is, frankly, unique in relation to how other jurisdictions operate.
    In English, what Optum is saying is the Commonwealth thinks contracts should be three-way – PBM, pharmacy, and payer/PBM customer.
    That is patently impossible; there are tens of thousands of employers and other entities contracted with PBMs, which in turn contract with thousands of pharmacies.

From the AG press release:

“Our workers’ compensation insurance system has specific processes in place to help ensure drug pricing is handled fairly, maintains transparency, and keeps costs down,” AG Healey said.

My view – well, no.

If I read this interpretation right, Massachusetts wants something no other state does to solve a problem that no other state seems to think exists.

I suspect the AG’s office is also pursuing similar litigation against other PBMs – and more’s the pity, because from what I have been able to learn, the AG did NOT handle this “fairly”.

If that’s a misinterpretation, it’s due to a lack of responsiveness and clarity from the gentleman from the AG’s office who chose to NOT be “transparent”.

What does this mean for you?

If you’re a PBM, make sure you’re on top of this.

[note – Optum is not a client, and we’ve actually crossed swords several times of late. Regardless, from what I can tell Optum did NOT attempt to drive “up costs and…unlawfully profit.”]

note 2 – happy to re-engage with the AG’s office at any time.


Mar
22

Wildly off-topic 2…

Again my fascination with the minutiae that brings defeat or victory causes me to diverge from managed care stuff to dive into what’s happening in Ukraine, why, and guess what the end result will be.

(Here’s my first post which dives into the why crappy vehicle maintenance and mud season are really helping Ukraine)

The damage Russia is doing to Ukraine and the Ukrainian people is immeasurable.  Yet it pales in comparison to what it is doing to itself, its future, its world standing, its economy . And it will get worse, because

Ukraine is still winning (or perhaps more accurately Russia is not, which is the same as Russia losing), and

The western world is unified as it has never been.

First, the no-fly zone. Unfortunately this is a no-go because:

  • Russian planes are not doing nearly as much damage as artillery and rockets – which CANNOT be stopped by a no-fly zone.
  • Implementing a no-fly zone would require NATO countries’ airplanes to:
    • bomb Russian ground radar and anti-aircraft assets – some of which are INSIDE RUSSIA
    • shoot down Russian air assets (planes and helicopters)
    • shoot ordnance (missiles, rockets, shells) that might cross the border into Russia)
  • Direct confrontation of Russian assets by NATO forces would support Putin’s claims that it’s Russia vs NATO and the west, thereby:
    • solidifying his position in Russia and
    • making the use of nuclear/biological/chemical more defensible  – at least in Putin’s mind and others in Russia.

Also, we (NATO, that is) are about to send some very capable ground-to-air missile systems to Ukraine, systems which Ukrainian soldiers are likely familiar with and will need little additional training on. Some of these systems have the ability to shoot down cruise missiles as well as planes and helicopters.

the contrail is from a Ukrainian rocket about to hit a Russian attack helicopter.

and here’s the helicopter as it hits the ground.

Second, “we should be doing more to help the Ukrainians” Well, like what?

Anti-tank rockets? Drones? Medical supplies? Anti-aircraft missiles?

check, check, check and check.

I’m also guessing our intelligence services are helping a LOT by sending data on Russian military movements to Ukrainian forces, data that those forces use to target precision munitions, identify potential threats, and better understand the tactical situation. Of course you’ll never hear about this.

[note more than two dozen (!) Republican Senators voted against legislation providing $13.6 billion in additional aid to Ukraine, then blasted the Biden Administration for “not doing more” to  help the Ukrainians.]

Okay, here’s what I’ve learned from untold hours of reading twitter feeds from some very well-informed and knowledgeable posters…

Logistics

Russia is having logistical problems – for we civilians, that means their supply chain is in very bad shape. If we don’t get our drill bits, Etsy order, or several pair of shoes to try on, that’s a tragedy.

If an invading army runs out of artillery shells, food, medicine, rockets, medical supplies, and most importantly – fuel – it’s much worse. Hard to fight a war if your:

  • soldiers are hungry,
  • you can’t patch up your wounded, and
  • your tanks, trucks, command vehicles, and mobile artillery run out of fuel.

Which appears to be happening.

Couple issues here –

  1. the Russians can’t get the stuff they have on hand to the troops that need it because those Ukrainians who were supposed to welcome them with open arms didn’t get the memo. And,
  2. Putin and his generals evidently didn’t stock up on everything a modern army needs because they assumed (1.) above was reality.

There are reports that Putin has been asking China for food, artillery shells, medical kits, and probably everything else. (That’s why President Biden told Premier Xi Jinyang – in no uncertain words – to NOT send military goods to Russia)

Okay, back to 1…

Fuel. 

Its mud season, and melt season, which means many roads are impassable which forces vehicles to go cross country – which means crossing streams/rivers. Armies have specialty vehicles intended to do this, but…

As we discussed a while back, vehicles require roads, which are narrow, can be mined, and offer lots of opportunities for the Ukrainians armed with man-portable rockets to blow them up.

The classic tactic is to destroy the front and rear vehicles, trapping the rest in the middle. Drivers then have a Hobbesian choice-  stay on the road and risk getting blown up by rockets or head off road where they risk getting blown up AND/OR stuck in the mud.

Which seems to be happening.

2. Those fancy hypersonic rockets Putin is using? he doesn’t have that many. And they cost about $100 million EACH. Using them now – against a nation that should have surrendered weeks ago, may be an indicator of desperation.

He’s actually been forced to use anti-ship rockets against land-based targets. Which implies he’s running out of regular rockets. And artillery shells. and lots of other stuff.

Here’s the worst part – Russian casualties – killed, wounded, missing, taken prisoner – are staggeringly high. 

Typically, for every killed-in-action (KIA) there are three wounded (WIA). If this holds here, we’re talking over 50,000 additional casualties.

This is stunning.

By way of comparison, in 9 years in Afghanistan – a brutal war indeed – the Soviets lost 9500 KIA.

So in less than a month the Russians may have almost twice as many KIA than in 9 years in Afghanistan.

“Worst” because many of those soldiers were conscripts with little education, poorly fed and trained, unaware of where they were going and why, but told they would be welcomed with open arms.

Where do we go from here?

  1. Will Putin use WMD (weapons of mass destruction)?
    I don’t know – and no one else does either. But I’d say it is likely he does something horrific, because he’s Putin and will likely be shot if Russia fails in Ukraine.
    Chemical is the likeliest as he will try to blame it on Ukrainians blowing up an ammonia or chlorine storage facility.
    Due to massive corruption in Russia it is highly unlikely Russian troops have protective gear. That implies Putin will use chemicals on civilians and do so far from his own troops. Then again, he does not care if his guys get slaughtered and could blame that on Ukraine.
  2. Stalemate
    Russia is making some progress in the south, and appears to be stalled in the north and west – if not losing ground.
    It is nearing bankruptcy, has lost massive amounts of equipment, and cannot get critical components to replace that equipment and has suffered more than 50,000 casualties.
    Ukraine’s morale is high, its civil and professional forces are performing incredibly well, supplies are coming and its people are unified yet it has a much smaller air force, is fighting an enemy that does not care who or what it kills.

Where does this end up?

No one knows.

What does this mean?

Support Ukraine. 

Please consider a contribution to Care. Care is a very reputable and highly effective NGO with a rich history of successfully mitigating disasters and helping people. They are doing great work in Ukraine.

Screenshot your contribution and put it in comments. I’ll post it – and my ever-lasting thanks.


Mar
21

Future of the Workplace post COVID – WCRI #3

My posting service sends out posts at 10 am eastern, so I decided to hold off on flooding your inbox with reportage from WCRI’s annual confab and spread things out.

Today we’re reporting on a panel discussion re the future of the workplace post-COVID (let’s HOPE we are “post” COVID)…[Ed note – these are paraphrases; corrections welcomed and apologies for errors]

Denise Algire, director of risk initiatives and national medical director for Albertsons Companies (and a good friend); Dr. Craig Ross, regional medical director for Liberty Mutual; and Dan Allen, executive director for the Construction Industry Service Corporation, a non-profit labor management association were the panelists.

Dan Allen – The vaccine requirements have been very well received by workers in construction – strong educational outreach, not a “hammer”, rather focused on getting the word out – safety is the imperative – healthcare demands all workers are vaccinated, so workforce depends on being being safe and being vaccinated to work in healthcare and many academic projects.

Construction workers are essential workers and are often right next to each other, so separating by 6′ is tough – collaboration is the key.

Denise Algire – Albertson’s relied on education and empowerment – did not have a vaccine requirement unless required by the state.

Long Covid –

Dr Ross – post acute symptom covid is considered a disability, so think carefully about how you approach this. There are 200 different symptoms in 20 different body systems…no consensus regarding diagnostic criteria or treatment for for Post COVID conditions (PCC). A recent study published in Nature compared post covid patients to a control group – one key finding was an increased risk for CV (cardiac) complications – most significant was myocarditis – 5x greater incidence in covid patients. [I think this is the link.]

Dan Allen – be ready to work with employees struggling with long COVID, there’s a very long list of potential symptoms/conditions…the key question is how do you address those? Employers must work with occ medicine specialists to better understand these symptoms and potential impact thereof.  mental health resources-  take frequent breaks – listen to understand where the patients are coming from – not as straightforward as our tupical WC claim.

Dan – there’s no WFH (work from home) in construction which leads to more risk of getting exposed on the job – to address this, construction sites have implemented scattered job site times; come early, come late hand washing stations, and mask regulations increased that safety.

Denise – grocery workers were essential workers as well – Albertsons’ put together a clinical team, realized no one size fits all – key is listen to employees and balance that with collaboration – looking at teaming and ensuring folks working on stuff together are at the office at the same time – going forward work  will be a hybrid approach –

Also – we need to keep re-assessing as COVID persists as the situaiton changes  – and may likely continue to change

Craig Ross DO – business needs to continue to invest in safety and safe workers

Dan – safety and health care critical – union training on these issues is paid for out of each worker’s hourly pay – “right to work” states kill apprentice and other training programs which strongly advocate for safety…Construction results in over 20% of workplace deaths in the US in an industry with <6% of workers.

The construction work force is aging and unless you train them well you’ll get more injuries. The great resignation started before the pandemic – don’t overwork and overexert the workers you do have.

Craig – going forward we will likely see increased repetitive trauma due to WFH  – calls for increased employee assistance.

Any changes in claim composition?

Dr Ross – claims composition didn’t change except more severe injuries – more severe multiple body part claims…there wasn’t a delay in care, telemedicine ramped up early and seems to be used in specific situations especially mental health. There have been very few vaccination claims to date; and multiple studies suggest it reduces risk of long covid.

Dan – suicide rates in construction are highest of any other industry – 53 workers/100k…why – big macho thing – injured workers don’t report injuries – working on mental health days, collaboration w businesses – have a foreman who talk to workers – let them know you care about them – talk to the workers so they can share issues.

Addressing the use of opiates and finding alternatives has been a big help – sometimes there’s a little bridge from using opiates as treatment to patients using them to address stress. Hope is we’ve learned from COVID and you’ll see safer workers and safer worksites, suicide presentation, calisthenics before work…there’s dollars for training in the infrastructure bill for minorities to help them get introduced to careers in construction.

Misclassification is a huge issue for insurers, workers, and builders – “cheat to compete” – they take advantage of immigrants – put em into jobs, unskilled, untrained, misclassified workers,  cheap untrained unsafe labor means legitimate contractor loses that job  construction is substandard and project has problems.

What does this mean for you?

Behavioral health was my big takeaway...be open, let workers know they are not alone and you’re open to listening, that there is no stigma.

As one who’s dealt with panic attacks for 25 years, I completely agree – yeah I get them, yeah they suck, and yeah you’ll get through this and we are here for you.


Mar
18

How’s the work comp “system” today?

A panel discussion on the State of the Workers’ Comp System featuring Alan Pierce, David Langham, John Ruser and Bruce Wood closed WCRI’s 38th Conference. The discussion was spirited, there were significant disagreements all handled with respect and courtesy – take a lesson, Washington!

There’s no question the “system” is way better than it was fifty years ago when the National Commission’s report was published…the panelists disagreed on how much “better” it is – among other issues.

Unfortunately what was not addressed in any detail was the state of the “system” today, rather the panelists focused mostly on how we got here. That was a miss, although my bet is Dr Ruser just ran out of time.

Alan Pierce JD opined [paraphrasing here] that all cost cutting efforts came at the expense of the injured worker, citing changes in Massachusetts’ reduction of benefits in the 90’s and other events. He also noted that issues related to compensability of injuries incurred by older folks with degenerative conditions are increasing, often to the detriment of the injured worker. Pierce is a passionate worker advocate with deep experience, albeit in one jurisdiction – Massachusetts.

Pierce asserted this has happened in large part due to the decline in organized labor and increased political power of employers. Unfortunately Mr Pierce went way over his allotted time, reducing other panelists’ time and robbing the audience in the process.

After Mr Pierce completed his soliloquy, Bruce Wood weighed in.  Bruce noted many states adopted key recommendations set forth by the national commission, then the work comp market collapsed around 1990, creating an “existential crisis.”

Bruce noted the industry was in such dire financial shape that state regulators adopted measures to address the largest cost driver in comp — permanent partial disability. He also challenged Pierce’s characterization of the industry’s prior acceptance of paying for care for aging-related conditions, citing changes in specific states to address that issue, changes that Bruce stated were necessary to help regain financial stability.

David Langham – a workers’ comp judge in Florida – criticized the production of the National Commission’s report, averring that the report was limited due to time constraints. Langham noted there needs to be a balance and legislators/regulators seem to make changes that are weighted too far towards employers or employees. Langham called for legislators to focus on getting things back in balance, noting few or no injured workers are involved in the legislative process, nor are any smaller  – or midsized employers for that matter. Kudos to Judge Langham for keeping to his allotted time.

Asked about the role of the Federal government, Pierce suggested perhaps there should be a set of minimum standards for worker benefits states should comply with…then noted this might become the de facto universal standard, thereby the “floor” becomes the ceiling.

Langham noted the public doesn’t have much faith in the Federal government, but failed to point out why that is the case – which I would argue is caused by two factors:

  • the vilification of public service by many pundits and politicians.
  • the abject failure of most elected officials to actually work for us, instead whipping up outrage and working only to get re-elected.[Of course the Federal government has problems…every large organization does…you tried to use your health insurance lately? called your cable company? mobile phone company?]

Wood noted that the last time Congress addressed any of the Federal programs was 1984…I would note that this is NOT the fault of those programs, but rather the responsibility of Congress.

Which, frankly, has not done its job.

My view

Change has to be driven by stakeholders.

Well, insurers are making record profits – they don’t see any need to change. Employers’ workers’ comp costs are at a historical low – they don’t see any need to change.

Injured workers may well see a need for change, but their intentions and desires are often co-opted by profiteers cloaking their insatiable thirst for yet more dollars in the guise of “helping workers.” I’m looking at you, mail order pharmacies masquerading as advocates…

Physician dispensing accounts for half of all drug spend in several states – yet delivers zero benefit to injured workers and sucks hundreds of millions out of employers and tax payers.

Many – but not all – hospitals in Florida are absolutely screwing employers and taxpayers, yet legislators and regulators in the pocket of the hospital industry aggressively resist any attempt at reform. Meanwhile, Florida’s doctors get paid less to treat work comp patients than their fellow physicians in pretty much every other state – and those same legislators and regulators do nothing.

I ran into old friend and colleague John Swan on the way out of the hotel (btw I LOVE the Westin Copley Square – great service, terrific gym, wifi works).

John said something we – and I – need to ALWAYS remember – the only people with “standing” to work on policy and interact with legislators are workers and employers.

The rest of us – insurers, TPAs, service providers, brokers, consultants, judges, attorneys, medical providers – are tangential at best.

 


Mar
16

WCRI kicks off…

It is SO GREAT to see faces, shake hands, smile and see it returned, reconnect with colleagues and friends after a looooong two years.

Scroll to the bottom for impacts on P&C and work comp…

Gallagher Bassett’s Russ Pass opened the conference – full disclosure I’m a big Russ Pass fan; he’s incredibly thoughtful, measured, and knowledgeable, and WCRI is lucky indeed to have Russ as Chair.

Dr. Bob Hartwig dove into the impacts of COVID on the work comp line….I had several cups of coffee so felt almost ready to keep up with the estimable Dr. Hartwig.

Inflation

is at a 40 year high, started by supply chain issues, then exacerbated by fiscal/monetary policy, wage increases and now Russia’s war on Ukraine and the impact on energy prices. Inflation is driven by price increases in energy, food, vehicles and “core goods” — NOT from services including medical care.

Oil is going up and down – the China Shenzhen shutdown has cut prices quite a bit as demand falls (that’s my take, not Dr Hartwig’s). We are also a LOT less vulnerable to oil prices now as cars are twice as efficient as they were in 1980.

Hartwig noted that as bad as things are today – they really aren’t that bad.  As one who graduated college into high inflation and high unemployment, I heartily agree.

Dr Hartwig noted there’s a 20-25% chance that we enter a recession within the next year…although others think the chances are higher than that.  that would have a MAJOR impact on workers’ comp, as employment would drop and we might well see attendant claiming-related behavior.

Hartwig also noted that reserve adequacy might suffer if inflation stays high for a some time.  Not sure I see that – WC is WAY over-reserved today so there’s plenty of dollars in the kitty to make up for inflationary pressures.

Part of the driver of the current labor issue is a lot of people have been in and out of the workforce due to illness. That said, about half of businesses are having a tough time filling jobs…as only 82.2% of those in their prime working years in the workforce that’s likely a much bigger driver. Dr Hartwig opined that problems with childcare and fear of contracting COVID along with unemployment benefits are major contributors.

Wages went up over the last year, with average hourly wages up 10.6% from 2/2021 to 2/2022.  That’s a lot, especially compared to recent increases which were mostly in the 2 – 3% range for the last decade or so. (Ed note – I’m really encouraged by this – great to see folks in lower wage industries like hospitality get big boosts in their income – well deserved!)

More info…

  • Non-farm payroll is back to where it would have been if COVID never happened – that is remarkable/historic/great,
  • the “quits rate” seems to have leveled off,
  • more of us are retiring – especially the 65 – 74 year olds,
  • and more than half of the 55+ are now retired…(what’s wrong with the rest of us??)
    • that’s the first time this has ever happened – says Dr H.
  • one of the biggest drivers of economic growth is…population growth. As we aren’t making babies like we used to, and for unfathomable reasons are severely limiting immigration – that’s a drag on the economy.

Impacts on P&C

COVID cut premium growth in half – BUT that was still much higher than COVID’s impact on th overall economy.

Work comp saw a 10% decline in premiums in 2020 (not including state funds) – by far the biggest decrease in P&C.

P&C investment yields were 2.6%, the lowest level in 60 years. As interest rates edge up, investment yields will increase.

The overall work comp combined ratio is projected to be 90 in 2021 after an 87 in the previous year. That, dear reader, is super-profitable compared to the line’s historical returns.


Mar
15

CWCI – what’s happening in California – part 1

The brainiacs at CWCI presented the results of their latest research last week…video is here.

I’m a big fan of CWCI’s work because:

  • it is super timely – much more so than any other research organization
  • it covers almost all California claims
  • CWCI’s researchers are very insightful and
  • they explain the implications clearly and concisely.

Top takeaways…

COVID is one persistent bugger…the repeated peaks are driven by variants – reminding us that viruses evolve, adapt, and persist.

The major jump in January 2022 was driven by Omicron…January numbers were 13% higher than the previous peak – remember Delta?

That said, and yet another reminder – to date COVID claims have NOT been a major cost driver – far from it, and that’s primarily because COVID claims either A) didn’t incur any payments or B) didn’t incur significant medical spend..

[According to  CWCI’s Rena David, The majority of the “no medical or indemnity claims” may well be mostly those that were reported by the employer when there was a possibility a worker had COVID exposure but either the claim didn’t go forward or there wasn’t a positive test.]

While median costs for LT COVID claims with medical expenses were modest – and a lot lower than non-COVID claim costs, the gap narrowed considerably for claims at or about the 90th percentile for LT claims with medical expense.

BUT COVID claims were still less expensive for non-COVID claims – as if we needed more proof that COVID claims will not break the bank.

What does this mean for you?

As goes California, so goes the rest of us – just a little later.


Mar
14

Are we there yet?

Last week’s CWCI conference was – as usual – stuffed with useful information you can’t find anywhere else.

We’ll start off with this – Mark Schniepp PhD’s discussion of the state of the economy. Interesting takeaways indeed…

First up, consumer sentiment is not great – despite a booming jobs market, rising wages, low consumer debt and strong household finances including a solid savings rate, folks seem concerned about inflation. (note these data don’t account for the Russian war on Ukraine).

Second, jobs. There’s a giant number – as in a record – of job openings. This is pushing wages up – which I’d argue is a good thing, as the middle class’ wage increases have long lagged income increases among the super-rich. The lack of child care is a major factor – Dr Schniepp noted:

“among prime-age workers – those without children have fully returned to the workforce.”

I’m quite sure you, dear reader, know families that are constantly stressed by the lack of child care and the impact that has on work.

As one who graduated college at the height of the inflation back in 1980, when mortgage rates were in the teens and inflation wasn’t much lower, I get the concern about inflation.

That said, jobs were scarce indeed back then. So, compared to the early eighties, people are doing quite well, but IMO people are paying way too much attention to things like gas prices.

Gas accounts for just one out of every fifty dollars of personal spending…demonstrating once again that people are NOT rational.

The Russian War on Ukraine will likely drive some costs higher although we Americans are much less vulnerable than folks in Africa which rely on Ukrainian wheat and other grains.

Dr Schneipp does NOT expect inflation to persist, and noted that most key economic indicators are rising, consumer demand is strong, corporate profits are really high and business investment is surging.

The net…

We are not rational beings. The economy is doing quite well, you are probably doing pretty well (unless you can’t find child care), higher gas prices REALLY don’t affect you, and…you don’t live in Ukraine.

More to come tomorrow…


Mar
11

I told you so.

I cannot stand that statement…yet it is spot on. I’ve been posting on this for some time, often feeling like Cassandra.

Healthcare staffing shortages are fast approaching crisis levels, with major implications for each of us.

From ModernHealthcare:

As of last month, 27% reported critical shortages to the Health and Human Services Department…During crisis levels in the early phases of the pandemic, mortality rates spiked as hospitals rationed care. One-quarter of COVID-19 deaths between March and August 2020 were attributable to overstretched hospitals, according to the National Institutes of Health. Patients with the most serious non-coronavirus illnesses suffered under the same conditions. [emphasis added]

HHS recommended that providers use the Sequential Organ Failure Assessments score, which evaluates organ function to determine patients’ likelihood of mortality if they were to receive treatments or beds. Those most likely to die go untreated and often are diverted to palliative care.

Terminal burnout is the main driver. Nurses and hospital staff have been dealing with entitled, arrogant, mean-spirited patients many of whom are unvaccinated for more than two years.

One of the drivers is the archaic, hidebound, and wildly incompetent way we license nurses. Full disclosure – a future family member and nursing school graduate has been waiting three months for their nursing license paperwork to come through.

This at a time when nursing shortages are forcing hospitals to close entire departments and shutter entire floors.

It doesn’t have to be this way; the licensing compact adopted by 35 states and Guam allows some nurses licensed in one state to practice in others – with limitations.  Revamping the criteria and removing limitations would speed up the licensing process immeasurably.

But the licensing debacle is an effect, not a cause. The real cause is the unvaccinated who get COVID and spread and their enablers.

What does this mean for you?

Some people’s “freedoms” are killing others. 


Mar
9

Work comp’s moving to electronic payments…

When was the last time you wrote a check?

When was the last time you manually deposited a paycheck?

When was the last time you bought stamps?

The world is switching to electronic payments – they are wholly secure, incredibly cheap, and super efficient. Yet some work comp payers are still writing checks and mailing them to providers, while others that have begun the journey are still mailing thousands of checks and EOBs every week.

Given work comp’s top challenges – declining premiums and fewer dollars and fewer resources for administration, and the ease of adopting e-payments – makes zero sense.

Paying providers is one of those “have to get it right” things that suck up resources and staff time. The challenges are many –

  • ensuring the provider’s banking info is exactly right
  • fraud prevention
  • postal challenges
  • tying the EOB to the payment
  • producing and delivering 1099s
  • answering provider questions about payments

In group health and governmental programs, electronic payments are fast becoming mandatory.

Aetna, United Healthcare and other giant payers are mandating electronic payments for their providers…as work comp accounts for less than 1% of total US healthcare payments, payers that don’t/can’t pay electronically  will find their costs going up and provider relations suffering.

Join me next Friday March 18 for a webinar on electronic payments and work comp – free registration is here; California CLE and claims credits are available. Hosted by WorkCompCentral, Change Healthcare’s Bill Barbato and I will dive into:

  • how to evaluate the impact of e-payments on costs and margins,
  • what you should expect from your e-payment vendor;
  • how e-payments get implemented;
  • why providers want e-payments, and
  • how paying providers can generate revenue.

Change Healthcare – formerly Emdeon – is the industry leader in electronic payments…

What does this mean for you?

With declining premiums adding pressure to admin expenses, electronic payments are a must-do.

Change is an HSA consulting client.

 


Mar
4

The jobs boom

Gas prices are up, there are concerns about inflation, and some shortages continue – that’s the bad news.

The good news is the hiring boom that’s been going on for over a year shows no signs of abating, AND wage increases seem to have moderated a bit – which may be good news on the inflation front.

As a result, unemployment is down to 3.8% – a great number by any standard.

From the New York Times:

Job openings are near a record high. Layoffs are at a new low. And hiring has remained strong in the ebb and flow of successive waves of the pandemic — employers have added at least 400,000 jobs every month since May, the longest such streak on record. [emphasis added]

The economy is moving in the right direction; things are looking solid for a robust 2022 indeed.

What does this mean for you?

More workers = more health insurance and workers’ comp premium dollars.


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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