Insight, analysis & opinion from Joe Paduda


Long Covid’s impact on workers’ comp

Is the subject of a WCRI webinar at 2 pm eastern TODAY. No charge, but there’s a limit of 500 registrants.  Register here.

The webinar follows publication of WCRI’s Dr. Bogdan Savych’s study of Long COVID’s impact on workers’ comp (Study is free to WCRI members; non-members incur a fee).

A very brief summary from WCRI CEO Ramona Tanabe:

“Among all workers with COVID-19 claims, 6 percent received treatment for long COVID conditions, some more than a year after the initial infection. At an average of 18 months of post-infection experience, these workers received more than 20 weeks of temporary disability benefits and received about $29,000 in medical care.”

Note the relatively low medical cost…$29,000.

Other studies have examined Covid costs for patients covered by commercial health and Medicare Advantage. (note some are NOT Long Covid)

Long Covid – a study published in May of 2022 (note that was a while ago…) indicated the average annual medical costs of LC was $9,000.

CDC – costs average around $9,000 for care in the first 6 months after confirmed infection.

  • Using a large electronic administrative discharge database, Shrestha et al estimated a per-patient cost of $24,826 for inpatient care for adult patients with COVID-19.
  • Tsai et al examined claims data and found that the mean cost per outpatient visit of a Medicare beneficiary with a COVID-19–related diagnosis was $164.
  • Bartsch et al used simulation modeling and estimated median direct medical costs of a COVID-19 diagnosis ranging from $57 to $15,943, depending on the patient’s age and the severity of the case.
  • Another study found that COVID-19–related hospital costs per adult hospitalization varied from $8,400 in a general ward to more than $50,000 in an intensive care unit with a ventilator (7).

A useful synopsis of Long Covid issues, treatment, and symptoms is here.

What does this mean for you?

To date, Long Covid is not expensive. Regular readers would have anticipated this.


Not invented here

If we didn’t invent it, it didn’t need to be invented. 

That’s an expansion of the well-known “not invented here” meme, one far too common among workers’ comp insurers, TPAs, health plans and other large organizations.

We have all encountered this countless times…you can see it in the “Not Invented Here” bias visible in expressions of execs dismissing a new approach, front-line workers rolling their eyes during training, mid-level managers listing in great detail all the reasons this will never work.

I recall a session with the “business analytics” team from a very large workers’ comp insurer, set up by an exec that wanted to “get my ideas” on health care data analytics and the uses thereof…This quickly devolved into a litany of “yeah we already do that…yup tried that and it didn’t work…nope that will never work here…

Digging into a couple of these objections quickly revealed the dismissing party didn’t even try to understand the idea, how it would help them, why it was actually NOT something they’d done before.

Sure, this infects EVERY organization, but the infection is far less dangerous in those that value open discussion, seek contrary opinions, keep asking questions, and are open to learning from failure.

There’s a big push to get more young people involved in the industry.

Like many industries insurance is graying-out; unlike many, insurance is finding it hard indeed to attract the best and brightest. The “Not Invented Here” cancer is a major reason creative, innovative, bold thinkers quickly dismiss the idea of working in insurance, workers’ comp, and claims.

Not so for potential workers satisfied with doing the minimum, happy to parrot their bosses’ trite and obsolete views as they laze their way through the workweek.

The futility of this post is the organizations where NIH is most pervasive are those most blind to that infection.

What does this mean for you.

Asking painful questions is hard. It’s also key to survival.




Good news Friday…

Well, in an effort to counter the stupidity that has infected some in Washington, I’ll do my best to find glimmers of good news to start your weekend.


Ukraine is making solid if not spectacular progress in its offensive…and the news that we are sending very capable missiles may help our allies speed things up. The missiles – known as ATACMS – are very elusive and pack a big punch. These are NOT the long range ATACMS…at least not yet.

Grain, shipping, and avoiding world hunger

Resilient Africa headed south to deliver grain

Most notably, Ukraine has figured out how to win the war at sea – without having any ships. This has enabled Ukraine to ship grain to Africa and other places , a huge help for people at high risk of starvation. Seven ships have passed through Ukraine’s “grain corridor” despite Russian threats to sink any and all ships.

Aging…or not.

Big medicine is spending gazillions on research to help us live longer. While that’s kind of a good thing, reality is most of what kills (excluding firearms, traffic accidents, and drugs) us is due to:

  • not enough exercise
  • not enough sleep
  • too much food
  • too much alcohol

So, the “good news” is if you commit to exercising (cardio and strength), sleep, a healthy diet and one drink per day, you won’t need to buy whatever Big Medicine is selling.

And you can use those dollars to buy books, go to concerts, visit your grandkids, and donate to worthy charities!

Lastly, Crime.

News from the FBI that its efforts to combat violent crime is yielding dividends.  From the FBI…The FBI, alongside its state and local law enforcement partners, executed over 4,000 arrests, over 2,500 drug seizures, over 1,600 weapons seized, and the dismantlement of over 50 violent organizations.

remember that when some knucklehead politician says he’s going to eliminate the FBI..

(note three family members worked for the FBI (two were special agents), one died in the line of service, so, yeah, I’m “biased”)




Medical debt is crushing Americans

One out of three adults has medical debt. 

For many, this has a major impact on daily life…

Medical debt can be a huge obstacle, preventing families from buying a home, purchasing or leasing a vehicle, even paying for college for their kids.

That’s because credit bureaus include medical debt in their scoring algorithms. 

Looks like that will be changing…

From the Vice President:

The Consumer Financial Protection Bureau will propose a new rule to make clear that medical debt cannot impact the credit scores of the American people.  Once this rule is final, it will mean, one, that

consumer credit reports will not include medical debt and, two, that

creditors will not be able to use medical debt to determine a person’s eligibility for credit. 

Almost 2/3rds of those with medical debt had insurance when they began treatment...a quarter of those had their claims denied.

What does this mean for you?

Help is on the way.


A gubmint shutdown and you

Joni Mitchell’s Big Yellow Taxi provides today’s lede…and for good reason. The handful of elected House members on the verge of shutting down the entire government claim no one will notice when the Feds are furloughed.


Here’s a very brief list…

  • Most inspections of hazardous waste sites and drinking water and chemical facilities would stop.

  • CMS will furlough non-essential workers, potentially delaying MSA processing

  • OSHA will shut down all but critical operations
  • FEMA has begun rationing its money, pausing about $1.5 billion in longer-term recovery projects to ensure it has enough cash on hand in the event of a major, deadly crisis

  • Workplace safety inspections would be reduced or, if the shutdown persists, potentially stop

  • New applications for Social Security will be delayed, affecting some claim settlement negotiations
  • In past shutdowns the E-Verify system (for employers to verify work status/eligibility) wasn’t operating, likely limiting new hiring
  • Major infrastructure projects would stop
  • The Community Health Center Fund (CHFC), which sends federal funding to health centers – could be halted, among others…patients would have to seek care elsewhere, further increasing the burden on hospitals.
  • Enrollment in clinical trials would be delayed or postponed
  • Grants for new clinical research would halt
  • Funding for Federal courts runs out October 13 (although some may be able to continue operating)
  • 10,000 kids would lose access to HeadStart  – and thousands of others would also lose daycare, impacting parents’ ability to work.

sources here, here, and here.

What does this mean for you?

After you’ve burned the place down, where will you live?


Leaving Las Vegas

Quick takeaways from National Work Comp…

Don’t know what total attendance was, but seemed somewhat less than in pre-COVID years. Exhibit hall corridors were pretty empty despite sessions located around the exhibits.

Newest thing du jour – AI...sessions on AI, vendors promoting various applications, attendees mentioning AI in conversations about claims, data interpretation, claim intake, you name it.

Nurse triage – just…stop. Far too many are touting nurse triage – almost all without a clue as to what exactly this is, why they want to do it, what a “nurse” is, and how this will improve things. More on this in a future post, but for now:

  • define nurse – do you need an RN? APRN? LPN? nursing assistant?
  • what expertise/training/experience does this “nurse” need? orthopedics? emergency medicine? trauma? behavioral health?
  • okay, so a new RN is on the phone with a person…exactly what value does this add? Be specific.
  • more to come.

Events – by all reports myMatrixx’ get together was really well attended...I didn’t get to any others as they were past my east-coast bedtime. I do miss the myMatrixx transportation services from years past :( (mM is a consulting client)

There was a beach party outside my window that prevented a lot of us form getting to sleep before 11. Mandalay Bay staff was far less than helpful, told me this was on me as I should have checked the event calendar before booking my room (WTF!) and offered to send housekeeping up with a couple earplugs…I will NEVER stay there again.

Optum’s dog party was a big hit – great idea, really smart marketing, and good buzz generator.

Provocative session addressed anxiety, suicide and depression – more on that later. Sobering and much needed. Really respect the speakers for sharing their views and personal experiences. Yvonne Guibert – you are an inspiration.  

Booth staff – STOP pitching your stuff. JUST STOP. Until you have a decent sense for what the person in front of you needs, wants, is challenged by, don’t say anything other than a one-sentence line about the service/product your company delivers. 

have an excellent weekend.


Vegas starts…

The annual gathering of the work comp tribes begins today – I’m reprising a post from a couple years ago on lessons I’ve learned…

1.  Realize you can’t be everywhere and do everything. Prioritize.

2.  Leave time for last-minute meetings and the inevitable chance encounters with old friends and colleagues.

3.  Unless you have a photographic memory, use your smartphone to take voice notes from each meeting – right after you’re done – or write down key points immediately.  Otherwise they’ll all run together and you’ll never remember what you committed to.

4.  Introduce yourself to a dozen people you’ve never met.  This business is all about relationships and networking, and no better place to do that than this conference.

5.  Wear comfortable shoes, get your exercise in, and be professional and polished.  It’s a long three days, and you’re always ‘on’.

Finally, in these day of YouTube, phone cameras, Twitter, Instachat and SnapGram, what you do is public knowledge.  That slick dance move or intense conversation with a private equity exec just might re-appear – to your dismay.

And beware the white man’s overbite!!!


Yelling into the void

I attended a New England Journal of Medicine webinar on value-based care yesterday…net is I heard a lot about “patient centric” care, “patient experience” and quality but precious little about functionality and patient-specific or patient-desired “outcomes.”

Except for a few tangential mentions by the Optum Medical Director, what patients actually want was not addressed at all.

This is a big miss.

Like so many other failing industries, healthcare is completely missing the point – which is delivering what the consumer wants. “Patient experience” is mostly was the office clean, the nurse nice, the floor quiet.

We are ignoring this at our peril…we are not asking what patients actually want from healthcare; NOT the processes and functions noted by one of the panelists but how patients define “healthy”, what they want to be able to do, what functionality is important to them, how they want to live their lives.

Healthcare is provider and process centric;  the entire industry has failed to address what consumers and employers want from healthcare.

Here’s hoping that healthcare figures this out faster than Detroit did.

What does this mean for you?

Healthplans and healthcare providers that figure this out will kick butt.



Medical inflation in work comp…

Isn’t a problem. In most states. Today.

That is the headline takeaway from WCRI’s presentation last week…

First a few key factors.

  • Drug spend is a much lower percentage of total medical today than it was a decade ago. I’m quite confident total drug spend in WC today is 40% lower than it was 15 years ago.
    • That equals a reduction of about $2 billion.
  • Facility costs continue to be the main driver of what inflation there is. Inpatient (IP) and outpatient (OP) hospital inflation averaged 2.5% annually from 2012 to 2022;
  • Facilities account for 53% of total medical spend – 26% of which is OP; 9% is ASCs (Ambulatory Surgical Centers)

The details…

the best way to think about medical spend is per claim…this accounts for changes in claim volume (which is driven by injury rate and total employment).

Leaving out COVID’s impact (see end note for details) medical costs have barely budged for more than a decade…up a paltry 2 percent per year. 

However…Facility costs are a big problem for all payers…exacerbated by massive consolidation in health systems which allows them to charge “facility fees” for services rendered in physicians offices and clinics. (what a scam…)

Work comp specifically…

National averages don’t mean much if you operate in states like Florida or Wisconsin, where poor controls on workers comp medical billing enable providers to hoover dollars out of employers’ and taxpayers’ pocket.

Of note, drug costs would likely be several hundred million dollars lower if it weren’t for the profiteers enabling physician dispensing.

What does this mean for you?

All costs are local…which means all cost management approaches must be as well.

COVID…medical costs for claims during COVID were down 10% – decreases in utilization and price drove this with utilization the main driver. Not surprising…during COVID no one wanted to go to any healthcare facility for anything not essential.

This was totally predictable...


Good news Friday…Build America, Buy America

You may not have heard of the Build America, Buy America Act…here’s why it is good news indeed for US manufacturing and construction – and employment.

BABA lays out requirements for US content in federally funded infrastructure projects, requirements that specify how much Made in the USA content is needed to qualify for Federal funding.  

BABA impacts at a minimum,

  • the structures, facilities, and equipment for roads, highways, and bridges;
  • public transportation;
  • dams, ports, harbors, and other maritime facilities;
  • intercity passenger and freight railroads;
  • freight and intermodal facilities; airports;
  • water systems, including drinking water and wastewater systems;
  • electrical transmission facilities and systems;
  • utilities;
  • broadband infrastructure; and buildings and real property; and
  • structures, facilities, and equipment that generate, transport, and distribute energy including EV charging.

All iron and steel must be produced in the US…all manufactured products must have at least 55% minimum Made in the USA content, all construction materials must be “produced in the US” AND manufacturing processes must take place within the US.

per capita funding

Building trades welcomed the new guidance, with Nevada, West Virginia, Mississippi,  Louisiana, Wyoming and Tennessee among the states that will benefit  from new hiring and vastly improved: 

  • roads,
  • bridges, 
  • wildfire protection, 
  • electricity transmission, and
  • broadband.

Check out your state’s funding here.

What does this mean for you?

Better roads, schools, broadband; more good jobs; and more workers’ comp premiums and claims. 

Joe Paduda is the principal of Health Strategy Associates



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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