Insight, analysis & opinion from Joe Paduda

< Back to Home


Quick News Briefs for work comp folks

First up, another round of applause for the good folks at the Accident Fund  – their use of predictive analytics combined with medical management expertise to identify and intervene in workers comp claims with potentially inappropriate opioid usage was one of the top ten innovations in the entire insurance industry – group, life, property casualty, and reinsurance. (Accident Fund is an HSA consulting client).  Kudos to Jeffrey Austin White, Pat Walsh, Paul Kauffman, and their colleagues and co-workers.  This is EXACTLY the kind of project work comp carriers should – and can – be doing to attack this issue.

A reviewer for Best’s Review put it this way:

“the idea of using predictive analytics informed by medical subject matter experts with workers compensation claims management software in order to identify – and pro-actively facilitate early intervention when appropriate – cases where injured workers might be reliant on opioids…strikes me as particularly innovative…”

In a related bit of news, makers of so-called “tamper-resistant” opioids are losing a battle to prevent generic versions from hitting the market – this means workers’ comp payers’ drug costs will be lower as they won’t have to pay the premium price charged for branded drugs.  While manufacturers Endo and Purdue claim their new formulations are primarily designed to increase patient safety, the timing of their introduction – just as their current brand drugs’ patent protection expires – indicates profits may be the primary motive…

A great summary of the components of the fiscal cliff deal was put together by the National Priorities project.  In chart form, it tells what happened, what it means, and what’s next.  Read it during lunch…

One of the key components of the deal was the extension of current Medicare reimbursement for physicians.  Under SGR, reimbursement was slated to drop 26.5%, however the deal extends current rates for the rest of the year.  As most WC doc fee schedules are tied indirectly to Medicare, in some states this has a direct impact on WC; in all it as an indirect impact as a cut in reimbursement would likely have led to even more cost shifting to comp…

Of note, there are several deals still working in the comp services/managed care arena.  Now that the cliff deal is done, and the deadline for changes in the capital gains rate has passed, we’ll likely see a bit of a slowdown in transactions.  However, even though the capital gains rate is increasing from 15 to 20 percent, there will still be a lot of transactions in 2014, albeit not at the feverish pace we saw at the end of last year.

Finally, with Michigan and Illinois joining the increasing number of states restricting upcharging for repackaged drugs dispensed by physicians, some payers are starting to see price increases for repackaged drugs in Florida, Maryland, and other states where the sky’s the limit.

Tomorrow, predictions for 2013.  Hoping to do better than 65%…

4 thoughts on “Quick News Briefs for work comp folks”

  1. Joe:

    65% right on your predictions isn’t bad when compared with the approval rating of Congress…and they keep getting re-elected!


Comments are closed.

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.



© Joe Paduda 2023. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.