Insight, analysis & opinion from Joe Paduda

< Back to Home


What to check out at the Work Comp Conference

For those attending the National Work Comp and Disability Conference in Las Vegas next week, here are a few things you may want to check out.

Following up on last week’s webinar reporting the results of our Survey on Opioid Management in Work Comp, I’ll be discussing the report and answering questions at CID Management’s booth.  It’s an invite thing, so click here to get signed up.

Wednesday at 5:30 good friend and colleague Peter Rousmaniere will be discussing his new book, Work Safe: An Employer’s Guide to Safety and Health in a Diversified Workforce.  The event will be held in the Mandalay Bay Hotel; stop by either the Concentra or Broadspire booth to get details.

MedRisk (consulting client) will have their magician on hand; if you haven’t seen him do his stuff, it’s a must-see.

I’ll be at Millennium Labs’ booth (1245) Wednesday at 10 and 4, stop by to catch up on the latest in drug testing, new illicit substances making the rounds, and creative things folks are doing to try and fool the testers.

The AMA – American Medical Association is there.  You may want to ask them what their position on physician dispensing for profit is; I and others (thank you, American Insurance Association!) have been trying to get them to get real about this for years…their policy statement says it’s a no-no, but their lobbyists seem to support it.

Alkermes is the company that manufactures Vivatrol; the injectable intended to address opioid addiction.  I’ve heard some payers are considering the medication as part of a comprehensive treatment program – may be worth checking them out.

There are a ship-load of medical device companies on the floor, most with products intended for spinal surgical implants.  There are also a few companies offering solutions to the implant problem. You may want to visit one of the suppliers, then hop on over to a cost containment firm to compare and contrast… 

Gensco Labs – these are the wonderful purveyors of SpeedGel(r), that amazing concoction guaranteed to speed recovery, reduce pain, maybe even grow hair on turtles, and all for a price just ten times more than it’s almost-identical off-the-shelf competitor; Ben-Gay.

Ask them: How exactly is your stuff different and better than Ben-Gay? Show me the research!

Alas, Automated Healthcare Solutions (the folks who sued me for defamation in federal court, only to have the case thrown out), is not exhibiting; located in the same Florida ‘hood as Gensco, and sharing at least one corporate exec, perhaps they don’t want to steal the limelight…

I’m going to try and report from the conference, but with few minutes to breathe it will be difficult – at best.

Pleasant travels, and remember – what happens in Vegas, gets recorded on smartphones.

6 thoughts on “What to check out at the Work Comp Conference”

  1. I don’t understand how you can call out others like the AMA and the company that owns York TPA for physician dispensing and not call out your own client, Stone River/Progressive PBM, for doing the same thing. Seems a bit self-serving.

    I am happy to show you evidence of tens of millions of dollars in paid transactions to Stone River where the medications were dispensed in a physician’s office with a repackaged NDC as well. Let me know when and where, so long as you agree to come clean with your readers after you see the proof.

    After Presciption Partners, which is Automated Healthcare Solutions billing arm, Stone River is the second biggest physician dispensing faciliator in the country.

    1. Joe – thanks for the comment.

      Couple responses.

      First, you state that Progressive is a client. It is not and has never been. Your assumption is incorrect.

      Second, Progressive, and other PBMs for that matter, do have contracts with dispensing companies and billers. They have to in order to meet their payer customers’ requirements.

      Hope that clarifies things.

  2. Last I checked, this morning actually, Progressive is a member of CompPharma. Unless I am mistaken, and I might be, members of this group pay membership fees to the CompPharma principals, of which you are one. Thus, members of this group, including Progressive/Stone River, pay you, so you are the principal and they are your client.

    Progressive/Stone River is in exactly the same business as AHCS/Prescription Partners – Stone River has direct contracts with physician practice groups, similar to how they operate with retail pharmacies, whereby Stone River reimburses the physician group for the transaction, accepting the risk and billing for that same transaction under the Stone River TIN. I will be happy to show you plenty of examples of Stone River bills and the cover sheet they use when billing for these transactions. Will you post the evidence on this blog so others can see and make up their own minds?

    Also, the practice of PBMs contracting with physican dispensing firms may be expedient as they capture retrospective discounts and transactions, although I don’t think it is right. This practice promotes what you would agree is bad behavior, and the contract itself protects and enables those who profit from this bad behavior.

    1. Joe – Progressive/PMSI is not a “client”. They are a member of CompPharma, which is a consortium of WC PBMs. Other members include Healthcare Solutions, ESI, Catamaran, myMatrixx, HealtheSystems. I and my partner facilitate, coordinate, implement, and attempt to provide some direction. This is not a client:consultant relationship but more of a trade group.

      I do not nor have I consulted with Progressive. I have done work in the past for many other PBMs, but not for Progressive.

      The Stone River function you are describing is the traditional “third party biller” function, which Stone River and its predecessors have been involved in since that business’ inception. In point of fact, SR’s third party billing business has been declining over the last few years, which is intentional as they have moved to more of a PBM business model.

      I’m not surprised that they are handling bills for doctors; that’s core to their business practice and something they have been doing for years.

      However, unlike Prescription Partners and other companies, there is a MAJOR difference; SR does NOT sell them the drugs directly or thru an affiliated or sister company.

      I’ve been quite public about my disgust with the practice of physician dispensing in fact I’ll be speaking about this again on Thursday at NWCDC.

      I see SR’s role as fundamentally different from those other firms. I thank you for your interest in ending physician dispensing; the world will be a better place when it is outlawed.

  3. Call it what you want, but vendors who pay to belong to a trade group to which you are a principal are clients. If you want to put the “members” of your trade group in one bucket and your consulting clients in another, that’s your business, but since they all pay you, you have a duty to disclose these relationships.

    Nice try, but nearly all of the vendors that operate in the physician dispensing space, including AHCS/Prescription Partners, operate exactly the same way as Stone River. A review of the websites and a basic understanding of the workflow is all that is required to validate my point. I thought you were an expert here?

    In this model, which drives about 85% of the physician dispensed bills, the physician practice does NOT purchase and re-sell the drugs. Instead, the physicians dispense the drugs under their license and practice act, the vendor pays the physician in some fashion after the drugs are dispensed, and all of the billing to the payer and risk is managed by the vendor. Bottomline, ClaimOne, Prescription Partners, Stone River, and the others all bill under their own billing numbers and operate the same model.

    Very few physician dispensing vendors sell the drugs direct to the physician practices. When they do, the physicians include the drug charges as a line/s on the physician’s bill and bill under the physician’s billing number. Seems most physicians prefer the guaranteed reimbursement model from Stone River and Prescription Partners as that’s the dominant model in this space.

    I am happy to educate you and your members on exactly how this all works. I can show bills from vendors like Prescription Partners, Bottomline, and Stone River and compare them to the bills with drug lines billed direct from the physicians. Will this help?

    1. Joe – again, thanks for the comment. A couple points.

      1. Do not tell me what I should do on my blog. I have no need for advice from you on this topic. I disclose who my clients are, there is a list on my website, and I do not need you to tell me what my duty is.

      2. Second, what Stone River does or does not do is irrelevant to my position on dispensing. You may want to call them out; that’s your prerogative. Create your own blog, shout it from the hilltops, whatever. You may not use my blog to further those efforts unless you do so in a respectful and appropriate way.

      3. I do not need a lesson from you on the practice of dispensing. Since 2006 I’ve been heavily involved in educating the industry about and directly attacking dispensing. I am very aware of the business models and operations of players in this business, “education” from you is not needed nor necessary.

      4. Finally, at the risk of appearing self-righteous, I’ve been more active, more public, and done more to end this practice than any other individual in this business. I’ve been harassed, sued, and lost business because of this stance. I’ve spent hundreds of hours educating payers, regulators, legislators about this issue, and will spend hundreds more – and I get NOTHING for this. I find your comments patronizing, ill-informed, and inappropriate.

      This conversation is over.

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 2024. 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.