At the closing session at NCCI, Barry Lipton reported on their research on MSAs, research based in large part on 2200 files provided by Gould & Lamb. In 2011, CMS approved $1.1 billion of MSAs…
- MSA dollars account for 40% of the average proposed settlement
- half of the MSA dollars are for prescription drugs
- “the differences between proposed and CMS-accepted MSA settlement are largely due to drugs”
- only 20% of submissions are for claimants <50
- 29% of submissions are for more than $300,000;
- but, most submissions are for much lower amounts;
- so 62% of costs are for the 29% that are for more than $200k.
- The highest initial submission approval rate was about t50% before 12/12; during 12/12, the approval rate zoomed up to 92%. this happened to be the same month where processing vendors changed…
- median processing time has dropped dramatically to 41 days in Q4 2013
- Median MSA approved amounts have been very stable at around $42,000 over the last four years.
- recall CMS doesn’t cover off-label use of drugs, so any non-cancer claims with opioids are going to require full funding of future projected spend
The net – from my perspective, if you have an addicted claimant, CMS is going to want a lot of dollars set aside.