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Friday catch-up

It’s been a bit busy this week; helping my sister take care of our mom in Maine.  Mom is 96 and ready to move on. She’s had an amazing life; grew up during the Great Depression, master’s degree at 21, ran the FBI’s fingerprint lab during WWII and worked for the CIA overseas in the fifties. Tiny, tough, and very, very smart.

Here’s what’s been happening this week…

Thoughtful post from Richard Krasner on medical cost drivers in workers’ comp. Richard’s dug into the recent NCCI analysis of medical cost categories; his take is inpatient hospital costs are a primary driver.

That makes sense for several reasons.

  • health systems are rapidly consolidating the healthcare provider industry, so more providers bill using facility codes every month.
  • health systems know work comp is a very profitable line; at a time when governmental payers are reducing reimbursement, their financial analysts are digging under every bed to find dollars.
  • health systems are very good at reimbursement – they’ve got more people, more systems, more resources and use them very effectively.

Which makes WCRI’s upcoming webinar on provider choice all the more important.

Following their study on the issue, the fine folk from Cambridge Mass. will walk us through what actually happens when employers or employees control the choice of provider. There’s a good bit of nuance here; it isn’t black and white.

HealthNewsReview has a great piece on a very questionable “research study” published by Proove Biosciences. Proove has been hyper-aggressively pursuing workers’ comp business; I’ll let HNR give you their view of Proove’s press release about a “study”:

[the] release summarizes a study showing that the company’s algorithm, which combines genetic markers with lifestyle and behavior variables, accurately distinguishes between healthy patients with no history of opioid abuse and patients receiving opioid addiction treatment. The study, however, may be comparing people with opioid use disorder with the wrong control group, given that a more useful distinction would be between those who have become addicted and those who have used opioids in similar circumstances without becoming addicted. In addition, the news release fails to provide information about the study’s funding source, nor does it note that four of the study’s six authors work for Proove. [emphasis added]

HNR goes on to state: this tool and others like it have been criticized for both reliability and questionable marketing practices.

Intriguing data on Medicaid patient access and satisfaction, from Axios

While you are spending time with friends and family this weekend, enjoying the extra day off and remembering those who made this possible, you may want to consider how fortunate we are.

Tom Lynch penned a piece in WorkersCompInsider about a Massachusetts worker who broke his leg in a construction accident. The guy fell off a ladder, but his employer didn’t carry work comp insurance. Did the boss get in trouble? No – but he did turn the worker into Immigration and Customs Enforcement, who threw him in jail. The victim in this has a wife and three young kids and, as you can imagine, is terrified.

So are his kids.

Have a great weekend.

14 thoughts on “Friday catch-up”

  1. Love your blog on WC but would love to hear more about your mom’s life..sounds like a pioneer in many ways…

    1. Thanks Lisa – much appreciated. Her master’s thesis was on the role of women in the California Gold Rush; her “boss” at the FBI’s fingerprint lab was a man with no HS diploma; mom ran the place even though she was his “secretary”. Traveled all over the world, raised us in Cyprus, Thailand, northern Japan, Germany, England, Okinawa. Had to leave the CIA when she and Dad married; women couldn’t be married and work back then!

      1. Another example of Hidden Figures. She sounds like someone I would have liked to have met.

  2. Wow, Bless your Mom and her Spirit. She is an amazing Woman and must be really proud of her children!

  3. Joe,

    THANK YOU!!!

    Four and a half years since I began my blog, and this is the first time you have linked back to one of my posts, especially since I have done the same for you many times over. From the bottom of my heart, thank you.

    Now, as to your mom. She sounds like a remarkable woman, a woman of accomplishment (after all, she had to put up with that Hoover guy), and worked for the CIA. No wonder you know so much and get all kinds of information. You take after your mom as an analyst and investigator of truth about insurance, healthcare, and workers’ comp.

  4. Joe, how I love your posts; this one in particular. How amazing your mother sounds. Now I know where you get your respect for strong women. Thank you for sharing a little bit of her with us! My thoughts are with you and your family.

  5. Thanks for sharing your moms story with us. Enjoy your remaining time with your mother.

    As always, an interesting post about healthcare cost drivers

  6. Wow! Thank you for sharing the memories of your mom. What a great lady! Thoughts and prayers to you and the family.

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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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