Month: September 2017

Sep
7

Thursday catch-up

Posted by Joe Paduda on Thursday, September 7th, 2017 | Comments

Genex acquires Prium…

Good move by Genex, as Prium’s portfolio of services including physician review and pharmacy management ties in well to Genex’ current offerings. I’m a big fan of Prium CEO Michael Gavin – he’s one of the most thoughtful, intelligent, and measured people in our business…good news is he’s sticking around.

Kentucky’s making big progress on opioids

Thanks to WCRI’s Vennela Thumula PharmD for her study on how new legislation (HB-1) helped to reduce the number of new work comp patients receiving opioids.

The legislation required prescribers to check the Prescription Drug Monitoring database prior to prescribing opioids, limited opioid prescriptions, and implemented mandatory educational and patient treatment practices.

Key Takeaways

HB-1 immediately reduced opioids prescribed to patients in the first 12 months after the date of injury.

Both the percentage of patients receiving opioids and the amount of opioids decreased by more than 15 percentage points.

Major surgical patients weren’t significantly affected by HB-1; not much change in prescribing to these folks.

Patients with back sprains and similar diagnoses had far fewer opioid scripts.

Thanks to Andrew Kenneally, Communications Director of WCRI, for the head’s up…

Opioid marketing practices

Kudos to Sen Claire McCaskill, D MO, for publicizing opioid manufacturer Insys’ alleged efforts to get approval for fentanyl product Subsys through misrepresentation. McCaskill’s report included an:

audio recording of conversations between an Insys employee and pharmacy benefit manager representatives related to a Subsys prescription for Sarah Fuller, who later died from an alleged fentanyl overdose. This recording suggests the Insys employee in question repeatedly misled Envision Pharmaceutical Services to obtain approval for Ms. Fuller’s Subsys treatment—heavily implying she was employed by the prescribing physician and misrepresenting the type of pain the patient was experiencing.

Sarah Fuller

This follows other reports of Subsys’ unethical and potentially illegal marketing practices, where other Subsys reps said they called payers, saying they were from doctors’ offices and were seeking approval for the drug.

Hell is too cold for these people. 

Finally, a very revealing piece in HealthAffairs provides more insight into just how powerful big healthplans are:

insurers with market shares of 15 percent or more (average: 24.5 percent)…negotiated prices for office visits that were 21 percent lower than prices negotiated by insurers with shares of less than 5 percent.

Differences in providers’ and insurers’ bargaining power are a major contributor to variation in commercial health care prices

Workers’ comp folks – you’re lucky if a generalist work comp PPO’s market share at a practice is 3 percent…

Back out onto the campaign trail!

Sep
5

Big changes a-coming in workers’ comp.

Posted by Joe Paduda on Tuesday, September 5th, 2017 | Comments

Here’s what I see coming.

Quick take – what happens this fall and winter will bump up premiums, injury rates and claims costs.  

Insurers will see rising premiums, claims service entities more work, and some insurers and re-insurers’ bottom lines will be hit hard.

Companies focused on servicing work comp patients in Texas and Florida are going to be very busy.

Hurricanes are the “why”

Harvey, Irma, and as-yet-unnamed storms are likely to make this the worst of all hurricane seasons – and we’re nowhere close to the end of the season.

Harvey alone may cost close to $200 billion. With Irma – now a Category 5 hurricane with winds over 175 miles per hour – storm tracks favoring a Florida landfall, we could be looking at a second blockbuster bill. (note cost projections are all over the map

There are huge implications for the workforce – starting with public safety workers, moving to clean-up crews and workers making emergency repairs. Then comes re-building: residential, public, commercial, and industrial construction, plus repairs to infrastructure.

Remediation will follow and take years. The huge petro-chemical operations around Houston mean waterways and land will be seriously polluted.

And, hopefully, big changes to storm and climate change mitigation planning, which will require major investments as well will mean billions in spending and lots of work for construction workers

Roads, water and sewage systems, rail, power generation and transmission, pipelines, ports and terminals, communications infrastructure all were hammered by Harvey and Irma may be just as brutal.

Implications.

Higher payrolls – Hundreds of thousands of workers will be needed today, next month, and for years to come. They will be working in high-frequency, high-severity jobs, and many may be poorly trained and supervised. And good, experienced workers will be costly due to supply-and-demand.

It’s highly likely tens of thousands will be undocumented; our governmental leaders will have to decide whether they are going to strictly enforce immigration laws or turn a blind eye. 

Labor fraud – I’m betting a large percentage of clean-up and construction workers will be undocumented, which means a likely explosion in labor fraud. Unscrupulous employers will bid on clean-up work, knowing they can screw immigrants out of pay and those workers have no recourse.

Higher injury rates – inexperienced workers putting in massive hours in dangerous places doing dangerous work = lots of bad injuries, plus exposure to nasty chemicals and pollutants.

What does this mean for you?

We’re about to see the most significant change in workers’ comp in decades.

Sep
1

Labor Day Special Edition

Posted by Joe Paduda on Friday, September 1st, 2017 | Comments

Happy Labor Day Weekend readers!

Make sure to thank the folks who work hard every day to make our lives better – teachers and support staff, building trades, healthcare workers, factory folks, agriculture and food workers, public safety, transportation, public works, and everyone else we often take for granted.

Here are a few articles of interest…worth thinking about as you watch parades, cook up your masterpiece on the grill, and enjoy the opening of the College Football season.

What’s been top-of-mind for me is how we’ve commoditized our workers, thinking of them as “expense” instead of an “asset”.  One of the most reprehensible anti-Semitic, racist, nasty people in business – Henry Ford – recognized employers need to pay their workers enough to buy the goods they make. Somehow we’ve forgotten this, along with the truth that workers are people, have intrinsic value, and deserve to be treated as such.

The best employers I know think of their workers as assets, not expenses. They know that when people feel valued and respected, those people do amazing work.

Here in upstate New York, one of the best employers I’ve ever come across is Tessy Plastics, a privately held company with about 900 workers that makes everything from those tiny plastic thingies that close ziplock baggies to surgical stapling devices used in gall bladder surgery.

Facing the loss of their largest customer fifteen years ago, Tessy relied on its workers to bounce back and become an amazingly successful company. I know a lot of Tessy employees, and they love what they do, work incredibly hard and smart, and as a result Tessy is doing very, very well.

We all can learn a lot from Tessy.

On the other hand, there’s a lot of worker risk and abuse out there.  First up, a reminder of how some workers are mistreated, abused, and oppressed by scummy bosses.  Thanks to workerscompensation.com for the heads’ up.

Law enforcement officials in New Jersey busted a company that was allegedly taking advantage of undocumented workers, cheating them and their clients in multiple ways, including money-laundering.

The explosion in the Arkema chemical plant outside Houston is another reminder of the risks faced by workers, risks that almost always are ignored by all of us until something catastrophic happens. Fortunately none of the 60 workers were at the plant when the storage trailers started exploding, but public safety workers were.

For those looking to help out with donations, the Greater Houston Community Foundation is one site that’s been thoroughly vetted.

Have a great weekend!