Things you may have missed…

The recession…or lack thereof.

News this morning that our economy grew at 2.4%…further encouraging news as it appears we are heading for a soft landing (ie very limited or no recession).

Also, personal income growth grew nicely at 2.5%…

From NYT:

“If you’re looking for a working definition of ‘resilient,’ look no further than the American economy,” said Joseph Brusuelas, chief economist at RSM. “This is absolutely rock-solid.”

Good info on the impact of the soft landing from HBR here.

What does this mean?

A good economy = more good-paying jobs and better lives for many.

From the desk of GB’s Dr Gary Anderberg comes an excellent summary of global warming’s impact on specific jobs.  Gary is excerpting from a KFF research report published in January

“highlights” include:

  • We estimate there are over 65 million nonelderly adult workers in occupations at increased risk for climate-related health risks, accounting for over four in ten of nonelderly workers.
  • Among nonelderly adult workers, many people of color, noncitizen immigrants, and workers with lower educational attainment and income levels are disproportionately likely to be employed in jobs with increased climate-related risks.
  • Nonelderly workers in at-risk occupations are about twice as likely as their counterparts in less at-risk occupations to lack health insurance (16% vs. 7%)

And the temps just keep on rising...this summer will break all records for heat, deaths from heat, heat-related injuries…

and it’s only going to get worse.

What does this mean?

This global warming thing has real consequences – as in higher occupational injuries and illnesses.

Last – and most awful, “the greatest country in the world” – at least when comparing American kids dying by gunshot to other industrialized nations

from KFF

What does this mean for you?

More of us know of more families devastated by gun violence. 


2023 predictions for workers’ comp – how am I doing? part 2

Loyal readers know I hold myself accountable…if I call out others, I need to do the same for my own errors and misjudgments.

also – I dumped my Twitter account and moved to Threads – joe_paduda is the handle.

so here’s the second half of my predictions for work comp in 2023 (first 5 are here)

6. The growing impact of global warming will force changes in risk assessment, management and mitigation; technology adoption; and claims.
The predicted (heat injuries, wildfires, hurricane intensity, sea level rise) and unforeseen (atmospheric river-driven flooding, landslides, and destruction and others) changes in climate and weather will lead to more and different injuries and illnesses, higher risks for fire fighters and public safety workers, and unpredictable problems related to polluted storm water runoff, water-borne disease and perhaps invasive species.
Yup. See reports of heat-related injuries in Texas, including this tragedy that led to a lawsuit. Much more to come…(he said with no joy)

And an excellent analysis by the brainiacs at Milliman...

credit the Guardian

7. Payers and perhaps regulators will make significant efforts to address rising facility costs.
As for-profit healthcare systems look to pad record profits and not-for-profits seek to survive, payers will be looking for better cost control answers than simply doing more of the same stuff they’ve been doing for the last two decades. Network discounts (NOT THE SAME AS SAVINGS) are declining as facilities wise up to most payers’ lackadaisical/ineffective attempts at employee direction and unsophisticated contracting strategies.
Smarter payers will deploy multiple payment integrity layers  – both pre- and post-payment. All should demand more – much more – from their bill review vendors/technology suppliers, all of whom have long refused to entertain the thought that they could do better – much better.

Inconclusive…some evidence but not anything indicating a trend…

8. Premiums will increase – mostly late in the year.
As infrastructure, green energy, re-shoring of chip manufacturing and EV incentives ramp up in the fall so will employment. While there’s disagreement among economists (yeah, who woulda thought??) expect big hiring in categories from archeologists and bridge builders to wireless broadband construction workers.  Manufacturing, heavy construction, trades, logistics will all be hiring…as these tend to be higher frequency (more claims than average) and higher severity (claims are more severe and costly) this means higher premiums and more claims.

Good news indeed for my friends in Cincinnati!

Too early to tell.

Oh, and mark me down for one who does not see a significant recession in our near future.  I know, I’m no economist (who disagree a lot about this) but hiring is too strong, these major investments are on the horizon, and inflation is coming under control  – all indications that a “soft landing” is more likely than not.

Somewhat inconclusive, although more economists are following my lead (ouch! sprained my elbow patting myself on the back!)

9. SB1127 – aka the CAFE Act (California Attorney Full Employment Act) will cause heartburn and consternation among Golden State employers and tax payers.
SB1127 shortens the time period for employers to determine the compensability of claims, a change which will lead to – among other problems – more initial denials and less time for injured workers to receive medical care while their employer researches the claim. Further, AB1127 appears to allow for penalties of up to $50,000 for claims that are “unreasonably rejected” by the employer – but the bill a) doesn’t define what constitutes an “unreasonable rejection” and b) doesn’t exclude claims that are already closed.

Expect attorneys to look for the Golden Ticket case – one that they think will establish precedence – and pursue it like a starving person at a Vegas buffet (or Cafe’).

Too early to tell

There’s good news too…I don’t see much else on the regulatory horizon that is cause for concern.

10. More consolidation among payers and service providers.

Yup. Enlyte bought Anthems workers’ comp network, accuro Solutions acquired Spashlight, Bardavon is looking for someone to buy them before it’s too late, and there are at least two other “processes” in process. 


VERY excited to announce a new ManagedCareMatters feature!

This incredibly prestigious award is strictly limited to one per month…so the competition amongst state legislators and regulators is BRUTAL.

So many aspire to the prestige and national recognition that the D/LRM brings that hundreds tirelessly beaver away, busting their humps to outdo the knuckleheads across the State Line, steam coming out their ears as they scribble away at the whiteboard, even calling on ChatGPT when their abundant natural intelligence doesn’t meet the mark.

This month it goes to…


Congratulations to the Great Potato State! As of July 1, Idaho became the only state without a specialized committee to review deaths related to pregnancy!!

The [now-defunct] Maternal Mortality Review Committee, or MMRC was composed of a family medicine physician, an OB-GYN, a midwife, a coroner, and a social worker – and others. Data collected and analyzed by MMRCs is used to:

more fully understand the circumstances surrounding each death, determine whether the death was pregnancy-related, and develop recommendations for action to prevent similar deaths in the future…

(sounds kinda Pro-Life to me, but hey! whadda I know?)

The legislators who decided to sunset the committee weren’t available for comment, although one has to respect their bold, Pro-Life commitment to not helping figure out why moms are dying!

It’s even gutsier when one considers that two Idaho hospitals just announced they will no longer provider maternity care, AND OB/GYNS are leaving Idaho, AND the state has among the most restrictive anti-abortion laws in the country…(state law prohibited termination of ectopic pregnancies, which are never viable and can be fatal if not treated. This specific prohibition of this Pro-Life Legislation was later overturned by the State Supreme Court).

Despite Idaho’s pregnancy-related mortality ratio of 41.8 pregnancy-related deaths per 100,000 live births in 2020, a third higher than the nation’s (already very high) maternity mortality rate, legislators determined the Committee’s $15,000 annual cost was far, far too much to spend…even though it was entirely funded by a Federal Grant.

The de-funding/killing off of the Committee by Idaho’s Pro-Life Legislature to save Idaho taxpayers…nothing! sets a VERY high bar for other legislators…kudos to the Idaho Legislature for their undying commitment to…dying.

Footnote – 75 of 117 Idaho OB-GYNs recently surveyed by the Idaho Coalition for Safe Reproductive Health Care said they were considering leaving the state. Of those, nearly 100% — 73 of 75 — cited Idaho’s restrictive abortion laws.

The inaugural award sets a high bar indeed…

What does this mean for you?

Get to it you aspiring DL/RM recipients!


Research on wearable tech – it’s the data too!

Two recently-published peer-reviewed studies give more insight into the utility and effectiveness of wearables/digital health.

Key takeaway – digital health will affect care management and patient recovery in ways we are just beginning to grasp. 

One study examined 864 patients’ use of Plethy’s Recupe program.

Top takeaway – The better a patient’s mood, the lower their pain level and the more they comply with their exercise programs. While correlation is not causation, the connection between mood and recovery is clear.

While this may be obvious, the real takeaway is wearable technology can be an early-warning system, giving care givers and other stakeholders (i.e. claims adjusters, care managers) real-time insight into their patients’ mood and pain level.

Instead of waiting for the practitioner’s notes, reading and interpreting those notes, and (hopefully) determining the patient’s mood and pain level, wearable tech can alert care givers and case managers to potential recovery-delaying issues and intervene before problems become entrenched.

Digital health – specifically a wearable sensor plus Recupe app – is also associated with strong adherence to a home exercise program, significant decreases in pain and improvements in range of motion. This descriptive study looked at total knee arthroplasty patients, finding “Recupe patients recovered to lower pain levels with fewer patient visits and health care utilization [than reported by other published information].”

What does this mean for you?

Taken together, these studies show digital health’s effects are broad indeed…the instant access to key data points can help stakeholders quickly respond to patients’ needs and issues.

note – Plethy is an HSA consulting client.




2023 predictions for workers’ comp – how am I doing?

Time to check in and see how well/poorly my predictions for 2023 are panning out…

  1.  The soft market continues…
    And it won’t harden in 2023. Medical costs remain very much under control (with  an exception), rates continue to drop, employment remains very strong (essential for return-to-work) and there’s lots of payers fighting for market share.
    So far so good…this is a done deal.
  2. Medical spend is NOT a problem – and will NOT be in 2023.
    With a couple notable exceptions – to be covered in a future post – medical inflation will remain under control. In part this is driven by much lower drug spend and more specifically the continued decline in opioid spend. The latter has a big impact on claim closure and total medical spend.
    Yep. Done deal #2
  3. Behavioral health and its various iterations will gain a lot of traction.
    More State Funds, carriers and TPAs will adopt BH programs, more patients will benefit, and more dollars will be spent. There’s a growing recognition that medical issues aren’t hindering “recovery” near as much as psycho-social ones. This is great/wonderful/long-needed and will really benefit patients and payers alike. Kudos to early adopters, and LETS GO to you laggards!
    No conclusive evidence one way or the other…
  4. One Call will be sold. 
    I keep forecasting this…and one day I’ll be right.  It has to be this year. CEO Jay Krueger and colleagues have OCCM on a better track, but structural problems (i.e. declining claim volume) and internalization of One Call-type services by Sedgwick and others make the future…less than promising. Couple that with recent ratings actions by Moody’s and S&P and it’s time to do the deal.
    Not yet…but increasingly likely.
  5. New technology will make its impact felt.
    Wearables, chatbots (I HATE THEM), and Virtual Reality-driven care are three ways tech platforms/systems/things will significantly ramp up in ’23. Expect several large/mid-tier payers to adopt new tech in a major way – aka not just a small pilot.
    Structural issues with health care (try to find a LCSW or Psych-trained counselor), lack of trained adjusters, and frustration with rising rehab expenses are all contributors.
    Ramping up is happening…albeit from a pretty low starting point.  Expect more to come in coming months

Monday – the rest of 2023 projections…


Hospital misdiagnoses harm or kill 800,000 Americans a year

A just-published research study found:

Annually almost 800 000 Americans are permanently disabled or die annually due to misdiagnoses.

That is equivalent of a fully loaded (318 passengers) 787 crashing with about a 50/50 split between deaths and serious injuries every three and one half hours every day (24/7) for an entire year.

At that rate, how many tickets do you think the airlines would sell? So why does Big Med get away with it? (thanks to a very insightful reader for this analogy)

And this was based on a study of hospital discharges BEFORE COVID and its attendant staffing crises.

The study in the British Medical Journal comes on the heels of an HHS analysis of diagnostic errors in Emergency Departments that estimated:

  • 7.4 million misdiagnosis errors are made every year,
  • 2.6 million people receive a harm that could have been prevented,
  • another 370,000 are permanently disabled or die because of the misdiagnosis…
  • This equates to about 1,400 diagnostic errors every year per emergency room across the country.

In general diagnostic accuracy is pretty good; 1 in 18 patients are inaccurately diagnosed (5.7%).

What’s pretty scary is the diagnosis error rate across hospitals varies “up to 100-fold.”

Notably fractures were among the most commonly misdiagnosed conditions…(p 18)

HHS’ full report is here.

What does this mean for you?

Be your own healthcare advocate and don’t be afraid of questioning physicians.


The cost of heat

While ignoramuses continue to deny we humans are changing the planet’s climate, folks with P&L responsibilities are calculating the cost of heat and heat-related injuries.

The direct cost of one “heat prostration” claim is about $38,000.

The average company has to generate $1.2 million in revenue to cover each heat prostration claim.

Want specifics?

Excessive heat also creates more injuries of all types…injuries to cherry harvesters in Washington State increase 1.5% for every 1 degree C above 25 C (77 degrees F) – mostly from falling off ladders.

California data shows:

    • compared to days with temps in the 60s,
      • on days when the temperature was between 85 – 90 degrees Fahrenheit…the overall risk of ALL types of workplace injuries was 5 to 7 percent higher.
      • when temps topped 100 degrees, the overall risk of injuries was 10 to 15 percent greater.

OSHA has a very handy calculator employers can use to estimate their costs – especially useful for the half of the country broiling under record temps.

Oh, and the workers most affected by heat? That would be the lowest paid workers, those leases able to afford time away from work…you know, the ones the work comp industry should be “advocating” for.

What does this mean for you?

Ignore science at your financial peril.


Work comp and workplace mass shootings

Sorry to end the week on a bad note – kudos to Texas’ Department of Workers’ Comp for highlighting workplace mass shootings in their just-concluded annual conference. The presentation is here.

The Lone Star state is all too familiar with these awful events [subscription required]…the most recent saw 23 killed and 22 others injured when a racist gunman opened fire in a Walmart store in El Paso.

It isn’t just Texas; we’ve had more than one mass shooting every day during the first three months of this year, with more than 600 victims.

California’s State Fund insured the Borderline Bar & Grill back in 2018; the State Fund’s handling of the awful situation provides a blueprint for all insurers…you would be well-advised to study up on that.

Compassion, creative engagement, empathy and doing the right thing no matter what were the basis of the State Fund’s response.

Until some measure of sanity emerges from Congress, the work comp industry will have to rely on improving the way it handles these disasters.

What does this mean for you?

Once again, work comp is left to handle society’s failings.


A week away from the blog is now past…here’s what I missed.

myMatrixx’ Chief Innovation Officer Cliff Beliveau – one of the smartest and most articulate tech people I have ever met – penned an excellent summary of AI’s potential uses in and impact on workers’ comp in yesterday’s WorkCompWire.

Cliff highlights key opportunities and challenges in claims, medical management, fraud detection and claims oversight…download his piece and save it.

Will automation disrupt construction? A better question might be “when will automation disrupt construction?”

Even better “when will what parts of the construction industry be disrupted by automation?”

All are addressed here.

Net is this – the author isn’t convinced we’ll see massive automation within the next decade...but points to a key use of technology that is already speeding up construction  – and making it more efficient to boot.

Surprise! medical bills and Junk healthplans – defined as plans with significant limits which often aren’t clearly identified up front – are facing increasing scrutiny. The White House is proposing strict disclosure standards and time limits on junk plans…

“The new proposed rules would close loopholes…that allow companies to offer misleading insurance products that can discriminate based on pre-existing conditions and trick consumers into buying products that provide little or no coverage when they need it most,”

The two – surprise! bills and junk plans, sort of complement each other…the junk plans don’t protect families from healthcare providers’ aggressive billing practices.

The proposed rule would highly limit duration of the plans, requiring clear disclosure of policy terms (as in written in English), and close coverage loopholes.

And one more note of interest for smaller employers looking at self-funded plans, and especially level-funded plans...AM Best’s April 28 2023 Market Segment Report indicates:

  • 2 out of 5 small employers (3 – 199 employees) are in level-funded plans
  • Just a year ago it was 1 out of 8 employers…
  • stop loss insurance loss ratios jumped to 85% in 2021 driven by new and very expensive specialty drugs and a lot more million dollar claims.

Just in the last year, 5 specialty drugs, each costing more than a million dollars annually per patient – have come to market.

What does this mean for you?

Smaller employers be very, very careful of self-insuring… 


Tilting at windmills

Is an apt metaphor for my ongoing and – so far – futile effort to get industry “thought leaders” to focus on the impact of human-caused climate change on worker health – and workers’ comp.

But, never one to admit a cause is hopeless (see my past battles to stop physician dispensing)…here we go again.

KFF just published an analysis identifying the:

occupations that are at increased risk of climate-related health impacts, examines the characteristics of workers in these jobs, and discusses the implications of these findings

This should be required reading for actuaries, underwrites, and risk managers…especially those in states:

  • with record high temperatures – looking at you, Texas;
  • vulnerable to hurricanes – looking at you, southeastern coastal states;
  • and under air quality alerts due to wildfire smoke – looking at most of the midwest and northeast – and western states too.

so much for my rowing workout this morning…or construction work, or agricultural work, or roadway maintenance, or utility upgrades, or forestry, or sanitation, or first responders…

Key takeaways from KFF’s research…

  • there are over 65 million nonelderly adult workers in occupations at increased risk for climate-related health risks, accounting for over four in ten of nonelderly workers.
  • workers in occupations with increased climate-related health risks are more likely to be uninsured, contributing to challenges accessing health care.

For risk managers, actuaries…and anyone a) committed to worker health and/or b) with dollars at risk, ere’s a handy list of occupations with high exposure to climate-change related health risks…

What does this mean for you?

Reality always wins. 

Ok trolls, have at it…