Insight, analysis & opinion from Joe Paduda
Back and neck injuries account for a third of all workers comp claims costs. That’s no surprise to industry types, and is a further affirmation of how tough it can be to manage comp claims.
Back injuries can be notoriously difficult to resolve, expensive to treat and impossible to determine if a back injury was related to employment.
The bright light of practice evaluation is making more than a few physicians uncomfortable; these docs have decided that it is somehow unfair for insurers to suggest members go to specific physicians.
So, like all red-blooded Americans, the docs are suing the insurers.
While the docs in question may think they are standing up for their rights, their actions look more childish than professional from here.
If you’re wondering why your company’s drug costs are going up, one likely contributor is the dramatic increase in the use of pain medications. Retail sales of five leading pain drugs jumped 90% from 1997 to 2005 led by oxycodone’s six-fold increase.
CMS will no longer pay for medical treatment(reg req) for injuries or illnesses resulting from hospitalization. Expect private insurers to follow suit.
Its about time.
The NY WC reforms are going to significantly reduce workers comp premiums –a point that many of the legislation’s critics are all but ignoring.
Restaurants, dry cleaners, and health clubs will see a 40% reduction; nursing home premiums will drop 37%, tool manufacturers 38%. These cuts will improve the viability of these businesses, and in the case of manufacturers, potentially keep jobs in the Empire State. Nursing home margins have been suffering for several years; WC premiums are a significant cost so the reform is quite meaningful.
With health care THE domestic political issue, there’s hope that finally something will be done.
Bob Laszewski tempers that hope with his critique of the current administration’s approach, noting that health care was nothing more than a political cudgel wielded in a cynical, and apparently unsuccessful attempt to shift voter sympathies.
Bob’s analysis is sobering.
As part of my ongoing effort to educate myself about pharmaceutical pricing, pricing strategies, marketing, and the various components of the distribution channel, I found PharmaFraud – a relatively new blog ‘penned’ by a self-described whistleblower from within the industry.
And now I know I don’t know squat.
I’m not a fan of anonymous blogs, blog posts, or comments, but PharmaFraud’s author looks to know of what s/he speaks.
For a biting condemnation/explanation of pricing, read PF’s piece on Distribution Channels.
We’re getting a clearer picture of the implications of NY’s adoption of a (very low) fee schedule for WC prescription drugs. As I’ve noted before, the WCB has clearly stated its opinion that the regs do not allow for reimbursement above the fee schedule.
The initial reaction to the news from several large pharmacy chains (at the National Association of Chain Drug Stores conference in Boston) ranged from disappointed acceptance to belligerent rejection.
Work comp claim frequency is down, but severity (claims costs) is up.
What to make of this?
The recent imposition of a work comp pharmacy fee schedule in New York has shaken the industry – and that’s not hyperbole. The latest news out of Albany is likely to intensify the aftershocks.
The preliminary guidance from the State is PBMs cannot charge more than the fee schedule, and cannot pay pharmacies more than the fee schedule.
Continue reading NY’s workers comp fee schedule – further developments
