Insight, analysis & opinion from Joe Paduda

Mar
4

Medical malpractice – fixed or broken?

The medical malpractice insurance business is either back under control and meeting the needs of the market without the benefit of major and widespread tort reform, or is in crisis, near death, and likely to expire without major tort reform.
Where you sit determines what you see.
From consumer watchdog group Americans for Insurance Reform comes the following excerpt from their press release:
“Americans for Insurance Reform (AIR) released a new study today confirming the wholesale decline of medical malpractice insurance rates nationwide. The AIR study also shows that this phenomenon is occurring whether or not states enacted restrictions on patients’ legal rights, such as “caps” on compensation. The medical malpractice insurance “crisis” is over, according to the study.
AIR’s study is based on the most recent Council of Insurance Agents and Brokers survey of market conditions, showing that the average rate hike for doctors over the past six months has been 0 percent. This is following similar results for the last quarter of 2004, which saw rates rising only 3 percent at the end of that year. By comparison, rates jumped 63 percent during the same quarter of 2002. ”
In contrast, the Council of Insurance Agents and Brokers released their own interpretation of the numbers, noting:
“‘ to interpret that data to mean that the ‘crisis’ is over is a gross misrepresentation of the situation,” Crerar said. “First of all, having rates stabilize for one or two quarters doesn’t mean those rates have gone down. It only means that they have not gone up any farther. It is like saying that just because gasoline costs $2.50 a gallon today, down from $3 a gallon last year, we don’t have an energy crisis, and gas is cheap.”
CIAB also finds fault with AIR’s math, and reading CIAB’s interpretation it does appear the Americans for Insurance Reform could do with a little more practice with the calculator.
So, what’s the real deal?
Well, the malpractice “crisis” is partially related to insurance cycles (we’re in a transition from a hard market to a confused one right now), and as I’ve noted before, has a relatively small impact on overall health care costs. While the med mal debate is interesting, it is a sideshow – med mal is not a major force in US health care.
That said, the interesting point is that the drop in rates is occuring in states that implemented tort reform and those that did not. Makes one wonder what influence tort reform has on costs…


Mar
2

Medicare development timeline

Jason Shafrin at Healthcare-Economist.com has provided a brief timeline of the development of Medicare in the US.
Jason’s blog is quite good; heavy on the policy side (no surprise there) with several excellent summaries of data-rich topics such as price elasticity of employer-based health insurance.
I recommend it to fellow policy wonks.


Mar
1

Noe owes $13 million to Ohio

An audit by Ohio’s Bureau of Workers Compensation has revealed that Tom Noe and an associate owe the Bureau over $13 million. And, one of Tom Noe’s partners in the rare coin business has pleaded not guilty to seven felony counts related to alleged thefts from Ohio’s state workers compensation fund. The miscreant, Timothy LaPointe, was escorted from the courtroom in handcuffs before being fingerprinted and released on bond. LaPointe is accused of corrupt activity and six counts of tampering records, proving yet again that cover-ups are always a bad idea.
Meanwhile, more details on Noe’s transgressions are coming out every day. The latest scoop is Noe spent the State’s funds lavishly on house improvements, entertainment, golf outings, and collectibles such as political pins.
The Toledo Blade has an in-depth review of the Noe case, including a follow-the-money section that is quite interesting. Notably (no pun intended), Noe was appointed to his post as a fund manager for Ohio’s BWC despite the fact that he was not qualified; he did not file adequate financial records; and the Bureau allowed Noe’s lawyers to write the agreement between Noe and BWC.


Mar
1

Health Wonk Review plans

Several folks have expressed an interest in submitting posts to and being kept abreast of our latest venture, Health Wonk Review. Some have asked for copies of the “rules”, a word that makes me break out in hives. So, here are the guidelines we’re working with today.
1. HWR is going to be published every other week. This may change to weekly based on interest.
2. The host will rotate with each publication.
3. The host determines which submissions are included in their edition of HWR.
4. Submissions will include the poster’s name or nom de chroniquer (the nickname under which they post), the url of the blog, the url of the submitted post, and a synopsis of the post.
5. Submissions are due by 9 am EST every other Wednesday – that means March 8, March 22, etc.
6. The host will include the name and email of the next host in their edition of HWR.
7. A separate website for HWR is in development and will be out sometime next week. Details to follow.
8. The host for next week is Matthew Holt – ‘matthew@matthewholt.net’; March 22 host is Kate Steadman – ksteadman@gmail.com; April 5 is David Williams [dwilliams@mppllc.com].
9. We are going to see how this goes and take it from there. As of yesterday, there were 577 hits on “health wonk review” on google – so we are getting a bit of traction.
Finally, thanks to all for their contributions, support, and cross posting.
Joe


Feb
28

Wal-Mart’s difficult position

The “Wal-Mart” legislation on the docket in over 20 states is pushing some pro-business advocates into a Hobbesian choice – support Wal-Mart and other opponents of mandatory benefits legislation, thereby adding thousands to Medicaid rolls, or support the legislation and place a heavier financial burden on the world’s largest retailer.
Wal-Mart and several other large employers have thousands of employees covered under state Medicaid programs. The modestly paid employees qualify for the taxpayer-funded coverage due to their relatively low income. And, Wal-Mart’s health insurance plans are too expensive for these employees; different souces indicate different participation levels for employees, but none report participation above 46%. (The Wall Street Journal claims 46% of employees are enrolled in the company’s plans, other sources indicate 43% of the company’s 1.3 million workers are covered under their plans in 2005, a drop of five points from last year’s 47%.)
The average income for a Wal-Mart employee is less than $20,000 per year, making it difficult for them to afford even the least-expensive plans offered by the company. The company has developed a low-cost alternative plan (the “Value Plan”) that provides minimal coverage for an employee contributing $11 per month; while there are tight limits on benefits in the first year, these restrictions make sense; they will help mitigate adverse selection risks.
Improvements to the health benefits annonced by CEO Lee Scott include a reduction in the eligibility waiting period from two years to six months for full time workers; allowing children of part-time workers access to the plans; and reducing the waiting period for part time workers.
There are more than enough Wal-Mart bashers and advocates throwing stones over these and other issues. And the company is (somewhat unfairly) being made into a whipping-boy for a national problem. Remember, the number of employers offering health insurance has dropped by 15% over the past five years…
Simply put, labor expenses are a very significant part of Wal-Mart’s overall cost structure, and health benefit costs are hitting the company both directly (via employees on insurance) and indirectly (via the tax burden from uncompensated care, Medicare and Medicaid). This increases the company’s cost of doing business, and thereby their prices to consumers.
This is not a value statement, but reality.
What does this mean for you?
The US health care system is a burdeon on employers and our industrial competitiveness.


Feb
27

First Health still without WC exec

Industry sources indicate that Coventry Health’s year long effort to find a leader for its’ First Health workers comp managed care entity has hit another snag.
Evidently the last candidate rejected an offer from Coventry within the last few days, leaving Coventry with an empty pipeline. The job has been open for about a year, and search firm Spencer Stuart has had the engagement for a few months.
Faithful readers will note that I reported Coventry was close to naming an exec a few weeks ago. For unknown reasons the deal could not get done. My take (based on nothing but idle speculation) is the workers comp business may well be more competitive and tougher than Coventry either knows or admits. Aetna’s Work Comp Access program appears to be gathering momentum; Concentra has not stumbled recently; and specialty managed care vendors such as MedRisk and CHOICE Medical Management are “hollowing out” First Health’s network business by taking out pieces of the network (PT and Florida respectively). First Health will be losing big chunks of business from two of its largest network customers this year.
Perhaps the candidates know they are not being asked to take over a thriving market dominator, but rather right the ship of a firm that has grown stagnant and stale.
What does this mean for you?
The right leader could return First Health to prominence in this sector. The longer this goes on, the more important it is to select – and sign – the right candidate.


Feb
26

Ohio’s BWC coingate gets even better

It isn’t often that international auction house Sotheby’s gets involved in workers compensation cases, so the news that two of their numismatic experts pulled an all-nighter looking for coins missing from the Ohio Bureau of Workers’ Compensation is “top of the fold” stuff.
According to a report in the Akron Beacon Journal, Sotheby’s was contracted to track down and value the rare coins that were part of the BWC’s investment “strategy”. This highly unusual investment was made possible by the work of Tom Noe, a now-indicted political crony of Ohio Gov Bob Taft (R). .
Noe, who faces criminal charges for his allegedly illegal campaign contributions and other acts, had been storing the coins at several of his shops around the country, including ones in Sarasota, Maumee Ohio, and Colorado. Unfortunately, the Sotheby audit indicates that the coins they were able to locate are worth between $21 and $27 million; about half of the advertised value of BWC’s investment.
Highlights of the audit included the appearance of an Ohio State Trooper complete with badge and gun at one of Noe’s shops during the on-site audit. Evidently the Sotheby’s people were getting nowhere until the Law arrived, after which they stayed up all night looking at doubloons and double eagles (I’m guessing’).
So, the scandal that won’t fade away (much to the delight of this blogger) gets even better. Somewhat like a rare coin, it continues to appreciate the longer it is around.


Feb
24

UPDATE – Health Wonk Review

This is the premiere edition of Health Wonk Review, a biweekly (or so) compendium of the best of the health policy blogs. We’ve asked over two dozen health policy, infrastructure, insurance, technology and managed care bloggers to send in their best, provided to you in Cliff Notes style. We’ll do this every couple of weeks or more often if the host wants to.
Why? Bunches of reasons.
First, the last two months have seen a renewed interest in the health care policy arena, triggered by Pres. Bush’s State of the Union address, the financial difficulties of GM et al, the emergence of consumer-directed health plans, and the Part D mess.
Second, there are so many excellent policy blogs in the ether that it is impossible for anyone to keep abreast of them all.
Third, Nick Genes’ Grand Rounds has done such an excellent job covering the medical blogger community it inspired us to try to do the same on the policy side (plus Nick has already done most of the heavy lifting figuring out this type of thing so we didn’t have to do too much work).
And as you’ll read, we’re off to a pretty good start.
UPDATE – for a couple of late entries, click below…

Continue reading UPDATE – Health Wonk Review


Feb
22

PBM win over third party biller

For the dozen or so people in the workers comp business who follow these things, the recent win by ScripNet in its ongoing legal battle with third party biller (TPB) WorkingRx was excellent news – at least for the payers.. The court threw out WorkingRx’s lawsuit, noting that it had “no greater right to reimbursement from ScripNet than a pharmacy would have.”
WorkingRx and its competitor Third Party Solutions have been working two fronts in their effort to stabilize their businesses; suing payers who refuse to pay their bills in full, while attempting to sign deals with pharmacy benefit managers and payers in return for a “discount” off the TPB’s (inflated) charges.
The court win is by no means the final word; TPBs have proven to be remarkably resilient and are proof that businesses that can evolve quickly can survive.
What does this mean for you?
More clarity from the courts re the legal position of TPBs.


Feb
21

Health care quality measures, politics, and dollars

There are lots of moving parts, political agendae, and battling priorities in the pay for performance movement, and it is getting even complicated-er. Today’s announcement by the AMA that it will produce metrics for assessment of physician quality (registration required) is a clear indicator that financial motivations have, at least temporarily, outweighed physicians’ measurement phobia.
There are two distinct but closely related and very powerful forces at work here – one financial and the other political. Financially, the key issue is concern among docs that these “quality indicators” will be used to reduce reimbursement. And that fear is not unfounded. One has to look no further than the latest Federal budget proposal and the annual battle over the mandatory reduction in Medicare physician fees to understand that the phobia has a solid foundation in reality.
Politically, Bush’s pronouncements in favor of consumerism as the solution to the health care cost crisis have painted him into a corner. Critics (myself among them) have noted many problems and challenges (read near insurmountable obstacles) with this approach, chief among them its breathtakingly na


Joe Paduda is the principal of Health Strategy Associates

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