Insight, analysis & opinion from Joe Paduda


Thursday catch-up

Between doing grandfatherly duties (hanging out with our granddaughter), business obligations and snow plowing, it’s been a busy week.

here’s what’s up.

COVID stuff

Yeah, like you, I was hoping this pandemic would be just an unpleasant memory by now. Far from it.

Omicron has substituted transmissibility for lethality, so far more of us will catch COVID, but far fewer of us will get very sick or die. BUT – and it’s a huge BUT, the net impact is more of us are getting sicker.

And the impact on healthcare facilities and the increasingly burnt-out people who work in those facilities is the worst it’s been since COVID arrived on our shores.

Another of those knock-on effects of COVID…hospitals can’t discharge patients because a) rehab facilities don’t have room, b) there aren’t enough home care providers to hep the patient recover at home. So, patients that COULD be discharged – thus freeing up beds for sicker people – aren’t.

Which leads to more stress on hospitals and hospital staff.

Side note – in case you missed it, the US has lost 10,000 ICU beds over the last year – because there aren’t enough healthcare workers to care for ICU patients.

Last week saw a new peak in hospital admits for patients with COVID… most troubling is the rapid rise in kids 4 and under that have been admitted.

There’s been a lot of discussion about patients admitted with COVID vs patients admitted due to COVID. This needs unpacking.

Lots of us have health issues, which are called “morbidities”…asthma, high blood pressure, obesity, diabetes and the like. Very broadly, the more you have, the worse it is, because one exacerbates the other(s).

COVID is in that while a patient may not have a bad case of Omicron, that patient’s immune system now has to deal with a respiratory (and perhaps other) problem(s) on top of being overweight, older, hypertensive and pre-diabetic.  The result is the patient is in the hospital longer, takes longer to recover, and full recovery is less certain.

About those “co-morbidities”…some irresponsible media types butchered CDC Director Rochelle Wolensky MD’s comments on COVID and co-morbidities. 

One such media type tweeted “CDC director admits over 75% of Covid deaths had at least 4 pathological conditions (comorbidities). Since the total death rate is 0.27% this means healthy people have a 0.0% death risk.”

That is NOT what Dr Wolensky said. She was referring to COVID deaths among vaccinated individuals – NOT all COVID deaths.

Her point was that vaccinations protect us from COVID, but people in very poor health are still vulnerable; most of the vaccinated people who died were in very poor health BEFORE they got COVID.

Sheesh. This isn’t that hard people…


Registration for CWCI’s annual meeting is now open here; March 8 is the date. As of now it is live and will be streamed as well. Walnut Creek is the location, and attendees will hear solid research on the impact of COVID plus a study on injured worker access to care.

Today NCCI and several state regulators are discussing the impact of COVID – you can register for the webinar here. You can download the team’s report here.

Lots of great information. presented in an accessible format.

What does this mean for you?

Don’t retweet unless you check the actual source information, because you may look like an idiot.




We are not “In This Together”

In a tiktok video circulating among healthcare workers a traveling nurse bluntly describes the very near future – no beds. For those blithely going on about their lives, ignorant of the impact of the anti-vaccine movement on our healthcare system and the people who take care of us, the video should be required viewing.

There is a direct connection between vaccine resistance and the dire state of our healthcare system, yet most resisters seem quite unconcerned about the effects of those decisions on their neighbors, family, friends, coworkers, and the healthcare system and healthcare workers.

Today, one out of five hospitals is critically under-staffed, the result of staff burnout, increasing frustration and intolerable working conditions. Over the last year the nation has lost more than 10,000 staffed ICU beds and almost 4 out of 5 of the remaining beds are occupied.

The combination of a flood of COVID patients and staff losses from resignation and COVID quarantine is exacerbating the staffing crisis and affecting non-COID patients. In almost half of all states, hospitals are postponing elective surgeries  – forcing patients to delay  hip replacements, cancer surgery, non-urgent cardiac bypass operations and other non-emergency care. Legally required to care for COVID patients regardless of their ability to pay, a growing number of hospitals have been forced to limit or forgo elective procedures. The longer this persists, the bigger the financial impact on facilities unable to bill private payers for lucrative services.

Here in New Hampshire’s Upper Valley hospital ICUs are nearing full capacity, National Guard troops are helping staff emergency rooms because ER nurses are needed in ICUs and CCUs. What used to be 12-hour shifts are now stretching beyond 13.

Nurses don’t have time to use the bathroom much less grab a bite to eat or get off their feet for a few minutes.

Staff nurses making $45 an hour are working alongside traveling nurses earning 3 times that. At some hospitals workers exposed to or testing positive for COVID are required to take PTO (personal time off) while in quarantine, a policy that infuriates the very people tasked with caring for us.

The explosive spread of COVID has led to more primary care physicians refusing to see patients in person, demanding patients go to Emergency Rooms for COVID tests, throat cultures, blood pressure tests, and other diagnostics. Staff are furious at this as it further overloads ERs and more people are needlessly exposed to COVID.

Of late, every day brings more bad news for staff. PPE supplies are tightening , the American Heart Association just released a policy change telling healthcare workers they don’t need PPE while doing CPR on COVID-positive patients and the CDC is telling healthcare workers exposed to COVID they need only isolate for 5 days.  A few facilities are asking nurses that tested positive for COVID to come to work anyway. Hardly the policies, practices, and statements that will engender loyalty and strengthen commitment among healthcare staff.

It’s not as if administrators have many other options. They are beyond swamped, scrambling to find enough people to fill the next shift, unable to plan much beyond that. With more and more nurses and other staff quitting, that task will just get harder and harder. That said, hospital administrators can and SHOULD be doing a lot more for front-line staff.

Retention bonuses, day-care assistance, hazardous duty pay are among the measures smart administrators should be taking.  Alas few are.

Health care is in crisis today in Alabama, Ohio, New York, Washington DC, Michigan, Georgia, and Rhode Island.  More southern states are about to enter crisis stage, overwhelmed with COVID patients most of whom are unvaccinated.

The reality is America is not “in this together”; far from it.

Our healthcare workers, our healthcare system and the mask-wearing vaccinated are on one side, desperately trying to protect all, care for grievously ill patients and save lives. The unvaccinated and their enablers are on the other, blithely ignoring the consequences of their decisions while demanding care when they fall ill.

While some groups have every right to be careful if not outright suspicious of vaccines (the Tuskegee tragedy’s fallout is still resonating), the vast majority of the anti-vax crowd’s claims are patently false and easily refuted. Some states are even paying unemployment benefits to vaccine refusers who’ve lost their jobs, rewarding behavior that is directly responsible for our collapsing healthcare system.

It’s not as if COVID is the only problem facing our healthcare system.  The mess that is information “sharing”, fee for service reimbursement, balkanized delivery systems, ineffective over- and under-regulation and the for-profit motive that drives most of US healthcare all contributed to the crisis. But COVID – and the politicization of vaccines and masks – is different.

With choice comes consequence, with freedom comes responsibility.

Unfortunately, that’s exactly what is missing – a willingness on the part of most vaccine refusers to take responsibility. What’s also missing is a willingness to hold refusers accountable. Pundits and politicians want us to be patient, to listen, to engage, educate, empathize and respect divergent opinions. For two years we have been doing just that, and while we have been listening and seeking to understand our healthcare system nears collapse.

We respect vaccine refusers’ right to make those decisions, and they must accept and take responsibility for their central role in the collapse of our healthcare system.

 Without that, we will never be in this together.



Predictions for workers comp in 2022, part 2

Last week the first five predictions about what happens in workers’ comp this year went up…today’s the second five.

6. With one or two exceptions, don’t expect much in the way of private equity investments.

There may be one or two large transactions, and a couple small ones, but outside of that, the bloom on the workers’ comp rose appears to be fading.

7. OneCall will be sold and/or split up. 

The BlackRock and KKR entities that are the current owners are not operators; they are debt owners. CEO Tom Warsop has squeezed out all the squeezable costs – and then some. Growth – defined as new business from new customers – is not happening. Add the overall drag on work comp services from the still-real drop-off in claims and claims services, and the reasons to hold on and hope are few indeed.

Plus, if interest rates increase – which is a distinct possibility – and if private equity interest in workers’ comp continues to diminish from it’s current modest level – also a distinct possibility – OCCM’s owners may well decide to sell soon rather than watch values decline.

8. COVID’s impact on costs and rates will prove to be minimal.

COVID claims are cheap, few are anywhere close to catastrophic cost levels, the effect of presumption laws and regulations is not much of an effect at all, and many employers – especially health systems – are forcing employees to use PTO rather than file for WC when they test positive/have symptoms.

Most research organizations and actuaries would do well to reflect how their early predictions were so…bad.

Helpful hint – two places to start; a) the tendency for WC “experts” to catastrophize and b) the almost-complete lack of understanding of healthcare drivers, costs, cost structures, reimbursement, and epidemiology.

9. There will be no big issues in workers’ comp. “Big” defined as important, needle-moving, disruptive, revolutionary.

No, medical marijuana is NOT a big issue – neither is COVID, or presumption, or the mid-term elections (there is ZERO interest in workers’ comp on the federal level) or remote work (does anyone seriously believe office workers tripping over toys will amount to any real dollars?)

Oh, and with rates at all time lows, frequency continuing to drop, and medical costs (with the exception of physical therapy and facilities) flat, coupled with ongoing supply chain and labor market issues, execs at big employers are (justifiably) completely uninterested in workers’ comp.

If the big girls and boys don’t see any issues, there aren’t any.

10. Here’s the kicker – the biggest long-term concern for workers’ comp is global warming...yet this is getting zero attention.

There’s going to be an inevitable increase in issues related to heat, flooding, fires, drought, tornados and hurricanes. This is getting more real every day yet remains all-but-ignored by pundits, policy-makers  and rate-makers.  We can expect more heat-related claims. Hurricanes, fires, and tornados will increase in number and severity; affecting logistics, labor, construction, and claims. The research is clear.

What does this mean for you?

As always, success favors the insightful, and failure plagues the ignorant.


2022 Predictions for workers’ comp

Once more I head out on a limb to prognosticate on the events and trends that will shape 2022.

  1. The soft market will continue.
    Carriers are still over-reserved, rates are still too high (see the opioid hangover), capital is still flowing into workers comp (gotta love that looooong tail), and employment growth may continue to be modest (low wage workers have discovered that working at crappy jobs isn’t always a have-to, especially when child care is unavailable and unaffordable).
    On the other side, wage growth will likely continue (thus partially mitigating the above drivers) as more employers finally figure out that people aren’t interested in crappy jobs for crappy wages.
    Caveat – towards the end of 2022 we may well see a bit of tightening as construction, infrastructure, green energy and other initiatives start up and get operational.
  2. TPAs will add more business, mostly from carriers.
    As work comp continues to shrink, insurers will ramp up efforts to shed assets and expenses to reduce their cost structure. By outsourcing claims, carriers are trading the high fixed costs of a claims infrastructure for the variable cost of a per-claim admin fee.
    The smarter carriers will negotiate hard so they don’t get screwed by medical management and other non-fixed fees…but many carriers aren’t that smart.
  3. Insurers will reduce staff, particularly in claims.
    Well, of course. see #2 above. However, TPAs will look to add claims staff, so experienced, well-trained claims folks will be highly sought-after.
  4. IF total medical costs go up – and I doubt they will  – the increase will be marginal.
    Yeah, I know there’s lots of press and punditry about work comp medical costs aka “severity” increasing – and most of it is flat out wrong.

    I’ve read far too many investment banker slide decks, “research” reports and surveys of work comp executives that talk about rising medical costs –  almost all are not based on data or solid research.
  5. That said, facility and therapy costs will go up.
    Mostly because a) medicare is increasing reimbursement for therapy which trickles down to work comp fee schedules, and b) some healthcare systems and for-profit entities (looking at you, HCA, especially in Florida) have figured out how to bust open the work comp piggy bank.

Monday – 5 more predictions.

What does this mean for you?

Work comp will just muddle along…


2021 Predictions – How’d I do, part 2

Yesterday we went through the first 5 of my predictions for 2021, today we’ll wrap up the second batch before I attempt to predict what 2022 brings.

6.  The workers’ comp insurance market will stay soft.

Here’s a few reasons why.

  • There’s hundreds of billions of capital floating around out there, looking for a home. Workers’ comp insurance has been a) quite profitable and b) is a great place to park dollars.
  • Claim counts continue to decline – while COVID is accelerating the decline, the structural drop is embedded in the business and is here for the long term. Next year there will be fewer claims, and the following year even fewer.
  • Medical inflation remains pretty low (while there are troubling indicators that costs will bump up, overall trend remains low historically)
  • There are lots of insurers fighting for a shrinking market, and it only takes a couple cutting prices to force others to join in.Verdict – True. Although this is really directly related to another prediction about rates, so if one was true, the other almost certainly had to be. Then again, if one was false, I’d be 0 for 2…

7. More layoffs and staff reductions will hit insurers and TPAs
See #6 above.  Fewer premium dollars = fewer administrative dollars; fewer claims = less need for staff. Layoffs hit several insurers last year and we can expect more to come.

Verdict – False. There are anecdotal stories about a few reductions here and there, but nothing big except…Reports indicated AIG “transferred” employees  – apparently primarily claims staff – to Gallagher Bassett as part of its move to offload fixed costs.

Where I really went wrong was predicting TPAs would have layoffs…Since TPAs’ biggest growth is coming from carriers offloading work to them, and if carriers are laying off staff, then the work has to go somewhere – and that “somewhere” is to TPAs. So, that was an unforced error.

8. Other than presumption and tele-services, there will be very few significant moves in WC regulation or legislation.

Between drastic reductions in state revenues due to sales and other tax receipts affecting staffing and state legislatures and governors all-consumed by COVID responses and budgetary issues there’s little oxygen left to fuel any material changes to work comp regs. While it would be great to see Florida’s legislature stop facilities raiding workers comp to make up revenue shortfalls, that’s highly unlikely.

Verdict – True. And there wasn’t much in the way of presumption or tele-services changes…no, a few states addressing medical marijuana is NOT significant.

9. OneCall will be sold and/or broken up

While the current debt load is a LOT less than it was under the previous owners and the current CEO is an improvement, the decline in claims hit One Call hard in 2020.   The first half of 2021 won’t be any better with employment numbers and claims counts likely reduced due to the pandemic.  On the plus side, there’s still lots of investor money looking for deals.

Net – I expect the company to change hands this year. Whether it is sold as one entity or broken up is TBD.

Verdict – False. That said, it’s just a matter of time…the bleeding has mostly stopped, but growth is anemic at best, service levels remain suspect, and financials have gotten better in large part due to lots of expensive staff exiting the company

10. Opioids and other dangerous drugs will get a lot more attention.

With COVID dominating everyone’s calendar, workload, thinking and energy, we all dropped the ball on managing opioids. That will change.

chart below is from The Economist.

With prescription volumes, MEDs, and duration likely up during 2020, expect payers to re-engage with prescribers, PBMs, and employers to get things moving in the right direction.

Verdict – False.  NIOSH published a timely report on opioid issues among construction workers but other than that – very little material action.

This is REALLY disappointing. I get that COVID was a lot to handle, but the opioid crisis got even worse last year with a record number of opioid-associated deaths. That, and the fact that long-term usage of opioids is likely the most significant contributor to claim duration and long-term claim cost should have insurers, employers, and TPAs focused on addressing chronic opioid usage.

The net – overall 5 True, 4 False, and 1 pending.

Gotta do better than that.


2021 predictions – How’d I do?

It’s time once again to see how I did on my 2021 predictions for workers’ comp.

Today we’ll dive into the first 5 and finish up with the last 5 tomorrow.

  1.  Total premiums will stay low.
    As employment, payroll, and injury rates all remain under pressure, total premiums will remain significantly lower than we’d expect in a non-COVID, non-recession environment. We are also on the tail end of the opioid cost bubble, with actuarial projections still over-compensating for what was rampant overuse of opioids.
    Unemployment will persist at least thru the first half of 2021 – and likely the first three-quarters – helping to keep premiums lower. There are some predictions that employment will ramp up towards the end of the year; let’s hope so.
    Implications abound.

    Verdict – True. Wages did increase significantly (Good news indeed for hospitality, leisure, construction, logistics, healthcare and retail workers!) but premiums and rates mostly dropped. Florida, California, and other states saw decreases, continuing a decade (or so) long decline in rates and premiums.
    Note – Actuary Mark Priven – and I – both believe rates are still too high.

  2. Facility costs will spike.

Hospitals are in dire financial straits, with 2021 bringing no respite from the cash crunch experienced by the entire industry when people avoided facilities, put off elective procedures, or weren’t able to get care due to facility restrictions.
As desperate financial managers look high and low for any and all revenue sources, you can bet your house they’ll be focused on workers’ comp. Payers have:

    • few effective price or utilization controls;
    • an often-lackadaisical approach to cost management;
    • bill review programs and processes hopelessly outclassed by sophisticated revenue maximization technology; and
    • management that doesn’t know that it doesn’t know;

thus payers are going to see facility costs – already the largest part of medical spend – jump.

Verdict – too early to tell. We won’t know until we get 2021 data, which will be sometime in mid-Q2 for most states. I’ll go out on a limb and double-down on my prediction; facility costs – as a percentage of total spend – have increased significantly in 2021

3. Consolidation
Seems I’ve been forecasting increased industry consolidation for years…it’s not a prediction but more acknowledgment of reality. Workers’ comp is a declining industry with shrinking claim counts and flat expenses – and that isn’t going to change.

COVID has accelerated the process dramatically; with claim counts down 15-20%, there are fewer claims to adjust, fewer services to medically manage, fewer bills to pay, fewer dollars to compete for.
Because there will be fewer revenue and premium dollars next year than this, more consolidation is inevitable.
I expect this to be most pronounced among medical management firms and TPAs, and the big to get bigger. Genex/Mitchell/Coventry, Sedgwick, Concentra are all likely consolidators. Not sure about Paradigm.

Verdict – True. Paradigm has bought HomeCareConnect; Enlyte (Mitchell/Genex/Coventry) acquired QualCare (and reports indicate Enlyte is for sale); and Sedgwick is buying up tangential businesses (JND Legal Administration, Temporary Accommodations, Managed Care Advisors, and several other firms).

4.  Drugs will re-emerge as a significant problem
After several years of declines in opioid prescription volumes, it looks like things headed in the wrong direction last year.
Prior Auth requirements were relaxed, refills extended, and states loosened restrictions on prescribing. Add to that patients weren’t able to get to their PT visits and surgeries were postponed. The result – I expect we’ll see drug costs in 2020 flattened out, and opioid usage actually increased (We will know a lot more in mid-late March when I complete my Survey of Drug Management in WC).
That was last year; as COVID is returning with a vengeance, expect to see continued increases in 2021.

Verdict – False. Drug costs continued to drop in 2020 and reports from multiple industry contacts indicate that continued into 2021.

5. COVID claims aren’t going to be costly.

Despite all the caterwauling we heard back in 2020, COVID costs have been minimal. That will not change. Yes there will be long-haulers, but those will be very few indeed. Yes there will be more claims, but most will cost just a few thousand dollars.

Verdict – True. All credible research and reporting indicates COVID claim costs have been pretty low. Not surprising to those who actually have a grasp of healthcare cost drivers and treatment expenses.
More on costs here, here, and here.

The Net – 3 True, 1 False, and 1 pending.

What does this mean for me?
I’ve got to relook at my thinking re drugs and drug costs. I know as much about drugs in workers comp as anyone, and I clearly got this one wrong.  


Good news on the COVID front

Some good news on the COVID front – well, good compared to the $%*#%Storm we’ve had for two years.

First, the good news is tempered by reality – Omicron is incredibly transmissible. It feels like you could catch the damn thing if you drive by a patient on the highway.

Three studies published yesterday or just before agree – Omicron-infected patients generally aren’t as sick as those infected with other variants. A UK study and one in Scotland had similar results – Omicron patients had less severe and shorter hospital stays – and fewer of them. Another from South Africa indicated Omicron patients were hospitalized a quarter as often as non-Omicron patients.

Warning – these are PRELIMINARY reports and have not been peer-reviewed; it is possible results will change after the review process is completed.

And, Pfizer’s COVID treatment bill got the nod from the FDA. From FiercePharma:

Pfizer has agreed to supply the U.S. with 10 million courses of Paxlovid for $5.29 billion ($529 per course). On Wednesday, the company also revealed it will supply 2.5 million courses to the U.K. on top of a previous agreement for 250,000 courses.

Paxlovid will only be available – for now – via the FDA’s Emergency Use Authorization (EUA). If you aren’t vaccinated because you think the vaccines didn’t go through enough testing, you need to understand that Paxlovid has had far less testing – and there’s been zero real world experience with it.

So here’s the bad news.

Because far too many of us are NOT vaccinated, hospitals are swamped with COVID patients – the vast majority of whom are unvaccinated. So, while Omicron isn’t as deadly as other variants, the fact that it is far more transmissible means there are going to be many more patients who WILL be hospitalized, need ICU/CCU care, and many of whom will die.

What does this mean for you?

Get vaccinated and wear a mask. 

Or don’t ask for Paxlovid if you get COVID.


Our healthcare system is breaking – part 3

Here in northern New England emergency departments are being staffed by National Guard troops. Hospitals’ ER staff – trained to handle critical care patients – are being shifted to critical and intensive care units already short-staffed due to burnout and overwork.

Hospitals are once again halting all non-emergent care as beds are full, staff are exhausted, and supplies constrained.

Omicron’s incredible transmissibility coupled with a core group of unvaccinated people is driving the disaster – and make no mistake, disaster it is.

In the UK, Omicron infections are doubling every three days.

Here in the US, Omicron accounts for three out of every four new COVID infections.

To date the evidence seems to suggest Omicron infections may be a bit milder than previous variants, although other data appears to contradict that statement. Net – it’s still early.

Two key points (source here)

  1.  Vaccinated people are much less likely to get Omicron than the unvaxxed.
  2. Omicron may still infect those of us who are vaccinated, BUT the infections are relatively mild and, unlike the unvaxxed, we are MUCH less likely to be hospitalized or see the inside of an ICU.

Omicron is likely to burn very hot and very fast through our healthcare system; I’d expect that 6 – 8 weeks from now most will be behind us.

BUT – the damage COVID and the unvaxxed have done to our healthcare workers and the healthcare system will be felt for years.

  • About one in five healthcare workers left their job since COVID started.
  • There are far fewer healthcare workers in nursing care facilities and community care facilities for the aged today than there were pre-COVID.
  • Wages for workers in those sectors are up more than 12% – which will drive costs up too.
  • U.S. Bureau of Labor Statistics projects that 500,000 seasoned nurses are expected to retire between now and the end of 2022, creating a shortage of 1.1 million nurses.

Numbers are soulless. Here’s what COVID feels like to those trying to save COVID patients…

Last December, at the height of the winter surge, (a 14-year ICU nurse)  cared for a patient who had caught the coronavirus after being pressured into a Thanksgiving dinner. Their lungs were so ruined that only a hand-pumped ventilation bag could supply enough oxygen. Alexander squeezed the bag every two seconds for 40 minutes straight to give the family time to say goodbye. Her hands cramped and blistered as the family screamed and prayed.

…when the same family called to ask if the staff had really done everything they could, “it was like being punched in the gut,” she told me. She had given everything—to that patient, and to the stream of others who had died in the same room. She felt like a stranger to herself, a commodity to her hospital, and an outsider to her own relatives, who downplayed the pandemic despite everything she told them. In April, she texted her friends: “Nothing like feeling strongly suicidal at a job where you’re supposed to be keeping people alive.”

Shortly after, she was diagnosed with post-traumatic stress disorder, and she left her job.

If that’s not enough, watch these videos of nurses…

Full disclosure – a family member works at Dartmouth-Hitchcock in the emergency department – this is what they deal with every day.

What this means for you.

  • Do NOT have an accident, stroke, appendicitis, or slip on ice
  • If hospitals in your area are still open for elective procedures, they won’t be in the very near future. 
  • Health insurance costs are going to spike
  • More of your unvaxxed family and friends are going to die a miserable death.
  • Healthcare is going to be harder to get and more expensive, waiting times will be much longer, and the healthcare experience will be more mechanical and less caring.

Get vaccinated and wear a mask. If you don’t, then take responsibility for your decision.


COVID update

Oh ^&%$*&^%^.  Here it comes again.

“IT” is the umpteenth wave/surge of COVID, a marvel of evolutionary adaptation.

IT has also killed 800,000 of our sisters, brothers, daughters, sons, parents and grandparents, friends and neighbors, co-workers and colleagues.

IT is also blowing up our healthcare system; 4 states are turning to their National Guard to staff critical services.

IT has driven healthcare costs over the $4 trillion mark as costs spiraled up almost 10 percent in 2020 – more than double the 2019 inflation rate. Taxpayers’ costs rose almost 4 times faster than the overall healthcare world – mostly driven by COVID.

Commenting on this, HealthAffairs noted;

OK, the good news.  Omicron seems to mostly infect the airways leading to and from the lungs, which helps make it more transmissible. It doesn’t get too deep in the lungs (in most instances); this may be one of the reasons it isn’t as deadly as other COVID variants.

Myocarditis occurring after vaccination is quite rare, according to research published in a UK Journal “However, natural infection from SARS-CoV-2 is linked to a substantial increase in the risk of serious outcomes from developing myocarditis, pericarditis, and cardiac arrhythmia, researchers say.”

What does this mean for you?

Get vaccinated AND mask up.


Friday update

Apologies for lack of posts this week; this was the annual father-son hunting trip, and work is strictly banned.

Here’s what happened this week…

News hit the wire that Enlyte (aka Mitchell Genex Coventry) is for sale. Owner Stone Point Capital (deep experience in workers’ comp) is reportedly “exploring a sale” of the company which is generating about $450 million in earnings (I’d be a bit careful about that figure as sellers almost always include stuff in “earnings” that doesn’t usually “count” as such.)

There aren’t too many potential buyers for a deal this big as we’re talking a “multi-billion dollar” deal.

HomeCareConnect was bought by Paradigm – more on this later, but my initial take is this is a smart move by the big cat case management company as it brings a well-regarded DME and home health provider into the fold, allowing Paradigm to capture all that revenue and margin on their financials.


The fine folk at WCRI have just released a very helpful report on the use and reimbursement of telemedicine in work comp.  The report is free to members; non-members get their copy for a nominal fee.

From WCRI; the report addresses:

evaluation and management and physical medicine services. It investigates the patterns of telemedicine utilization among these services in workers’ compensation during the early months of the pandemic (primarily March–June 2020) across 28 states. It also examines the actual prices paid for the most frequent services delivered via telemedicine versus in person across the study states.

NCCI researchers collaborating with various other agencies published a summary report on the impact of COVID on workers comp. Download a copy at the link…

Key takeaways include:

  • Covid claims are cheap – as in a LOT less costly than non-COVID claims
  • There’s a “new” claim category – “Indemnity only” that accounted for a plurality of claims.

Interestingly,  more and more insurers have stopped waiving member payments for COVID treatment.

Oh, and costs varied a LOT across states – $49k for non-complex hospitalizations in Maryland vs $129k in New Jersey. That’s likely largely due to Maryland’s very smart hospital charge regulation policies.

from FairHealth

The median length of complex hospitalization declined from a peak of 13 days in April 2020 to 7 days in July of this year…which is likely a big contributor to lower treatment costs.

What does this mean for you?

The investment community’s fascination with workers’ comp will be put to the test.

If you get COVID, you’re gonna pay a lot for your care – if you go into the hospital. 

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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