Insight, analysis & opinion from Joe Paduda

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Dec
6

Fun Friday Factoids

In St Pete at CompPharma’s annual meeting, so can’t do a deep dive into any big blog-able issues…yet there’s so much deserving of attention.  Here – in easily digestible bite-size chunks – are a few items of interest.  Happy dining!

Congress will NOT fix the Medicare physician reimbursement issue this year – so they will boot that can into Q1 2014.  Why do you care? Because work comp fee schedules are usually based on Medicare’s rates, so this will affect work comp.  And, if it is changed, it will impact cost-shifting and commercial reimbursement rates.

Since Florida implemented its Prescription Drug Monitoring Program, oxycodone-related deaths have dropped 41%.  Someone remind me why the governor refused to fund this for months…

Higher medical costs in northern California appear to be driven by consolidation of the provider market.  A report in the NYTimes discusses Sutter Health’s high charges and the lack of justification therefore, Sutter is one of the most costly providers in the nation.

A hearing in Pennsylvania on physician dispensing in work comp included a discussion of the higher medical costs, longer disability duration, and higher indemnity expense associated with doc-dispensed drugs.  Reportedly one of the legislators displayed an ad from a dispensing company’s website that discussed how dispensing docs could make $100,000 without doing any work.

Enrollment in Exchanges has picked up dramatically; according to the Kaiser Foundation, as of this time last month 1.3 million applications had been completed, a quarter of those from California.  WIth over 26,000 enrollments in just the first two days of December, there’s a lot of pent-up demand yet to work its way thru the system. We shall see if the back end, where data gets shared with insurers, holds up. Jury is out…

 


Joe Paduda is the principal of Health Strategy Associates

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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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