Today’s catch-up is pretty workers’ comp-centric. Lots going on, so here we go.
The ACOG (APAX-Coventry-OneCall-Genex) conglomeration continues. A couple of items of note; APAX is out recruiting several execs to add depth and experience to the senior management ranks. They are looking for case management pros, and word is at least one former Coventry exec is being targeted for a return.
On the Coventry network side, a well-informed source indicates a couple hospital providers in TN and GA recently renegotiated a new contract with Aetna……and with a significant decrease in the discount % below fee schedule.
On top of the news that the Geisinger and Washington hospital system contracts did NOT include workers’ comp, it is not surprising that payers are seeing a decline in “savings” from the Coventry network.
Cheers from here for former Oregon SAIF CEO John Plotkin; an Oregon court just ruled that former CEO Brenda Rocklin is NOT entitled to a state-paid defense of Plotkin’s suit against her and others. Rocklin was allegedly involved in ousting Plotkin based on what I can only describe as ludicrous, made-up, laughable charges based on statements by Plotkin that, if they were actually made – which is highly doubtful in some cases – merit no punitive action at all.
Seriously, asking an actuary to speak English is “culturally insensitive”? Since when are actuaries a “culture”? Warning a colleague that your dog is a “humper”? talking about a goats “teats”? Even this liberal progressive Democratic ACLU member Obama fan can’t fathom how anyone could possibly construe those comments as “offensive”.
Kick their asses, John! (and so I am not misconstrued, “asses” means their butts, not their donkeys)
At another state fund, things continue to spiral down. The latest news (courtesy of WorkCompCentral’s Ben Miller) from North Dakota regards WSI’s (state fund) use of “Independent” medical examiners – which look anything but.
Fully three-quarters of the IMEs support the WSI adjuster’s position.
So, no big deal, right?
Wrong. Those (very) few who follow WSI know long-time and highly-regarded Medical Director Luis Vilella recently resigned. Why? Well, it appears his concerns about medical decisions were a major factor; evidently adjusters and their legal department used “outside” medical experts instead of Dr. V. The full story on this rather distressing – and all too common) lack of judgment by WSI senior management is here.
Notably, David DePaolo noted just yesterday that state requirements around IMEs may have made it difficult for adjusters to locate in-state physicians able and qualified to perform IMEs. HOWEVER, this is a separate issue from the Dr V problem as it pertains to IMEs and not peer reviews.
Meanwhile, Karen Foshay has produced a three-part series on the California compounding mess. The FBI is involved, an infant has died, and one of the alleged participants was recorded saying ““I’m a behemoth, I make 8 to 10 million a month.”
Is there a place for compound in workers’ comp? Yes. HOWEVER, the legitimate use of compounds is all too rare as crooks, thieves and liars are using compounds as the route to huge profits, regardless of the consequences for patients, employers, and taxpayers.
Hope your weekend is excellent!
Hi Joe, rumor has is that the APAX Coventry deal fell through and further talks have ceased. Do you have any information pertaining to that? Thanks
Curious – haven’t heard that. There has been ongoing concern about the “transferability” of the PPO provider contracts and the ability/willingness of Aetna to maintain those and assist in the transition.
If things have fallen apart, my GUESS is this would be a primary factor.
That said, I have not heard that the talks are off.
Interesting rumor; did that come from Apax, Coventry, or just a streetcorner preacher?
I notice that you haven’t posted on Coventry in a while and the alleged sale to Apax. If it winds up NOT happening and you don’t retract your statements or comment on them, your credibility will go out the window, even more than it already has.
Splain – thanks for the comment. Two thoughts. First, the tentative closing date is October 1. Second, as I’ve noted repeatedly, there’s a good chance this doesn’t happen, and if it doesn’t it may well be due to the issues surrounding recontracting the network.
If the deal doesn’t happen, it will likely be due to the contracting issue, coupled with the profitability of the business compared to the price APAX is willing to pay.
I suggest you go back and read all the posts – when you do you will be the one doing the retracting.
Cheers!