OSHA’s heat rule is out…

OSHA’s long-awaited proposed heat rule is out.

There are two heat index thresholds – one at 80 and 90 degrees F based on temperatures in the shade (as we all know it can be a LOT hotter in direct sunlight.)

At 80F, employers would be required to:

  • provide drinking water,
  • provide break areas that workers can use as needed, and
  • have a plan for new and returning workers to adjust to the heat by gradually increasing their workload.

At 90F employers would have to:

  • monitor workers for signs of heat illness,
  • provide mandatory 15 minute rest breaks every 2 hours,
  • check on people working alone ever few hours, and
  • issue a hazard alert warning worker to stay hydrated.

Workers in “sedentary” jobs, those working inside where temps are kept below 80F, emergency response workers and remote employees are exempt, as are public employees including school workers.

From Bloomberg Law:

Once published in the Federal Register, the proposal will go through a public comment period and further White House review before it’s finalized—a process that could continue into 2025.

The timing is fortuitous…at least 45 million of us will be living with temps at or above 100 degrees F this week…including thousands of workers in California’s Central Valley and eastern Louisiana.

The EPA will release a report today indicating the heat wave season is a month and a half longer today than it was in the 1960s, and the average heat wave is a third longer.

What does this mean for you?

Very much needed…more workers are dying of heat-related causes than ever; human-caused climate change is speeding up; and injury totals climb along with temperatures.





Medicare’s future – Private insurance.

Under a new Trump Administration, Medicare will be privatized, with “Medicare Advantage the default enrollment option” for seniors.

This despite the myriad and well-documented problems with Medicare Advantage

from Commonwealth Fund

From a Medicare Advantage member:

“I have very little control over my actual medical care,” he says, adding that he now advises friends not to sign up for the private plans. “I think that people are not understanding what Medicare Advantage is all about.”

What’s worse is the member – Richard Timmins – may well not be able to switch back to regular Medicare with a supplemental policy (Medigap) that includes most healthcare providers and covers deductibles and other expenses.

Only four states — Connecticut, Maine, Massachusetts and New York — prohibit insurers from denying a Medigap policy if the enrollee has preexisting conditions such as diabetes or heart disease.

Traditional Medicare – managed by the Centers for Medicare and Medicaid Services – allows access to pretty much any physician, therapist, hospital or facility.

What does this mean for you?

Handing Medicare over to private insurers limits choice, access, and patient control over their healthcare. 



A beautiful Friday morning here in New York’s Finger Lakes…here’s the good news from this week.

First, the Supreme Court rejected the Purdue Pharma opioid settlement agreement – thereby allowing victims to pursue legal action against the Sackler family. As one who’s been deeply involved in the opioid disaster for a decade and half, I have somewhat mixed feelings about this – but have to support the Court’s decision.

The settlement would have shielded the Sackler family – many of whom were top execs and owners of Purdue – from personal liability.

It’s not hyperbole to say the Sacklers were directly responsible for the deaths of tens of thousands of daughters, sons, moms and dads, husbands and wives, friends and neighbors.  The settlement would have allowed these killers to keep some of their billions while avoiding any potential criminal or civil liability.

The downside is the settlement would have provided hundreds of millions of dollars for treatment and recovery services for addicts…losing those dollars is a tragedy.

That said, its very likely the Sacklers and Purdue will still have to provide funds to victims…and some of the Sacklers will now face civil – and potentially criminal – prosecution.

Lower drug costs

From CNBC:

  • The Biden administration  will impose inflation penalties on 64 prescription drugs, lowering costs for certain older Americans enrolled in Medicare.
  • A provision of Biden’s Inflation Reduction Act requires drugmakers to pay rebates to Medicare if they hike the price of a medication faster than the rate of inflation.


The economy grew by 3.1% YoY last year…a really solid result!

What does this mean for you?

Sacklers don’t avoid prosecution and liability, drug costs will drop, and the economy is pretty darn solid. 

Reminder – switching to Substack shortly – this may look differently in your email!


Opioid reduction in work comp and the impact on patients and prescribers

A just-published research study examined the impact of reductions in opioids on workers’ comp patients and prescribers in Ohio and Washington.

(our research which includes payers’ opioid spend is here)

Key takeaways:

  • Providers reported more limited and cautious prescribing than in the past
  • Both patients and providers reported collaborative pain-management relationships and satisfactory pain control for patients.
  • Despite the fears articulated by pharmaceutical companies and patient advocates, opioid review programs have not generally resulted in:
    • unmanaged pain or reduced function in patients,
    • anger or resistance from patients or providers, or
    • damage to patient–provider relationships or clinical autonomy.
  • Other insurance providers with broad physician networks may want to consider similar quality-improvement efforts to support safe opioid prescribing.

From Milbank Quarterly:

The data analyzed in this study were a subset of data collected within a larger parent project—a comparative effectiveness study of the WC agency ORPs [opioid reduction programs] implemented in WA and OH.

I’d note that some Ohio patients and providers surveyed had real and significant challenges with access to care, approvals and care management. The report noted:

The fact that some of the problems described above seem to be particularly acute in OH could be a result of the fact that most WC claims in OH are handled by MCOs, whereas in WA, claims are processed directly by the L&I. The uniquely negative experiences of patients and providers navigating injuries and pain management in OH could be because of MCO dynamics, such as staffing challenges, management issues, or other operational problems. In addition, some MCOs are for-profit companies, which may render them more likely to deny expensive medications, procedures, or consultations.

Note – I was a member of the Advisory Committee for this research project; it was funded by the Patient-Centered Outcomes Research Institute.

What does this mean for you?

Overall, efforts to reduce inappropriate opioid use have been:

  • effective,
  • helpful in getting patients and providers to collaborate, and
  • have not resulted in unmanaged pain. 


Solving pain – opioids, NSAIDs, and better options

WCRI’s latest report on drugs in workers’ comp has some excellent news...opioid usage dropped 29% from Q1 2021 to Q1 2023.

WCRI’s data is from 28 study states representing the vast majority of workers’ comp drug spend.

It may well be that NSAIDs are replacing opioids, a welcome event but not without potential downsides, namely side effects of some NSAIDs and far too much physician dispensing of these (mostly) very cheap drugs.

Fortunately other promising therapies – with very low risk – are also now available.

The FDA has authorized AppliedVR’s RelieVRx for treatment of chronic low back pain. RelieVRx’s authorization came after extensive research and massive clinical trials; the latest included over 1,000 participants.

The study was a large randomized controlled trial (RCT), evaluating virtual reality (VR) therapy for treating chronic low back pain (CLBP) at home.  Published in Mayo Clinic Proceedings: Digital Health, the study found AppliedVR’s RelieVRx program produced clinically meaningful improvements in clinically severe and diverse adults with CLBP.

What does this mean for you?

Much safer and quite effective treatment for chronic low back pain = lower risk and excellent outcomes.

AppliedVR is an HSA consulting client. And I’m damn proud to work with them.


State moves that will affect workers’ comp

The state legislation that will MOST affect workers’ comp is often not ABOUT workers’ comp – rather it deals with other parts of the healthcare ecosystem.

For example:

Regulating Pharmacy Benefit Managers


At least 41 state legislatures introduced bills targeting pharmacy benefit managers (PBMs), which are third parties that help manage prescription drug benefits on behalf of both public and commercial insurers. That includes California, New Hampshire and Rhode Island, where bills have passed at least one legislative chamber and lawmakers are still in session.

Notably, governors in 13 states signed PBM reforms into law this year. For instance, Washington and Oregon banned spread pricing, in which prescription drug middlemen charge health plans more than they pay pharmacies and keep the difference. Idaho, meanwhile, implemented legislation requiring PBMs to transfer 100 percent of manufacturer rebates on to insurers.

Gotta say some of these are short-sighted and based on faulty understanding of the roe and actual practices of PBMs. That’s not to say PBMs are faultless…my firm has audited a number of work comp payers’ pharmacy programs…and suffice it to say there’s a lot of gaming out there.

By far the worst was the Federal program…

What this means – legislation may well lead to changes in WC PBM contracts and pricing.

Expanding Medicaid:

  • stabilizes hospital financials a lot,
  • helps ensure rural and inner-city facilities keep their ERs open,
  • improves the health of lower-income folks and workers, and
  • likely reduces hospitals’ and health systems’ shifting costs to workers’ comp payers.

One of the last holdouts is Mississippi, the poorest state with the worst health outcomes, highest infant mortality rate, and shortest life expectancy. Pushed by a broad coalition of business, not-for-profits, and consumer groups, at long last the state’s legislature is attempting to expand Medicaid, although it’s doubtful the bill will pass and be signed into law.

Nonetheless, one has to celebrate small victories, and the fact that the legislature is even considering expansion is good news. 

Frankly, detractors’ arguments against expansion are tissue-thin, not fact-based, and when questioned, beyond superficial.

What this means – Medicaid expansion -> healthier workers, more access to care and lower healthcare  costs. 

Hospital and provider consolidation

WaPo – A recent study found that hundreds of hospital mergers have escaped federal antitrust scrutiny in the past two decades because the Federal Trade Commission lacks the funding and staffing to crack down on all anticompetitive deals.

And, states are increasingly concerned about private equity investors’ impact on  healthcare access and cost. 16 state legislatures – both blue and red – have introduced bills dealing with this issue this year.

What this means – a possible slowdown of provider consolidation. 

ALSO – MCM will be changing from WordPress and MailChimp to Substack next week – if you don’t get a blog post notification by July 5 check your spam/junk/trash folder. 


Lots of good stuff going on these days. First, good …well actually great news is from Pennsylvania.

From WESA:

Pennsylvania is getting another $29 million in federal funding to clean up abandoned mines, as part of the mine cleanup projects also aimed at promoting economic development.

Pennsylvania is getting nearly $245 million for mine cleanup in the latest round of funding through the federal infrastructure law.

Mark Farrah and associates comes the news that health insurance applications in Texas are growing dramatically. That’s the good news… The bad news is this is coming because Texas has ended the Medicaid expansion which brought insurance coverage to tens of thousands of previously uninsured Texans during the Covid crisis.

from Farrah:

following the end of federal protections on March 31, 2023, private enrollment in Texas surged by over 1.81 million enrollees through March 31, 2024, while Medicaid dropped by an inversely proportional 1.83 million

Finally, the Economist magazine’s news that solar now accounts for 6% of our electricity production and is growing rapidly.

Unlike other energy sources, the ingredients for solar cells are limitless, getting cheaper, and getting more efficient.

What does this mean for you?

More very good jobs in the Keystone state,

healthier Texans, and

yet more evidence, the transition to solar is rapidly increasing,




Workers’ comp pharmacy – the latest

We are finishing up our Annual Survey of Pharmacy Benefit Management in Workers’ Comp…here’s three findings from the 15+ we’ve done so far.

1) 60% of respondents are reporting an increase in overall drug spend – with reasons varying from more claims to an uptick in catastrophic cases to jurisdictional impacts.

While we’re a long way from done and more respondent data is coming in, if the trend continues this would be the second year of “non-decrease” in spend, signaling that the years-long drop in spend has stopped – and may have reversed.

This from last year’s Survey…this year’s will include 2022 and 2023 data.

2) Conversely, 80% of respondents are reporting lower opioid spend year over year. If other respondents’ data is consistent, this marks the seventh consecutive year of a decrease – wonderful news indeed as patients and providers choose safer – and often more effective – solutions to pain.
This from last year’s survey

3) Most respondents see a future for AI in the PBM world… but the emphasis is definitely on the future. There seems to be significant hesitation around implementing AI-based tools at this point. Ultimately, respondents see a range of “futures” – ranging from 100% automation of the entire process driven by AI to those who see AI focusing largely on early trend identification and clinical management improvements.

If you woulds like to participate, leave your info in the comment box below.

Public versions of our Annual Survey report are available for download here at no cost and no registration – note respondents get a much more detailed version of the report. 

Thanks to HSA’s Jay Stith and Helen Knight of CompPharma for their work on this year’s Survey.


Facility cost does NOT equal quality – part 4

Back to Florida… the home of many workers comp payers’ nightmares.

This time in Miami – where we find Kendall Hospital.  A large teaching hospital, level 1 trauma center, and…the most costly facility within a 10-mile radius.

Combining scores for patient safety, clinical outcomes, patient engagement and cost, Kendall Hospital ranks 6th out of 7 local facilities with a score of NEGATIVE .17 – largely due to its high cost but also because of its unpopularity with patients and below average clinical outcomes.

Kendall earns the worst score possible of -10 for cost – and for years has been one of the most expensive facilities in the area. Of the facilities in the area receiving a grade for patient satisfaction, Kendall ranks last with just a .8 out of 10 and scores a 3 out of 10 in clinical outcomes.

There’s one nearby hospital that scores waaaaay better on Health Strategy Associate’ proprietary Facility Assessment Tool; Larkin Community Hospital.

Larkin Community Hospital, earns a 0 for relative price (the LOWER the score for price the better)– the top score for the metric. It also scores 7 out of 10 for clinical outcomes (more than twice Kendall) and has a high patient safety rating at 8.3 out of 10.

Put it all together, and Larkin comes in as one of the top-rated facilities in all of Florida.

What does this mean for you?

Two things…how many of your patients are going to a very costly hospital with poor scores on patient safety and clinical outcomes?

And what are you going to do about it?

This post penned by Jay Stith, the brains behind HSA”s Facility Assessment Tool (c).


Good news Friday…jobs and wages are up, inflation’s down.

Going to be a nice weekend in New York’s Finger Lakes…hope it’s just as nice wherever you are…

Here’s the good stuff that happened this week…

Jobs and increasing wages

The economy is boomingadding over a quarter million jobs in May, continuing 41 consecutive months of job gains.

Wages increased over 4% year over year, driven mostly by the service sector.

Inflation’s dropping

Fox news reported “inflation cools more than expected in May” yesterday…the producer price index fell 2/10ths of a point, the biggest drop since October. (Producer prices are inflation measures at the wholesale level – before it reaches consumers)

The biggest driver???

Gas prices plummeted 7.1%.

Medical debt

The Consumer Financial Protection Bureau (CFPB) proposed a rule that would remove as much as $49 billion of medical debts that unjustly lowers credit scores for 15 million Americans.

The rule will:

  • strip medical bills from most credit reports,
  • increase privacy protections,
  • help to increase credit scores and loan approvals, and
  • prevent debt collectors from using the credit reporting system to coerce people to pay.

The CFPB was created to help consumers, and it has been remarkably effective. Bookmark the site for help with bank issues, junk fees, mortgage problems, credit  card fees, auto loans…

What does this mean for you?

More dollars in families’ pockets and more jobs + better debt ratings = happier people.