Insight, analysis & opinion from Joe Paduda



Mar
28

Two big things

Aren’t getting near enough coverage from industry media.

We’re talking about the battle over prior authorizations (PA) and the Change Healthcare cyber attack.

Both have major implications for healthcare and workers’ comp; I’ll very briefly summarize both here and we’ll dive in next week.

Prior Auth.

PAs are used by healthcare payers to evaluate medical procedures, drugs, facility services and treatments before approving them. There’s been a major effort by the AMA and others to restrict the use of PAs, claiming PAs are all about increasing insurer profits, harming patients, delaying care, and leading to the end of civilization.

Well, maybe not the last, but pretty close.

PAs were instituted decades ago because some treatments/services/procedures/ hospital stays appeared to be unnecessary.

Several states appear ready to restrict the use of PAs or otherwise limit their use, add requirements and tighter time limits. 

Needless to say, there’s a lot of claims and counter-claims out there, some pretty strident with language intended to inflame.

Net – keep a close eye on this…it’s an election year and pols may well lean into the PA fight…likely on the side of physicians.

Change cyber attack.

I posted on this a few days ago…Change, which is part of UnitedHealthcare’s Optum subsidiary, suffered a major cyberattack a few weeks ago, one that has crippled a huge chunk of payer-provider electronic communications.

From WebMD

Change Healthcare, part of Optum and owned by UnitedHealth Group, processes about half of medical claims in the U.S. for about 900,000 doctors, 118,000 dentists, 33,000 pharmacies, 5,500 hospitals, and 600 laboratories…

Much of the system is (reportedly) back up and running, but the fallout  – severe cash crunches for small practices, delays in PA transmissions, confusion on what’s covered and what isn’t – continues to make life miserable for office staffs, providers, insurers and banking entities. 

Net – expect the Feds to dive deep into this, assess impacts, require much studier cyber protections and regulatory controls/monitoring of healthcare’s electronic information exchanges.

note – Change was an HSA consulting client prior to it’s acquisition by Optum.

 


Mar
27

They lied to you.

A really scary study was just published…one that shows just how deadly healthcare misinformation is.

Not “can be”, but is.

Remember those politicians promoting hydroxychloroquine as a cure for COVID – AFTER studies showed it had little to no benefit – and was dangerous?

Well, they have blood on their hands.

A very well done meta-analysis (rigorous review of all available research studies)  estimated there were 16,990 hydroxychloroquine related deaths in hospitalized patients in six countries.

One of the studies, known as the RECOVERY trial, showed a significant increase in cardiac mortality among patients receiving hydroxychloroquine (HCQ). 

The study published in PubMed this February is here.

Two things.

First, anyone willfully lying – or passing along someone else’s lies – to people terrified of a deadly disease has much to apologize for. Would these people tell friends and family to eat rat poison?

Drive drunk?

Inject fentanyl?

Of course not – yet by pushing HCQ misinformation out to friends and family, they did much the same thing.

Second, in a case before the Supreme Court, some politicians are trying to argue that spreading misinformation – like “hydroxychloroquine cures COVID” is “protected free speech.”

What utter BS. Again, is it okay to tell kids – “hey, vaping is good for you!”… or “Sure, unprotected sex is fine!” or “No car seat needed – just carry your baby sister in your lap!”

Tobacco companies and the opioid business are just two examples of industries forced to pay billions for publishing lies.

 

As noted in yesterday’s post, thousands of us are dying from preventable causes…that’s really, really bad…what’s much worse is politicians legitimizing deadly disinformation. 

What does this mean for you?

Spreading deadly misinformation is NOT “free speech”. It is a cynical and disgusting abuse of power.

 

 

 


Mar
26

The Pro-Life solution to the US health crisis

There’s a health crisis in the US – more people are dying younger, most from preventable diseases.

The good news is this is fixable. Sure there are any number of causes –

  • the opioid epidemic continues to destroy lives,
  • more kids are killed by firearms than anything else;
  • cancers associated with pollution are a major killer in some states;

all of which require thoughtful and very well-executed policy changes…which will take a lot of time, during which many more of us will die.

Like any complex problem the first task is to determine where the problem is. Thanks to the CDC, we know.

The lightest shaded states have the lowest life expectancy…

And the deepest red indicates states have the longest life expectancy.

8 of the States with the two lowest life expectancies have not expanded access to Medicaid…

And all of the States with the highest life expectancy HAVE expanded Medicaid.

Healthier people – kids, moms, grandparents, the disabled – live longer, more productive lives. And people with access to healthcare are far healthier than those without.

What does this mean for you?

If you are pro-life, the solution is blindingly obvious.

 


Mar
22

Good news, Friday!

Here it is, spring at last.

Well…not here in central New Hampshire where we’re going to get somewhere from 21″ of snow to…3-6″.  Gotta love the northeast in “spring”!

Income vs Inflation

Things continue to improve with worker income increases outpacing inflation.

From USAToday:

the average salary in the U.S. has grown by 5.4%, there was a gain of 3.2% in the Consumer Price Index for All Urban Consumers. This indicates that the average income increase is also an increase in people’s real income — taking into account their spending power.

Workers have seen steady increases in earnings over the last two years…

Two other items of note:

  • Black unemployment fell beneath 5 percent for the first time in history this last April.
  • There are 6 million more jobs today than in December 2019.

Innovation

The CHIPS Act – bipartisan legislation that funded development of domestic computer chip research and manufacturing – is creating tens of thousands of new jobs, many in Ohio, Arizona and Nevada.

And that’s just the start.

Today, a total of zero computer chips are manufactured here…in less than 6 years, 20% of the world’s most advanced chips by 2030 will be made in the USA.

That is great news indeed for workers, families, national defense, and our position in the world as the leading innovator of next-gen technology.

Kudos to politicians on both sides of the aisle.  

Innovation

One of the issues with healthcare research is studies, findings, and interpretation thereof may not factor in differences between male and female conditions, treatments, reactions to those conditions and treatments, long-term complications, and diseases and medical issues specific to either sex.

To address these disparities, The Administration announced a “new NIH-wide effort that will direct key investments of $200 million in Fiscal Year 2025 to fund new, interdisciplinary women’s health research…”

As more than half of Americans are female, this is very welcome news.

What does this mean for you?

We are getting wealthier and healthier.

 


Mar
20

Deconstructing Comp Pod!

Friends and colleagues Yvonne Guibert and Rafael Gonzalez went waaaay out on a limb and asked me to do another podcast.

I was all over the place, but Yvonne and Rafe were kind enough – and smart enough to rein me in when I diverged away from what was supposed to be the focus – impact of economics and the upcoming election on workers’ comp.

A deep dive into the economy started things off – how the House of Representatives affects physician reimbursement – and how that affects workers’ comp.

and how Medicaid dis-enrollment affects workers’ comp.

and how wage increases have outpaced inflation.

Listen on!


Mar
15

Medicaid

Checking in on Medicaid…41 states have expanded Medicaid, and by dribs and drabs some of the holdouts are moving to do the same.

Georgia may well be the next state to follow suit; a court recently ruled in favor of the Peach State’s approach.

Medicaid is one of those rare programs that delivers way more than it costs – economic impact is strongly positive, beneficiaries are much more likely to be healthy enough to work, clinical outcomes improve…

Oh, and uncompensated care costs drop – a LOT…so health systems and hospitals have less incentive to hoover dollars out of employers’ pockets.

Infrastructure investment – Billions of dollars will be invested to  improve infrastructure in places that need it most. From WaPo:

Earlier this week the White House unveiled $3.3 billion in federal grants to remove or retrofit highways that separate minority neighborhoods in many cities from jobs, entertainment centers, hospitals and other services.

In one of my adopted hometowns – Syracuse – the process is well underway. This rights a wrong done decades ago when politicians steamrolled poor folks in poor neighborhoods to build highways to suburbs.

Employment and long-term care

Yes, healthcare worker staffing is a big issue...the good news is much of the potential shortfall can be addressed by immigrants. 

Longterm care is particularly affected…three out of ten workers in long term care are adult immigrants.

What does this mean for you?

More opportunities, improved health, and more healthcare workers = a better place to live and work and raise a family.


Mar
13

Hackers disable nation’s largest healthcare data interchange

A major cyber attack has crippled the nation’s largest healthcare authorization and payment system, leading to weeks of missed payments.

From WaPo:

The hackers stole data about patients, encrypted company files and demanded money to unlock them. Change Healthcare subsequently shut down most of its network as it tried to recover.

The system owned by Change Healthcare, a subsidiary of United Healthcare, has been down since February 21; reports indicate BlackCat, a shadowy hacking group is responsible. BlackCat and/or a closely related entity reportedly received what appears to be a ransom payment of $22 million

UHC reported Change’s pharmacy processing functionality had been restored last week, and its

electronic payment platform would be reestablished beginning March 15, and that it expected to start testing and establishing claims network connectivity on March 18, with service restored through the week.

Don’t expect a full recovery then; that’s the date UHC will start testing a rebuilt system.

Change’s electronic communications, billing and payment system handles everything from utilization review to bill submission to validation to payment and reconciliation for hospitals, health systems, provider groups, clinics, specialty providers, pharmacies and Pharmacy Benefit Managers.

According to Change, the system handles about 15 billion transactions a year, or about half of all medical claims.

What does this mean for you?

P&C insurance execs and Boards should re-think  their chronic under-investment in all things IT.

note: HSA consulted for Change prior to its acquisition by UHG in 2022.


Mar
12

It’s a stutter.

I had a bad stutter for years,

From mid-seventh grade up thru high school I struggled mightily to get the words out, to avoid humiliation, laughter, scorn and – worst of all – pity.

As a formerly eloquent speaker and school play actor I had no idea what happened, why, how to fix it, and whether I’d ever be able to stand up in front of people and just…say   my   name.

It came and went for years after high school…I have a very painful recollection of  stuttering badly while giving a talk about exercise physiology during graduate school, watching the group suffer along with me.

Over the years I forced myself into situations again and again as I tried to overcome stuttering…for reasons unknown my stutter eventually faded into a distant if very painful memory.

I relate this because I am appalled by the media’s laziness, stupidity, crassness, and total lack of empathy all on full display when discussing President Biden’s occasional word stumbles. He’s not going thru dementia, nor does he have Alzheimer’s, and he’s not suffering the after-effects of a stroke.

Nope, he’s got a stutter.

Unlike me, the President has not fully conquered his stutter, yet he puts himself out there every day, knowing all too well he’s going to be laughed at, mocked, and demeaned because he stutters.

The meme-makers, mockers and insulters are pathetic indeed, seeking to drag down a person because of a sometimes-disabling condition, to use Biden’s condition to make them feel better about themselves, to get a cheap laugh from equally-pathetic barroom morons.

As for the media, I am furious with TV anchors, pundits, reporters, and editors for failing to address this consistently, fairly and completely. No, these superficial “personalities” would much rather parrot the “he’s old, see he can’t finish a sentence, mixes up his words, mumbles at times, and veers off track…” idiocy.

Well, you idiots masquerading as media those are ALL STRATEGIES STUTTERERS USE TO TRY TO GET THE WORDS OUT.

Mumbling hides stutters.

Mixing up words happens when you are desperately trying to find a word to use instead of the word that’s stuck in your throat.

Not finishing a sentence is because you can’t get the last words out without stuttering.

Going off track – same..

What does this mean for you?

How would you feel if you stuttered? Couldn’t communicate verbally? Got laughed at for something you can’t control?

I thought so.    So don’t be a jerk.

 


Mar
11

WCRI – the heat is on.

Kudos to WCRI – it is the first workers’ comp research organization to give center stage to the impact of climate change – primarily heat – on workers’ comp claims.

Dr David Bonauto of Washington’s Labor & Industry (state WC fund) led a session on Washington’s analysis of climate change’s affects on workers. A few quick takeaways…

There have been three studies re Heat Related Illness (HRI) in WA based on 16 years of data.  There were only about 850 accepted HRI claims out of 1.7 million…but the hidden impacts of heat are just beginning to be understood.

  • Heat increases absorption of chemicals thru the skin and potentially increases toxicity, a major concern for ag workers working with insecticides and fertilizers
  • Heat and wildfire smoke increases cardiovascular disease; it appears the mechanism is chronic inflammation.
  • Excessive heat leads to “incredibly diminished productivity”
  • There is a much higher [67%] risk of injury when temperatures are above 82-86 degrees compared to a baseline of 76 degrees.
  • The most vulnerable industry?   Public administration…my guess is this is driven by first responders and fire fighters.

thanks to MTI America’s Nikki Jackson for the slide pic

WA L&I isn’t the only organization doing credible research – WCRI research found 14% more claims occurred at times of high heat – think of these as indirectly related injuries. Falls off ladders are an example.  Great to see WCRI dig into this, although it would have been even better if we had this information several years ago.

The second employer session provided much-needed perspective from executives dating with the fallout from climate change.

Joann Moynihan from Travelers said the industry needs to broaden this dicsussion…it’s not heat claims specifically, but heat-related claims…Ms Moynihan’s words to the effect of “this is an indication of where the. industry is headed” should be a wake-up call to stakeholders who are mostly sleepwalking through massive changes to the work environment. 

Chrissy Lynch of the Massachusetts AFL/CIO described how workers in Mass are now dealing with forest fires…”we never thought we would”…that and it “doesn’t really snow here any more…we are trying to figure things out on the fly.

What does this mean for you.

Wake the *&^%** up. 


Mar
8

Good news Friday!…jobs and pay are both up!

275,000 new jobs last month – VERY good news indeed!

Since the beginning of 2021, over 10 million jobs have been created.

Yesterday’s jobs report showed strong employment growth across multiple industries;

 

Over the last 3+ years, 800,000 manufacturing jobs have been created..

Along with big job increases, wages are up too.

Last month average hourly earnings rose to $34.57 – a 4.3% increase YoY. (that’s about $69,000 a year)

From USAToday:

“Since the spring of last year, pay increases have outpaced inflation, giving consumers more purchasing power.”

What does this mean for you?

More jobs + higher wages = more payroll + more consumers buying more stuff.

Note – thanks very much to several folks at WCRI who thanked me for doing the Good News Friday posts – I appreciate you.

J.  – thanks for sharing that even though we may have different political views, you appreciate the posts.

Have a most excellent weekend!


 

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