Author: Joe Paduda

Feb
19

The good ones

Posted by Joe Paduda on Thursday, February 19th, 2015 | Comments

There are plenty of bad actors in the workers’ compensation industry – there are also lots of people – many unrecognized – who do the right thing day in and day out.  Some do so behind the scenes, others are right out there in front.  In my 25+ years in the business I’ve met – and watched – many of these women and men, and come to respect and admire them for their tireless commitment to making the work comp world better.

A few weeks ago I posted about the passing of Anne Searcy, M.D., noting “Her passing reminds us all that there are many people striving every day to do the right thing for the right reasons.”

Dr Searcy and the many people who share her selfless dedication deserve our thanks, our appreciation, and certainly broader recognition for the work they do and the impact they make.  Fortunately there are efforts such as the Comp Laude Awards (thanks to Dave Depaolo and his colleagues at WorkCompCentral) and others that focus on the good folks in comp. These efforts deserve more attention as they remind us (me especially) to not lose track of the good.

Bruce Wood is one of those good people.  Responsible for workers’ comp at the American Insurance Association, Bruce is a behind-the-scenes guy who truly understands and wholeheartedly supports the purpose of workers comp – prevent injuries and take care of the workers who do get hurt on the job.  To say he is dedicated is to damn with faint praise; Bruce is passionate, professional, and effective; he really cares.  In the eight years I’ve had the honor of working with him, I’ve seen the respect industry leaders have for his ability to effect positive change quietly, without drama or fanfare.

Bruce brings together industry professionals with outside experts to share ideas and puzzle out solutions to issues as diverse as opioids and second injury funds, medical treatment innovation and employee classification, black lung disease and “opt-out” options.  Somehow he’s able to get a group of industry execs from very diverse companies to agree on policies that improve the system for injured workers, employers, and taxpayers.

Partially as a result of his yeoman work, AIA has added members, most recently Accident Fund Holdings, Inc.

By enabling the industry to speak with one voice supporting the right thing, Bruce is one of the good ones.  That’s not to say he’s perfect; Bruce’s political leanings are (as my lovely bride would say) diabolically opposite from mine…but I’m working on it!

What does this mean for you?

There’s hope for workers’ comp.

Feb
18

The Thursday catch up

Posted by Joe Paduda on Wednesday, February 18th, 2015 | Comments

Sorry, dear reader it’s been a very busy week.  here’s what I;ve been tracking.

At WCRI, Rick Victor’s now the CEO and his apparent replacement has been named.  While that’s good news, what’s better is longtime WCRI exec Ramona Tanabe has been promoted into a new position of EVP and Counsel. Ramona is universally respected for her ability and knowledge; she’s one of the most talented people at a very talented place.

Back to the new guy; John Ruser, Ph.D comes to WCRI with a wide range of experience at the Bureau of Labor Statistics and in other positions at the Departments of Labor and Commerce.  I expect there will be a blurb up on WCRI’s site here in the near future.

Here’s a brutally funny – albeit 17 minute long – John Oliver video on pharma marketing.  It’s well worth your attention, as only the John Olivers of the world can make something this disturbing this entertaining.

Sticking with drugs, and the aggressive marketing of same, I’ve been immersed in the world of hepatitis C drugs for a couple of weeks.  Well, if not immersed, perhaps toe-dipping.  Anyways, turns out these new miracle cures may well not be cures at all.  The research cited to assert claims of a cure is pretty very hugely limited; one mass media article looked at outcomes after a whole six weeks of treatment…and further erred/exaggerated/got this entirely wrong by assuming “no more virus” is the same as an actual “cure”. 

btw, Health News Review is a terrific site for those questioning the validity of mass media reports on anything medical.

As if this wasn’t enough, news just out that health care spending may have grown by 5.6 percent in 2014, driven largely by…you guessed it…prescription drug costs which zoomed up 13%, and possibly higher net health insurance costs.

The numbers are preliminary, to be sure.  Of course, the real metric is health care costs as a percentage of GDP; we’ll have to wait another month or so for almost-final GDP and health care cost figures.

That’s all for now…

 

Feb
17

To understand, be at WCRI

Posted by Joe Paduda on Tuesday, February 17th, 2015 | Comments

The annual WCRI meeting is just a couple weeks away – if you haven’t signed up, you better do it now – here.

I caught up with Executive Director Dr. Rick Victor via email last week to get his take on key findings.  Understanding Rick doesn’t want to give too much away, here’s what attendees will hear..

MCM -There’s been a lot of recent research coming from WCRI; what has been the most surprising result that will be discussed at WCRI?

Rick Victor (RV) – An underappreciated, but likely very significant unintended consequence of the Affordable Care Act  is shifting cases from group health to workers’ compensation.

MCM – What is a key finding attendees will take away?

RV – Why surgery rates vary from state to state

MCM – Do you see any conventionally held wisdom that will be confirmed, or rejected, by research presented at WCRI?

RV – For states that do not have fee schedules, the decision to adopt one is a strategic decision from which there may be no going backwards

One of the most useful aspects of the WCRI Conference is there are few events where the audience is as sophisticated, diverse, and knowledgeable.  That’s why the conference is always sold out.

What does this mean for you?

Better be there…

Feb
13

The individuals suing to overturn Obamacare

Posted by Joe Paduda on Friday, February 13th, 2015 | Comments

An enterprising journalist located the 4 individuals so harmed by PPACA that the Competitive Enterprise Institute is taking their case, now known as King v Burwell, to the Supreme Court.

Two of the four qualify for hardship exemptions – that is, because even the cheapest PPACA plan would cost them more than 8 percent of their income, so they are exempt from the individual mandate.

“King” in King v Burwell is one of these two; he’s an uninsured 64 year old smoker who will soon be on Medicare.  Mr King is somewhat ill-informed about “Obamacare”, but as his income is low, he avoids the individual mandate.

The other, Rose Luck, is, if anything, even less informed about Obamacare; she warned her Facebook buddies Obamacare will “cost some people 77,000 dollars a yr.” While she won’t be required to buy insurance, Ms Luck is no fan of the person whose name is used to label PPACA; she did call the President the “anti-Christ” and said Obama was elected by getting all “his Muslim people to vote for him.”

I don’t see how these two worthies were actually “harmed”, as in, suffering any material or measurable or painful or negative consequences, from PPACA

Brenda Levy is also few months away from qualifying for Medicare, has actually never attended any of the court proceedings, and, when told that her suit could eliminate health insurance coverage for several million fellow citizens, was kind of upset, saying “I don’t want things to be more difficult for people…I don’t like the idea of throwing people off their health insurance.”

(about 8.2 million Americans will likely lose coverage if King wins)

Still, she doesn’t like Obamacare, even though she could have bought a plan for $148 at a time when she claimed her premiums were $1500 a month…

Which brings us to the fourth litigant, Doug Hurst of Virginia Beach VA. Although Mr and Mrs Hurst too would have qualified for a very large subsidy, Ms Hurst is vehemently anti-Obamacare.  When approached by the reporter, she would not provide any insights into her position or rationale.

Still, Mr Hurst and Ms Levy at least seem to have the legal “standing” to claim PPACA has somehow harmed them.  I don’t see how the other two litigants can, as they aren’t required to do anything due to their low income status.

So here’s my question.  Is this the best group of litigants the Koch-backed CEI could come up with?  How about someone who had to change health plans, or an employer mandated to offer coverage? A provider affected by lower reimbursement perhaps?

There’s no question PPACA can be improved; there’s also no question many opponents’ blind fury makes for pretty crappy strategy.

What does this mean for you?

CEI is little better than Hurst, King, or Luck – ill-informed ranters who don’t have any idea what they are litigating.  Of course, CEI does have the dollars to bring a case that may well cost 8.2 million Americans their health insurance.

 

Feb
12

Romance is in the (health care policy) air!

Posted by Joe Paduda on Thursday, February 12th, 2015 | Comments

A romantic but but not icky edition of Health Wonk Review is up at Peggy Salvatore’s Health System Ed blog.  Peggy covers all manner of romance and passion, minus the omni-present 50 shades stuff (thank you Peggy!)

Whether it’s a quick and highly readable explanation of Medicare’s Sustainable Growth Rate, a paean to the individual mandate and history thereof (thank you GOP!), or an alert about the dangers of nursing, Peggy’s got it for you!

 

Feb
10

The anti-vaccination idiocy

Posted by Joe Paduda on Tuesday, February 10th, 2015 | Comments

Penn and Teller profanely destroy the anti-vaccination case in a 90 second video well worth watching.

Unfortunately, many of the so-called anti-vaxxers won’t watch it, or understand it, or believe it.  No, they are willing to put their own kids – and everyone’s kids – at risk because of a completely wrong, now-retracted article in the Lancet purported to show a link between vaccinations and autism.

When, of course, there is NO SUCH LINK. As this group of parents with kids afflicted with autism eloquently shows…

And there’s any number of lunatics claiming vaccinations cause all type of horribles, e.g. whack-job, cartoon character Michelle Bachman’s assertion that the HPV vaccination can cause mental retardation…

From the other side of the political spectrum, there are anti-vaxxer liberals who don’t get refuse to understand/outright deny the science – nice to know we all have morons in our midst…

Fortunately, people in third world countries are a lot smarter than these cretins –

“We take vaccines so for granted in the United States,” Melinda Gates told HuffPost Live in January…

“They will walk 10 kilometers in the heat with their child and line up to get a vaccine because they have seen death. We’ve forgotten what measles deaths look like. We’ve forgotten … the scourges they used to be. But in Africa, the women know death in their children and they want their children to survive.”

The anti-vaxxers claim it is their right to jeopardize their kids – and yours. Fine.  While one could make a compelling case that their stupidity is grounds for a charge of child abuse, there’s a much bigger public health issue here, one that is all too obvious now that these idiots have allowed their kids into public spaces where they’ve infected others.

That case is simply this – if you choose to do, or not do, something that creates a significant public health risk, then you get to pay for the consequences.

Monetarily, criminally, civilly.

DWI, knowingly infecting partners with STDs, failing to keep firearms locked up, texting and driving, all are akin to the anti-vaccine movement.  And all come with legal consequences.

What does this mean for you?

Be careful, stupidity didn’t die out with the Middle Ages.

Feb
6

Friday catch-up

Posted by Joe Paduda on Friday, February 6th, 2015 | Comments

Just two things today – Let’s start with the CorVel – Fort Worth PD incident.  After a police officer was shot, CorVel sent a nurse to the hospital, where the nurse was accused of asking “inflammatory” questions by an outraged Mayor.  This hit the print and video media, and CorVel has been pilloried by some for “insensitivity”.

My take is this appears to be blatantly unfair to CorVel and the responding nurse.

According to a piece in WorkCompCentral this morning, an internal investigation at CorVel indicates the nurse acted appropriately; CorVel is supposed to send a nurse immediately upon notice of a catastrophic injuries – standard practice across the industry. The nurse has a list of questions to ask, including the condition of the injured employee.  Evidently the nurse asked the family these questions, and the family was upset.  According to CorVel, the police liaison person mishandled the nurse’s visit.

I’m no CorVel fan, but they are getting a raw deal here.  CorVel has apologized to the family; from what I’ve read it looks like the Mayor is the one who should be doing the apologizing.

Bob Wilson has a slightly different perspective; he notes timing is everything.  True indeed, altho in this case CorVel would have been damned if the nurse wasn’t doing what s/he was supposed to when s/he was supposed to.

Coming on the heels of a not-favorable earnings report – with lower overall earnings driven by declining profits on the TPA and network businesses – this must make for some unhappy execs at CorVel HQ.

Maryland’s dropped the ball on doc dispensing in work comp

I’ve got to take state legislators, a few insurers, and the regulators to task here.  A number of stakeholders signed a letter agreeing to not propose legislation to address doc dispensing for the next two years.  They based this decision on data provided to the Workers’ Compensation Commission, data that – according to the Commission’s Chair – showed a decrease in physician dispensing from 2011 to 2014.

The Chair – Karl Aumann – is a good man, but I have to challenge this assertion.  I haven’t seen the report that Chairman Aumann is referring to, but hope to get a copy.  In the interim, I defer to WCRI, which reports an increase in doc dispensing in Maryland.  For some reason Aumann doesn’t trust WCRI’s information, which makes him one of the very few people who take issue with that august institution’s findings.

What’s most troubling is the letter  – and the logic for the legislative hiatus – completely ignores the biggest problem with doc dispensing; medical costs are higher, disability is longer, and indemnity expenses are higher.  The “it isn’t as bad as it used to be” logic is faulty at best.

I’d also note the letter misstates AIA – the American Insurance Association’s “position” on the legislative hiatus.  My sources indicate that AIA did and does have a position; they were NOT in favor of a hiatus and wanted a bill that would address the core issue.

This is a big weekend – it’s the opening of the college lacrosse season – here’s hoping your team does well…unless it’s Siena…

Feb
5

The now-notorious 59 modifier

Posted by Joe Paduda on Thursday, February 5th, 2015 | Comments

I’m really puzzled about two things.

After 4500+ views of my post re the 59 modifier and its use/abuse, an energetic conversation on Mark Walls’ LinkedIn group on the topic, and a bunch of conversations with PT providers, what’s surprising is the:

  • apparent lack of concern amongst most PT providers about this, and
  • the lengths to which some are going to spin this as a “non-issue”

For the providers, it isn’t so much a lack of concern as misplaced anger.  Many of the  commenters and PTs I’ve spoken with are painting all managed care companies with the same broad brush, an approach that is as unfair and wrong-headed as characterizing all PTs as over-utilizers.  Do networks make money by connecting providers and payers? Yes.

Is this somehow “bad”? Of course not.  Aggregators work in every industry in this country – from insurance to hospital supplies to shoes to department stores to travel.

In work comp, there are networks that don’t alter provider treatment codes, and there are networks that do.  If you want to know if your network does, ask them.

Providers should be focusing on the impact of networks adding the 59 modifier to the treating providers’ bills.

Specifically;

  • are you, treating provider, getting paid fairly for this treatment that you allegedly didn’t bill correctly for?
  • your treatment records now reflect higher utilization for many patients; as networks are constantly evaluating and assessing provider performance, are you being judged fairly?

OK, on to the messaging.

There is an obtusely-worded document currently circulating that makes several rather stunning statements, including:

  • Treating providers correctly use the 59 modifier the vast majority of the time
  • 59 modifiers should be used on less than ten percent of PT bills
  • The network reviews the clinical documentation and adds the 59 modifier if appropriate

Given that some HSA clients have seen modifiers on more than 40 percent of their bills, it’s hard to see how a network could take the time to individually review clinical documentation on each and every bill, then make a determination that 40% of bills needed to be changed.

Especially when those treating providers bill correctly the vast majority of the time.

The coding experts I have spoken with all agree: no network should ever change a treating provider’s coding, which this document indicates the network actually is doing.  OK, perhaps the coding experts I spoke with don’t know what they’re talking about…

and perhaps your spouse is going to win “The Voice”.

We are left with the rather clear statement that less than 10% of provider bills should include the 59 modifier.

What does this mean to you?

If more than 20% of PT provider bills include the 59 modifier, somebody got some ‘splainin to do…

because your PT costs and “savings” may well be inflated.

Feb
3

Update on OneCall’s executive moves

Posted by Joe Paduda on Tuesday, February 3rd, 2015 | Comments

In a press release issued late yesterday, OneCall Care Management indicated the company had named Chris Watson as EVP Operations.  While the release doesn’t provide any clear indication if this position is superior to the current two “divisional” COOs, word is Watson will have overall responsibility for all operations.

A press release about Ms Lane’s new position noted that Bob Zeccardi will “continue in his role as CSMO (Chief Sales and Marketing Officer); I had written yesterday “Long-time sales boss and all-around good guy Bob Zeccardi has moved into a different role, partially replaced by Matt Dougherty, former eastern regional sales VP.”

Clearly, Bob remains as CSMO; my earlier characterization of a “new role” for Bob may well be in error.  Not trying to dissemble here, rather basing this on sources indicating sales will be aligned with the two operational “divisions” (my word, not theirs) with DME (labeled EDM for some reason by OCCM insiders) home health, dental and “doctor” in one division and PT, Imaging, and Transportation/Translation (T&T) in the other.

I asked OCCM’s PR folks for clarification and received copies of three press releases; one referenced above, one about Linda Lane’s new position as EVP Business Development, and one about their CIO (which I noted yesterday), followed by a statement to the effect that they wouldn’t comment on sales strategy and alignment as that is proprietary.

Be that as it may, if there have – or haven’t – been changes we’ll know pretty soon.

(Note only one of these releases is up on their site; the two dated yesterday aren’t up yet. Sometimes it takes a little time to get press releases posted to company websites.)

Hat tip to WorkCompCentral for the notice…

Feb
2

Quite a Friday

Posted by Joe Paduda on Monday, February 2nd, 2015 | Comments

While the dust is a long way from settled, it is quite apparent there have been some major changes in personnel among some of the big players in workers comp services.

Two senior Coventry staff – industry veteran and network expert Bruce Singleton and COO Chris Watson – have moved on, with Singleton reportedly bound for Multiplan.

Coventry has promoted a divisional operator to the COO slot.

Watson is now at OneCall Care Management; different takes on his role.  Currently there are two COOs; one (Dave Olson) over PT, T&T, and imaging and another (Will Smith) on DME, home health, dental and the rest of the business.  Will be interesting to see how Watson fits in.

Long-time sales boss and all-around good guy Bob Zeccardi has moved into a different role, partially replaced by Matt Dougherty, former eastern regional sales VP.  In account management, Linda Lane has relinquished her position as head of account management to assume sole responsibility for servicing a couple of major accounts.  Her replacement is reportedly Jeff Flannagan.

Aaron Quick, a key executive involved with some of Align’s largest accounts, also resigned recently.

And, in the only public announcement, OCCM hired a new CIO on Friday as well, this time from outside the industry.

Word is there may be more changes afoot in OCCM’s C-suite – if they haven’t a;ready happened.

What’s driving these changes?

I’d guess Coventry folks have been reading the proverbial wall writing and are only too glad to move on.

As for OCCM – major changes in sales, account management, operations, and IT leadership point to rather more dramatic goings-on.

it appears the Align folks are ascendant; I won’t speculate as to why Apax saw fit to bring in another operator – if, in fact, Watson is in that role.

We will know a lot more this week.  Here’s hoping this works out well for those who deserve it to.