Aug
30

Help me understand…

Why some people refuse to get vaccinated, but are fine with taking large doses of drugs commonly used for horse de-worming.

Out of 163,000,000 people fully vaccinated, there have been 1,263 COVID deaths…yet anti-vaxxers still refuse to do the easy, safe, and smart thing.

Yep, in just one state, Missouri, there’s been a big jump in calls to the poison control center due to people in distress from taking ivermectin; at least two Mississippians have been hospitalized due to overdosing on the drug…. and 7 out of 10 calls to the center have been for ivermectin.

Ivermectin is also a big problem in Texas…

Ivermectin “tablets are approved by the FDA to treat people with intestinal strongyloidiasis and onchocerciasis, two conditions caused by parasitic worms.”

News flash – COVID is NOT transmitted by parasitic worms. Nor is there ANY credible evidence it protects against COVID or has any meaningful effects.

Yes, there is a research paper based on a meta-analysis authored by several scientists but these “scientists”:

  • didn’t disclose they are members of a group promoting ivermectin;
  • ignored the fact that most of the studies cited had “incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias,”
  • views were rejected by the leading scientific society focused on infectious diseases; and
  • another meta-analysis rejected the ivermectin-supporters’ “conclusions.”

Oh, and “The few existing higher quality clinical trials testing ivermectin against the disease uniformly have failed to find a positive result. It’s only the smaller, lower-quality trials that have been positive. This is a good indication that the drug probably doesn’t work.”

Double Oh, and the rest of the scientific world isn’t having their BS.

Triple Oh... after internet sleuths raised concerns about plagiarism and data manipulation, the preprint server Research Square withdrew the paper because of ‘ethical concerns’.”

And one more Oh…

Not only is ivermectin very much unproven, it is also dangerous when taken in large doses. From the FDA:

You can also overdose on ivermectin, which can cause nausea, vomiting, diarrhea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma and even death.

There are multiple reports of people taking horse-level doses of ivermectin;

Again the FDA:

animal drugs are often highly concentrated because they are used for large animals like horses and cows, which can weigh a lot more than we do—a ton or more. Such high doses can be highly toxic in humans.

Moreover, FDA reviews drugs not just for safety and effectiveness of the active ingredients, but also for the inactive ingredients. Many inactive ingredients found in animal products aren’t evaluated for use in people.

Meanwhile, reality is “less than 0.004% of fully vaccinated people had a breakthrough case that led to hospitalization and less than 0.001% of fully vaccinated people died from a breakthrough Covid-19 case…”

So we have knuckleheads overdosing on horse de-worming drug while they refuse to get vaccinated because…why?

They’re suicidal?

No – it’s actually because their “tribe”/”clan’s” views are more important to those individuals than ANYTHING else – including their lives and the lives of their loved ones, babies, grandmothers and spouses.

What does this mean for you?

Belonging to the tribe, and being accepted by the tribe, is the dominant force in the life of anti-vaxxing ivermectin-takers – and no amount of science, marketing, education, compassion or reason is going to get most of them to change.


Aug
12

Hypocrisy and Hippocrates

A physician posting on MedPage blamed many of the problems in healthcare on private equity…and for-profit insurers.

That takes some…[insert anatomical reference here]. While his assault on Private Equity does have some merit, I can’t let his assertion that the profiteers are insurance companies stand.  What makes me nuts is Liu’s mindless and demonstrably false assertion, coupled with his complete inability to see that he is part of US healthcare’s cost problem.

Dr Mitchel Liu stated “For-profit insurance companies have long been regarded as the ultimate offenders in medical profiteering.”
Wow. Coming from a physician, who make more than docs in any other country, that is ballsy indeed.
Reality is physician compensation is a key driver of healthcare costs, and one of the reasons our healthcare costs are so much more expensive than other countries’. For-profit healthplans do make billions…but their margins are tiny compared to healthcare providers.
Liu also says:
“It’s time for medicine, including individuals and professional societies, to restore the integrity of the physician-patient relationship by taking a strong stand against all forms of corporate greed.”
Well, docs are often partners in Ambulatory Surgical Centers and hospital outpatient surgery centers.  Many docs belong to big multi-specialty groups that are quite profitable.  And, docs make a lot of money.
What does this mean for you, Dr Liu?
How about taking a stand against physician greed, Dr Liu?

Aug
3

It doesn’t matter

if you think COVID is overblown, just the flu, not going to hurt you, came from a Chinese lab, or part of some bizarre plot by the New World Order.

it doesn’t matter if you haven’t been vaccinated because you haven’t had the time, don’t believe it works, think it contains a tracking chip, don’t trust science, think it needs more study, or are just lazy.

What matters is the unvaccinated are dangerous as hell. The more of us who get infected, the greater the chance COVID morphs again into something far deadlier and far more infectious.

Let’s talk freedom for a second. The old argument about where our freedom of speech stops is “you can’t yell “fire!” in a crowded theater.

Well, you don’t have the “right” to set a fire in a crowded theater. That is exactly what the unvaccinated are doing.

Even if COVID doesn’t get more dangerous, it is crystal clear the unvaccinated are why we may be headed back to lockdowns, mandatory masking and physical distancing, remote “learning” and all the awfulness that we are just now starting to leave behind us.

Not getting vaccinated is a “personal choice” to:

  • expose yourself and your loved ones to COVID,
  • tell your employer you don’t want to work,
  • tell first responders and healthcare workers you don’t care about them, and
  • make the rest of us pay for your healthcare if/when you get sick.

Those of us who are vaccinated can also make a “personal choice”;

  • you don’t get to work around us,
  • we won’t pay for your healthcare, and
  • you will be held liable for infecting others.

What does this mean for you?

Get vaccinated.

 


Jun
29

You bet your life.

For my friends out there who remain unconvinced COVID vaccinations are a good idea, please think again.

Breakthrough infections – fully vaccinated people contracting COVID – accounted for only about 1 in every 700 hospitalizations.

Put another way, people who haven’t been vaccinated accounted for 699 out of 700 hospitalizations.

A similar dichotomy holds for COVID-related deaths; fully-vaccinated people account for less than one out of a hundred COVID-related fatalities.

Not surprisingly states with lower vaccination rates are seeing higher infection, hospitalization and death rates.

Great source for tracking state-specific data

Arkansas, Oklahoma, and Missouri are among those states likely to experience increases in COVID infections, hospitalizations, and deaths.

There is another factor in play here – unvaccinated people are far more likely to get infected, become a COVID host, and pass their germs on to others. So not only do they risk their own health, they also endanger many more people.

And – and it’s a BIG and – the more people infected, the more likely COVID will mutate and become more transmissible and deadlier. We’ve already seen this with the Delta variant; transmission rates are increasing rapidly especially in the South.

What does this mean for you?

Please – get vaccinated.


Jun
24

The Delta Variant

You are as done with COVID as I am.

COVID is not done with us.

Here in New York’s Finger Lakes everything is open; had a great family night out yesterday, no masks required for those of us fully vaccinated, hiring signs are all over, and the joy that is upstate NY in summer is in full swing.

While we are blissfully enjoying life, the Delta Variant is:

That’s the bad really bad news.

The good news is vaccinations – especially the ones based on mRNA (e.g. Pfizer) are still “spectacularly effective” against the Delta variant. 

As in 96% effective in preventing hospitalizations.

However, that’s after both doses; a single dose is just 33% effective at preventing symptomatic illness.

Here’s the thing. The more of us that get infected, the greater the chance that the damn virus morphs into a deadlier, more transmissible, and thus even bigger problem. So far the vaccines we have are working.

But – and it’s a damn big “but”, far too few of us are vaccinated. That’s particularly true of southern states, where a combination of misinformation,  awful treatment of minorities by some governmental entities and segments of the medical community (the Tuskegee experiment being a prime example) and resulting mistrust, and difficulty with the J&J vaccine have combined to drastically slow vaccination rates.

click here for detailed state-specific data

Here’s a great graphic detailing state progress towards full vaccination…

All this is to say that the fewer vaccinated people there are, the more likely COVID will mutate into something even worse.

What does this mean for you?

Get vaccinated.

Note – if you want to debate or disagree, cite credible sources for your statements. Period.


Jun
17

Thursday catch-up

Doing my best to avoid work on Fridays…so moving this occasional catch-up post to Thursdays…

COVID

Promising news on the effectiveness of a drug to help infected patients fight off the virus was reported by the Economist. The good news – Regen-Cov:

saved the lives of many of those unable to make their own antibodies in response to SARS-CoV-2. Such “seronegative” individuals constituted about a third of the 9,785 hospital patients in the study…compared to a control group given standard treatment … 20% more patients survived

The bad news – it’s stupid expensive, and supply chain issues are hampering production.

A study conducted by the National Institutes of Health indicates COVID may have been in circulation earlier than originally thought. Blood samples from Illinois, MassachusettsMississippi, Pennsylvania and Wisconsin indicate the virus was in those states in December 2019. An earlier CDC study found similar evidence in California, Oregon, and Washington.

These findings indicate a better and more thorough process to identify disease outbreaks may well be warranted.

Comp drugs

WCRI is hosting a timely webinar on Interstate Variations and Trends in WC Drug Payments on June 24. Register here. Gotta say I’m darn impressed by the researchers’ ability to obtain, analyze, and report on payments as recent as Q2 2020. This makes WCRI’s information much more actionable for regulators, clinicians, and payers alike.

Dr. Vennela Thumula and Dongchun Wang of WCRI will be guiding us thru their findings; the webinar is free.

I am finishing up the latest Annual Survey of PBM in WC which will have 2020 and 2019 data; last chance to participate and receive a detailed, respondent-only version of the report. If you want to participate let us know in the comment section below (there’s no cost to participants).

Couple interesting – and very preliminary – takeaways…

  • growing interest in transparency, along with an increased awareness that this isn’t a simple issue.
  • spend continues to decrease, with respondents attributing some of the decrease to COVID.
  • opioid spend continues to drop, but most respondents are still struggling to help chronic pain patients/long-time users of opioids reduce usage.
  • there’s a growing awareness that the PBM pricing model needs to change. With spend declining and a push for transparency, knowledgeable payers understand that paying PBMs less year after year is not sustainable.

Previous public versions of the Survey Report are available here for download at no cost.

 

 

 

 

 

 

 

Hospital pricing

Hospitals are supposed to be publishing their prices – at least Federal regulations require them to. But those smart, sneaky administrators are figuring out all kinds of ways to avoid telling you how much it will cost for that MRI, drug, band-aid, or lung transplant.

From JAMA:

hospitals must publish discounted cash prices (applicable to uninsured patients) and payer-specific negotiated rates. Second, hospitals must display price data, including expected out-of-pocket costs, for “shoppable services” that can be scheduled in advance (eg, office visits) in a consumer-friendly manner that facilitates service-specific comparisons across hospitals (eg, price estimator tools). [emphasis added]

As of early March, only 17 of 100 randomly selected hospitals were complying with the regulations. The penalty for non-compliance is…wait for it…

$300 a day.

Perhaps if the Feds charged hospitals the same way hospitals they charge us, we’d have a bit more compliance. 

How about…the Feds tell the hospitals after the fact what the cost will be, based on a “compliance chargemaster” that takes into account the hospital’s margin, quality scores, number of collection suits it has filed, and medical error rate.

Thanks to the estimable David Deitz MD PhD for the head’s up.

Wellness works

Finally, HealthAffairs reports wellness programs don’t really improve population health, reduce healthcare spending, or improve employment outcomes. 

Almost 40 years ago, I was halfway through a Master’s of Science in Health/Fitness Management when it became obvious this was NOT going to be a lucrative career…quite the opposite. Not saying I was prescient, just that employers sensed this was a nice-to-have and not a got-to-have, and that lack of importance showed in salaries.

Dodged that bullet.

And really finally, congratulations to my favorite baseball team – the White Sox have the best record in baseball after taking 2 of 3 from Tampa Bay. I

know my friends in the Bay area will be heckling me when the Rays surge again…hey, you gotta take advantage of good news when it comes!


Jun
15

A business model in search of a problem

The workers’ comp services business is brutally competitive; a shrinking pie fought over by increasingly aggressive vendors, each striving to differentiate and demonstrate value.

Smaller players and newer entrants are pushing hard, attempting to show how their approach/service model/pricing/technology is better than more-established competitors’. This is keeping the big players on their toes, forcing them to improve, revise, deliver, respond…even innovate.

I can’t – and wouldn’t – fault any vendor for its efforts to differentiate. For buyers, the key is to discern which “differentiators” are actually useful, and which are just marketing-speak intended to make the vendor’s business model viable.

Blah blah blah blah blah…blah

A couple ideas may help separate the real from the flashy.

First – what problem does this solve? and is that your’s, or the vendor’s?

I’d suggest buyers can cut to the core if they ask:

  1. is this is going to decrease my combined ratio?
  2. by how much over what time period?
  3. at what internal cost? and
  4. how – exactly – is it better, and by how much, than my present approach.

Second, what proof statements is the vendor using to get your attention?

Are they comparing their “results” to industry leaders? If so,

  1. Where – exactly – are they getting the data re the leaders’ results?
  2. What is the basis for comparison – are the types of claims, patient demographics, injury types and severity, diagnoses, co-morbidities, employer types, and jurisdictions the same for the new vendor and the industry leaders?
  3. Does the new entrant have enough claims (that are similar to its competitors) for the comparison to be statistically valid?

Finally, dig deep into the methodology and thinking behind the vendor’s approach. Do they really understand at a deep level the problem they are solving, and can they clearly articulate:

  • the causes and origination of the problem (e.g. facility costs are increasing due to revenue maximization efforts by healthcare systems driven by financial pressures)
  • why the current solutions do not meet the buyer’s needs (e.g. broad-based WC PPOs have little negotiating leverage, don’t assess quality, and benefit from high prices and lots of services), and
  • how their solution is better, sustainable, and where and how it integrates into the buyers’ operations, processes, and technology and is consistent with regulatory requirements.

What does this mean for you?

This is not to say there aren’t better answers out there – indeed there are.

The key is to quickly identify solutions with real potential to solve your problem, as opposed to those that solve the vendor’s.

 

 


Jun
11

Low prices every day = higher taxes

Cheap stuff isn’t cheap…you always pay way more than you think…because the hidden costs of that cheap stuff are damn expensive.

Two examples…

Walmart’s slogan is “Save people money so they can live better.”

McDonald’s mission statement includes “make delicious feel-good moments easy for everyone.”

The two giants (and McDonalds franchisees) employ over 4 million workers, paying wages that are significantly higher than the Federal minimum (which is $7.65 an hour) – but certainly not a “living wage.McDonald’s shift workers make less than $10 an hour; Walmart’s was a lot higher, almost $15 an hour.

In just 6 states, 15,000 Walmart and McDonalds workers and many of their families are on Medicaid. Undoubtedly tens of thousands more get their healthcare from free clinics or in hospital ERs. This is especially true in states that did not expand Medicaid – looking at you, Florida, Mississippi, Arkansas, Alabama, and a dozen more.

The median cost of Medicaid – which is NOT per employee, but the employee and dependents enrolled in Medicaid – is about $8000. If we figure just 20% of Walmart and McDonalds’ employees on Medicaid have dependents, taxpayers in those six states are paying $120 million a year for Walmart and McDonalds’ employee healthcare. 

Add to that the cost of uncompensated care for the uninsured – which is subsidized by overcharging privately-insured workers and workers’ comp payers – and its blindingly obvious cheap stuff is far from cheap.

This isn’t just Walmart and McDonalds; workers at Uber, DollarGeneral, Fedex and Amazon and many other companies get their health insurance – and supplemental food aid – from you, the taxpayer. In fact, more than half of Medicaid enrollees are employed by private companies.

Make no mistake – I’m not blaming McDonalds or Walmart or any other company for doing what they are doing – or rather not doing.  Americans are addicted to buying lots of stuff (a lot of which is redundant or really not needed) and demand low prices.

What does this mean for you?

These companies are giving us what we demand, and we are paying a hefty price for cheap stuff. 

 

 


Jun
4

Good luck with the truck.

Let’s get real.

You and your kids are driving 80 mph on a highway, when a truck suddenly veers in front of you.  Since you are a quick-thinking insurance person, you estimate your chance of dying if you hit that truck at about 40 percent – just a bit better than even odds.

Or, you can swerve off the road – where your chance of dying is 1 percent – about 1 in 100.

This…

Or this…

What do you do?

That’s the question facing vaccine skeptics.

Vaccine skepticism is driven by memes, misunderstood data, a lack of understanding of basic math, pure laziness, demagoguing, and social media’s incredible ability to publicize nonsense.

Recently I had an electronic conversation where a COVID vaccine skeptic (my characterization, not their’s) cited “publications and VAERS” as sources for their concerns…I don’t know what publications the commenter was referring to; the only reference provided was a 14-month old TV report.

[reminder – if you discuss or debate, provide credible sources – ideally primary source – for your opinions.  Do your homework and don’t be lazy.  If you spout unsupported opinions – looking at you TJ – be prepared to be skewered.]

Leaving that aside, let’s talk VAERS, the vaccine reporting service run by the CDC and FDA. VAERS accepts reports from providers, vaccine recipients (or those who say they had a vaccine, parents, and “others” of any adverse event regardless of proof that it was caused by the vaccine. And VAERS reports can show deaths due to ANY CAUSE – could be drunk driving, hang gliding, heart attack, cancer, whatever.

Want proof ?A few years back VAERS accepted a report of a doc who felt like he was becoming the Incredible Hulk after a vaccination.  

VAERS is often misrepresented by Vaccine Skeptics lying about “problems” and deaths allegedly caused by the vaccine. [Here’s a great review of VAERS reporting issues]

Ok, the data.

VAERS received 4,178 reports of deaths (0.0017% of all who received the vaccine) between Dec. 14, 2020 and May 3, 2021. Remember about 165 million of us have had at least one shot. [source above]

Even if ALL 4,178 deaths were “caused” by a vaccine – and there is ZERO evidence that’s the case –  reality is your chance of dying from a COVID vaccine is far less than getting struck by lightning.

Compare that to your chance of dying from COVID – I ran the numbers here for a 55 year old white man from zip code 92111 with no pre-ex. The risk is .07 percent.

This person is 40 times MORE LIKELY TO DIE OF COVID than from an “adverse event” after you get a Covid vaccine.

What does this mean for you?

Science always wins…or, put another way,

Good luck with the truck.