For those I caught with my April Fool’s post…I hope you took it in the spirit in which it was intended…

Okay, back to reality (oh no….)

Hospital closures and cutbacks

Another hospital in a non-Medicaid expansion state is closing its ER and shuttering its inpatient care facility. The facility was acquired by a competitor a mile away a few years back…if this goes like most acquisitions folks around Anniston Alabama will likely have poorer outcomes and pay higher prices…

Ignore the corporate happy speak from the owners…this is the same stuff every exec that buys a rival hospital says.

Oh, and here’s research showing the link between Medicaid expansion and hospital closures.

Consolidators are doing just fine…the CEO of CHS just “earned” $8.3 million in pay and perks.

Obamacare…aka the ACA.

Remember way back when folks got all worked up about the ACA, how it was going to kill off old folks, destroy the “best healthcare system in the world”, cost millions of jobs and bankrupt thousands of small employers…and lots of people hated it?

News flash – Americans like it.  A lot.

That’s because:

  • Pre-existing conditions are covered.
  • Kids can be covered under the parent(s)’ insurance till they are 26.
  • 45 million Americans get insurance thru Obamacare and/or benefit from its provisions.
  • Provisions ensure adequate benefits for mental health, emergency care, maternity and child care and seven other key healthcare needs.
  • People who actually had Obamacare plans realized it saved lives.

Oh, and since people with health insurance are healthier than those without, if they’re hurt on the job, they recover faster and employers don’t have to pay to treat co-morbidities. 

We’re going to dive deep into the ACA in a coming week…stay tuned for more facts.

Change Healthcare cyber attack

It isn’t over. Owner United Healthcare recently stated patient data had been stolen by hackers.

This is a much bigger story – with much wider implications – than many think.

What does this mean for you?

More stuff affects you and your business than you may think. 


Rural hospitals – and healthcare – are in deep trouble.

With the unwinding of Medicaid post-COVID emergency, rural healthcare is falling deeper into financial trouble.

Consulting form Chartis just published their review of rural healthcare…among the findings

The unwinding issue is exacerbating problems in states that failed to expand Medicaid…the vast majority of which are those with the most hospitals in financial distress.  Simply put – they have to deliver way more healthcare to people without health insurance.


Across the 10 remaining non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming), the percentage of facilities with a negative operating margin increased year-over-year from 51% to 55%. These states are home to more than 600 rural hospitals…Several of these states are among the most severely affected by hospital closures and a loss of access to care.

The percentage of America’s rural hospitals operating in the red jumped from 43% to 50% in the last 12 months.

418 rural hospitals are “vulnerable to closure” according to a new, expanded
statistical analysis.

Healthcare deserts are a huge problem for rural America, especially in areas with lots of extractive industries (mining, energy, agriculture. Workers in those industries are much more likely to suffer severe occupational injuries, injuries that benefit greatly from care delivered in the “golden hour”.

What does this mean for you?

Not expanding Medicaid is killing rural healthcare.


Facility costs and quality – are you operating in the dark?

Probably yes.

Facilities account for between a third and half of work comp medical spend – and that share is increasing as health systems and hospitals consolidate.

Reality is there’s major variation between hospitals  – some are stupid expensive, others quite reasonable; some have crappy quality, others excellent quality.


Here’s a good one for our colleagues in Louisiana…two hospitals less than 15 miles apart, with VERY different costs and similar quality ratings.

Note costs are for MSK conditions…pretty relevant to workers’ comp.

So, you can send your injured workers to a VERY expensive facility  – Tulane – that does a handful of complex surgeries OR…

To a MUCH less expensive facility – Ochsner – that does 14 times more surgeries (practice makes perfect…)

Let’s add a CMS quality metric...for our friends in the Sunshine State, you can send injured workers here…

solid quality, and very reasonable pricing…

or…here (just a few miles away)

to a facility with a bottom-of-the rating by CMS and costs more than double its higher-quality neighbor.

These data are available from a few states and CMS (takes some digging); HSA also has developed a national tool enabling instant facility comparison across multiple quality, patient safety, and cost metrics – drop a comment below if you want info.

What does this mean for you?

Do you want to spend $98,000 at a  facility that does few procedures, or a quarter of that at a facility that does hundreds?




Hospitals are…

a) in desperate financial shape, on the verge of bankruptcy…

b) doing quite well thank you, enjoying very healthy profits…

c) both.

The answer is…C.

For-profits – HCA, Tenet et al are doing great, while (most/many) not-for-profits are really struggling, with some on the verge of/going into bankruptcy.


Very briefly, for-profits (there’s lots of nuance here, but generally);

  • don’t take Medicaid patients,
  • have very strong orthopedic and cardiac surgery practices which are very profitable;
  • do their best to avoid/transfer/not care for the uninsured.


  • include inner-city and rural facilities that must take Medicaid and
  • serve as primary care providers for the indigent and uninsured and
  • deliver lots of babies and provide general med/surgical services which are marginally profitable

What does this mean for you?

Hospitals of all types are looking to maximize revenue, especially from very profitable payer types.

Is that you?




MedRisk acquires Medata

MedRisk and Medata just announced the former has acquired the latter.

Pretty interesting move…note I’ve worked with Medata in the past and worked with Medrisk for decades – and still do.

The official release is below – here’s my take.


Data – Medata has a wealth of data on all types of medical services; MedRisk has data on millions of (physical medicine) episodes of care. Together, there are several potential benefits:

  • More information is good, helping identify best practices and providers with – and without – good outcomes. This will help improve patient outcomes.
  • Medata has data on post-PT costs, medical care, provider usage and other very useful information. This will help MedRisk better understand care delivered after a therapy episode and identify opportunities to improve return to work, transitional duty practices, and issues that may arise post therapy.
  • Network development – Medata has a wealth of information spanning decades on  physical therapy, occupational therapy, and chiropractic services’ prices, reimbursement, utilization and trends. These data will further help improve MedRisk’s network and enable it to provide better information re provider performance in- vs out-of-network.
  • These benefits will be felt soonest by mutual customers, but over time will improve results for each company’s unique customer base.


MedRisk is the largest manager of physical medicine in work comp and does a LOT of bill review in that space. Now that it owns a BR company, BR costs should decrease, improving margins albeit it on the margin.

With bill information coming into Medata, MedRisk will be better able to identify out-of-network therapy and where possible and appropriate either enroll the therapist if credentialing approves or divert the  patient to an in-network therapist. This will improve patient outcomes, increase payers’ network penetration and likely reduce cost of care.

Here’s the press release…

MedRisk acquires Medata to further improve the claims experience for customers, patients, and providers


King of Prussia, Pa. (January 9, 2024) — MedRisk, the leader in managed physical rehabilitation in workers’ compensation, has announced its acquisition of Medata, one of the leading providers of cost management and clinical solutions in the United States.

With this acquisition, customers of both companies will have access to expanded care management and cost containment offerings in workers’ compensation.

“We are excited to add Medata to our team,” said Sri Sridharan, MedRisk CEO. “This will further enable us to deliver superior claims outcomes and experience for our customers, for the patients we serve every day, and for our provider partners. In addition, we will now be able to leverage our inventory of data from both organizations so we can deliver unique insights and additional innovative solutions.”

Based in Irvine, California, Medata provides the most comprehensive cost containment and document management solutions in the workers’ compensation and auto liability industries.

“We are thrilled to become part of MedRisk,” said Medata President Tom Herndon. “Our companies recognize customers want greater alignment among their service partners, and this change strengthens our foundation and will drive investment into product innovation. Together, we will leverage our collective resources to continue delivering exceptional products and services to our customers.”

“For 30 years MedRisk has focused on creating a better experience for patients, our customers, and the entire industry,” said Mike Ryan, MedRisk Executive Chairman. “The addition of Medata is a natural and exciting step forward for us to further accomplish that mission.”

About MedRisk

Based in King of Prussia, Pennsylvania, MedRisk is the nation’s largest managed care organization dedicated to the physical rehabilitation of workers’ compensation patients. For more information, please visit www.medrisknet.com or call 800-225-9675.

About Medata

Based in Irvine, California, Medata provides the most comprehensive cost containment and document management software and solutions for the insurance industry. The company serves insurance carriers, self-insured companies, third-party administrators, state funds, and public entities in the workers’ compensation and auto liability industries. For more information, please visit www.medata.com or call 800-854-7591.

# # #

Media Contact:  Helen King Patterson, King Knight Communications, 813-690-4787, helen@kingknight.com


Provider consolidation = Higher workers’ comp costs, longer disability

Healthcare provider vertical integration increases work comp medical costs, increases disability duration, and does not deliver better outcomes.

And, provider consolidation continues to increase.

The lede is the one-line summary of WCRI’s latest – and quite useful – research.

Olesya Fomenko and Bogdan Savich collaborated on a very well done study of vertical integration of providers’ impact on work comp, and their research bodes ill indeed.

Summarizing the experts’ findings, vertically integrated providers had: 

Some detail…courtesy WCRI

And if you think that’s bad…here’s the impact on disability duration…

These conclusions generally align with what we’re seeing from other payer types…consolidation leads to higher prices and negative to neutral impact on outcomes.

That isn’t stopping consolidation  – far from it.

What does this mean for you?

Find out how consolidated provider markets are where your business is. And watch for more consolidation, as that will predict higher costs.


Optum employs(?) more doctors than any other organization

The giant subsidiary of United Healthcare employs [>]90,000 MDs and 40,000 more advanced practice clinicians – far more than any other entity.

That’s more than one out of every ten physicians, and a far higher percentage of practicing MDs.

While that’s pretty amazing, its just one of the many investors, healthplans, private equity firms, large healthcare systems, and insurers snapping up all manner of healthcare providers.

In fact, almost three-quarters of all physicians are employees of companies or healthcare systems/hospitals – not members of physician-owned practices.

As with everything in healthcare, location makes a big difference.

One of the biggest drivers has been Optum’s acquisitions, which included Kelsey Seybold, a very large practice in Texas…Optum reportedly paid $2.2 billion for the business.  And, that happened AFTER the time period in the graph.

What does this mean for you?

Your healthcare will be driven by investors’ goals.

note – Optum’s communications folks asked me to publish a correction, because not all of the 90k docs are “employees”…I asked how many of those 90k docs are “employees”; Optum’s reply was “We don’t break out the numbers because we focus on the total number who serve our risk-based patients.”

I’m quite sure Optum knows the number. why they won’t release it is a mystery.

I also asked – twice – whether the “physicians who contract directly with Optum” (which make up some/part of the 90k docs):

  • exclusively contract with Optum,
  • are allowed to contract directly with other payers, and/or
  • is Optum the contracting intermediary?.

I didn’t get an answer.

So, all I can tell you, dear reader, is Optum directly employs ≤ 89,999 physicians, and may or may not allow those “non-employed” physicians to contract with other payers.


The worst job ever.

Has to be nursing in a health system or hospital.

There’s bullying of young nurses by “more senior” nurses…

Management dismissing nurses’ complaints about sexual harassment, groping, violence and abuse.

Awful hours,

Having to ask if you can go to the bathroom

Seemingly endless shifts

Forced overtime

Working next to – and training – a travel nurse with half your experience who makes twice what you do.

And lest we forget, dying in droves during the early days of COVID.

Here in the Upper Valley in New Hampshire, I recall signs and posters and cheering for nurses and other staff in the early days of COVID.

This lasted about 2 months…followed by COVID deniers using, screaming at, hitting, and abusing nurses.

From heroes to scapegoats, the fall was catastrophic and all too real. This wasn’t unique to northern New England.

Several family members lived through this hellscape, and it isn’t getting any better.

The net is this – our healthcare system is collapsing and the very people who are desperately trying to keep it – and us – functioning are being served poorly by management.

What does this mean for you?

Thank every nurse you know, see, meet, or encounter. They really, really need and serve it.

And call out those – including management – that don’t acknowledge, protect and respect nurses.

note – this very likely applies to many if not all those who work in healthcare facilities…I limited it to nurses because I have first-hand knowledge of their plight.



Yelling into the void

I attended a New England Journal of Medicine webinar on value-based care yesterday…net is I heard a lot about “patient centric” care, “patient experience” and quality but precious little about functionality and patient-specific or patient-desired “outcomes.”

Except for a few tangential mentions by the Optum Medical Director, what patients actually want was not addressed at all.

This is a big miss.

Like so many other failing industries, healthcare is completely missing the point – which is delivering what the consumer wants. “Patient experience” is mostly was the office clean, the nurse nice, the floor quiet.

We are ignoring this at our peril…we are not asking what patients actually want from healthcare; NOT the processes and functions noted by one of the panelists but how patients define “healthy”, what they want to be able to do, what functionality is important to them, how they want to live their lives.

Healthcare is provider and process centric;  the entire industry has failed to address what consumers and employers want from healthcare.

Here’s hoping that healthcare figures this out faster than Detroit did.

What does this mean for you?

Healthplans and healthcare providers that figure this out will kick butt.



Work comp provider networks and access to care

Of late there’s been “confusion” in several quarters about the impact of provider networks/PPOs/specialty networks on access to care and outcomes.

These uninformed or willfully ignorant folks claim all manner of bad stuff is due to workers’ comp provider networks – without an iota of evidence to support those assertions.

Let’s pick on the Golden State…

Let’s be clear…actual research shows:

there is NO significant difference in access to care for patients treated within or outside a Medical Provider Network.

This from CWCI’s report

Similarly, there was no significant difference in distance from the patient to provider between MPN and non-MPN patients.

Quoting CWCI…

The latest proximity to care findings also track with results of CWCI’s April 2021 research which found that 99 percent of claims in which treatment was rendered by an MPN provider, and 98 percent of non-MPN claims met the state’s access standards.

What does this mean for you?

Do NOT give any credence to statements similar to: “of course, paying providers less than fee schedule affects access to care” UNLESS they are backed up by real research and not built on a pile of unfounded and unsupported assumptions.