Facts for this weekend’s chats!

Whether you’re chatting around the grill, conversing at a swim meet or hockey game, or between quarters of a football game, here’s the real scoop on the economy, with immediate responses to show you’re the one with the real story.

hint…the “everything sucks” narrative is flat out wrong.

  1. No one wants to work these days! 


Net is the percentage of everyone 16 and older working today is within a half point of pre-COVID participation rates.

No, there is NOT some huge number of Gen Zs, millennials, or whatever that’s said “screw it, we’re outta here, and I’m gonna live with/off my parents forever!”


And…for the core group – folks 25-54 – labor force participation is near an all-time high at 83.5%!


2. Well…there just aren’t that many people working!

Hmmm…There are more people employed now than ever, and employment has been increasingly steadily for the last three years.

credit FRED.

3. Okayyyyy…but inflation’s higher than wages, so we’re falling behind!!

Well, no – since way back in March – 9 months ago – earnings are growing faster and more than inflation, so you can buy MORE with your weekly paycheck today than you could a few months ago.

source Statista

What does this mean for you?

You are gonna be soooo smart.


Getting smarter about PT.

Why do some patients need more PT than others?

Why does a therapist’s treatment duration vary for patients with the same diagnosis?

What conditions have the most impact on patient recovery?

Thanks to WCRI’s Vennela Thumula PharmD; Randall Lea MD; and Te-Chun Liu there are answers.

WCRI’s latest research based on FOTO data digs into just how big an impact mental and physical health co-morbidities – and other factors – have on improvements in functional status.

The methodology is robust indeed, the data solid as it gets, and the insights provided by the researchers quite valuable.

Using FOTO’s 100 point scale, their research indicates patients with both physical health and mental health comorbidities see about 20% less improvement in functional status than patients with no comorbidities.

courtesy WCRI

Co-morbidities – aka health conditions a patient has in addition to the one you’re focused on – may be physical – think obesity, hypertension, arthritis – or mental – depression, anxiety/panic attacks, sleep dysfunction.

Quick takeaways…

About two-thirds of patients have a physical or mental health comorbidity, and these comorbidities definitely affect the patient’s ability to recover.

The more comorbidities a patient has, the greater the impact on recovery.

More troubling still, the more likely these patient would have “very limited” function at the end of therapy.

The researchers also looked at the same metrics for non-work comp patients…and found comorbidities had similar if not more impact on recovery.

And…it isn’t just comorbidities.

Quicker access to PT had an even greater impact on recovery than physical or mental health complications. The details are on page 43 of the study. If you’re not a WCRI member, become one to get access to all their great work at no charge.

Non members will have to pony up a few bucks to learn more.

What does this mean for you?

Great research is really useful…use this to help injured workers get better faster. 




Good news Friday – unemployment and wages are up…inflation is DOWN!

Sometimes the experts get it wrong – really wrong.

Which can be very good news indeed.

Exhibit 1 – Surprising many economists, the “soft landing” – reducing inflation WITHOUT super high unemployment – is real.

A key indicator shows the inflation rate is now lower than it was 2 years ago.

Now…you will hear some caterwauling that this or that measure is wrong because it isn’t what people actually buy. Okay, let’s look at what people actually spend their money on – a metric called the “Harmonized Index of Consumer Prices” – it’s the green line in the graph below.

As of July 2023, that rate is a paltry 2.5% – right in line with the Fed’s desired inflation rate.

Make no mistake, engineering a soft landing defined as fixing inflation without high unemployment – is rare indeed…Those of us who remember the early eighties recall mortgage rates of 17%, unemployment in the high single digits, and a job market that was horrible/awful/lousy…(I graduated college in 1980…)

The other part of this is wages…which have gone up by about the same amount as inflation – except for nonsupervisory workers.

Those workers have seen “considerably” higher wage increases. The recent strike settlements will make those workers even happier…which will drive consumer spending…which drives the economy…which increases tax revenue…which lowers the deficit.

For some reason a lot of folks don’t believe things are going well…in fact, a recent poll “found that 51% wrongly believe that unemployment is nearing a 50-year high rather than those who believe it’s actually low (49%).” [emphasis added]

When you’re in a funk it can be tough to believe there’s good news…but things will get even better.

Over the next decade, the Inflation Reduction Act, CHIPS Act and other legislation will create another 1.5 million jobs – per year. Source is Moody’s Analytics)

What does this mean for you?

The economy is good – and getting better – and this is very good news indeed.




When you’ve seen one state…

The brainiacs at NCCI have a must-read post detailing physician services’ costs and utilization in most states.

Gotta say this is one of the most useful and insightful analyses I’ve seen from anyone. Kudos to NCCI.

Couple highlights…

  • VERY wide range of physician costs – on a service year basis, state costs range from $800 to almost 4 times that.
  •  Using NCCI’s utilization metric (units), utilization varied almost as much – from fewer than 1000 to more than 2500 units.
  • one of the most insightful learnings is about the factors contributing to variations in utilization…

  • “service intensity” is the most important driver of variation; NCCI’s definition is the “collection and type of physician services rendered on average for a claim given its diagnosis and whether there was a major surgery.”

What does this mean for you?

Your medical management strategy MUST be state-specific. 


CompScope is up…medical costs are not.

It’s that time of year…when the brilliant minds at WCRI release the latest CompScope report.

The top finding…is likely to surprise many…

Couple observations:

  • yes, this was during COVID….medical costs during COVID were LOWER, not higher than previous in previous years. Those who understand medical care delivery anticipated this, alas that is a very small group.
  • no, medical costs in comp are NOT increasing significantly. Haven’t been for years.
  • That’s because we’re still benefiting from the opioid hangover effect.

Warning – Medicaid disenrollment aka “screw the poor folks” will push facilities and healthcare systems in many states to look for revenue replacements.

And, because work comp is pathetically awful at controlling facility costs, we can expect facility costs to increase – which will increase medical costs.

You can register for WCRI’s  webinar highlighting findings from this year’s report here….tune in November 16, 2023 @ 2 pm eastern.

What does this mean for you?

It is long past time to start preparing for higher medical spend.


Work comp bill review – the state of the industry

Over the last two decades work comp bill review has A) changed a lot and B) remained stagnant.

Both things are true…

Here’s the top takeaways from our just-released Survey of Workers’ Comp Bill Review (public version is available here; respondents received a much more detailed version).

Top findings are as follows (scores are 1 – 5, with 5 being highest):

  1. The BR industry’s overall rating from 2018 hasn’t changed, with an overall average grade of 3.2.
  2. Today there’s almost no differentiation in ratings across the major vendors; scoring has become more compressed since 2018.
  3. Customer service is of utmost importance in establishing a successful BR relationship. It is the primary reason respondents gave for changing vendors.
  4. There is a noticeable difference between executives and front-line employees in the evaluation of their BR vendor’s customer service. Front-line employees’ average score was 3.6, while executives scored 4.2.
  5. Automation is a hot topic in the industry, with a focus on improving turnaround time, auto-adjudication, and quality. However, some respondents are still looking for their BR vendor to better handle basic tasks.
  6. E-billing is gaining popularity, particularly among larger respondents and those who handle BR internally.

Couple deeper dives.

As noted above the survey included both front-line staff and management respondents; it won’t surprise many readers to learn front-line folks are not as satisfied with their BR vendor as their titular superiors are...that’s because execs value “savings” (which are mostly ephemeral as they are just reductions below some arbitrary benchmark, not actual medical cost reductions) – while front-line workers value efficiency, simplicity, clarity and quick problem resolution. 

Since execs make buying decisions, vendors mostly focus on what I would argue are often meaningless metrics. (don’t get me started on reductions below billed charges…)

More broadly, since our first BR Survey way back in 2009:

  • there’s been major consolidation…there were more than 11 vendors back then (remember Stratacare?  CS Stars? CompReview? Ingenix?) and market share was pretty spread out. Today, the number of vendors hasn’t shrunk much, but market share is much more concentrated. 
  • BR vendors have yet to embrace real payment integrity tools. There’s way too much “we know what we are doing” and way too little “we can always get. better”. The arrogance of ignorance is nowhere more entrenched than among BR company execs (not all, but almost all).
    And that, dear reader, is because buyers aren’t pushing vendors hard enough.
    That is NOT to say some payment integrity vendors aren’t at fault; they are too rigid in their pricing or workflow requirements, just too hard to work with.

What does this mean for you?

Buyers – push harder.

BR companies – you can do better.  A LOT better.


COVID vaccines’ impact on newborns

If pregnant moms are vaccinated their babies were less likely to die, get very sick, or end up in the NICU (neonatal ICU) than unvaccinated mom’s babies…

That’s the findings from a very large Canadian study just published.

But wait…there’s more!

during their first 6 months (longer durations were not part of this initial study) babies from vaccinated moms were much less likely to get COVID than babies from unvaccinated mothers.

And, there was NO evidence that babies may have been adversely affected by the vaccinequoting one of the researchers:

The study “provides further reassurance on the safety of maternal mRNA COVID-19 vaccination during all trimesters of pregnancy for newborns and infants,”

Details on the study are here.

Maternal Covid-19 vaccination offers infants immunity for up to 6 months


What does this mean for you?

Yes, there are some potential limitations, but this is yet more evidence that vaccinations save lives.

If you want to challenge the study, provide credible citations to support your statements.  Anything from Robert Kennedy does not meet that standard.


Good news Friday….

Ok, time to set aside the current clustermess in the House of Representatives… because…

there is REALLY good news about the economy!

Inflation is waaaay down…and has been trending that way for months.

Core inflation in August was darn close to the Fed’s 2 percent target, signaling things have vastly improved.

Wages are growing faster than inflation

which is one reason personal consumption (what people spend, not what businesses and governments spend) remains quite strong… (personal consumption is a major economic driver)

13 million new jobs have been created since mid-January 2021, meaning there are more people working now than…ever.

What does this mean for you?

Don’t let negativity drag you down…Reality is, we are in far better economic shape than we were a few years ago.

Even pre-COVID.




Long Covid’s impact on workers’ comp

Is the subject of a WCRI webinar at 2 pm eastern TODAY. No charge, but there’s a limit of 500 registrants.  Register here.

The webinar follows publication of WCRI’s Dr. Bogdan Savych’s study of Long COVID’s impact on workers’ comp (Study is free to WCRI members; non-members incur a fee).

A very brief summary from WCRI CEO Ramona Tanabe:

“Among all workers with COVID-19 claims, 6 percent received treatment for long COVID conditions, some more than a year after the initial infection. At an average of 18 months of post-infection experience, these workers received more than 20 weeks of temporary disability benefits and received about $29,000 in medical care.”

Note the relatively low medical cost…$29,000.

Other studies have examined Covid costs for patients covered by commercial health and Medicare Advantage. (note some are NOT Long Covid)

Long Covid – a study published in May of 2022 (note that was a while ago…) indicated the average annual medical costs of LC was $9,000.

CDC – costs average around $9,000 for care in the first 6 months after confirmed infection.

  • Using a large electronic administrative discharge database, Shrestha et al estimated a per-patient cost of $24,826 for inpatient care for adult patients with COVID-19.
  • Tsai et al examined claims data and found that the mean cost per outpatient visit of a Medicare beneficiary with a COVID-19–related diagnosis was $164.
  • Bartsch et al used simulation modeling and estimated median direct medical costs of a COVID-19 diagnosis ranging from $57 to $15,943, depending on the patient’s age and the severity of the case.
  • Another study found that COVID-19–related hospital costs per adult hospitalization varied from $8,400 in a general ward to more than $50,000 in an intensive care unit with a ventilator (7).

A useful synopsis of Long Covid issues, treatment, and symptoms is here.

What does this mean for you?

To date, Long Covid is not expensive. Regular readers would have anticipated this.


Medical debt is crushing Americans

One out of three adults has medical debt. 

For many, this has a major impact on daily life…

Medical debt can be a huge obstacle, preventing families from buying a home, purchasing or leasing a vehicle, even paying for college for their kids.

That’s because credit bureaus include medical debt in their scoring algorithms. 

Looks like that will be changing…

From the Vice President:

The Consumer Financial Protection Bureau will propose a new rule to make clear that medical debt cannot impact the credit scores of the American people.  Once this rule is final, it will mean, one, that

consumer credit reports will not include medical debt and, two, that

creditors will not be able to use medical debt to determine a person’s eligibility for credit. 

Almost 2/3rds of those with medical debt had insurance when they began treatment...a quarter of those had their claims denied.

What does this mean for you?

Help is on the way.