Thursday catch-up

Between doing grandfatherly duties (hanging out with our granddaughter), business obligations and snow plowing, it’s been a busy week.

here’s what’s up.

COVID stuff

Yeah, like you, I was hoping this pandemic would be just an unpleasant memory by now. Far from it.

Omicron has substituted transmissibility for lethality, so far more of us will catch COVID, but far fewer of us will get very sick or die. BUT – and it’s a huge BUT, the net impact is more of us are getting sicker.

And the impact on healthcare facilities and the increasingly burnt-out people who work in those facilities is the worst it’s been since COVID arrived on our shores.

Another of those knock-on effects of COVID…hospitals can’t discharge patients because a) rehab facilities don’t have room, b) there aren’t enough home care providers to hep the patient recover at home. So, patients that COULD be discharged – thus freeing up beds for sicker people – aren’t.

Which leads to more stress on hospitals and hospital staff.

Side note – in case you missed it, the US has lost 10,000 ICU beds over the last year – because there aren’t enough healthcare workers to care for ICU patients.

Last week saw a new peak in hospital admits for patients with COVID… most troubling is the rapid rise in kids 4 and under that have been admitted.

There’s been a lot of discussion about patients admitted with COVID vs patients admitted due to COVID. This needs unpacking.

Lots of us have health issues, which are called “morbidities”…asthma, high blood pressure, obesity, diabetes and the like. Very broadly, the more you have, the worse it is, because one exacerbates the other(s).

COVID is in that category...so while a patient may not have a bad case of Omicron, that patient’s immune system now has to deal with a respiratory (and perhaps other) problem(s) on top of being overweight, older, hypertensive and pre-diabetic.  The result is the patient is in the hospital longer, takes longer to recover, and full recovery is less certain.

About those “co-morbidities”…some irresponsible media types butchered CDC Director Rochelle Wolensky MD’s comments on COVID and co-morbidities. 

One such media type tweeted “CDC director admits over 75% of Covid deaths had at least 4 pathological conditions (comorbidities). Since the total death rate is 0.27% this means healthy people have a 0.0% death risk.”

That is NOT what Dr Wolensky said. She was referring to COVID deaths among vaccinated individuals – NOT all COVID deaths.

Her point was that vaccinations protect us from COVID, but people in very poor health are still vulnerable; most of the vaccinated people who died were in very poor health BEFORE they got COVID.

Sheesh. This isn’t that hard people…


Registration for CWCI’s annual meeting is now open here; March 8 is the date. As of now it is live and will be streamed as well. Walnut Creek is the location, and attendees will hear solid research on the impact of COVID plus a study on injured worker access to care.

Today NCCI and several state regulators are discussing the impact of COVID – you can register for the webinar here. You can download the team’s report here.

Lots of great information. presented in an accessible format.

What does this mean for you?

Don’t retweet unless you check the actual source information, because you may look like an idiot.




Our healthcare system is breaking – part 2

Earlier this week I wrote the first in what is likely to be a wholly dispiriting series of posts documenting the decline of our healthcare system.

Make no mistake, in many areas it is coming apart at the seams. While the causes are many, there’s no question COVID has both sped up and steepened the fall.

Healthcare job vacancies are twice the historical high, with one out of every ten jobs unfilled. We are missing about 1.9 million nurses, doctors, technicians, administrators, lab techs, therapists, nutritionists, counselors, case managers, social service workers, aides, and support staff.

From the Bureau of Labor Statistics… note the graph includes both social workers (about 200k openings) and healthcare about 1.7 million.)

At the end October,

  • more than half of the healthcare job openings were for RNs
  • 15% were for LPNs
  • 7^ for nursing assistants
  • 17% for therapists.

Many of the healthcare workers that have been able to hang in there are exhausted, scared, emotionally scarred and beyond frustration.

Statistics don’t mean anything? OK, here’s what this feels like…

What does this mean for you?

You don’t know what you’ve got till it’s gone. 

Reminder to Trolls and Cowards

I highly value disagreement but only if it is courteous, fact-based and the other side isn’t hiding behind anonymity.

A reminder to all commenters; with rare exceptions – as in when I know who you are – anonymous comments are banned. You know who I am, it is only fair that I, and your fellow readers, know who you are. Indeed there are sometimes good reasons for anonymous comments, but never when you attack, insult, denigrate, and rant. So, Cowards are not welcome here.

Similarly, I’m done debating Trolls who engage in fact-free rants and/or cite completely not-credible “sources” (no, InfoWars is NOT a credible source). If you want to debate, avoid these common pitfalls.


A promising new tool for physical therapy

I’m approached by lots of companies looking for advice on how to get their products/services into the workers’ comp and/or group health space…most are:

  • not exactly ready for prime time &/or
  • don’t have enough solid research behind them &/or
  • have glaring deficiencies &/or
  • just don’t feel right.

But when Bill Zachry called me about Plethy, I paid attention (disclosure – Bill is a long-time friend and colleague, has huge experience in workers’ comp, and is one of the finest people I know).

While Plethy’s Recupe is technically in the digital musculoskeletal space, Recupe is unlike other approaches in that the technology is not the focus, rather a key component of a comprehensive approach that supports physical therapists’ work with patients. Yes there’s a smartphone-based app, yes there’s a sensor that is used to help the therapist monitor exercises and recovery, yes the data can be seamlessly shared with other members of the patient care team.

In my experience devices of this kind are either driven by technologists or clinicians – both have challenges. Technologist-driven approaches often have significant clinical gaps, while clinicians’ efforts are usually clunky and hard to use.

Plethy has involved orthos, DPTs, and other clinicians in the entire development process, which has been managed/done by highly experienced tech experts with deep background in tech product development.

Tech should NEVER displace the involvement of clinical experts. Rather tech should support those experts, provide actionable information and do so with minimal hassle factor.

So far, Recupe checks those boxes.

What does this mean for you?

We are getting there…

note – I am an advisor to Plethy.


Don’t miss out

on WCRI’s 38th Annual Issues & Research Conference, March 16-17, 2022. Mid-March is a great time to be in Boston!  Then again, pretty much anytime is.

Register here.

on NCCI’s latest update on claim frequency and severity – spoiler alert, frequency is still declining, although it’s hard to unpack the influence of COVID from structural drivers. Hat tip to Carolyn Wise and Kevin Fernes for their helpful research and cogent explanation of the data.

More surprisingly, severity – which is workcomp-ese for costliness – declined last year – for non-COVID claims.

Also notable – and consistent with what I predicted last year COVID claims are way less costly – as in two-thirds less costly – than non-COVID claims (this isn’t about chest-pounding, rather pointing out that this was predictable – but few in the WC world have the health care/medical system insights to do so)

Also worthy of your attention, Chris Brigham MD is hosting a discussion of Post-Acute COVID via Webinar – registration is here and is complimentary.

Finally, in yet another example of the consequences of stupid, a physician who testified before Congress that Ivermectin would prevent COVID…wait for it…got COVID. As concerning, there have been 2021 1,810 cases of ivermectin poisoning in the U.S. in the first 10 months of this year, compared with 499 for the same period in 2019.

What does this mean for you?
Understanding healthcare would be really helpful for workers’ comp execs.


The giant of healthcare

UnitedHealth Group projects its 2022 revenues will be around $320 billion – that’s equivalent to 7% of total US healthcare spend. (around 80% of UHG revenues flow through as medical expenses.)

UHG is the largest of the health insurers, capturing 14.4% of total premiums – or one of every 7 premium dollars. (thanks to Jeff Kadison for the math correction)

The four largest health insurers capture 4 of every 10 premium dollars.

It also made the most profits through the third quarter of 2021 (most of CVS’ revenue is not from its health insurance business.)

For readers in the workers’ comp business, UHG’s projected 2022 medical spend  is about 8 times larger than total US workers’ comp medical spend.


Facts vs beliefs

The medical community is wrestling with ethical issues arising from vaccines.

Simply put, should unvaccinated people infected with COVID be treated differently than the vaccinated?

This isn’t just an academic exercise; here in the Upper Valley of New Hampshire and Vermont, emergency rooms, critical care units, ICUs and Pediatric ICUs are stuffed full of COVID patients, almost all of whom are unvaccinated.

The Governor has issued an Executive Order intended to give hospitals more flexibility in setting up overflow units. At least two NH hospitals have postponed or halted elective surgeries as a result of the latest COVID surge.

Michigan may be in even worse shape.

The implications are real and potentially tragic.  Parents, friends, children or neighbors in car accidents, struck by heart attacks or strokes, suffering from kidney failure or pancreatitis or appendicitis or anaphylactic shock may find their local hospital doesn’t have an open bed and/or is operating short-staffed.

The latter is worsening by the day, as nurses, support staff, physicians and other clinicians are exhausted, frustrated, angry and despondent over long hours and the need to treat unvaccinated COVID patients. That and a relatively tiny number of healthcare providers have also bought into the lies perpetrated by antivaxxers, exacerbating the staffing shortage as they lose their jobs.

The exception to this discussion is for populations that have been mistreated, lied to, abused and misled by eugenicists masquerading as researchers.

The arguments for NOT treating those adults who are unvaccinated by choice (rather than due to a medical exemption) go like this…

  • the “slippery slope” argument – once we do this, then we’ll
    • refuse to treat obese people for heart disease, kidney disorders, diabetes, hypertension etc; smokers for heart disease, cancer or COPD; drinkers for liver disease – as if individual decisions with repercussions limited to that individual are the same as antivaxxers’ potential to spread infections, contribute to variant development and possibly kill family members, kids, health care workers and co-workers in the process.
      • as long as we’re talking about obesity…it isn’t
        • communicable,
        • preventable by vaccination, or
        • filling ICUs to over-capacity.
  • the false equivalency argument
    • refusing to treat the “unvaxxed by choice”? than you shouldn’t provide care to women who have unplanned pregnancies – as if a one-time event is equivalent to a person’s brazen willingness to potentially infect dozens of us.
  • the “you are violating my freedoms” argument
    • if we can ban smoking in schools, restaurants, offices, airports and public transportation, we can certainly require immunization and penalize those without valid exemptions (if you think you should be “free” to smoke in a school or medical facility, that’s a whole different issue)
      • Oh, and pets are required to be immunized against dangerous diseases, as are kids.

Which leads us to the facts vs beliefs issue.

“Beliefs” – that you are a better driver than anyone else so should be allowed to drive at twice the speed limit through a school area and your child doesn’t need to be in a child safety seat and you don’t need to wear a seatbelt and you can hold your liquor so driving buzzed isn’t a problem for you; that you know more than 99% of the experts so you won’t get vaccinated, that children don’t die of COVID are NOT facts.

And when those beliefs are demonstrably false – as the anti-vaxxers’ arguments clearly are – the moral dilemma becomes more complicated.

“Freedom” isn’t free – if you want to be free to be unvaccinated, then you – no one else but you – have decided to accept the consequences of that decision.

Actually, that’s not right – because your decision is directly affecting your neighbors, family members, and co-workers. It is directly affecting my family members who work in healthcare, people you will infect, and lives you will disrupt.

In fact, freedom from disease, from economic disruption, from grief when loved ones die – comes at a cost – and that cost – however slight – is all of us getting vaccinated.

What does this mean for you?

Spare us the false equivalencies, the slippery slopes, the my freedoms nonsense, get the damn vaccination and wear a damn mask.

And when you get COVID, stay home and don’t interfere with our freedom to be free of COVID.

A more comprehensive discussion of the arguments against vaccination is here.



COVID conversations, curiosities and cures

Three-quarters of a million of our friends, family, neighbors and coworkers have died of COVID.

That is a mind-blowing number, made personal because all of us know of someone who died of the disease or has a family member that did.

Remember 9/11 killed about 3,000 of us.

Of course, the unvaccinated are dying at a far higher rate than the vaccinated, and the vaccine divide is becoming more partisan by the day. Unvaccinated English people were 47 times more likely to die of COVID than those who had been fully vaxxed for more than three weeks. 

KFF’s survey reports the race/ethnicity vaccination gap has shrunk significantly, while the partisan divide has grown over time.

Today, the most significant factor determining vaccination status is political affiliation. 

What’s sad beyond belief is this

That said, 6 out of 10 of those who identify as leaning or Republican have received at least one dose.

Thanks to Broadspire’s Marc Cunningham for hosting me on the Beyond the Claim podcast; Marc and I spoke about the impact of COVID on workers’ comp, the need for deeper understanding of medical drivers, and what the future holds.

Advocate Healthcare Aurora’s Teresa Clarke took the stage in the second episode, and dove deeper into COVID and healthcare. Teresa manages AHA’s work comp program, and has been in the trenches since day one of the pandemic.

Hat tip to Broadspire’s Chris Stephenson for handling all the heavy lifting on the pod.

Two new medications show a lot of promise in treating COVID. And no, neither are Ivermectin.

Pfizer’s Paxlovid is in the Emergency Use Authorization process; the Federal government is expected to contracted to buy 10 million doses of the medication.

When given within three days of symptoms, Pfizer’s antiviral reduced the rate of death and hospitalization by 89 percent for those at high-risk of developing severe illness.

Merck’s drug “reduced the risk of hospitalization and death by nearly half among higher-risk people diagnosed with mild or moderate illness.”

What does this mean for you?

Get vaccinated, because you might die if you don’t.


Infrastructure = jobs = premiums and claims

Three days ago President Biden signed the Infrastructure Investment and Jobs Act, a notable accomplishment coming after bipartisan support in Congress.  Pretty remarkable that this happened at all; past Administrations  – both Democratic and Republican that enjoyed majorities in Congress were unable to pass this desperately needed legislation.

There’s lots of good news in the Act; including: (source Business Facilities)

  • US$47 billion in climate resilience measures to protect buildings from the storms and fires that result from climate change
  • $65 billion to repair and protect the electric grid, build new transmission lines for renewable power and develop nuclear energy and “green hydrogen” and carbon capture technologies
  • $39 billion to continue and expand current public transit programs, including help that allows cities and states to buy zero- or low-emission buses
  • $66 billion to fix Amtrak and build out its service along the Northwest Corridor, in addition to building tens of millions for high-speed rail and other commuter rail
  • $7.5 billion to build electric vehicle charging stations;
  • $25 billion to repair airports to reduce congestion and emissions, encouraging the use of low-carbon flight technology

States are already targeting the funds for much-needed projects; North Carolina is getting $1.5 billion for bridge repairs,  broadband expansion, and transportation upgrades – and more dollars for other projects.

Wyoming’s roads, dams, water systems and bridges will get $2.5 billion in repairs and upgrades.

Arizona’s rapidly expanding population desperately needs new infrastructure – and big improvements to utilities especially water as well as ports of entry along the border. 

The federal Transportation Department “plans to open competition for the first round of port infrastructure grants funded by the bill within 90 days, as part of a broader effort to ease supply chain bottlenecks slowing down the delivery of goods.”

That will impact Long Beach, Savannah, Houston, Los Angeles, Miami, Mobile, Seattle, Norfolk and other critical ports.

The question is – how fast will these dollars translate into employment? I’d say next summer we will see a noticeable impact as plans that are already under development get funding commitments.

The Federal Highway Administration projects each billion dollars in highway funding supports 13,000 jobs.

S&P estimated a:

 $2.1 trillion boost of public infrastructure spending over a 10-year period, to the levels (relative to GDP) of the mid-20th century, could add as much as $5.7 trillion to the U.S. over the next decade, creating 2.3 million jobs by 2024 as the work is being completed.

The Act is about $1.7 trillion in spending, so we’re looking at about 1.9 million jobs. 

Of course, that is an estimate – it could be higher or lower. However, there’s no question workers’ comp will see:

  • higher premiums;
  • more claims; and
  • higher severity.

What does this mean for you?

Prepare for some much-needed growth. 


for hospitals, Cost ≠ Quality

Some hospitals are efficient – defined as delivering excellent care at relatively low cost, while others are quite inefficient – high cost, not great care.

Then there are the high cost and unknown quality of care facilities – but the net is this – cost ≠ quality, and quality does not cost more.

The Lown Institute has done some great research on this, and identified the nation’s 10 most efficient hospitals – the criterion being how much Medicare was charged compared to how many patients died 30 and 90 days from admission. OK, that isn’t by any stretch a comprehensive definition, but the results were revealing.

Costs ranged from $9,000 to $27,000 per patient…and if all hospitals operated as efficiently as the top 10, we taxpayers would save $8 billion each year.

Of course private payers are charged more, and pay more than Medicare. Nonetheless, efficient hospitals are going to be efficient for all payers.

Here’s the top ten.

  1. Pinnacle Hospital (Crown Point, Ind.)
  2. Saint Mary’s Regional Medical Center (Reno, Nev.)
  3. MercyOne Dubuque Medical Center (Dubuque, Iowa)
  4. Encino Hospital Medical Center (Encino, Calif.)
  5. Park Ridge Health (Hendersonville, N.C.)
  6. Oroville Hospital (Oroville, Calif.)
  7. Saint Michael’s Medical Center (Newark, N.J.)
  8. UnityPoint Health-Meriter (Madison, Wis.)
  9. East Liverpool City Hospital (East Liverpool, Ohio)
  10. Maple Grove Hospital (Maple Grove, Minn.)

Curious about another hospital?  Click here to find out how it ranked.

What does this mean for you?

Knowledge is power – but only if you use it.


Big doings! and natural immunity vs vaccination

Well. that was welcome indeed.

Looks like the Dems in Congress have reached a deal on controlling (some) drug prices. As with all legislation, it is far from perfect, no one is particularly ecstatic, but then again, politics is the art of the possible, and the deal WILL help control drug price increases. Especially for older Americans who now get out-of-pocket spending on drugs capped at $2,000 a year and diabetics who will get a cap on insulin at $35.

Will this effect workers’ comp? Unlikely. WC drug fee schedules are based on AWP except in Cali, where it is based on Medicaid.

The Labor Department’s jobs report this morning showed over half a million people were hired last month, a major jump over prior months. Over 5 million (!) have been hired since January.

This means – higher payrolls = more people insured, more payroll, more consumption.

I expect employment will be a topic of conversation at WCRI’s annual meeting, slated for March 16 – 17 in Boston. Save that date and make sure you are on their mailing list as this always sells out.

All things COVID

Two drug manufacturers reported positive results for their new COVID treatment medications.  Just-released data from a clinical trial indicated Pfizer’s Paxlovid cut the risk of hospitalization or death a whopping 89 percent when administered within three days after the start of symptoms. Paxlovid won’t be widely available for several months, and then will likely be prescribed mostly to high-risk people.  Treatment will cost about $700 per patient.

Merck’s  molnupiravir will cost about the same; it has been approved for use in the UK and the manufacturer has applied for an Emergency Use Authorization (EUA) here in the US.  As reported in the Economist, research

“found the interim results of a trial found that patients with a risk factor for covid-19 were 50% less likely to be hospitalised or die if the oral antibiotic was taken in the first five days after symptoms.”

While neither is available just yet, expect both to get EUA approval shortly.  BTW, remember the vaccines were also administered under EUA.

We are learning more each day about long COVID, and much of what we are learning isn’t good (note that’s not surprising, as first we need to understand the problem and only then can we work on solutions). Significant GI problems are one issue, and the more severely affected patients also present with anxiety and sadness. That’s not surprising either, as nothing makes you more miserable than a severe GI problem.

BUT… one of the report’s authors noted “We do not know whether the psychiatric symptoms are a cause or a result of the GI symptoms, but we suspect it is likely to be both,”

About 20 million of us have experienced symptoms such as difficulty breathing, pain, hypertension and fatigue that are consistent with long COVID. Get the latest on November 17 at noon eastern when the National Institute for Health Care Management hosts a time of a webinar on the “Implications of Long COVID for patients and the health care system.” Register here.

Alert for some readers advocating “natural”immunity… A new study found “unvaccinated US adults who previously had COVID-19 contracted the disease at more than five times the rate of those who were fully vaccinated.”

What does this mean for you?

Get the shot.