Nov
6

Friday catch up

Election week in America – the never-ending show continues…

Here’s what else happened this week.

Online registration for the CompLaude awards opened up; you can sign up here for the December 3 virtual event. Congratulations to all the nominees.

The fine folk at WCRI continue to pump out relevant research; I have a lot of catching up to do but did manage to dive into their analysis of New York’s work comp systems and the results thereof. Quick takeaways:

  • Medical inflation has been pretty flat since 2014, driven by decreasing costs for non-hospital providers. You read that right; costs dropped by about 1 percent per year from 2014 – 2019.
  • Hospital outpatient payments per claim went up 2 percent per year over that period
  • Drug costs in the Empire State have dropped by 9 – 12 percent per year, driven by
  • a 48% drop in morphine equivalents per claim, and a 23 point decrease in the percentage of claims with an opioid script.

Way to go New York.

Addiction treatment

A great piece in WaPo about contingency management, a treatment approach that is yielding promising results. Essentially it rewards drug users with money and prizes for staying abstinent. Some folks don’t like it on moral grounds; they feel its wrong to reward addicts for staying clean.

I’m no ethicist, but this strikes me as a reasonable objection. However, it has to be balanced against the good that comes from helping people recover. Critics’ high morals kind of pale in comparison to keeping people alive.

For now, only the VA is paying for this. It’s long past time private insurers and Medicare/Medicaid stepped up.

All things COVID

I haven’t been paying nearly enough attention to the eruption of COVID; will do a couple posts next week to catch up.  In the meantime, here’s treatment news.

From MedScape, good news; it appears the risk of cardiovascular problems in young athletes recovering from COVID isn’t as high as once thought.

Okay, that’s the good news. The not-good news is the most common version of the virus has mutated and is now more contagious. However, we appear to have dodged a bullet – this version of the virus also mutates much more slowly than other common viruses. It’s really hard to attack a virus that’s constantly changing as scientists are constantly playing catch up.  A relatively stable virus means the development of vaccines and treatments should be a lot more productive.

Lastly, there’s been a lot of misinformation that doctors and hospitals are over-counting COVID cases because they make more money. In a word, that’s a lie. Hospitals do not receive extra funds when patients die from COVID-19. 

Miscoding patients and deaths would be fraud and could result in criminal prosecution.

For the relatively small percentage of patients that don’t have health insurance, there is Federal money available, HOWEVER, healthcare providers can only submit claims that list covid-19 as a patient’s primary diagnosis. Patients with COVID often die of sepsis and other conditions; in those cases providers get paid nothing.

Net – there is zero evidence to support that assertion. None whatsoever.

I find this incredibly offensive; one of our daughters is a nurse working in a major hospital and her husband is a clinician at a VA facility. 1700 healthcare workers have died of COVID – 200 of them are nurses.

These lies are reprehensible.


Oct
28

The Sturgis Superspreader Event

Increasing evidence points to August’s Sturgis motorcycle rally as a major contributor to the big increase in infections throughout the upper midwest.

With 400,000 folks spending days talking, drinking, eating, recreating, socializing, dancing, singing, and generally having a great time – mostly without masks, sanitizer and obviously with no social distancing, this should come as no surprise.

Sturgis’ Meade County has experienced a major jump in case infection rates, helping to steepen South Dakota’s infection curve.

Using phone tracking data, researchers found:

counties that contributed the highest inflows of rally attendees experienced a 7.0 to 12.5 percent increase in COVID-19 cases relative to counties that did not contribute inflows.

Sturgis’ location in South Dakota was problematic as the state has done little to encourage responsible behavior, choosing to allow individuals and local entities to decide on public health measures.

The study has been met with some criticism, however other reports indicate outbreaks linked to Sturgis attendees happened in Colorado, Minnesota, Washington, New Jersey, North Dakota and other states.

One can argue about the validity of this study or pick apart specific issue, but one cannot justify 400,000 maskless people mashing together in the midst of a pandemic.

None of us like to be told what to do – me included. The idea of someone telling me what to wear, where I can and cannot go, things I can and cannot do…is why I’ve worked for myself for 25 years.

With that freedom comes responsibility, and the freedom-loving folks who went to Sturgis likely robbed thousands of others of their freedom to live COVID-free.

What does this mean for you?

We are all in this together – for good or ill.

Thanks to Pete for inspiring this post.

 

 


Oct
27

More hospital consolidation = higher prices

The only demonstrable impact of facility consolidation is higher prices.

There’s also solid evidence that more concentrated health care markets are associated with lower health care quality.

While the number of deals dropped by about 21% in the first half of this year as everyone’s attention focused on COVID and the impact thereof, a number of transactions still took place.  Conversely, several deals in process totaling around $23 billion were abandoned, victims of a variety of challenges.

Consolidation may actually accelerate as facilities hammered by the financial impact of COVID19 seek safe harbors.

The latest consolidation is in the north-central part of the nation, with 2 not for profit systems working on an a deal driven in large part of a desire to help the systems expand their footprint.

I’d expect more, although the increasing number of facility closures may well put a damper on deals as some run out of time.

This is particularly damaging in rural areas, where over a hundred hospitals have shut their doors over the last decade.

From Bob Shepard, UAB

What does this mean for you?

There will be fewer hospitals tomorrow than today, which likely means higher prices.


Oct
22

COVID update – where we are today v2

Had a posting issue yesterday; email notifications did not go out to all subscribers – reposting this  – apologies if you already received this.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
21

COVID update – where are we today.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
20

WCRI’s latest and greatest

For decades WCRI’s CompScope reports have provided deep insights into workers compensation in many states. The information is germane not only to those focused on specific states, but for anyone looking to understand what works and what doesn’t, how regulatory changes affect stakeholders, and how systems adapt to those changes.

The latest versions are the 21st edition, adding new depth and detail. Streamlined access to specific information and data via quick tabs is a big plus.

I took a deep dive into WCRI’s Florida report, and came away with two key takeaways.

  • If you are a facility, you should love the fee schedule.
  • If you are a medical provider, you should hate it.

Medical providers – docs, PTs, specialty providers – are paid about 30% less than the median state, with PTs at 28% less, E&M codes at 21% less, and x-rays reimbursed at a rate 45% less than the median.

Hospitals are making huge bucks off workers comp – especially for inpatient visits.  Recent data indicates well over half of all inpatient episodes are “outliers”. Once claims incur more than $59k in charges, reimbursement switches from per diem to percent of charges, more accurately known as “license to steal.”

I get why hospitals are desperate to make huge dollars charging Florida’s employers and taxpayers outrageous amounts: the state didn’t expand Medicaid and has the second highest percentage of non-elderly folks without health insurance (Texas is tops).

Florida hospitals have to treat a lot of folks without health insurance, and they are looking to workers’ comp to help pay for that treatment.

Oh, and COVID’s fallout is adding to hospitals’ financial woes. (take the info above with a grain of salt; it was put out by the Florida Hospital Ass’n.)

The result – hospitals are getting killed financially.

What does this mean for you?

Make time to read and understand solid research. It will determine your future.


Oct
14

Hospitals – it’s not just about the cost

All hospitals are NOT alike – and there’s a quick and highly credible way to identify the facilities highest-rated for quality – and those on the other end of the scale.

The Center for Medicare and Medicaid Services (CMS) has an online tool that allows you to review hospitals’ overall Star ratings. CMS uses a 1-5 star rating metric with the more stars the better.

Here’s how hospitals within 25 miles of Tampa FL stack up.

The overall rating is based on a set of specific ratings that address key measures including:

  • clinical outcomes;
  • patient safety;
  • patient engagement; and
  • cost.

There are a number of “sub-measures” that make up each category, one of particular interest may be facility-associated infections and other safety indicators. Information on timeliness and effectiveness of care is here.

You can download data on each and every hospital reporting to CMS or just pick the facilities of interest; the data is here.

CMS just completed a broad and deep assessment of patient impressions of hospital outpatient services and Ambulatory Surgery Centers; you can find results for individual outpatient facilities here and ASCs here.

For those seeking highly credible data on hospital costs, RAND’s latest research makes data highly accessible.

What does this mean for you?

If you aren’t assessing facilities’ quality, you should be.


Sep
28

COVID catch-up

Like many, I’m suffering from COVID19 burn out. This weekend’s news that more than 200,000 of us have died from the disease was a much-needed kick in the pants; I’ll do better keeping track of news – good and bad – about the pandemic and its impact on us.

To start, kudos to the California Workers’ Compensation Institute for their excellent work tracking the impact of COVID on workers comp in the Golden State. Their interactive tool is here; takeaways from the latest update (for 2020 to the end of August) include:

  • CWCI projects there will be 48,000 COVID claims incurred through the end of August
  • About 13,500 will be denied
  • Healthcare will account for about 4 out of ten claims accepted
  • Retail and food services will account for about one of every eight claims accepted
  • Including both COVID and non-COVID claims, claim counts are down 26% from 2019 levels.

Data

About 200,000 of us have died from COVID19; about one of every fifty of us has tested positive. And the number of infections keeps increasing at a troubling rate, especially in Rocky Mountain states and those just to the East.

Treatment  – 2 medications are helping infected patients, a couple more are showing promise, and – once again – hydroxychloroquine is NOT on that list.

Vaccines – 11 are in late stages of testing, and 5 are being used in a limited way (there’s overlap between these two groups)

WorkCompCentral is hosting a free webinar focused on the impact of COVID19 on Florida’s workers’ compensation system and stakeholders. The Registration is here; the webinar is tomorrow, September 29 at noon Pacific, 3 Eastern.

Lots more going on – will keep you posted.

What does this mean for you?

Wear a mask. Properly! over your nose AND mouth.

Thanks to Brad James for the reminder. 

 


Sep
25

Friday catch up

Pre-existing conditions, drug development, COVID-related GI problems, and marketing screwups…

First up, pre-existing conditions

Yesterday President Trump issued an executive order affirming “it is the official policy of the United States government to protect patients with pre-existing conditions.”

Well, yeah. It is today, because the ACA/Obamacare – which specifically protects patients with pre-existing conditions – is the law of the land, despite dozens of GOP efforts to overturn it. 

Couple other key issues.

  1. Without legislation signed into law, the Federal government – and the President – can’t enforce a “policy”.
  2. The executive order wasn’t released, so we don’t know what it actually says.
  3. The Trump Administration backs a lawsuit that would overturn the ACA and thereby eliminate pre-existing condition protections. 

What this means – don’t watch what someone says, watch what they do.

For more details on GOP and Democratic healthcare plans, click here.

Super-useful research on healthcare prices paid by private healthplans – kudos to RAND for updating their ongoing analysis. RAND compares prices paid by privately insurers – including work comp – to Medicare, allowing you to compare relative prices for individual facilities.

Thanks to Michael Costello for the link.

One takeaway – HCA hospitals are pretty expensive…(you can find prices for pretty much any hospital on RAND’s map)

Drug development

Pretty much all new drugs developed over the last decade relied on research you – the taxpayer – paid for.

That includes $6.5 billion of taxpayer dollars invested in remdesivir, one of the very few drugs found to be useful in treating COVID19.

COVID19

Alarming piece in JAMA yesterday reported patients with Acute Respiratory Distress Syndrome caused by COVID19 are at significantly higher risk for major gastrointestinal problems. Pretty solid science behind the research.

An earlier article highlighted the opioid epidemic during the COVID19 pandemic; there are definite limitations to the research due to small sample size and possible clinician bias. With those provisos, key takeaways include:

Good news – J&J will start Phase 3 trials of its vaccine. Unlike some other vaccines, it is a single shot and can be stored in a refrigerator for up to 3 months (others require two shots and must be stored at ultracold temps).

Marketing malfeasance

And lastly, an excellent article in the Harvard Business Review about marketing in current times.  A critical takeaway – do NOT just talk about social responsibility; DO it. Kudos to Starbucks; after mandating that workers could not wear anything with Black Lives Matter while working, the company realized it screwed up and reversed course.

For the umpteenth time, if you do screw up, apologize fully and without dissembling.  None of these “I’m sorry if anyone is offended” non-apology apologies; from the article:

With “cancel culture” as pervasive as it is, a one-time reaction is as good as letting an issue get ahead of you. Instead, treat apologies or mea culpas as the first steps of an ongoing dialogue designed to bring about thoughtful and meaningful progress.

Here’s hoping the White Sox turn things around in the upcoming series with the Cubs…and your team wins this weekend.

Be well.


Sep
4

Friday catch-up

Lots happened this week – here’s the big stuff.

COVID’s impact on work comp

WCRI is hosting a free webinar on the delivery of medical care and RTW during the pandemic.  Hosted by WCRI CEO John Ruser PhD and Randy Lea MD, the webinar will also include Mark Herbert MD, an infectious disease specialist.

Sign up here for the September 24 event, it kicks off at 2 pm eastern.

Drug prices

No, payers’ drug costs are not dramatically higher. In fact, net costs after rebates and other payments are flat to lower.  That’s one of the key findings from Adam Fein PhD’s analysis of the top PBM’s results. Kudos to Express Scripts, CVS, and Prime Therapeutics for publishing true cost data; one only wishes all PBMs did the same.

Ever wonder where all those new drugs come from?

Well, pat yourself on the back – because you, dear taxpayer, funded most of the initial R&D behind new drug development. Here’s the takeaway:

every new drug approved by the Food and Drug Administration (FDA) for the decade from 2010-2019 was associated with basic science funded by the NIH.

The IAIABC’s annual meeting kicks off next week; registration is still open here. Lots will be covered, including a discussion of COVID claims, presumption, fee schedule improvements, and of course EDI.

David Dubrof is PBM myMatrixx’ new Chief Sales Officer. I’ve known David for 20+ years; he is one of the very few “A” players in work comp services sales and a consummate professional. (myMatrixx is an HSA consulting client). David is all in on myMatrixx’ industry-leading push for price transparency.

How’s that budget process going?

Imagine trying to set up a curriculum for an unknown number of students with an unknown level of education. Or meal planning for an unknown group with different dietary requirements that are also unknown.

Well, that’s budgeting 2021. Never has that been so…fraught/uninformed/scary/pointless as it is today. If you need a break from trying desperately to figure out how to justify/rationalize your 2021 forecast and budget, read this.  It’s an excellent discussion of budgeting in a time of huge uncertainty.

Family is coming in this weekend to celebrate our new granddaughter’s arrival – have to say this is much-needed these days; the nastiness and bad news is getting to be a bit much.

Hope your weekend is filled with joy.