Category: Research

Nov
7

CompScope is up…medical costs are not.

Posted by Joe Paduda on Tuesday, November 7th, 2023 | Comments

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.

Oct
31

Work comp bill review – the state of the industry

Posted by Joe Paduda on Tuesday, October 31st, 2023 | Comments

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.

Oct
26

COVID vaccines’ impact on newborns

Posted by Joe Paduda on Thursday, October 26th, 2023 | Comments

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 vaccine… quoting 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.

Oct
6

Good news Friday….

Posted by Joe Paduda on Friday, October 6th, 2023 | Comments

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.

 

 

Oct
3

Long Covid’s impact on workers’ comp

Posted by Joe Paduda on Tuesday, October 3rd, 2023 | Comments

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.

Sep
27

Medical debt is crushing Americans

Posted by Joe Paduda on Wednesday, September 27th, 2023 | Comments

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.

Sep
14

Yelling into the void

Posted by Joe Paduda on Thursday, September 14th, 2023 | Comments

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.

 

Sep
11

Medical inflation in work comp…

Posted by Joe Paduda on Monday, September 11th, 2023 | Comments

Isn’t a problem. In most states. Today.

That is the headline takeaway from WCRI’s presentation last week…

First a few key factors.

  • Drug spend is a much lower percentage of total medical today than it was a decade ago. I’m quite confident total drug spend in WC today is 40% lower than it was 15 years ago.
    • That equals a reduction of about $2 billion.
  • Facility costs continue to be the main driver of what inflation there is. Inpatient (IP) and outpatient (OP) hospital inflation averaged 2.5% annually from 2012 to 2022;
  • Facilities account for 53% of total medical spend – 26% of which is OP; 9% is ASCs (Ambulatory Surgical Centers)

The details…

the best way to think about medical spend is per claim…this accounts for changes in claim volume (which is driven by injury rate and total employment).

Leaving out COVID’s impact (see end note for details) medical costs have barely budged for more than a decade…up a paltry 2 percent per year. 

However…Facility costs are a big problem for all payers…exacerbated by massive consolidation in health systems which allows them to charge “facility fees” for services rendered in physicians offices and clinics. (what a scam…)

Work comp specifically…

National averages don’t mean much if you operate in states like Florida or Wisconsin, where poor controls on workers comp medical billing enable providers to hoover dollars out of employers’ and taxpayers’ pocket.

Of note, drug costs would likely be several hundred million dollars lower if it weren’t for the profiteers enabling physician dispensing.

What does this mean for you?

All costs are local…which means all cost management approaches must be as well.

COVID…medical costs for claims during COVID were down 10% – decreases in utilization and price drove this with utilization the main driver. Not surprising…during COVID no one wanted to go to any healthcare facility for anything not essential.

This was totally predictable...

Sep
8

Good news Friday…Build America, Buy America

Posted by Joe Paduda on Friday, September 8th, 2023 | Comments

You may not have heard of the Build America, Buy America Act…here’s why it is good news indeed for US manufacturing and construction – and employment.

BABA lays out requirements for US content in federally funded infrastructure projects, requirements that specify how much Made in the USA content is needed to qualify for Federal funding.  

BABA impacts at a minimum,

  • the structures, facilities, and equipment for roads, highways, and bridges;
  • public transportation;
  • dams, ports, harbors, and other maritime facilities;
  • intercity passenger and freight railroads;
  • freight and intermodal facilities; airports;
  • water systems, including drinking water and wastewater systems;
  • electrical transmission facilities and systems;
  • utilities;
  • broadband infrastructure; and buildings and real property; and
  • structures, facilities, and equipment that generate, transport, and distribute energy including EV charging.

All iron and steel must be produced in the US…all manufactured products must have at least 55% minimum Made in the USA content, all construction materials must be “produced in the US” AND manufacturing processes must take place within the US.

per capita funding

Building trades welcomed the new guidance, with Nevada, West Virginia, Mississippi,  Louisiana, Wyoming and Tennessee among the states that will benefit  from new hiring and vastly improved: 

  • roads,
  • bridges, 
  • wildfire protection, 
  • electricity transmission, and
  • broadband.

Check out your state’s funding here.

What does this mean for you?

Better roads, schools, broadband; more good jobs; and more workers’ comp premiums and claims. 

Sep
6

Scary stuff…COVID death details

Posted by Joe Paduda on Wednesday, September 6th, 2023 | Comments

A just-released study found striking differences in death rates from COVID based on political party affiliation.

The study reviewed “538,159 deaths in individuals aged 25 years and up in Florida and Ohio between March 2020 and December 2021…”

more from JAMA

“Between March 2020 and December 2021, excess death rates were 2.8 percentage points (15%) higher for Republican voters compared with Democratic voters…(Table)….political party affiliation became a substantial factor only after COVID-19 vaccines were available to all adults in the US.”

After April 1, 2021, when all adults were eligible for vaccines in Florida and Ohio, this gap widened…with excess deaths among Republican voters 43% higher than among Democratic voters.

(you can get a higher resolution view here)

What does this mean for you?

Take a step back and consider how it came to this.