The Shutdown’s impact on workers’ comp

Almost four weeks into the Trump shutdown, it’s time to examine how this will affect workers’ comp.

“…I am proud to shut down the government for border security…So I will take the mantle. I will be the one to shut it down. I’m not going to blame you for it.”

Briefly, not much – if it gets resolved soon.

I don’t think it will – more on that below.

First, key Federal agencies are pretty much unaffected.

Second, with a few exceptions, contractors for Departments that are now without funding are furloughed or on leave. 420,000 workers have to keep working – without pay. Several hundred thousand more are not on the job

The Departments of Justice and Homeland Security (I still think that’s a pretty creepy title) and other key agencies and departments are particularly affected as thousands of their workers have to work without pay. Other unfunded departments include Agriculture, Commerce, HUD, Interior, State and Transportation.

The US Trade Representative’s office is closed, we’ll get no economic reporting on jobs or output or prices or GDP. and numerous other independent entities are shuttered.

Here’s the caveat – the longer this stupidity lasts, the more impact it has on the economy, workers, and workers’ comp.

The White House reports that annual GDP drops 0.1% every two seeks the government is shut down. That equates to about $10 billion a week in foregone products and services.

So far, we’re down about $30 billion – a pittance in a $21 trillion economy. What scares the bejesus out of me is this could drag on for months – which will do real and lasting damage to the economy, businesses, and tax receipts.

Identity Loyalty is why it may not end soon. Simply put, compromise isn’t possible because the powers-that-be and their supporters know in their hearts they are in the right – and no amount of data, facts, or logic will change that.

The Wall has a brand that is all its own. It is incredibly powerful to Trump supporters as it is all about protecting them and who they are and what they have from others. This can’t be under-estimated, and is why Trump’s base and the right-wing media were furious with him when he offered to compromise way back in December.

By the same token, the Wall represents all that Trump opponents dislike – if not hate – about the man and what he stands for. Agreeing to pay for the Wall would be amoral at best.

You may have noticed Trump and his allies have been trying to use different language when referring to The Wall…steel slats, border protection, border security. That reflects a desire to change the terms of the current “disagreement” (putting it mildly).

Alas, Trump et al have done such a good job branding the Wall that this belated effort to re-frame things isn’t getting any traction.

What does this mean for you?

For those who elected Mr Trump because they wanted a change, you are certainly getting one.


The Shutdown’s impact on healthcare

Is rather modest – until it isn’t.

Preparing for the next pandemic, monitoring food safety, preventive health services for at-risk people, new drug approvals – all are on hold or severely curtailed as the Federal government shutdown heads towards its fourth week.

Fortunately, funding for most health-related federal programs – the VA, Medicare and Medicaid, other CMS programs – was approved before the current impasse, so most of us will not be affected.

That is, if the shutdown is resolved soon. If not, the downstream effects are going to be felt more deeply – by more of us.

While it may seem like there’s not much impact on most of us, that would be wrong. Specific departments’ policies, funding approval processes, budgetary allocations and the like are often affected by other agencies. For example, there are significant pending changes to healthcare IT standards which must be approved before hospitals, healthcare systems, and other providers and payers can update their systems to comply with Federal laws and regulations.

Programmers are waiting for guidance, and will keep waiting until the deadlock is over. Some of these system updates have deadlines; while the deadlines should be extended if and when the politicos agree to a deal, what should happen in Washington – and did back when adults ran our government – often doesn’t.

This is just one example – and there are hundreds more. Reality is we live in an incredibly complex world, the Federal government is tasked with making sure that world is safe, non-toxic, operates well and does so efficiently. And most government workers are committed to doing that well.

The problem isn’t the workers; it is the press that vilifies them and the politicians that blame government workers for problems the politicians create and exacerbate.

Of course, for those who want to use our national treasure – the National Parks… if the knuckleheads in DC don’t get their stuff together, the Parks may be their own public health crisis.

What does this mean for you?

There are dozens of ways the government affects our lives – almost all of which we don’t know about or appreciate until it’s gone.


Vegas Day Two – Industry headwinds and poker

Yesterday’s top takeaway – the consolidation continues – and the impact can be seen on the exhibit hall floor.

Sure there were some new names on the floor, but there seemed to be fewer companies exhibiting this year than in the past.  Not surprising as work comp claims counts are down, premiums continue to drop, and there’s fewer dollars in the system to support service providers of all stripes.

Yet most companies are still planning to grow, and some of the biggest booths are from newcomers who don’t seem to know a lot about workers’ comp.

Investors talk about structural limits as “headwinds”, conditions that inherently limit growth opportunities.

Trade wars, full employment, declining frequency and employers that – for very good reasons – don’t care much about workers’ comp are combining to reduce growth in comp services.

Two possibilities.

Those headwinds may grow in velocity – or, a recession will increase claims and delay re-employment, which will help service companies while hurting payers’ combined ratios.

The companies planning to grow are hoping to draw to an inside straight.

A few – those with great customer service and a deep understanding of the business – have much better odds of success.

But most seem to be the chump at the table.


Bill Review Survey – Takeaway #2

One of the more intriguing findings from our third Survey of Bill Review in Work Comp and Auto pertains to data analytics.

Multiple questions probed into respondents’ utilization of data analytics. The questions ranged from the state of their data management program through the relationship between the future of BR and data analytics. In our 2012 Survey, numerous respondents stressed the importance of data analytics, data quality, data management, etc. But despite that emphasis six years ago, respondents seemed to have made little progress employing data analytics packages and integrating data analytics into BR and vice versa.

From the Survey Report (to be released in early December):

A surprisingly low number of organizations have invested significant resources into data analytics.  Only a handful of respondents report that their organization has acquired, sorted, and leveraged data sufficiently enough to begin building predictive modeling or provider profiles.

That’s not to say payers haven’t built data warehouses or aren’t developing analytics capabilities. In fact, “Every large and medium sized respondent said their organization aggregated and transferred bill review data to a data warehouse for analysis.” Rather, most are still in that data modeling development and construction phase; using that data to build models, profiles, and gain deeper understanding is still a ways off.

More narrowly, half of respondents who process their own bills internally tied a data analytics package to their BR product (a more limited approach than combining BR data with data from other sources such as pharmacy, claims, medical management, first notice, and external data sources) while only 6% of those who outsource bill processing used a data package with their BR.

This dichotomy isn’t surprising as external users are generally much smaller organizations.

To get even more specific, fewer than 20% of respondents mentioned building predictive models and in most cases respondents said data was compartmentalized and only used for particular departments such as finance.

We asked what was the greatest unmet opportunity in bill review; Only 10% of respondents specifically noted the importance of data analytics going forward. And, just 20% of respondents said that a higher level of data analytics would be the future of BR.

Considering the value added that accurate data analytics can provide on virtually all BR functions – not to mention the entire claims function, loss ratios, and financial results – and that a vast majority of respondents are not fully linking BR and data analytics, these results indicate significant opportunity.

Thanks to the 30 professionals who participated in the Survey, we have a clear picture of where the industry is today, and what they are looking for from vendors/partners tomorrow.

The respondents hail from all around the country, from insurers, state funds, TPAs, and large employers. Very large to very small, from national in scope to a single-state focus, these experts gave freely of their time and expertise and for that we are grateful indeed.

What does this mean for you?

The opportunity is clear.

Note – I’ve received several anonymous comments/emails lately.  I’d remind commenters that anonymous comments on MCM posts are ignored, as are comments with fictitious email addresses.

You know who I am. I and my readers need to know who you are.




ACA to Trumpcare, and the path along the way

Andrew Sprung has posted this month’s Health Wonk Review, highlighting a broad spectrum of perspectives on the Trump Administration’s ongoing efforts to emasculate the ACA, along with research into effectiveness of medical care, drugs, and a deep dive into Republican claims to protect those of us with pre-existing medical conditions.

Reinsurance, catastrophic plans, Texas v United States, are all covered in Andrew’s edition.



The trade war should scare you

Here’s why.

China can outlast the US.

China’s leaders aren’t afraid of public pressure to give in to Trump.

Despite claims to the contrary, the impact of tariffs on US consumers is being felt – and the pain, while minimal today, is growing.

The tariffs, intended to bring back manufacturing jobs to the US, are actually forcing US manufacturers to find other Asian countries that will make the same stuff China currently exports.

Agriculture is getting hit hard. China used to buy about $20 billion of our agricultural exports; that number is down significantly.  Retaliating against the Administration’s initial and follow-up tariffs, China increased tariffs on pork to 70%, effectively locking US producers out of a very lucrative market.

The price for soybeans, one of our largest exports, is down about 20% over the last six months.

source Nasdaq

The US is the largest soy producer in the world,  and China used to be our biggest export market.

As a result of the Trump tariffs, China is buying its soy, pork, corn, and other products from other countries, entering into long-term contracts with planters in Brazil and Argentina and elsewhere. While some will claim they’ll switch back when the trade war is over, that’s highly doubtful given the unpredictability of the Trump Administration.

The trade war is a double whammy for ag equipment manufacturers; steel and aluminum prices are up substantially, while demand for their equipment is down because farmers’ finances are on shakier ground. Certain types of steel commonly used in ag equipment is only made in Canada or Mexico, so equipment manufacturers have no choice but to pay the 25% tariff.

It’s not just agriculture.

The US imports more steel than any other nation; over 34 million metric tons last year alone. When manufacturers have to pay more for steel and other materials, they pass that on to their customers. So, prices are up, which may well drive down demand.

A Federal Reserve analyst looked at the impact of the tariffs on manufacturing; the results are troubling.

“all industries within the U.S. manufacturing sector source at least 10 percent of their intermediate inputs internationally. And, at the high end, the motor vehicles, trailers, and semitrailers industry sources about 30 percent of their intermediate goods from abroad.”

Here’s the takeaway.

U.S. firms that can will pass these higher costs on to the consumers of their products, leaving those consumers less money to spend elsewhere after paying higher prices for the goods affected by tariffs. Firms that cannot pass the costs on will, at best, have less cash flow to invest and expand in the U.S., or, at worst, will become unprofitable, lay off workers, or potentially go out of business. These tariffs increase production costs for U.S. manufacturers, placing them at a competitive disadvantage, and will, on net, destroy more output, wages, and employment in the United States than they create. [emphasis added]

What does this mean for you?

The trade war will likely:

  • drive down manufacturing profits
  • hurt the entire agricultural industry
  • reduce consumer demand for all goods and services

For work comp folks, we know that recessions lead to higher initial claim frequency, followed by longer-term disability duration.

Things look good now, after a 10 year economic expansion.

That will not last, and when it ends, it will be ugly.


Work comp/Auto medical bill review – initial takes

We are about a third of the way thru interviews for the third Survey of Medical Bill Review in Workers’ Comp and Auto; here are a few initial takes.

  • Bill review has progressed a lot in the last decade, with key advances in:
    • Auto-adjudication of more bills
    • Better coordination/integration with document management
    • Ability to more readily connect with other key systems e.g. treasury/finance, state reporting, claims
  • One area that still needs a lot of work – automated integration with UM/UR applications
  • E-billing is leading to more auto-adjudicated bills, but headaches as well.
  • In general, respondents don’t see a lot of differentiation among bill review vendors.
    • But some respondents point to key differences between vendors and application providers that should be top of mind for payers
  • The most common pricing methodology? so far, it’s a flat fee per bill for bill review and the old percentage of savings for everything else.
  • that said, there are some pretty innovative approaches to pricing out there that bear watching

The last time we did this survey was six years ago.  We will be comparing and contrasting results to document what’s changed and where things are going.

If you’d like to participate, shoot an email to infoAThealthstrategyassocDOTcom.  Substitute symbols for the caps.


Paradigm Outcomes acquired

Paradigm will be acquired by investment firm Omers, a Toronto, Canada headquartered company. Sources indicate the price was approximately 14 times earnings; by my calculation, the total valuation was above a billion dollars.

Till now, Omers had not been visible in the work comp services investment space. And, Paradigm was not “shopped” in the usual way; an investment bank is hired, books go out, bids are accepted, etc. The price is even more remarkable as there wasn’t an auction; the valuation continues what’s become the new normal pricing for work comp assets.

If it seems like you were just reading about a Paradigm acquisition…you were. The company just completed a deal to buy pain management network company AdvaNet.

Omers does own Premise Health, a worksite clinic firm, as well as two outpatient rehab and physical therapy companies – however sources indicate there are no plans for any collaboration or combination of assets.

What does this mean for you?

If you own a work comp services business – sell now!


King v CompPartners – good news, but another shoe to drop?

Yesterday California’s Supreme Court fully supported the State’s workers’ comp UR/IMR process.

That is excellent news.

First, here’s the key takeaway – the Court ruled that workers’ comp remains the “exclusive remedy” for resolving disputes related to treatment approvals/UR/IMR.

Second, the California Legislature may well take up the issue and require payers to take into consideration the potential medical effects of a treatment decision, perhaps including weaning off medications that are no longer approved.

The Ruling

UR/IMR is an inherent part of the workers’ comp process, and therefore falls under the exclusive remedy provision of work comp. So, the plaintiff could not sue the IMR reviewer for an allegedly adverse treatment decision.

(Any treatment arising from the plaintiff’s medical care – which in this case was allegedly due to the suddenly stopping a medication – is part of the work comp claim.)

Here’s how CWCI General Counsel Ellen Sims Langille put it:

We have long contended that exclusive remedy was the beginning and end of the discussion in this case, inasmuch as the URO was acting in the capacity of the employer, and as a statutorily required part of the claims process, and now the Supreme Court has agreed.  The URO was acting as the “alter ego” of the employer, and the utilization review itself is a statutorily required part of the claims process.  That is the very definition of exclusive remedy.

The Court of Appeal had made an obvious error in finding that the seizures suffered by Mr. King were compensable outside of the workers’ compensation system because there were no allegations that he was working at the time he suffered the seizures.  That is a fundamental misunderstanding of how compensable consequences work.  As our Amicus brief argued, the injuries alleged by Mr. King were derivative of a compensable workplace injury, and the new compensable consequences injuries fall within the scope of the workers’ compensation bargain — and within exclusive remedy.

But there’s more, which may lead to additional legislative action to address the underlying event behind King…again from Langille:

Concurring Opinions were filed by two justices, and may prove to be the enduring legacy of the decision.  Justice Liu frankly invites the Legislature to examine whether existing safeguards provide sufficient incentive for competent and careful utilization review, pointedly noting his skepticism that “a care plan… appropriate for the medical needs of the employee” was established before the Klonopin was discontinued.  Even the Majority Opinion referenced the same language from §4610(i)(4)(C).  Unfortunately, it does not appear that any of the justices understood that this subsection applies only to cases of concurrent review, which is defined under Reg.  §9792.6(d) as “utilization review conducted during an inpatient stay” and thus inapplicable to the facts of this case.  Be that as it may, it is likely that the next legislative session will include some effort to expand the safeguards for the injured worker under utilization review.

What does this mean for you?

Consider the impact of medical treatment decisions on the patient’s future condition. 


The big story – work comp rates continue to drop

Spent most of this week doing a long bike ride with two great friends – riding thru a 90 minute downpour, falling into a mud puddle, and marveling at two century-old engineering feats.

Glad I missed the poison ivy and horse poop…

Work comp premium rates keep tumbling

This is one of those very big stories that isn’t getting near enough attention. This morning’s WorkCompCentral had two stories that highlight just how much the world is changing.

WCC’s Greg Jones (one of the more diligent reporters I’ve read) noted that California may lose it’s place as the state with the highest work comp rates. 

Ohio’s public employers are looking at a 12 percent drop, capping off a seven-year run of decreases that have slashed premiums by almost 42%.

Meanwhile, despite high medical costs and lots of litigation, Louisiana’s rates have also declined some 30 percent over the last decade.  (thanks to LCTA’s Troy Prevot for the head’s up). While the reduction in employers’ and taxpayers’ costs is a very good thing, too-high medical costs and too-long disability duration are problematic indeed. But the story here is rates are dropping despite these significant cost drivers.

The biggest driver appears to be claims volumes – frequency declined 6 percent last year alone. While some argue that frequency is not a number, and therefore isn’t relevant, as we get very close to full employment, the “gap” between frequency (claims per 100 FTEs) and the actual volume of claims becomes pretty meaningless. (cue disagreement, which is welcomed)

What does this mean for you?

Lower rates will force insurers to reduce administrative expenses, overhead, staff, investments in technology.

Lower rates reduce premium taxes, a funding source for regulatory entities.

Historically low injury rates are continuing to drop, reducing the number of claims – which reduces the need for case management, claims adjusting, bill review, UM, peer review, IMEs…pretty much all claims services.

Insurers seeking to cut fixed costs to reduce Unallocated Loss Adjustment Expenses are moving claims to TPAs, a trickle that may become a flood.