Insight, analysis & opinion from Joe Paduda
We interrupt this healthcare blog to bring you a few moments of humorous relief…
Here’s for enthusiastic voters…
Gotta love Steve Schmidt et al…
Colbert is always so helpful!
Yeah, I don’t get it either…
Ouch.
And calls, and posters, and signs, and…
Oh God NOOOOOOOO!!!!!
What does this mean for you?
Everything.
President Trump has tested positive for the coronavirus; we’ll divert from our usual focus on healthcare matters to highlight what we know now, and potential implications.
It is important to understand that most people with coronavirus have no symptoms or relatively mild cases. Statistics favor a positive outcome for the President.
Infection source
We do not know how the President become infected. We do know that one of his closest advisers, Hope Hicks, tested positive. Reports indicate Hicks has multiple daily encounters with the President, traveled with him on Air Force One, and accompanied him on his latest trips.
The President’s health
Implications
CDC data indicates that one out of ten people in their 70’s with positive diagnoses of COVID19 died. The report did not separate data by sex; it is likely men are at higher risk of death. (note there are no credible reports that Trump has COVID19 – he has tested positive for the coronavirus which may lead to COVID19.)
The same study indicated almost one out of three COVID19 patients 70-79 with an underlying medical condition died; note that obesity was not specifically identified as a medical condition.
Near-term implications
First, the President will suspend his campaign schedule during a two-week quarantine period. Events will be canceled for the time being as his campaign awaits developments.
If his health is severely impaired, his powers as President can be delegated to the Vice President under the 25th Amendment to the Constitution until such time as he is able to resume those duties.
Worst-case implications
If a sitting President dies at any time during his/her term, the Vice President assumes the Presidency.
If a major political party’s candidate dies after being nominated by her/his party, and during the election campaign, that candidate’s political party would nominate a replacement candidate. The process differs by party; for the GOP, the Republican National Committee would oversee the process which gives each state the same number of votes it has at the party convention.
[Note the Democratic Party’s process is generally similar]
It is unclear what happens if the Party’s candidate is medically incapacitated at the time of the election.
There is no Constitutional provision to delay a Presidential election in the event of a candidate’s illness, incapacity, or death after nomination and before the election.
For more information on the latest details on COVID19 treatment, click here.
What to watch for
There will be a lot of political maneuvering and posturing , most of it just noise.
Rely on credible news sources – the major broadcast networks, NPR, and major newspapers – and ignore nonsense from YouTube, twitter, and the like.
And there are already lots of ridiculous conspiracy theories – ignore them too.
Another whirlwind week is just about over, and with it the summer of 2020.
Here’s important/interesting news that came across my virtual desktop this week.
COVID and Comp
More data on workers’ comp COVID19 claims is coming in; Virginia’s Workers’ Comp Commission has published data; key takeaway is to date, only 8.3% of COVID19 claims reported have resulted in benefit payments. That will certainly increase as claims develop.
More info on state COVID reporting is here – you can watch a recorded webinar on the subject here – Mark Priven and I dive into data from California and Florida and discuss the implications thereof.
Meanwhile, employment took another hit as last week more than a million Americans filed for unemployment. This continues a five-month run of claims at or above the million mark. 14 million of us are still without jobs.
COVID19’s impact on health insurance coverage
Several million people have lost their health insurance due to COVID19-related job losses. We don’t know the specific number – and it is certainly increasing – but it is likely between 3 and 12 million. (download the report for details).
Another perspective is here.
Most of those folks are lower-income workers and many are minorities; some may be eligible for Medicaid however states that did NOT expand Medicaid such as Texas and Florida will see an increase in uninsured care costs.
Congratulations to myMatrixx and new Chief Sales Officer David Dubrof; David is one of the very few “A” players in work comp services sales; myMatrixx will benefit greatly from his sales leadership. David and his colleagues are equally fortunate; payers have consistently rated myMatrixx the top workers’ comp PBM. (myMatrixx is a client)
NCCI published a report on the impact of fee schedule changes on outpatient facility costs. Good to see this rapidly-rising cost driver getting attention.
Implications
Ok, it’s been another terrific week…although my definition of “terrific” has changed a lot since January.
This being Friday, it’s time to lighten things up.
Today seems like…yesterday.
Therefore, it is time to look for a present for that special friend…
Some states are going back into lockdown, which is too bad cause you’re going to miss out on stuff like this.
SPORTS!
With worries about football season, baseball scheduled to play just 60 games, and the NBA playing in a bubble, it’s time to expand our horizons and consider other sports.
Baseball may not be it for this young player…
Looks like the SEC was practicing social distancing before we knew it was a thing.
This just in from Chicago…
That “other” football has to change too.
From an Eagles fan…
Finally, as a recovering Catholic, this brought back lots of memories.
So, who knew masks could be so dangerous?
In our continued effort to keep us all honest about “science” and “research”, I have to weigh in on a recent piece wherein some folks seem to be concerned about mask wearing’s impact on a person’s health. The Risk & Insurance piece noted:
A study (italics added) conducted by PN Medical, and as reported in The New York Times, found that extended mask wearing could lead to improper breathing, which could result in possible negative side effects such as anxiety, headaches, increased heart rate, dizziness and fatigue.
This wasn’t a “study”; it was a “small investigative trial”. Details are here.
The person who described it is not a clinician.
There’s no information on how many subjects were involved, if there were any controls, the demographics of the test subjects, the methodology used, how the multi-site “trial” was conducted to ensure consistency, weather conditions, temperature and humidity, time of day, and the many other factors that could influence a person’s post-mask behavior and physiology.
The story goes on to describe all the bad stuff that “might” happen, all of which are assumptions based on assumptions based on what is most definitely not credible research.
Further, the story is based on another reporter’s failure to accurately describe the “small investigative trial;” a New York Times reporter at that.
It is entirely possible that masks cause some issues…but they’ve been in use for decades and this is the first report I’ve seen that there is any concern.
We need to do better, folks.
IWP gets hammered by Massachusetts’ Attorney General
Finally, IWP Pharmacy, long the bane of many adjusters, agreed to a Consent Decree that requires major changes at the Massachusetts-based mail order pharmacy. Mass AG Maura Healey announced that IWP will pay an $11 million settlement and make major changes to resolve:
allegations that it failed to implement adequate safeguards against unlawful and dangerous dispensing, resulting in the shipment of thousands of potentially illegitimate controlled substance prescriptions across the country.
In perhaps the most stunning example of spin I’ve yet seen, IWP’s statement doesn’t even mention the settlement… in a post entitled “IWP Expands Compliance Program” the multiple changes to staffing, operations, compliance, and sales were characterized as:
steps…developed in collaboration with the Attorney General of Massachusetts, as part of a recent review they undertook of past business practices.
The AG’s statement read in part:
“Injured Workers Pharmacy created an illegal operation that put dispensing speed and volume over patient and public safety…They dispensed thousands of prescriptions for dangerous drugs, including opioids like fentanyl, with a shocking lack of regard for whether those prescriptions were legitimate.”
What does this mean for you?
Question reporting and go to the primary source.
Check your files for IWP patients.
Apologies for the dearth of posts; vacation and slammed with client work.
Went bike-packing last week in the wilds of Pennsylvania and Maryland – had a great time off the grid, camping out, solving world problems around the fire at night.
Alas the world just created more…
Here’s a quick update on what I missed.
the great re-opening…or, what scares the bejesus out of me.
About 25 million people that can’t work remotely are at high risk if they contract COVID19. So, they a) have to go to work, b) many take public transportation, and c) are at high risk due to pre-ex conditions and poor health. This does not bode well for states experiencing increases in COVID19 cases.
Many states appear to have decided the healthcare implications of opening up outweigh the economic and societal costs of staying closed.
Florida is one such state:
Here’s a snapshot of positive tests, go here to get data on your state. The graphs show case counts from January thru yesterday; the greener the background the steeper the decline, the redder the steeper the increase.
Hospitals in seven states are in danger of being overwhelmed with new COVID-19 cases as fatalities increased yesterday for the first time since June 7. 33 states and territories have a higher rolling average of cases yesterday than they did last week.
Meanwhile the Federal government is scaling back its support for testing in 5 states.
Employment, payroll, and workers’ comp
As I noted in an earlier post, the biggest impact on workers’ comp will not come from COVID19 itself, but rather the dramatic drop in employment, business failures, and payroll.
According to NCCI, job losses peaked a couple months ago and employment has recovered somewhat…however there is wiiiiiiide variation across states, with some states as low as 8% unemployment and others up to 20%.
Remember the PPP dollars run out in a week, and when those $$ disappear, employers who had to keep workers on payroll to qualify for PPP won”t have to keep them “employed.” So, watch the unemployment numbers for early July closely.
Insiders are expecting a big increase in the number of corporate bankruptcies driven by way too much debt, changing buyer tastes, and of course COVID19. My take is COVID19 will accelerate the jump in bankruptcies, but the underlying drivers are the root cause; lots of debt works great…until it doesn’t.
The term for companies that are having big problems covering their interest expense is “Zombie”, signifying an entity that is dead but still stumbling around. About one out of five publicly-traded companies earns this sobriquet.
What does this mean for you?
Stay tuned to reports on unemployment and payroll changes in July. If the numbers aren’t good, the implications are broad and deep.
If survey respondents’ estimates of claim count reductions are accurate, we’re looking at about 20% fewer work comp claims in 2020 than last year.
So, what does that mean?
That’s about 1.2 million fewer claims. We can expect a greater percentage of those filed will be lost time; in tough economic times, workers tend to not file claims for minor issues.
Insurers, State Funds, and TPAs
Profit margins for insurers and funds will be higher because there are fewer claims; yes revenues will be lower, but combined ratios will actually improve. But, while margins will be up, dollars of profit will be stable or, more likely, somewhat less.
I’d expect insurers to hunker down and hold on to as much cash as possible. Expect a big push to reduce Unallocated Loss Adjustment Expenses; think fewer dollars for IT projects and the like.
Execs will be looking for ways to reduce allocated expenses and claim costs. Here are a few that may get traction.
Service companies
Companies with very good customer relations and high service standards will win. While staff reductions are inevitable as case loads drop, service companies that manage those reductions wisely and humanely will reap benefits as the workers still employed will show their loyalty by going above and beyond for customers.
On the product side, many vendors are figuring out ways to help employers get safely back to work, prevent workplace infections, and facilitate medical access for patients with injuries. On-site employee assistance, testing access, cleaning services, scheduling support are all in play as is stress management and support for families dealing with illness.
Tele-services are a big part of this; big winners will be those that make the leap from using tele-as just a face-to-face visit to something more substantive, more diagnostic, more useful. There’s lots of creativity at work here…dare I say it innovation may actually become acceptable!
Expect more consolidation as private equity and venture capital owned firms (and others with solid cash reserves) try to buy out competitors, get their customers on board, and do it all on the cheap.
What does this mean for you?
Chaos brings opportunity – especially for those who remember this business is about helping people who are hurt get better.
It’s been a not-fun week – but far better here in rural America than a lot of other places…Here’s a few of the better memes I came across.
Science marches on!
For those who remember old movies…and why our kids are VERY thankful they are out of the house…
Here in upstate New York, barber shops and salons are open (Yay!) but getting an appointment is impossible (NOOO!)
My vote for best use of humor in a pandemic goes to…
This is just a bit too close to home…
Trekkies have weighed in…
EVERYONE is figuring out how to make their stuff relevant in these troubled times…
You can always rely on SNL to make the most of adversity…love in a time of COVID.
What does this mean for you?
There is life after pandemics – for some of us…
And that has big implications for private insurance and workers’ comp.
An insightful piece by Milbank Fund President Chris Koller details the carnage (Chris and I serve on Commonwealth Care Alliance’s Board of Directors).
Total healthcare spending in March was more than 5% lower than the same month in 2019.
From Altarum’s report:
This decline was led by the two largest spending categories: hospital spending, which showed an 8.7% decline, and spending on physician and clinical services, which declined by a huge 19.3%, year over year.
In late April, outpatient office visits were down more than 60%. Visit counts have rebounded in the last few weeks, but are still quite low – especially for surgical and orthopedic specialties. (From the Commonwealth Foundation)
The financial impact on healthcare providers is devastating. To date, big health systems have already lost about $400 million – each.
80% of New York doctors have lost more than half of their income, and providers in other states haven’t fared much better. Not surprisingly the ones hardest hit are those that do procedures – especially surgery. While primary care docs and behavioral specialists have been able to switch some patient visits to tele-services, that isn’t possible for proceduralists.
Implications.
Workers’ comp bill review systems, logic, and rules are woefully inadequate and payers using those systems will suffer the consequences.
Private insurers are significantly better off due to much more sophisticated systems…but over the longer term they can expect provider groups will push hard for increased reimbursement.
What does this mean for you?
Workers’ comp payers and private insurers are making a lot of money these days. That will not last.
They would be well-advised to invest now in reimbursement systems, expertise, and tools.
Drug rebate dollars account for a big chunk of brand drug costs – more than 40% in some cases. While list prices for brand drugs have been rising rapidly, net prices – the prices actually paid to the manufacturer – have not.
That’s mostly because manufacturers have been paying rebates to employers, insurers, and others in the drug distribution system.
This from Adam Fein PhD of Drug Channels:
A drug’s net price equals the actual revenues that a manufacturer earns from a drug. The net price equals the list price minus rebates as well as such other reductions as distribution fees, product returns, chargeback discounts to hospitals, price reductions from the 340B Drug Pricing Program, and other purchase discounts.
AARP is one of those making bank off rebates, along with lots of healthplans and insurers.
Workers’ comp
The picture’s a bit different in workers’ comp, for several reasons. Rebate payments tend to be lower because:
But – there’s always a but – rebates must be considered when evaluating your drug spend. If you are an insurer or self-insured employer, a few things to consider:
What does this mean for you?
These are your dollars. You need to ask the hard questions to be sure you’re getting the right answers.