Nov
19

What’s different now?

Nine months into the pandemic and well into the third wave, it’s time to see what’s changed – and for how long.

  1.  Remote is here to stay.
    Whether you are a claims professional, case manager, executive or manager,, clinician or administrative worker, its likely most if not all of your work is now being done outside the “office”.
    I don’t see that changing – many employers are going to maintain an at-home workforce. While IT and cyber issues and costs are significant, savings in real estate and associated costs are real. And quality of life is higher and cost of life is less; no hours spent commuting, more time with family, and no need for that extra car, parking spot, train pass, and business lunch.
  2. Selling and servicing is changing
    Service companies looking to sell their services or service accounts are working hard to figure out how to ply their trade remotely. Zoom calls, DoorDash lunches, virtual wine tastings and sports watching are just a few of the things we do today that would have been incomprehensible just 10 months ago
    I don’t see that changing anytime soon. With budgets slashed and travel risks high, business travel is over. As the economy tries to claw its way out of a very deep hole and companies look for any and every way to save dollars, expect financial folks to keep travel budgets near $0.00. One exception…
  3. Conferences will likely return
    The proliferation of conferences was getting overwhelming, with way more conferences than people to attend or sponsors to fund.  Hopefully the less valuable ones will disappear, and the key ones will continue – after revamping their business models.
    Pay to play has to go; it’s gotten to the point that at many events, conference sponsors get speaking slots regardless of the quality of the speaker or salience of the topic.
    Exhibitors are paying gazillions to stare at each other across empty aisles.
  4. Insurers are cutting back
    With premiums dropping precipitously, insurers are laying off staff, cutting IT projects, putting off investments and consolidating operations. If anything that’s going to accelerate as the winter looks long and dark, and the most optimistic projections indicating fall as the time things start to get back to what we once thought of as normal.
  5. Consolidation will accelerate
    As companies of all sizes and types face declining revenues, those that are stronger financially will win. There will be horizontal and vertical mergers (companies buying others in their business, and buying companies in different businesses).
    There are billions of dollars burning holes in investors’ bank accounts, desperately seeking acquisition targets. While investors will be cautious, expect them to seek out attractive targets.

What does this mean for you?

Adapt and succeed. A minute complaining about reality is a minute not used well.


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
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
5

COVID and work comp in the Sunshine State

WorkCompCentral hosted a webinar last week (you can watch at no cost) diving into key issues related to Florida’s experience with COVID19 and workers’ comp. Moderated by Rafael Gonzalez (one of the nicest people you’ll ever meet), the panel included a defense attorney, judge, and managed care executive providing different perspectives on COVID’s impact.

Most of the discussion focused on solutions; we’ll touch on the ongoing issue of claim acceptance before highlighting some of the solutions discussed by the panelists.

Claims filed v accepted

Judge David Langham noted that about 7,000 of roughly 17,000 COVID claims filed have been partially or completely denied, yet to date only a handful have filed petitions seeking benefits. (A petition would lead to a formal hearing.)

Ya’Sheaka Williams, a defense attorney, spoke at length about healthcare workers’ exposure, indicating that in her experience claims filed by these workers weren’t contested. She provided good insight into differences between “essential” vs “non-essential” workers, noting sanitation workers are even more important now than ever as it is critical to safely dispose of potentially contaminated materials.

Langham also noted that 96% of accepted cases have resulted in payments <$5,000; the average is <$1,000. (consistent with data Mark Priven and I previously reported)

Of course, as Langham indicated we do NOT know what the long-term impact of COVID19 on individuals will will be; there’s evidence that some individuals have lasting chronic conditions, some of which can be quite debilitating.

Langham averred “in the United States, we aren’t reporting who has recovered, whatever that means.” That surprised me, as a slide displayed earlier in the same presentation specifically reported recoveries in the US. (the picture below is from the same site, captured this morning)

In defense of Judge Langham, I hasten to add that in fact that while there is some reporting of “recoveries”, there’s no universally-accepted definition of “recovery”, nor is the reporting of recoveries consistent across states or even counties within states.  For example, Texas has reported 680,000 “recoveries”, while New York  – a state with much higher infection counts – has only reported 77,000, and California and Florida have not reported ANY recoveries. (at least as reported by JHU)

The lack of clear and specific definitions and guidance from the Federal Government – and a Federal mandate that reporting entities stick to those definitions and guidance – is highly problematic.

Matthew Landon, Chief Strategy Officer of MTI America, suggested employers ensure they are using the same processes, procedures, and strategies to evaluate COVID19-related claims that they use for all claims. Consistency is critical to demonstrate objectivity.

Lessons learned

Judge Langham noted that virtual hearings are proving we can use technology to speed up hearings, engage with claimants more effectively, and get to resolution quickly despite the inability to get together in person. He also encouraged all of us to “protect ourselves mentally and physically” so we can help others.

Kudos to Judge Langham for reminding us that before one can help others, one has to take care of oneself.

Landon identified telephonic translation services a key tool speeding up claims handling and ensuring the right care is getting to workers with language limitations. He also noted care within medical offices seems to be more effective as patients are seen more quickly with lower waiting times; office managers are working to keep the number of patients in offices as low as possible.

More care is being delivered in the home of late, a response to workers’ desire to avoid medical facilities.

Ms Williams reported Tampa Airport is partnering with BayCare Health Systems to provide passengers coronavirus tests on-site at no cost to the passenger, highlighting one example of companies working together to come up with creative solutions to reduce risk and personal stress levels.

She also was encouraged that the delays in accessing care experienced by many injured workers seem to have abated somewhat, a promising development as more clinical practices open up for on-site care and more providers adopt tele-medical solutions.

What does this mean for you?

Good information from folks with deep knowledge of Florida’s experience, much of it applicable to other states as well.

note MTI America is an HSA consulting client


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
18

Friday catch up; lots doing in workers’ comp

A very busy week indeed – here’s what happened.

MedRisk’s management changes

Long-time CEO Mike Ryan has stepped up to Executive Chair, and President Ken Martino is moving up to CEO. Mike has led the organization as President for more than 7 years. Founder and Chair Shelley Boyce named Mike CEO several years ago. I know Shelley, Ken and Mike very well.

MedRisk’s annual growth has averaged over 20% for the last decade. The company now employs 1,200 people, all located here in the US.

There’s no question MedRisk, perhaps the most successful company in the work comp services sector is in very good hands. (MedRisk is an HSA consulting client)

Mental health in the workplace – Great take on the big increase in workplace stress from HomeCare Connect’s Teresa Williams in today’s WorkCompWire.  Teresa notes that the percentage of adults with depression or anxiety has tripled over the last year. Her piece has helpful recommendations that employers:

  • list what they are doing to protect employees
  • be honest and straightforward about the employer’s financial situation
  • refer workers to trusted sources for information on COVID – NOT YouTube videos from random cranks
  • keep in mind that younger workers seem more vulnerable to stress than we older folks.

Progress in bringing science to claims handling

Congratulations to Gallagher Bassett’s Jeffrey Austin White and colleagues – GB’s Treatment Quality Index (TQI) was named Insurtech Initiative of the Year. The Index, coupled with Clinical Guidance, identifies which claims would benefit from what type of clinical attention and when to apply it.

There’s a lot of really good thinking behind TQI; it addresses one of the toughest challenges faced by claims handlers.

Innovate or else.

Coincidentally, GB’s Gary Anderberg PhD penned a terrific piece on what we have learned and can learn from COVID.  One of his 5 takeaways:

COVID has cast a strong light on the fact that we always act on imperfect, half developed information, that all decisions are provisional, that updating your data constantly and rigorously is not a luxury.

(GB is not an HSA client)

Gary’s piece came the same day the Harvard Business Review published a though-provoking article on innovation…noting one huge retailer spent 18 months developing and implementing curb-side pickup. This went pretty much nowhere…until COVID.

Substitute “telemedicine” for “curbside pickup” and “workers’ comp insurer” for “retailer” and you will learn a lot about the cost of not innovating.

What does this mean for you?

Great companies succeed by delivering the service customers don’t even know they want.


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.


Aug
28

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

  1. Fewer jobs = lower payroll = lower work comp premiums
  2. Things are tough and getting tougher for lower-wage workers, which are disproportionally people of color.
  3. More uninsured = more need for facilities to get $$ from those who are insured.

Aug
26

BWC’s dividends and drug costs

Last week Ohio’s Bureau of Workers’ Compensation announced it will consider $1.5 billion in dividends to policyholders.

This comes on the heels of a similar payout in April;

$1.35 billion went to private employers and $184 million went to local government taxing districts, such as counties, cities, townships, and school districts.

Together, the two dividend payments amount to a refund of all premiums paid by employers in 2018 and 2019.

The Bureau’s very strong financial results were attributed to excellent investment performance, a continued decline in claim counts, and “prudent fiscal management.”

A significant piece of this “prudent fiscal management” was the audit of BWC’s pharmacy program, an audit that led to the State Attorney General suing BWC’s PBM OptumRx. Subsequently AG Dave Yost accused OptumRx of overcharging “the state on 57% of 2.3 million claims between January 2014 and September 2018.” [it is important to note that BWC’s prior PBM was acquired by Optum and operated under a separate business unit]

The suit was later amended to reflect Yost’s allegation that overcharges exceeded $16 million.

BWC switched PBMs two years ago.

BWC’s drug costs have dropped significantly over the last couple of years; while a decline in claim frequency undoubtedly contributed to that drop, it is safe to say that prices paid for drugs helped slash pharmacy expenses.

And that has helped fund the huge dividend checks BWC’s customers are getting.

What does this mean for you?

Do you know you are paying only what you should? 

How can you prove that to your policyholders and customers?