Insight, analysis & opinion from Joe Paduda

Aug
3

CorVel earnings report

Managed care firm CorVel recently announced its results for the most recent quarter; revenues are down 7% and EPS dropped 12.5%. The company attributed its poor returns to soft claims volume in the workers comp sector (the source of most of CorVel’s revenues), higher costs for regulatory compliance, and soft case management volume.
Perhaps even more telling is the trend: profits for the quarter were .28 per share last quarter, .32 in the same quarter in 2004, .40 in 2003, and .36 in 2002. The profit margin is also slim at $2.8 million on revenues of $70 million. While the cost of revenues declined, SG&A expenses actually increased by 1%. One wonders how this is possible, despite the “increased costs of regulatory compliance.” Moreover, the stock carries a hefty P/E of 29, a valuation more in keeping with a growth stock than one with a three-year trend of flat or declining revenues and profits.
What is really hurting CorVel, which is most accurately characterized as a work comp managed care firm, is their business model and reliance on revenues and profits from nurse case management.
CorVel is highly decentralized, with operations management varying greatly from one office to the next. Some of their offices, notably northern Virginia, appear to be well run, while others, including south Florida, have significant problems as evidenced by the Broward County School Board audit. In addition, sources indicate CorVel’s IT infrastructure hampers their ability to serve national customers, as it has very limited ability to integrate across offices. I’m no IT expert, but the company’s dearth of national accounts seems to support that claim.
Nurse case management is a low-margin, high fixed-cost business that is mature, highly price competitive, and fraught with opportunities for “creative” billing. CorVel has hundreds of highly-compensated nurses that must be working billable hours at all times if it is to generate any reasonable returns. This is a tough, tough business that is likely dragging down results.
The company has made several acquisitons over the last couple of years which may have helped generate positive results; mention of these were notably absent in the earnings release.
In their earnings release, CorVel noted that it’s Network Solutions (PPO) revenues increased as a percentage of total revenues. This seems to imply that it was flat or negative quarter-over-quarter. Industry sources indicate that CorVel did not make it past the first round in a recent PPO network RFP process at a large national carrier due to an inability to share critical pricing data.


Aug
2

Broward County Workers’ Comp problems – part three

Back to my review of the audit of Broward County School Board’s workers comp program. My last post focused on some of the specific problems identified in the Broward School Board work comp audit. This post will concentrate on more global problems, and highlight some “indicators” that you may be able to use to identify potentially problematic issues with your own program.
From 2001 to 2004, the percentage of the total program costs that were paid to “outside” entities (e.g. CorVel and Gallagher Bassett) went from 14% to 22%. However, according to the audit report,
our tangible results, lost time, litigation expenses, permanent impairment ratings have not improved.”
Note – if your program management costs have increased but results have not improved, you have a problem.
CorVel (the managed care firm contracted with Broward’s TPA, Gallagher-Bassett), was paid over $2.7 million for the 2004-2005 school year, an amount which is greater than 10% of the actual claims paid. By any measure, that is wildly excessive. And the program is getting even more expensive – from FY 02/03 to FY 03/04, CorVel’s total expenses increased by 27.4%.
Note – if your costs go up 27% and results do not improve, you have a problem.
The average case load for CorVel’s field case managers went from 36 in 2003 to 31 in 2004. However, the number of case managers working Broward claims went from 8.6 to 12.5, an increase of almost 50%. During this period, the number of telephonic case managers did not vary, while their case load increased by 10%. Tellingly, the number of claims increased one percent during this time frame.
So, we have more case managers billing more hours for the same number of claims.
Note – if your FCM costs and staffing increases while the number of claims is static you have a problem
The audit report also noted “the District has a relatively large number of open claims which are quite old”; 146 cases are more than 10 years old, have incurred costs of almost $50 million, and comprise almost 19% of ALL claims.
Note – if one-fifth of your claims are over 10 years old, you have a problem.
The risk management department under-reported WC claims expense by about $1.7 million for the most recent school year. Leaving aside the question of “how is that possible”, this suggests a need for an annual audit to verify expenditures.
Note – if your books don’t balance, you have a problem
What does this mean for you?
This situation is gaining national attention, which should serve as a warning to vendors, risk managers, and regulators alike. Clearly there have been signs for some time of problems at Broward County – if you haven’t audited your program or services recently, best do it now.


Aug
1

Ohio’s Work Comp hospital cost problem

The recent report on hospital expenses in Ohio’s workers compensation system which indicated WC generates less than 1% of cases but 12.5% of profits for hospitals has become the proverbial kick that overturned the ant hill. The governor has ordered the Bureau of Workers Comp to determine if hospital costs can be reduced; a major union has called for deep reductions in hospital reimbursement; the Ohio Hospital Association has vowed to participate in discussions “with an open mind and a flak jacket”; and the Bureau itself has vowed to take an active role in the process.
The latest news on the issue comes from the Columbus Dispatch;
“This month, The Dispatch used the union’s analysis to show that during the past seven years, the bureau paid hospitals about $544 million above their actual costs to treat injured workers.
The hospitals made an average of about 50 percent on workers’ compensation cases, far more than they made for treating patients with private or government insurance, such as Medicare.
Bureau records show payments to hospitals rose 80 percent between 1997 and 2003, though the number of injured workers dropped by nearly a third.”
The study of the BWC’s hospital expenses was initiated by the Service Employees International Union and shared with the newspaper, who reviewed the data and participated in the analysis. According to the Dispatch, the “Service Employees International Union District 1199, which represents 27,000 health-care workers in Ohio, Kentucky and West Virginia, will pitch a proposal it says would save $90 million a year.
The union plan would reimburse hospitals for the cost of care – as defined by the federal government – plus 10 percent. Under the current system, hospitals are paid based on the bills they submit, which sometimes are multiple times the actual cost of care.
As an aside, one wonders how many union employees are working at hospitals that would be affected by their proposal


Jul
29

Aetna Work Comp head leaving

Robyn Walsh, the head of Aetna Workers Comp Advantage program, is retiring. No replacement has been named. Started over a year ago by Aetna as a means to enter the workers comp network business, AWCA has struggled to gain traction. While AWCA has attracted interest from several payers, the only payer customer signed to date is the Hartford, and only in Pennsylvania. However, the Hartford appears interested in expanding their relationship into other jurisdictions.
Walsh came into the position with little background in workers comp; she had previously worked in investor relations, networks, and pharmacy.
As I have noted previously, the logic behind group health payers entering the workers comp market leaves me scratching my head. There just is not that much revenue in workers comp.
What does this mean for you?
It is unclear if Walsh’s retirement is due to lack of success, a desire to change leadership, or if this was part of the plan all along. We’ll have to wait and see. In the meantime, before committing to do business with Aetna, watch carefully to see if Aetna does gain any traction in WC.


Jul
29

Pay for Performance – Medicare initiative

Pay for performance is likely to get a big boost from the Federal government. A bill linking physician pay under Medicare to reporting quality data will be introduced in the Senate before the end of the year, the first step towards a pay for performance model.
Sen. Chuck Grassley (D IA) is the protagonist; as Chair of the Senate Finance Committee Grassley has both jurisdiction and significant influence over the Medicare program.
According to California HealthLine;
“The legislation would allow the HHS secretary to reward providers first when they report quality data and later when they improve quality or meet certain quality thresholds. The legislation would establish a “value-based purchasing” system for providers — such as hospitals, physicians, Medicare Advantage plans, home health agencies and skilled nursing facilities. Under the bill, physicians who report quality data would receive the full update to Medicare reimbursements allowable under current law in 2007 and those who do not report quality data would have their updates reduced by 2%.”
Currently, physician reimbursement under Medicate is slated to drop by 4.3% on 1/1/2006. This decrease is part of past legislation, and has been rescinded in recent years. However, it does require Congress to act or the decrease becomes effective. In this case, it appears Grassley is using it to promote the “P4P” initiative.
What does this mean for you?
Pay for performance is likely to become a reality. You can choose to fight the very concept, or engage and contribute to the dialogue. As Congress is especially adept at the “blunt instrument” style of reform, physicians will be better served engaging rather than avoiding.


Jul
28

Ohio’s Taft dragged into workers comp scandal

The Ohio Bureau of Workers Comp scandal is now hitting Gov. Bob Taft hard. State Sen Marc Dunn has sued Taft to find out what he knew about the Bureau’s disastrous investments and when he knew it. Although Taft had released many of his records, some of the words had been blacked out and other documents were not provided to Dunn.
The Bureau of Workers’ Comp’s investments (the subject of much of the hue and cry) may have been noted in reports submitted by the BWC to Taft that were the subject of the suit. At first, Taft had fought the action, then decided to give in and provide Dunn with the materials. However, Taft has now said the redacted bits were subject to executive privilege, a strange claim as he has already waived that protection in this matter


Jul
26

Consumer directed health care research

For those interested in consumer directed health care and attitudes towards same, you may want to listen in on a telecon hosted by Harris Interactive and GreatWest Life on 7/28. Here’s the details.
Great-West Healthcare will release findings of its “Consumer Attitudes Toward Consumer-Driven Health Care” study on Thursday, July 28, 2005. The company will hold a conference call at 9 a.m. MDT (11 a.m. EDT) that same day, hosted by Cindy Donohoe, vice president of marketing and product development at Great-West Healthcare, and Kinga Zapert, Ph.D., vice president, health care division, Harris Interactive, Inc., to discuss the results. Those wishing to participate via telephone should call 866-261-3331 (moderator: Cindy Donohoe). This number can be accessed 10 minutes before the call begins, as well as during the call.
I’m on vacation then, so enjoy.


Jul
25

Insurer – Physician communication

One of the most important benefits of the internet is improved communication among and between folk who otherwise would likely not interact. And blogs add immeasurably to that improvement. For some time I have been reading and occasionally cross-posting to and commenting on several providers’ blogs, and more specifically two blogs written by thoughtful, highly intelligent, and obviously concerned physicians. The latest discussion is on DB’s Medical Rants and concerns pay for performance.
Another excellent physician blog is Health Care Renewal.
As one of the few “payer-side” bloggers, I have also received (or perhaps been subjected to) many comments from folk on the provider side. While the discussions can be contentious at times, they are direct, insightful, and helpful in advancing understanding.


Jul
22

More trouble for Ohio

An analysis of hospital expenses in Ohio indicates that the Bureau of Workers’ Compensation paid $1.6 billion for services that cost the hospitals less than $1.1 billion to provide. The mark-up, some $544 million, has been described by various stakeholders as “a positive profit margin”, “outrageous”, “ludicrous”, and “a cash cow for hospitals”.
The basic issue is hospitals are paid a set percentage of charges, a methodology that some suggest is open to misuse, as the hospitals set the charges. Ohio’s hospitals are paid 70% for inpatient and 60% for outpatient services. Scott Courtney, EVP of the Service Employees Union that conducted the study, claimed that “Hospitals arbitrarily set a price that’s not at all relevant to the cost of providing care.”
Both the BWC and the Ohio Hospital Association are disputing the SEIU’s conclusion that hospitals are generating a profit of some 65% on workers compensation, with the Association claiming the figure is in the 15 to 35 percent range.
My own experience examining hospital data, coupled with the experience of MedNet Connect (a consulting client), a firm that works with payers to evaluate bills to assess their


Jul
21

Workers Comp costs and premiums

While payments for workers compensation indemnity and medical expenses rose just 3.2% in 2003, employer costs were up three times as much. The data, from a report by the National Academy for Social Insurance, indicates claims costs totaled $55 billion while total expenses (claims plus premiums and equivalents) were up to over $80 billion.
This is not surprising. I have been talking for several months about the profitability of the workers compensation market, and NASI’s report clearly indicates that the industry’s recent strong profitability is due to increased pricing. The cognoscenti will also note that this “happy time” appears to be ending, as recent softness in pricing indicates there is more capital flooding into the market as outsiders (and insiders) decide they want some of that profit too. While it looks good now, remember that the industry’s present return on equity is well below that enjoyed by other sectors. Thus, on a relative scale WC is doing well, but on an absolute scale returns are mediocre.
The NASI report is perhaps the best summary of the state of the workers comp business in existence. While it is somewhat dated (due to the time delays in reporting in WC), it is well worth reading.
What does this mean for you?
If you are a seller, don’t cut prices. Period. If you are a buyer, think long and hard before chasing the latest cut-rate workers comp policy. Anyone who would sell that to you is less likely to invest in long-term initiatives that will benefit your program, and over the long term, your bottom line.


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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