Insight, analysis & opinion from Joe Paduda
Broadspire, one of the largest TPAs in the country, has announced a new network strategy which goes by the acronym BOLD, that is notable as much for what’s missing than what’s present. There’s no mention of Coventry in the list … Continue reading Broadspire’s the first
Read More...The evidence is pretty clear – low fee schedules don’t have much, if any, impact on drug costs. Sure, they give the appearance of action, and some actuaries and politicians are able to claim future cost reductions based solely on … Continue reading Work comp pharmacy fee schedules – what’s the answer
Read More...I was talking at length with a good friend who works for a large payer last week, discussing the process of getting the organization to make significant, and very much needed, improvements to their managed care program. This got me … Continue reading Why don’t comp payers change?
Read More...Cost-shifting – the practice of seeking higher reimbursement from some payers and patients to cover shortfalls due to low or no reimbursement from others – is rampant in the US health care system. Having worked with providers, health care systems, … Continue reading Auto insurance and hospital cost shifting – so THAT’s why my premiums are so high!
Read More...According to Bill Kidd’s piece [sub req] in WorkCompCentral this morning, several states are attempting to address the rapidly growing problem of surgical implant device fees via regulation or legislation – by basing reimbursement on the manufacturer’s invoice. While it … Continue reading Can the surgical implant problem be fixed?
Read More...As states take on the growing problem of surgical implant costs – the latest (and arguably greatest) effort by certain providers to reap huge profits from workers comp payers and employers, it’s time to delve into the problem – and … Continue reading Surgical implants – why the ‘price’…isn’t
Read More...As CMS seeks to ensure taxpayers don’t pay for care due to comp, liability, or other causes, Medicare Set-Asides will become more common. And as we’ve seen recently, one of – if not the – biggest cost areas is pharmaceuticals. … Continue reading Medicare Set-Asides – the real problem
Read More...Earlier this week we discussed the impact of pending changes in the world of big pharma will affect workers comp. Changes to Medicare physician reimbursement, also just over the horizon, will have a dramatic impact on workers comp in ways … Continue reading Where the work comp world is headed – part 5, physician reimbursement
Read More...Health Affairs’ most recent edition includes a piece [sub req] on the changing health care landscape in California, one that now has hospitals occupying the high ground. The historical background is telling; too many hospitals to begin led to tough … Continue reading Hospital costs in California – the tide has turned
Read More...I’ve long held that broad-based attempts to control the price of medical service are, at best, a short term fix, and at worst, a blunt instrument that actually encourages over-treatment and extended disability. Greg Krohm, Executive Director of IAIABC, has … Continue reading Are workers comp fee schedules driving up costs?
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