Back Surgery Varies from State to State

James Moore reported today on a study released last week by the Workers’ Comp Research Institute (WCRI).

Back injuries accounted for 20% of all workers comp claims, the study found.

The WCRI said that:

“Although common, how to best treat the injury—for example, when surgery is clinically appropriate or not—is controversial and lacks clinical consensus. Moreover, the frequency of surgery among workers with back injuries varies widely from state to state.”

There was a 200% variance between whether someone with a back pain diagnoses actually had back surgery:

• 20% of workers with back pain had surgery in Oklahoma or Tennessee
• Less than 10% of workers in California or Florida with back pain had the same surgery.

The three key factors that increased the likelihood of surgery, from the study are as follows:

• Surgery-intensive local practice norms – this is a very important component 
• Higher reimbursement rates for surgery, and
• More surgeons in an area each independently were associated with higher likelihoods that an injured worker had back surgery.

These are the states the WCRI used in the study:

• California
• Florida
• Georgia
• Illinois
• Indiana
• Iowa
• Maryland
• Michigan
• North Carolina
• Oklahoma
• Pennsylvania
• Tennessee
• Texas.

North Carolina is the home state of HSM, the company that sent employees to Costa Rica for back and other surgeries, as mentioned in “US Companies Look to ‘Medical Tourism’ To Cut Costs” and in “Self-insured firms offer medical tourism option to cut health care costs“, so I am not surprised that North Carolina was studied.

HSM’s employees had disc replacement surgery in Costa Rica that was far less expensive than here in the US, and provided their employees with greater mobility, something that the current treatment in the US, spinal fusion, does not provide.

So if you are an employer in any of these states, you might consider doing what HSM did, and go out of the country to provide your injured workers needing back surgery a less expensive alternative, that has a better outcome.

The choice is yours.

————————————————————————————————————————————

I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Name(required)

Email(required)

Website

Comment(required)

Hey, Hey, Ho, Ho…HMO’s Have Got to Go: InHumana, cont’d.

Dear Readers: I beg your indulgence one more time, so that I can finish the narrative of my previous post, “InHumana”.

After spending untold hours yelling and screaming, complaining and pressuring the folks at InHumana, my mother was transferred to another facility late yesterday afternoon.

My day began by contacting InHumana’s Customer Service department, and after speaking to one woman, I asked her to transfer me to a supervisor. I told both the CSR and her supervisor that the facility my mother was in was a dump and a roach motel.

I criticized the company for limiting the choices of facilities in my county, and as I said in my previous post, that was like wanting to buy a car, and your auto insurance company limits your choices to x number of dealers, and an even smaller number of models to choose from, which corresponds to number of “InHumana beds” available in each contracted facility.

While the supervisor escalated the issue to the Access to Care team, I contacted InHumana’s CEO and President, Bruce D. Broussard’s assistant. She transferred me to their Expedited Resolution team, and spoke to two women.

I had previously sent my article, “InHumana” to Mr. Broussard on Sunday evening after I wrote it, and informed all four women I spoke to. I also tweeted Mr. Broussard throughout the day.

I gave InHumana an alternate choice, and was informed some time later that they did not have any “InHumana beds” available at that facility. I told the women that I did not care if they were contracted or not contracted with a better facility, I wanted my mother taken out of there by end of business day.

I told them that as a $41 billion dollar company, that is about to be sold to Aetna, they can afford to spend a little more to put my mother in a better facility. They informed me that because she was in their Medicaid HMO, she was limited to certain facilities.

In the meantime, I called that dump, and spoke to the Case Manager there and informed her that I was upset with the quality of the facility, and that I wanted to have my mother removed from there. She also said I was limited because of her insurance, and said the same thing to her that I said to InHumana.

I threatened to call our attorney if InHumana or the roach motel did not get her out of there, and spoke to his assistant, who had returned my previous call from the previous Friday.

Later in the afternoon, I received a phone call from a woman from InHumana who said she was the representative for this area of Florida. She was contacted to assist, and was having my mother’s case reviewed by their medical director.

After doing some more yelling and screaming at the Expedited Resolution team member to get my mother out of that roach motel, I received a call from the Admissions person at the first facility we contacted on Sunday. She told me that they had a patient go home and that there was a bed available, and that they were going to make arrangements to have my mother transferred.

So it wasn’t due to InHumana’s efforts that my mother got out of that roach motel, but rather serendipity that a patient went home, thus opening up a bed.

But it did not have to be that way. This could have ended early on in the process if InHumana was more interested in the medical care of the patient, instead of protecting their bottom-line, and their shareholder’s value, not to mention the compensation Mr. Broussard must be getting, which would probably cover my mother’s stay in this new facility for quite a long time.

Today I informed by the Admissions office that InHumana only pays for TWENTY DAYS of rehab, and since she spent one day in that roach motel, we already used one day, so we have nineteen more days for them to pay.

After that, it becomes our responsibility, at $150 a day. I don’t know how long she is going to be there, but we don’t have that kind of money, so I will contact our lawyer for his advice,

This is why, along with the aggravation they put me through yesterday, I called this article, “Hey, Hey, Ho, Ho…HMO’s Have Got to Go”.

THEY ARE CHEAP BASTARDS.

InHumana

The following post is personal. In fact, it is very personal, so if you think that personal issues should not be aired on this blog, I beg your indulgence, and hope that after reading this that you will overlook this indiscretion. Also, it is somewhat off-topic, but when has that ever stopped me?

Early Friday morning, my mother fell in her bedroom. When her home health aide and I found her after unlocking her door, she was on the floor near the foot of her bed.

I called 911, and when they arrived, they attempted to pick her up, but she complained of pain, so they transported her to the nearest hospital for x-rays.

She was admitted to Bethesda Hospital West, a relatively new hospital in my area. In 2013, my father was taken to this hospital when he fell in the house, so we were familiar with the hospital and liked it.

Sunday morning, I was informed that she was going to be discharged and that the hospital was trying to get her into a skilled nursing and rehab center near the parent hospital of Bethesda West, Bethesda East.

The day before, the Case Manager for the hospital gave me a list of twelve centers that my mother’s insurance company, Humana, has contracted with.

Out of the twelve rehab centers, only three of them were less than ten miles from my house. The Case Manager contacted the Admission person for the center near Bethesda East, but when I tried to reach this woman, I had to leave voice messages for the woman who handles admissions during the week.

Every other center the Case Manager called did not have any Humana beds, and when I tried to call Humana’s Customer Service number from my house, their automated system informed me that they were closed. Yet, the Monthly statement they sent us says that you can call Customer Service on Saturday and Sunday.

The other rehab centers on the list are either too far away from my house, or too far for my mother’s aide to go to, so would have required us to get a new aide who would be unfamiliar with my mother, and who my mother would be unfamiliar with.

The orthopedic surgeon who consulted on my mother’s case recommended a place to my brother, who is also a physician, but he did not write down the name of the center.

When it was time to transport my mother to the rehab center that did accept her, I went ahead, and when I got there, I saw that the place was a dump.

The décor was ugly and outdated, the staff was just as ugly and looked very unprofessional. The place smelled, and the room was too small. The family of her roommate were too loud and looked like refugees. The staff had to ask them to go to another room because they were too upsetting to me and my mother.

If one was to compare the atmosphere and ambiance of Bethesda West to a five-star hotel, being transported to this rehab center was comparable to being in a roach motel.

I expressed my displeasure to the head nurse at this facility, and she understood my feelings. I told her that I was not taking this out on her, but rather Humana for the way my mother and I had been treated in getting her transferred to a rehab center.

This episode demonstrates that Humana’s only concern is with saving money, protecting their bottom-line profits, and being more concerned with their shareholder’s value, rather than the value such treatment would have on the patient and the patient’s family members.

Humana’s lack of sufficient, nearby alternative rehab centers, when there are plenty of other places in the area, their failure to accept where the hospital or the orthopedist recommended my mother to receive physical therapy, is example of how bad our health care system treats elderly patients and their families.

Therefore, I have called this article, “InHumana”, because they are inhumane, and quite frankly, suck. And now they are going to be bought by Aetna. So now, they are going to get bigger, more profitable, and probably cutback on services and facilities, instead of allowing patients to go wherever they want to go, or wherever a doctor recommends them to go.

It’s like this: say you want to buy a car, but your auto insurance limits you to only twelve dealers, and most of them are too far for you to travel to, and when you contact these dealers, they don’t have the kind of car you want. This is what InHumana is doing to us. They have limited the rehab centers we can choose from, and the ones we wanted don’t have any “Humana” beds available on a Sunday afternoon.

This is not only insane, it is also insulting to the families that they do not have a say in where they want their loved one to receive care. I guess the g-damn bottom-line is more important to InHumana than patient’s well-being and that of their caregiver family members. In a word, InHumana is cheap.

Breaking News on ACA and Exclusive Remedy

There are two news items to report about subjects I wrote about previously. The first item concerns the ACA, the second concerns the issue of exclusive remedy in Florida.

Regarding the first item, the Supreme Court of the United States (SCOTUS), in a 6-3 decision, upheld the Affordable Care Act subsidies under the federal exchanges.

Last week, I wrote an article, “SCOTUS Decision Could Benefit Medical Travel for Workers’ Comp“, where I said that James Moore believed that should the Court decide for the plaintiff, workers’ comp claims departments might get more traffic than they can handle.

This would have been one other way in which offering medical travel for workers’ comp would occur, but there are other legal challenges, and Congress may make changes as well.

So while the Court has ruled for now that the subsidies can stay, it remains to be seen if parts of the law remain, or if it is repealed completely, especially if a Republican wins in 2016.

The second news item, exclusive remedy in Florida, was discussed originally back in August 2014, in an article called, “Update on Constitutionality of Work Comp in Florida“. This was a follow up to an earlier article, “Constitutionality of Workers’ Comp Challenged: What that could mean for Medical Travel”

As reported today by Workers’ Comp Insider, a three-judge panel of the Florida 3rd District Court of Appeal overturned a ruling that challenged the concept of exclusive remedy.

In their decision, the Court ruled that plaintiffs did not have legal standing and the case was moot. The appeals court did not weigh in on whether the workers-compensation system was constitutional.

David De Paolo wrote today that the question is still open, and that the organizations pushing for constitutional change are continuing to fight.

So for now, both the subsidies under the ACA and the concept of exclusive remedy in workers’ comp in Florida have passed judicial review and live on another day.

But as we are seeing with the Confederate flag issue throughout the South, there are “bitter enders” who will continue to press on despite what any court rules, even the highest court in the nation.

————————————————————————————————————————————-

I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Name(required)

Email(required)

Website

Comment(required)

Too Many Cooks

We are all familiar with the old adage, “Too many cooks spoil the broth”.

Whether we are preparing a meal, or thinking outside the box in order to help employers to save money, the way benefits are provided, whether as group health under employee benefit plans, or as workers’ comp benefits, proves the adage true, time and again.

In my conversations with various individuals in the health care and workers’ comp industries, I have found that there are always too many cooks spoiling the broth of both employee benefits and workers comp insurance.

Yet, despite all reason and analysis of the various ills that plague the American health care system, and the workers’ comp system, there seems to be no end of fingers and hands in the pot.

Surely, none of us would want to go to a restaurant knowing that the food we just ordered had passed through the hands of a half a dozen or more, “cooks”.

Earlier this month, I wrote a piece titled, “Paralysis by Analysis: Or the Only Thing We Have to Fear Is, Fear Itself,” in which I said that that there are dozens of reasons (or maybe they are excuses) given by various individuals I have conversations with, as to why medical travel is not feasible or even profitable.

I also said that we stop doing things once we analyze it to death; or, to put it another way, overthink about something to the point of paralysis, either out of fear or as the point of this article, too many cooks are spoiling the broth.

But does it have to be that way?

No, it doesn’t, but that does not matter, at least not to the cooks. They will always find a way to put their fingers in the soup, put their hand on the scale, add too much spice, and underestimate the feasibility of trying a new recipe.

So rather than stepping out of the kitchen altogether, and leave the chef to doing the cooking, and leave the patron to eat the meal, they prevent the cooking process to go forward.

In my writing, I never said I had all the answers, but at least I don’t overthink or overanalyze the issue to the point of paralysis.

But I do see the need to bring in those who get it, and want to add some flavor to the broth, so that not only will the chef be happy with the meal, so too will the person who eats it.

I just don’t like too many cooks, that’s all.

————————————————————————————————————————————–

I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Name(required)

Email(required)

Website

Comment(required)

SCOTUS Decision Could Benefit Medical Travel for Workers’ Comp

Back in April, James Moore was kind enough to re-post one of my earlier blog articles on his blog, so I am returning the favor.

James writes a lot about workers’ comp and how to cut costs, so his insights into such things as the Supreme Court’s much anticipated decision on the Affordable Care Act’s (ACA) future, and how it may impact workers’ comp claims, is something that the medical travel industry needs to know about.

There are no doubt, many opinions on what the Court’s decision may mean for the viability of the health care law, the subsidies that the government has granted to those who cannot afford to pay for all or part of the premiums, as well as the future of health care in the US in general.

And there are just as many opinions on what impact, if any, this momentous decision will have on workers’ comp, because the issue of cost-shifting.

Should the Court find for the government in King v Burwell, then there will be very little impact on workers’ comp, as those who currently have coverage under the ACA will continue to receive insurance. But should the Court decide for the plaintiff, King, millions will lose that coverage, and many will try to get covered under work comp.

It is James’ view, that should the Court decide for the plaintiff, workers’ comp claims departments might get more traffic than they can handle in the coming summer months. So, it is imperative for anyone touting the benefits of medical travel to be aware that you can offer an alternative and a release valve to the workers’ comp industry, should James’ prediction come true.

Yet, House Republicans, as reported today in the New York Times, are worried about what might happen to them, should they prevail in the Court.

So James’ article is both timely and relevant to the purpose of this blog, to implement medical travel into workers’ comp in order to better serve the injured worker and his or her employer. The Court’s decision has, as James will point out in the article below, unintended consequences.

James’ byline appears at the end of his article.

ACA Subsidy Decision Could Affect Workers Comp

The US Supreme Court ACA decision could easily affect Workers Comp.  Let us call it the old Law of Unintended Consequences.

There are multiple articles on this blog concerning the Affordable Health Care Act (Obamacare) and its possible effect on WC.

For reference some of the articles are:

• Oklahoma’s Workers Comp Opt Out Program May Be Trumped By Obamacare
• Five Ways ObamaCare and Workers Comp Are Similar
• Obamacare And Its Effect On Workers Compensation

Would the Workers Compensation industry actually see a spike in claims if the Supreme Court guts the ACA?   My answer would be an unequivocal – Yes.

I have always felt since working my way through the WC claims hierarchy that people are going to look under every stone to find some type of insurance coverage.

A possible scenario in this case would be that all of a sudden someone cannot renew their ACA-sponsored policy.  Who could blame that person for attempting to file a WC claim to receive treatment for an injury that was originally treated under a health insurance policy?  Desperate people do desperate things.

This is not to say these types of claims would ever be accepted by a WC claims department. However, if the claim is reported, the requirement of a full investigation will still use up a large amount of time for a claims department.

The states and the Feds have all said they will bring in measures to keep health insurance alive for ACA policies.

However, would there not likely be a haircut of people covered as the health insurance carriers would only have to look at the Law of Large Numbers to see that a smaller group of health plan participants would prevent the risk being spread among a large enough group.

I am not advocating for or against the ACA.  Numbers do not lie, unless you look at the wrong numbers.

One only has to look to the opinion proffered by Dr. Richard Victor- the outgoing Director of WCRI. He presented a very interesting slant on how WC and the Affordable Healthcare Act would collide with each other.

The US Supreme Court ACA decision is likely days or weeks away.  In the words of Bananarama, it could be a “Cruel, Cruel Summer” if you work in a WC claims department.

By James J. Moore, J & L Risk Management Consultants

James’ blog can be found here at J & L Risk Management Consultants.

——————————————————————————————————————————————

I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Name(required)

Email(required)

Website

Comment(required)

America to Its Family Caregivers: You’re On Your Own

I want to deviate from the topic of medical travel and workers’ comp, to discuss the lousy way family caregivers are treated in the US today.

As an example, this writer and his younger brother, are dealing with the decline of our mother, who has Alzheimer’s. You may recall, that I wrote last year about the death of my father, so this coming Sunday will be the first Father’s Day without him.

But the real problem is with my mother. My parents purchased long-term care policies for each other, but my father ceased paying the premium because the company changed hands too many times for his liking.

My mother’s premiums were paid up to, and sometime after we filed a claim for home care for her. Since January of 2014, we have had more than half a dozen aides here for my mother, and at some time for my father as well, for which we paid out-of-pocket.

However, ever since my father’s passing, I am finding that caring for my mother after the aides leave in the afternoon, leads to problems arising that I am not equipped to handle. For example, within an hour after an aide leaves, my mother has accidents which she and I are not capable of dealing with, and she needs to be cleaned up and dressed.

There are other things that I, as her son, cannot do for her, but a woman could. Also, her illness prevents me from going out for some personal time, unless I pay for it, and plan it in advance. I need to have a life too.

Every time I ask for assistance in the late afternoon and evening, I receive the same response, no matter who I contact.

We are not financially able to place her in a facility, and I cannot afford to lose the money her Social Security brings in, which we use to pay bills.

About a month ago, my brother, who is a doctor, met with some representatives of a hospice company, and he suggested I contact them.

They sent someone to the house late last month, and told me that they really don’t provide that kind of care in the late afternoon and evening. Their services are paid for through Medicare, and would not cost us anything.

They would send doctors and nurses here during the day, which is fine, if she was confined to bed, which she is not, although she does sleep through the day and night at times.

However, in order to get extra home care, people have to pay for it because neither insurance nor Medicare will pay for it. And should she have to go into a facility, the government would take every last cent we have between me and my brother that our parents bequeathed to us, never mind that it might leave one of us out in the street.

Given the aging of the American population, and the fact that diseases like Alzheimer’s is getting more prevalent among the ageing population, such round-the-clock, or almost round-the-clock care will need to be paid for by either insurance plans purchased ahead of time, or by Medicare.

That it is not, is another sign that our health care system is broken, is beyond compassion and is only designed to provide profit for those who take advantage of the elderly and their families.

Two of my parents’ closest friends both passed away in the past three years, but they had the wherewithal to pay for round-the-clock care at home for, so neither of their sons had to worry about losing the money they would inherit. The younger son inherited it instead because his older brother is a multi-millionaire.

It is a sad state of affairs when a child is left with no outside support to care for an ageing and sick parent, especially when that child is financially struggling and is seeking a better life.

I know of, and have known others in my situation here in Florida, and that we have to sacrifice our lives, face the loss of whatever inheritance we may have for our own future, is not only wrong, it is criminal.

We as a society will need to address this issue, because we are all getting older, and this would be a very good way to provide needed employment for those whose skill-level are more suited for the caring profession than for flipping burgers at some unhealthy, fast food joint.

Not all of us are well-off attorneys who can place their aged mothers in a memory care facility without financial strain. A lot more of us need help, help that only can come from society at large.