Monthly Archives: October 2015

Independent Medical Review Upheld as Constitutional

As I mentioned this morning to a good friend, I normally shy away from writing about California work comp issues, but the following article by Stephanie Goldberg, is indicative of how the legal system has been corrupted to the extent that benefits are denied to injured workers when it is proved they are necessary to deal with their injuries, especially those that leave the worker unable to be gainfully employed.

In other words, the courts have helped the employers screw the workers once again, and this is not coming from ProPublica/NPR.

Here is the article from Business Insurance:

http://www.businessinsurance.com/article/20151029/NEWS08/151029727/constitutionality-of-workers-comp-medical-review-process-upheld-by?tags=|68|309|70|74|92|329|304

We can and should do better, and not just for blue collar workers, but for white collar workers as well. which is what Ms. Stevens is. And I know two other white collar women in CA who have also gotten the shaft from the system. I wrote about them in three separate articles, “The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System“, “The Stench of Fraud, Continued“, and “What Price Profit?“.

From what I have heard about the IMR process, not all of the reviewers are equipped or knowledgeable to review cases, and they only look at medical records (which by one account had been changed), so the process is unfair, no matter what the court said.

Workers’ comp is being undermined from within and without. It is only a matter of time until it it is completely gutted and done away with. That is the fault of stupid and greedy people, but it is also our fault for choosing leaders who allow this to happen because instead of looking out for the people, they look out for the interests of the wealthy and powerful.

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Three Years and Counting

Today, October 29, 2015, marks three years since I began writing this blog.

Before you offer your congratulations, let me tell you that the third year has been the hardest year to write for.

Why that is so is because there has been less written in the blogosphere about workers’ comp that is new and different from all the other years I have been writing.

After writing about the opioid abuse issue, the constitutionality of the exclusive remedy provision of the “grand bargain”, and the expansion of opt-out, among other challenges facing workers’ comp. there isn’t a whole hell of a lot that hasn’t been discussed ad infinitum.

You may have noticed that some of my posts more recently have shifted into the health care arena, and I have attempted to tie those issue to workers’ comp and implementing medical travel.

I have tried this year to get brokers, carriers, and employers to contact me personally by including an action statement at the end of every post, but even those had to be discarded when there was no response.

Yet, I persist in writing. Perhaps I am doing exactly what I have criticized the industry for doing, that is, doing the same thing over and over again, and expecting different results. However, in my case, I firmly believe that what I am doing is right, and have been fortunate this year to finally find some independent person who has the same idea (more on that at a later date).

One thing I have noticed is that as I re-publish my previous posts through Twitter and LinkedIn, especially with the help of Buffer, that I have been getting a few more views, and a few more “likes” on my articles than I did when they were first published.

I would prefer that I get more attention to what I am advocating and can turn my writing into a profitable venture that will provide me with steady income, but most importantly, give injured workers and their employers the opportunity to get better medical care and to save money.

The savings may not be there on a one-to-one basis, but in the aggregate, it may pay off, especially as health care costs in the US continue to rise unabated.

And I have continued to defend my idea to those of limited vision and understanding, because I know the direction human society is going, and I know that one day, it will not matter where one gets medical care, or any other service. A little known part of the TPP now being considered is called TISA, the Trade in Services Agreement, which I have been told, will be signed into law in the near future.

What impact that will have on the transfer of services is yet unknown, but many believe it will open up markets for such services as medical travel, as other trade agreements have opened up markets for goods and capital transfers, not to mention jobs.

So, I am optimistic that somehow this will happen. In the meantime, I continue to write as long as my fingers and brain allow me to write. Thank you for sticking with me these past three years.

Sluggish Hospital Improvement

Modern Healthcare published the following article that stated that there was sluggish improvement in patient safety in the nation’s hospitals.

Here is the link to the article:

http://www.modernhealthcare.com/article/20151028/HOLD/151029895/leapfrog-hospital-improvement-sluggish-despite-some-stars?utm_campaign=socialflow&utm_source=twitter&utm_medium=social

Still believe we have the best hospitals in the world, or just the most expensive?

It’s your choice, poor quality and high cost, or low cost and better quality somewhere else.

Or maybe the injured workers should make that choice.

A Hospital Bill We Can All Appreciate

Recently, a friend of mine received a hospital bill from a hospital they stayed at in Spain after suffering a life-threatening condition that kept her in the country longer than she expected.

The bill for her DVT/PE included a Chest x-ray, CT of the lungs and 2 nights of observation. The total in Euros was 1475.61. In US dollars, that translates to $1,641.02.

One reason given by a commentator on LinkedIn was that “the hospital (v. the US) is that they’re only billing you for incremental cost — there’s no capital expenditure or labor costs they need to recapture as that comes from other budgets. So, instead of your fractional share of billing, doctor’s salaries, etc., they’re just trying to keep the budget whole from the fact that you were there v. the bed being empty.”

But we know that hospitals are run like businesses, and many of them are owned by businesses, so they try to squeeze every last drop of profit out of the patient, or their insurance company.

Spain is not the only country that has lower cost medical, but travelling there for care is not yet practical until we can fly on suborbital commercial planes.

But there are places closer to home that will be much lower in cost, and not just for emergency care. But like the three monkees, we Americans are deaf, dumb and blind to reality, and unwilling to see that we are not No. 1.

Self-Insured Employers and Medical Travel: One Company’s Experience

Note: The following link is from an article originally published on December 15. 2013 in Business Insurance magazine by Joanne Wojcik.

http://www.businessinsurance.com/article/20131215/NEWS05/312159991

The following link is to an ABC News report about the same company in North Carolina, and highlights two of their employees, one a recent retiree, who traveled for medical treatment in Costa Rica.

http://abcnews.go.com/Health/americans-surgeries-overseas-us-companies-medical-tourism-health/story?id=20423011

I met the young Costa Rican woman in the video at a Costa Rican Medical Travel conference in Miami Beach in May of 2014.

Hospitals Launching Private Health Plans Have Concerns: What It Could Mean to Work Comp

My fellow FAU alumna, Maria Todd, wrote a very good article about what’s at stake for hospitals considering launching private health plans.

While Maria’s article focuses on hospitals and general health care, it would be prudent for the workers’ comp industry to pay attention to what she has to say, as her expertise in the areas of health care, hospital development, healthcare marketing and branding, concierge medicine and medical tourism has taken Maria around the world several times (lucky her – “I never get to go anywhere”).

There is one item Maria raises in her article that should be of vital interest to workers’ comp.

According to Maria, the process to launch private health plans is fraught with complexity and extreme financial risk. She goes on to add that it involves, at a minimum, obtaining a state license and meeting (and maintaining) capital reserve requirements adequate to cover IBNR (incurred but not reported) claims lags.

Those of us who have been in the claims arena of work comp know a little something about IBNR claims, and what that can do to both a carrier’s loss picture and an insured’s frequency and severity, which affects their experience mod.

If hospitals do choose to launch such plans, they will move closer to being insurance companies that happen to provide medical care, rather than just providing medical care as a hospital.

Maria’s recommendation is that they sink their money into something better that will float.

Turbulence Ahead for Workers’ Comp Market

There may be turbulence ahead for the workers’ comp market, according to an article today on PropertyCasulty360.

The article, by Nancy Grover, says that the market can be characterized as stable, but that there are changes in the nation’s workforce, as well as technological advances, that threaten the balance of the industry. (see “Workers’ Comp Besieged: Independent Views of the Problems Workers’ Comp is Facing” and “Workers’ Comp at a Crossroads: Where Does it Go from Here?“)

Grover states that the industry’s financial outlook is positive, but that the NCCI State of the Line report earlier this year, warned that there was “calm now, but turbulence ahead”.

I will have more to say on the challenges facing workers’ compensation when I publish my second presentation slides that I may present in Mexico this December.

Among some of the challenges, Grover reports the industry is facing are increased medical costs (I have written extensively about this as well), threats to their security systems, and the changing nature of the workforce (another issue I have mentioned before, especially with regard to immigration and medical travel in the Western hemisphere).

According to one industry source she cites, medical costs are the number one cost driver (see “Lost-Time Medical Costs Approaching $30K: When Will You See the Light?“).

NCCI found that the average medical cost per lost time claim grew by 4% in 2014, which was an increase from the previous three years, where the average medical cost rose between 2 – 3%, Grover said.

Drug prices are also a cost driver, according to Joe Paduda (see “Drug Costs Make Up Bulk of Work Comp Medical Costs [Infographic]“).

“The other thing happening is facility costs for hospitals and healthcare systems are going up at or near double-digit rates for many payers and not many are paying attention”, according to Joe.(see “Outpatient Facility Costs Rising Could Benefit Medical Tourism Industry“)

There are also market threats, Grover writes, such as the “on demand” economy with companies like Uber. Lyft and others raising questions for workers’ comp industry personnel.

Unfortunately, Grover does not offer alternative solutions other than those that are being tried, and have been tried, with little or no success.

One such “solution” is medical provider networks, to closely contain costs by managing care for injured workers, but as she points out, they have not proven effective among all states.

Here is what  some in the industry really looks like to this reporter:

hear-no-evil-see-no-evil-speak-no-evil

They keep saying and doing the same things over and over again, and costs continue to rise, challenges are rushing headlong towards them, opt-out expansion threatens to destroy workers’ comp altogether, but they are deaf, dumb and blind to reality and to alternatives. One wonders if they really are like these three. They just act upon instinct and don’t have a grasp of the changes around them outside of their little space.

Oh well, evolution works in strange ways, so there is hope.