Monthly Archives: December 2015

Top 10 Hospitals for Knee Surgery Under $50,000

To all those in the workers’ comp world who have pooh-poohed the idea of less expensive surgeries outside of the US, I give you the following blog post from Archimedicx for you to ponder while you are celebrating the birth of a Jewish carpenter.

Out of the ten hospitals mentioned, there is one US hospital. So that tells you that you are wrong, and that international hospitals are less expensive and can provide equal or better care than what is available in the US.

So those of you who think my idea is ridiculous and a non-starter, and you know who you are, look in the mirror. You are the ones with a ridiculous and stupid idea.

Merry Christmas, and a Happy New Year! Maybe 2016 will be the year workers’ comp grows out of its narrow-minded, American exceptionalism and embraces the globalization of health care.

Here is the link to the Archimedicx blog:

https://blog.archimedicx.com/traveling-for-medical-care/top-tkr-hospitals-under-50k/

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Very talented, detail-oriented, highly motivated, visionary thinker with extensive Risk Management, Property & Casualty Insurance, and Workers’ Compensation Claims experience, Risk Management Information Systems, Insurance Data Processing and Workers’ Compensation Statistical Reporting experience, possesses B.A. in Liberal Arts, an M.A.in History, and a Master’s in Health Administration degree (MHA), actively seeking a rewarding, and challenging position.

Willing to work hard, willing to learn, willing to teach, salary commensurate with experience, both professional experience and life experience.

Successful blogger with excellent written and verbal skills, strong financial and organizational skills, as well as  strong analytical and problem solving skills, .and can think outside the box.

Has strong knowledge of economic, social and political issues, as well as strong interest in global issues, including the growth and development of medical tourism.

Location is flexible, provided it is amendable, would consider non-US positions provided relocation is included. Strong English language proficiency, willing to learn others as well.

Will consider consulting opportunities. Contact me by email at: richard_krasner@hotmail.com or by phone, +1-561-738-0458, or cell, +1-561-603-1685. Resume/CV will be provided upon request, or can be viewed on blog or LinkedIn profile.

Employer Choice States See Lower Claim Costs

Introduction

When I started this blog three years ago, one of the first topics I covered was the issue of employee/employer choice of treating physician (see “Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation” and “Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation“).

Then in March of this year, ProPublica’s Michael Grabell and NPR’s Howard Berkes, wrote an article called, “The Demolition of Workers’ Compensation“, which was a first in of a series about the workers’ compensation system.

In the article, Grabell said that in 37 states, the worker cannot choose his doctor, or they are restricted to a list provided by their employer. This statement generated some concern from the industry.

My fellow blogger, Joe Paduda tried to get them to see both sides, but gave up the effort when it did not result in any discussion between them, as he wrote about the following day, calling the reporting a “public disservice”.

The next day, I wrote to Mr. Grabell, and told him that his facts were wrong. He told me in his response that he relied on data from the US Chamber of Commerce.

I told him that the WCRI and the state statutes were a more accurate source of information. My email thread covered eight messages that day. I provided him with the data I used in the articles cited above, and in the presentation I gave the previous November in Mexico.

Lower Costs When Doctor is Chosen By Employer

Business Insurance’s Stephanie Goldberg today reported on a study published in the latest issue of the Journal of Occupational and Environmental Medicine, that found that the average medical cost per work comp claim is lower in states where the employer chooses the worker’s initial treating physician.

Average medical costs were $308 lower in those states where the employer can choose the treating doctor for employees with low back pain, than in states where the workers were allowed to choose, Goldberg reported.

The study, sponsored by the Liberty Mutual Research Institute for Safety, said that states limiting treating provider change had higher medical costs than states that allow a one-time change.

There was however, the study found, no significant difference in average medical costs between cases in states that limit initial change and states that don’t, according to Goldberg.

Employers participating in a managed care organization, preferred provider organization or coordinated care organization in states like California and Florida, are allowed to to direct care. States like Arizona and Massachusetts allow workers to chose their providers.

The study also found, that the average medical costs ranges from $1211 in New York to $4514 in Texas, and length of disability ranged from 19 days in Missouri to 69 days in Texas.

The study was compiled using more that 59,000 low back pain claims between 2002 and 2009 from 49 jurisdictions, including Washington, DC, and did not include North Dakota and Wyoming.

Workers’ Comp Goes Federal: An Update

The other day, I wrote a post that said that state Medicaid programs will be able to recover all of the proceeds from a settlement that were expended on behalf of a beneficiary.

My reporting of MaryRose Reaston’s article garnered some very positive comments from some of my readers.

Yet, today, my fellow blogger Joe Paduda countered MaryRose’s article, and stated that “No, ACA has not ‘overstepped its bounds‘”.

According to Joe, the efforts by the states are just that, state-based, and they are allowed and enabled by federal legislation…separate and distinct from the ACA.

Joe cites an article written by Michael Stack, Principal of Amaxx LLC that summarizes Medicaid recovery in workers’ comp cases.

As Joe reports, Michael noted that the legislation that allows Medicaid to pursue settlements was part of the Medicare Secondary Payer Act, a part of the 2013 budget bill.

Normally, when I write about some issue someone else wrote about, I never have to provide my readers with an update that challenges the original author. Generally, my updates are just that, updates that add to the discussion. This is not the case here.

So just to be fair to everyone, I decided to correct the situation by writing a follow-up. I trust my readers will understand that I did not mean to mislead or take only one side.

ACA May Shift Claims to Work Comp: A Rebuttal

Back in September, I wrote a post that said a study by the Workers’ Comp Research Institute (WCRI) indicated that the ACA may shift claims to workers’ comp.

Last week, the WCRI held a webinar, which I attended, and along with the presentation by outgoing WCRI President and CEO Rick Victor, my fellow blogger, Joe Paduda, gave an opposing view.

According to Joe, “it’s very hard to attribute case-shifting to ACA) based on what I see as a very complex and diverse health care world.”

The reasons for Joe’s skepticism can be based on the following assumptions those who are making the case for case-shifting have expressed:

  • HMOs are capitated
  • there are financial incentives e.g. capitation at the primary care level
  • primary care providers are aware of the financial implications of case assignment
  • PCPs purposely assign cases to work comp based on those financials the ACA will lead to more Accountable Care Organizations that will use capitation more

To get deeper into Joe’s perspective on case-shifting, click on the following link to his blog post:

http://www.joepaduda.com/2015/12/aca-work-comp-and-case-shifting-the-details/

Here are the slides from the webinar:

WCRI Webinar Impact of the ACA on Claim Shifting Slides 12.10.15

 

Workers’ Comp Goes Federal

MaryRose Reaston, founder of Emerge Diagnostics, wrote an article on Insurance Thought Leadership.com today that said the Affordable Care Act (ACA), also known as “Obamacare” will dip into Workers’ Comp.

According to MaryRose, as of Oct. 1, 2016, state Medicaid programs will be able to recover all of the proceeds from a settlement that were expended on behalf of a beneficiary.

Medicaid, she says,  will be able to attach a beneficiary’s third-party liability settlement (including workers’ compensation) for the entire amount of the beneficiary’s award, and not just the amount allocated to medical expenses.

What this means, Reaston adds, is that funds intended to compensate beneficiaries for pain and suffering, lost wages or any damages other than medical expenses could be subject to the reach of state Medicaid agencies seeking recovery.

Many employers will be affected because the adoption of the ACA has afforded broader coverage under state Medicaid programs, MaryRose writes, because it now includes individuals who are within 133% of the federal poverty level (about $32,252.50 for a family of four in 2015), and under 65 years of age.

For the complete article, click on the following link:

http://insurancethoughtleadership.com/obamacare-expands-into-workers-comp/

 

 

 

 

 

 

 

Carta Abierta a la Comunidad Latinoamericana de Turismo Médico

Hoy celebra el primer aniversario de la creación de FutureComp Consulting, y el pasado 29 de octubre fue el aniversario de tres años de la creación de mi blog, Comp transformando los trabajadores.

En los tres años que he estado escribiendo mi blog, he asistido a turismo médico tres conferencias, dos en Florida y uno en México en noviembre de 2014, donde dio una presentación titulada, “Barreras, obstáculos, oportunidades y dificultades de implementación de turismo médico en compensación a los trabajadores.”

En estas conferencias han conocí a muchas personas de América Latina y han dicho de mi idea para la transformación de compensación a los trabajadores en los Estados Unidos mediante el envío de pacientes a los países de la región.

Hasta la fecha, no una persona que conocí en estas conferencias, ni quien ha leído mi blog y es de la región ha puesto en contacto conmigo para ofrecer su apoyo y servicios para hacer de esta idea una realidad.

Y al discutir la cuestión con los americanos, especialmente ésos en la industria de la compensación a los trabajadores, su respuesta ha sido llamarlo una idea estúpida y ridícula y no.

También han sugerido que médicos de su región no es hasta los estándares americanos, a pesar de que he señalado a ellos que no están garantizados los resultados aquí, y que errores pueden ocurrir en los hospitales locales.

Este es un ejemplo de una típica respuesta de alguien en la industria de comp de los trabajadores:

“Honestamente, turismo médico para empleados lesionados no funcionará. Ya estamos desafiados diariamente cuando empleados lesionados dejan el país y tenemos que brindarles atención fuera de los Estados Unidos. Te escucho pero es un tramo. No podemos obtener buenos resultados aquí odio pensar qué sucedería cuando enviamos algún otro lugar. Las leyes son mucho demasiado complicadas para obtener el resultado deseado”.

En mi blog, escribí el siguiente artículo basado en algunas observaciones sobre los medios sociales que incluí en un diálogo virtual, “Punto/contrapunto: A Virtual diálogo en el fondo de aplicación médica Turismo en compensación”.

En la presentación que dio en Reynosa, dijo que hay una falta de conocimiento acerca de la calidad de la atención médica en el extranjero (llamada “medicina de tercer mundo”) y que americano abrigó las actitudes negativas hacia la atención médica en el extranjero, así como la presunción conocida como “Excepcionalismo norteamericano” por el que médicos americanos sólo saben practicar medicina y sólo hospitales estadounidenses están calificados para ofrecer cuidado.

Sin embargo, no todos los americanos son así; de hecho, un abogado que representa a los trabajadores lesionados tenía cirugía de rodilla en Costa Rica y tenía una gran experiencia, quiere que sus clientes tengan también.

En mi presentación, presentado seis principales barreras y obstáculos para la implementación, pero escrito esta carta ahora, quiero decir a la comunidad de turismo de América Latina, que hay una séptimo barrera y obstáculo y es su incapacidad del mercado y defender su médico servicios a la industria del seguro americano y más concretamente, a comunidad de comp de los trabajadores.

Ha sido una de las razones por qué he estado escribiendo acerca de esto por tanto tiempo. En muchos de mis artículos, te imploro que hagas algo al respecto. Incluso dije esto en México cuando le dije que tenía que ir después del mercado; el mercado no vendrá a usted.

Por lo que no crees que yo soy un gringo loco, Norte Americano, aquí están algunos de los artículos que he escrito que hace exactamente eso:

“La estrellas alineado: México como un destino de turismo médico para los trabajadores de Estados Unidos nacidos en México, en compensación a los trabajadores”

“Un menor costo, atención médica de alta calidad está cercano”

“Limpiar el aire: mi defensa de la aplicación de turismo médico en compensación a los trabajadores”

“Far in front of the crowd”

“Muy por delante de la multitud”

“E PLURIBUS UNUM: América Latina y Caribe inmigración, compensación y turismo médico”

Por qué el turismo médico para Comp trabajadores es una idea cuyo tiempo ha llegado»

“Questions, Questions, How Medical Tourism Can Become a Real Alternative in Health Care and What It Means for Workers’ Compensation

“More questions, Questions: A Call for Answers from the Medical Tourism Industry”

«Más preguntas, preguntas: Una llamada para obtener respuestas de la industria del turismo médico»

Finalmente, la semana que viene iba a ser cuando yo me iba a dar una segunda presentación en México, esta vez en Puerto Vallarta, pero por motivos personales, tuve que sacar.

Esta es la presentación que iba a dar que describe los desafíos que enfrenta la compensación a los trabajadores, y lo que debe hacer la industria del turismo médico.

Así que mi reto es Latina y América Central. ¿Vas a comercializar sus servicios a esta industria, y defenderá su atención médica, como igual o mejor que la atención que recibe en los Estados Unidos?

¿Precio y transparencia? ¿Compartirán datos con líderes escépticos de su mejor atención médica, o vas a permitir que le llamen “barkers del carnaval”?

Estoy dispuesto a trabajar con usted. Sabes como contactarme.