Monthly Archives: September 2018

Trends in Workers’ Compensation Claims: Some Things to Think About for Medical Travel

It is rare that I post articles from the National Council on Compensation Insurance (NCCI) on this blog, and it has been some time since I discussed workers’ comp and medical travel in the same post, so I thought that this would be a good time to do so.

NCCI is the premier source for data collection in the workers’ compensation industry. Their focus is more involved with the factors that drive the cost of workers’ comp insurance, rather than specific issues in workers’ comp that one might find from reading the reports of the Workers’ Compensation Research Institute (WCRI).

As the article will note, there has been a decrease in frequency of claims, but an increase in severity. Claim frequency is defined by NCCI as the number of claims involving lost wage benefits paid, divided by earned premium. For those of you in the health care and medical travel worlds, just know that it means there are more claims reported to insurance carriers.

Claim severity, on the other hand, is defined as losses incurred, divided by the number of claims, for lost wage benefits paid. This will be of importance to the medical travel industry, as they have found a +16% increase in medical severity from 2011 to 2016.

I will let you read the rest of the article here.

Ex-UN chief Ban Ki-moon says US healthcare system is ‘morally wrong’ | US news | The Guardian

Here is an article from The Guardian newspaper that spells out what is wrong with the American health care system.

We should pay attention to what Secretary General Ban said.

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Exclusive: Former UN secretary general accuses ‘powerful’ health interests in the US of blocking universal healthcare

Source: Ex-UN chief Ban Ki-moon says US healthcare system is ‘morally wrong’ | US news | The Guardian

U.S. Near Bottom, Hong Kong and Singapore at Top of Health Havens – Bloomberg

Want medical care without quickly draining your fortune? Try Singapore or Hong Kong as your healthy havens.

Source: U.S. Near Bottom, Hong Kong and Singapore at Top of Health Havens – Bloomberg

When ICE comes knocking, healthcare workers want to be prepared | Healthcare Dive

Note: No matter where you come down on the issue of immigration and the undocumented, this process of rounding up men, women and children needing medical care is reminiscent of the tactics carried out not only by the Gestapo during the Nazi period in Germany, but every other authoritarian regime in history. We should be better than this. We are better than this.

 

Hospital staff are on the front lines in the fight against a growing threat to their patients’ health: fear.

Source: When ICE comes knocking, healthcare workers want to be prepared | Healthcare Dive

Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive

Note: One more state is attempting to include work requirements for Medicaid recipients, as previously posted in Arkansas Medicaid Work Requirement Failing Out of the Gate.

 

Two JAMA studies bolster critics of work requirements who say most Medicaid recipients who are able to work are already doing so, and tracking compliance will heap more administrative burden onto an already-taxed system.

Source: Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive

Mid-Week Catch-Up

Borrowing a page from another blogger, here are some items that I have seen this week that I did not immediately post to the blog. The first three are courtesy of Medical Travel.com.

From AHA.org, comes an article about the Zika epidemic I wrote about a while ago. About 14% of babies age one or older who were born in U.S. territories to pregnant women infected with Zika virus since 2016 have at least one health problem possibly caused by exposure to the virus, the Centers for Disease Control and Prevention reported today. About 6% had Zika-associated birth defects, 9% nervous system problems and 1% both.

From Health Affairs.org, comes a report about the fundamental flaw of health care and the recurring-payment-for-outcomes solution.

Bloomberg.org reported that US hospitals are shutting at a 30-a-year pace with no end in sight.

Lastly, Health Affairs blog posted an article about an issue I covered some years ago, the Medicare Shared Savings Program (MSSP).

Have a good rest of the week after remembering the fallen of 9/11. FYI, I was in Houston at the time, just having started a new job with Aon there, and heard about the first plane crashing into the north tower while driving to work and listening to the radio. As we were all new, and had little to do, I took a brief siesta and when I went into the hallway, was told to go upstairs to the break room. There was a TV on, and as I entered the room, the south tower went down. This NYC born kid was not sure what was going to happen next, surrounded as I was by all these Texans. I remembered the people and companies I knew there in both towers, especially my cousin who was there for the 1993 attack.

 

Botched Beauty: The Dark Side of Medical Travel

Richard’s Note: The episode of The Doctors TV show mentioned below is not a complete episode. There are multiple videos on the website of the show. It will take some patience to watch them all. Sorry for the confusion.

While channel surfing, I came across the Fox program, The Doctors. They were investigating botched surgeries performed as part of a medical travel experience. One woman died as a result of an uncertified physician and facility; the other woman cannot have plastic surgery on her posterior again after a botched Brazilian butt lift.

The woman who died was the aunt of one of the audience members.

Here is the video of the episode that aired today. I suggest the industry leaders watch this.

https://www.thedoctorstv.com/episodes/doctors-investigate-botched-beauty-across-border-can-you-buy-better-body-another-country

All parties responsible for medical travel must do a better job of policing and cleaning up the industry. This cannot keep happening without anyone doing anything about it. That is why it is not seeing an increase in patients going overseas. It’s your fault, so take responsibility. CLEAN UP YOUR ACT.

Arkansas Medicaid Work Requirement Failing Out of the Gate

Health Affairs blog published an article recently about the early experience of Medicaid recipients in Arkansas after that state implemented a work requirement in June.

Last month, I wrote an article that reported that work requirements for Medicaid worsen health.

The author of the Health Affairs article, Dr. Jessica Greene, is a Professor and the Luciano Chair of Health Care Policy at Baruch College, City University of New York. She conducted in-depth interviews with 18 adult Medicaid recipients in northeast Arkansas in mid-August.

Dr. Greene admits that the interviews are too small a group to provide generalizable results, the interviews do illustrate how the state’s policy is interacting with the day-to-day lives of Medicaid recipients to produce serious potential consequences that have little to do with policy’s stated objectives.

She outlined the results of her interviews as follows:

Lack Of Awareness

Two thirds of the Medicaid recipients (12/18) I interviewed had not heard anything about the new work requirement. “First time I’ve ever heard anything [about it],” a 31-year old man, who had started a vocational training program the day we spoke, said. “You’d think it’d be on the news or something. I ain’t seen it on the news, and I watch Channel 8 news every night.”

At Risk Of Losing Coverage

Of the nine people who, based on their age, should have received a DHS letter letting them know they were subject to the work requirement, four said they had received a letter. Two said the letters indicated they were exempt because they already met the SNAP work requirement.

The other two were at risk for losing Medicaid coverage. One, a 47-year old woman, said she had received her letter about three months earlier; she believed, incorrectly, that she had three months to report her hours. When I asked her if reporting her hours was an obstacle, she said she was struggling with very stressful life issues, including a mentally ill sister, and as a result the work requirement had not received much of her attention. The other person, a 40-year-old woman, described being overwhelmed by receiving the letter: “Basically… I’m like, okay, I’ve got this letter. I file it and I don’t know what to do with it…”

The other five who should have received a work requirement letter were either not sure if the letter arrived or thought it had not. When asked about receiving a DHS letter, a 42-year-old woman said, “I don’t know, I’m going to have to check and make sure [I didn’t receive the letter], because I need my Medicaid card for my sugar pill and my blood pressure pills.” A 46-year-old man, who had recently completed an inpatient drug treatment program, kicking a multi-decade drug addiction, wasn’t sure either. “I may have [received the letter]…I’m horrible about opening mail….I probably throw’d it away.” While the three others did not believe they received the letter, they were all exempt by either working and/or having children in the home, but likely needed to report their hours and exemptions in the portal to maintain Medicaid coverage.

Policy Not Sparking Work-Related Changes

Of the nine participants who were likely subject to the policy, only two were not meeting the 80 hour work-related activity requirement and did not seem to qualify for an exemption. Both told me that they were actively seeking work, and that the work requirement had not at all impacted their job seeking. In addition, those I interviewed between the ages of 19-29, who will be subject to the policy in 2019, either worked, went to school, and/or had children under 18 years old in the home. No one I spoke with reported that the policy had or would spark them to change their work-related activities.

Online Portal Challenging For Many

Participants described a very wide range of computer and online skills and access. Approximately a third said that reporting hours on the online portal would not be possible for them: “I can’t do that. I don’t have a phone. I don’t have a computer.”

Several, who were confident of their own skills, mentioned family members who would struggle. “Half my family probably doesn’t have a smart phone….A lot of people here don’t have internet still,” a 19-year old woman explained.

Mixed Attitudes About Linking Medicaid And Work-Related Activities

Almost all the participants believed that people who could work should be working. “I believe if you are able to work and you want the extra help that Medicaid gives, then you should work,” said a 28-year old woman who was currently working and has young children. But several expressed concern about those who had mental or physical conditions that would prevent them from meeting the requirement. One man raised questions about people who were “borderline” who were not officially considered disabled but still had serious health conditions. A 42-year-old woman, who works with people with disabilities said, “I think it’ll do more harm than good…. What they supposed to do, just get cut off Medicaid because they can’t meet those requirements?”

Others raised concerns about transportation needed to get to work and volunteering. “Some people don’t have vehicles, and sometimes it’s not necessarily their fault. Sometimes something happens and they lose their money… It’s not fair,” said a 21-year old recipient who is a college student. When I asked a woman who was looking for work whether she had tried to get help from the Department of Workforce Services, she said that she couldn’t get there because it was 30 miles away and there is no public transportation.

Not Going To Lift People Out Of Poverty

Participants were very skeptical about the Governor’s claim that the work requirement policy would help them out of poverty, as many were already working and still struggling financially.

One participant argued that the policy was not about getting people to work at all, but about reducing the number of Medicaid recipients: “It seems like a ploy for the state to save money. That’s all it is. It’s nothing about trying to get people back to work…”

Summing Up

Of the people I interviewed who were at risk of losing Medicaid coverage as a result of the work requirement, most were at risk because they lacked awareness of the policy or were overwhelmed by it, rather than because they were not meeting the 80 hours a month of work-related activities or the terms of an exemption. If this is true more broadly, the state will be ending people’s health coverage for the wrong reasons, adding credence to those who argue this policy is about reducing the rolls, rather than supporting people to get employment.

A 38-year-old woman who recently had to quit her job to get her niece, who she mothers, a birth certificate and other paperwork to start school argued that the policy does not take into account the complex lives of low-income people. “You are saying this should be possible, but you don’t know my circumstances. You haven’t been here,” she explained.

Given this limited, but anecdotal survey of the experience of 18 Medicaid recipients, it is clear that this idea is not rooted in any realistic and scientific study of how work requirements will affect Medicaid recipients, but rather is another way of getting people off the roles and moving towards eliminating Medicaid altogether, which is precisely what the Republican Party has been trying to do for decades. The war on the poor continues.