Category Archives: Conferences

NCCI’s 2017 Data Educational Program: A Personal View

Many of you have probably read my blog and notice that I sometimes refer to an organization called the National Council on Compensation Insurance or NCCI.

Back in the mid 1990’s, I worked there briefly, and also did a stint with a software vendor company reporting data to NCCI and independent state bureaus for workers’ compensation claims and policy data.

One of my blog readers told me about this year’s conference held in West Palm Beach and that we could me there. He came down from North Carolina yesterday, but left after the last class.

The program began on Tuesday, but I attended sessions starting on Wednesday. These are the classes I took:

  • Unit Statistical Data Editing and Correction
  • Medical Data Call Validation
  • Medical Data Collection Tool
  • Introduction to Unit Statistical Data Reporting (refresher course for me)
  • DCI Data Validation and Quality Issues
  • WCSTAT (Unit) Data File Submission and Processing
  • Unit Statistical Data-Premium Rating Programs and Exposures
  • Unit Statistical Data-Loss and Claim Conditions

Most of the classes were two hours long, with a fifteen minute break in between.

The classes were given by two presenters who rotated during the sessions, so that you did not get just one person’s knowledge and experience.

The participants ranged in age, but many were considerably younger than your humble writer. I had missed the 2oth anniversary reception Tuesday evening, but this was not really a social event, so it did not matter.

The technology I saw displayed this week was a far cry from what I worked with back in the 90’s, and is all web-based and very easy to learn. My impression from the information presented in all classes was that NCCI is taking a more customer-friendly approach to workers’ comp data reporting, which was something I found lacking back in the 90’s.

I know there are still areas of contention with some aspects of NCCI’s ratemaking role, as someone recently pointed out on LinkedIn regarding higher premiums for certain classification codes that are forcing small businesses out of business, but that is the exception and not the rule.

Overall, I felt it was worth it to attend, and I have gained a better appreciation for data reporting.

 

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Cut the C**P!

For my 300th article, I want to address the medical travel industry and its failure to rid itself of the crooks, liars, shysters, and phonies who prey upon the desperate.

Case in point, the article last Wednesday in the New York Times by Gail Kolata about one man’s experience getting stem cell therapy through medical travel.

This case is endemic of the industry’s impotence to police itself and get rid of those medical providers and hucksters who use slick promotional material to sell useless and often dangerous treatments or dubious procedures.

But what do you expect from an industry whose major organization is merely a conduit for funneling money into the pockets of the organization’s founders and their friends?

What do you expect from an industry that emphasizes attending conferences and not on standardizing the laws and processes for the provision of medical care across national borders.

When I started this blog over three years ago, I had high hopes that the industry would listen to what I had to say, and to at least consider offering medical travel to injured workers in the US. But as happened with the workers’ comp industry, no one has stepped up and offered to work with me.

I’m not mad at everyone in the industry. Many of you are very nice people and work very hard, but your focus is on such medical care as dentistry, cancer, cosmetic/plastic surgery, and other treatments not available in the US, or too expensive.

But helping those who are injured on the job, and many of whom are from many of the countries in this hemisphere who offer medical travel services, should be something some of you might want to do.

It was my hope that this industry would offer me a chance to change direction, but that has not happened, and now I am not sure if it ever will.  There does not seem to be any financial or employment opportunities here, just a lot of conferences and hyperbole.

Prove me wrong.


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.

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

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

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.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

WCRI – Day One, Part One

Day One of the WCRI’s annual conference began with WCRI’s Chairman, Vincent Armentano, of The Travelers Companies, introducing new President and CEO John Ruser. He presented the first s…

Source: WCRI – Day One, Part One

SPOTLIGHT Interview – October 31, 2013

This is the original interview published on October 31, 2013 by Medical Travel Today.com.

Medical Travel Today (MTT): Tell us your position in the medical tourism industry, as well as your thoughts on integrating medical tourism into workers’ compensation cases in the U.S.

Richard Krasner (RK): Currently, I am a blogger, blogging about the implementation of medical tourism into workers’ compensation.

I first began looking into integrating medical tourism into workers’ compensation when I needed a topic for a paper in my Health Law class as part of my M.H.A. degree program in March of 2011. A lawyer who was working for a medical tourism facilitator company at that time, and who had written an article in a law journal about medical tourism, gave me the idea after my first topic did not pan out. She thought that the legal barriers to implementing international medical providers into workers’ compensation through medical provider networks was a good idea, and since I had a small interest in the subject of medical tourism, I submitted that as my topic to the instructor.

He gave me his approval and, as I started to do my research, I found many articles on medical tourism and nothing on medical tourism and workers’ compensation, so I knew my task was a difficult one. But as the point of the paper was to write about a legal issue and persuade people one way or the other, I felt that I could mention the lack of literature on the subject and perhaps open up dialogue in that area. I then found a roundtable discussion from the January/February 2008 issue of the journal Telemedicine and e-health.

In the discussion, I found something that I had been looking for, but had not expected in a medical journal: a validation from four of the participants for my idea to implement medical tourism into workers’ compensation. I made their discussion the centerpiece of my paper, and thus my argument in favor of implementation. They said essentially that they thought that medical tourism could work for non-emergent, i.e., non-emergencies or long-range issues, such as knee or hip replacement, chronic back injury and repetitive action injuries, and that it would not be a leading offering. That is when the light bulb went on, and I realized that it could be accomplished as an option for the injured worker to consider.

Initially, my research consisted of finding articles that discussed medical tourism in destinations, such as India, Singapore and Thailand, and my thought then was that it might be a stretch to send injured workers that far away, but that maybe it could be done. Later on, as I got more involved in medical tourism through my attendance at the 5th World Medical Tourism and Global Healthcare Congress in October 2012, and through conversations online with another lawyer, I realized that the best chance for this to happen was in Latin America and the Caribbean, and that given the rise of the Latino population in the U.S., sending patients home to their home countries for treatment would present no language or cultural barriers, and would allow friends and family in those countries to visit them during recovery, which will improve their self-esteem and improve their recovery time.

I have since come to believe that all injured workers could be offered this as an option, not just those of Latin or Caribbean origin.

MTT: How will the integration benefit individuals, health insurance companies, and the entire medical community, both domestically and internationally?

RK: I believe first and foremost that medical tourism will have its most important benefit on the individual because of some of the things I mentioned above, namely little or no cultural or language barriers to overcome between Spanish or English in most cases, or between Portuguese or other languages in the region. Also, as I said, their friends and families back home can visit, which would make their recovery more relaxing, more pleasant and would show them that the patient is not sitting at home just collecting a check. It would also give the patient greater self-esteem and speed recovery. Finally, by being treated in the better hospitals in the home country, a patient’s friends and family will see that their loved one is being cared for by the best doctors and at the best facility in their country.

I think the benefit for the health insurance company or, in this case, the workers’ compensation carrier would be that they will not have to pay for expensive procedures, such as hip or knee repair/replacement, shoulder surgery, spinal fusion surgery or carpal tunnel surgery. This is despite the fact that many states have fee schedules for workers’ compensation, which tells providers how much to charge the carrier for each procedure, and which may be less than the normal fees charged. Nonetheless, as the recent New York Times article indicates, the U.S. has the highest cost for healthcare, and it is not slowing down, nor has the average medical cost for lost-time workers’ compensation claims, as I have written about in my white paper and my blog.

I think for the entire medical community domestically and internationally, it will have several benefits, the first of which will be the realization that healthcare is globalizing and that it is no longer possible to consider that quality medical care is available only in the developed world. Second, it will lead to the development of international accreditation standards, quality standards and other standards that up to now have hampered medical tourism’s expansion and growth.

These standards will take time to be adopted and will be expensive to implement for the medical tourism facilities involved, as it has already been for the implementation of other standards and forms of accreditation, such as from the Joint Commission International.

Thirdly, it will have the benefit of bringing American patients to medical providers in other countries, those who otherwise would never be seen by foreign doctors except for those who have gone to foreign-born doctors practicing here in the U.S., whether in private practice or in a hospital setting. Fourth, and this is more of an issue with workers’ compensation cases, doctors abroad will be able to get broad experience treating work-related injuries that they have never seen, thus adding to their medical experience, and providing their fellow citizens with that experience should they ever require it.

Medical tourism will open up global healthcare to all inhabitants of this planet, not just those looking for cosmetic surgery, or procedures that are too expensive or unavailable in their home countries. It will certainly open it up to those who otherwise could not afford to travel out of their country for treatment.

MTT: What would you say are the steps necessary to take in order for medical tourism to be integrated into workers’ compensation effectively?

RK: First, there has to be a removal of all or many of the legal barriers that I mentioned in my white paper, as well as many others that I could not or did not mention. Also, there has to be some understanding on how the legal issues surrounding medical tourism can be solved such as malpractice, legal liability, privacy issues, medical records transfers, etc.

There are financial steps that need to be addressed, such as which currency the payments will be made in, any incentives to injured workers, referring physicians, treating physicians, destination hospitals, as well as travel insurance coverage for things not covered under workers’ compensation. And lastly there has to be a willingness on the part of employers and insurance companies, third party administrators, and lawyers to accept medical tourism as part of workers’ compensation. I have discussed this with several people recently through emails, and in the past six months since beginning my blog, and have written about this as well.

As the Chinese say, a journey of a thousand miles begins with the first step. An industry like the workers’ compensation industry in the U.S., which is concerned with issues, such as pain medication abuse, physician dispensing of drugs and dealing with cost-curbing strategies that have failed, must come to the realization that the journey for them must begin now — before costs skyrocket any further.

MTT: What can you see being potential deterrents in integrating medical travel benefits into workers compensation?

RK: First of all, let me say that I don’t have all the answers, and I cannot foresee all contingencies and problems associated with traveling abroad for care. But I do want to make this clear so that your readers will not think that I don’t know what I am talking about, or that they will think that integrating medical tourism into workers’ compensation will be easy and not fraught with difficulties and complications.

It will not be easy, there are and will be complications from flying after undergoing surgery abroad, just as there are if the patient was treated at the local hospital. I am not a medical person, so my knowledge of how patients will tolerate air travel after surgery or what complications will arise is beyond my experience. But I can say this: I don’t see a difference between a patient who traveled abroad for medical care as a private patient for cosmetic, body improvement or other forms of surgery usually associated with medical tourism and a patient who is traveling abroad for surgery as a result of an on-the-job injury. Yes, there are differences in the process of treatment and aftercare and recovery, but if the private patient can develop complications, so too can the workers’ compensation patient.

To answer the question then, I think deterrents include a lack of will, fear of lawsuits in countries with laws that do not favor the insurance company or the employer, malpractice insurance and legal liability that does not meet American standards, employee choice to stay at home, and pressure from special interest groups like doctors, hospitals, pain clinics, rehab facilities, trial lawyers, etc.

MTT: During a time of rapid healthcare reform, why do you think medical tourism hasn’t been connected to workers compensation already?

RK: Because there is so much uncertainty over the impact the Affordable Care Act will have, not only on healthcare, but also on workers’ compensation. In my research on that subject, I found that there will be little immediate impact, but down the line there will be, especially as more people get health insurance, and also because of the doctor and nurse shortage, which will affect both healthcare and workers’ compensation.

There are critics of the law who say it will raise costs, and then there are those who say it will lower costs, as some have already pointed out recently. But only time will tell who is right and who is wrong. Finally, I don’t think many in the workers’ compensation industry have ever considered looking abroad, except to plan their next vacation.

MTT: Is there anything else you would like to add at this point that you think is significant in terms of medical tourism, workers’ compensations and/or the integration of the two?

RK: Yes, as I said in my blog post, The Faith of My Conviction, what is needed is the will to do it, the courage to make it happen, the hard work to get it there, and the determination to bring the two industries together. I have had experts tell me that it won’t happen, but I pointed out right away in my post the discussion I found between the four medical professionals, and I believe that as medical professionals they have a better understanding of the issues involved than I do as a layman. I trust their judgment of the issue and defer to them for my belief that it can be done.

So who is right and who is wrong? I don’t know the answer to that, but I do know this: for 20 years, the average medical cost for lost-time claims has gone from around $8,100 to almost $30,000 with no decrease in cost, but with a slowdown in the rate of increase. Is that progress? Is that a sign that all other avenues tried have not succeeded? Perhaps it will take higher costs to wake people up to the reality that medical care, like all other goods and services, always goes to those places where the goods or services can be produced at cheaper cost with better quality.

Change for Change’s Sake: What Real Change in Workers’ Comp Looks Like

Note: This is my 200th post, so I think you will find it to be one of the best articles I have written so far.

Every industry has its share of conferences, conventions and meetings around the country. The insurance and risk management industries, which includes the workers’ comp industry, is no exception.

In the early stage of my career, I worked for a small, retail insurance broker on New York’s Long Island, and the men in my company would attend the Risk and Insurance Management Society (RIMS) Conference every year.

I am sure they went there to learn about things other brokers were doing, make connections with insurance company executives, and workers’ comp service providers. But typically, these conferences allowed the participants to hang out with their buddies at the bar, and play a round or two of golf.

So I was mildly amused when I read an article posted today in The Workers’ Compensation Daily from Safety National Insurance Company, titled “It’s Time to Change Workers’ Compensation”.

The article discussed a recent meeting of the Harbor Health Systems 2015 MPN (Medical Provider Networks) Medical Directors, in which an executive from Sedgwick gave the keynote address. His address discussed the need for change in the approach to workers’ comp claims handling.

Harbor Health Systems is based in California, and through the writings of my fellow blogger, David De Paolo, and the personal experiences of two women I previously wrote about, “Ms. X” and “Ms. A”, the California workers’ comp system could use more than a keynote address to change the problems and abuses injured workers are receiving in that state.

FYI, Harbor Health Systems is a subsidiary of One Call Care Management, a company that for the past two years or so has been gobbling up smaller companies, especially in the pharmacy benefit management arena, as well as other smaller workers’ compensation service providers, and as Joe Paduda reported earlier this week, One Call Care Management has acquired an imaging company called MedFocus.

According to Joe, this acquisition consolidates One Call’s stranglehold on the market, so if this is the kind of change Mr. North of Sedgwick was referring to, then it is more of the same.

The article goes on to say that the role of a medical director is to be there to help injured workers to recover from their injuries and resume their lives. I believe “Ms. X” and “Ms. A” would beg to differ.

The article also goes on to say that for years, the workers’ comp medical networks have focused on two things: discount and proximity. They would send injured workers to the physician closest to the employer’s location who would agree to accept a discount on the treatment provided.

Over time, they realized this approach was flawed, and that they should identify the medical providers who produce the best outcomes and incentivize them to treat injured workers by compensating them fairly.

They are learning that when they find these superior physicians, they need to get out of their way and let them practice medicine. The rest of the article details how the industry needs to evolve in how they devote resources to claims, how to better explain the workers’ comp system and protections it provides, and to avail themselves of the opportunities the ACA provides to evolve the way medical care is delivered.

According to Mr. North, when it comes to change, there are three main categories of people:

  • Innovators – people who are truly creating change
  • Learners – people who take what innovators created and work to evolve it
  • Ignorers – people who are uncomfortable with change and have a tendency to ignore it as long as possible

He said that workers’ comp cannot evolve if they are unwilling to take risks and become innovators; otherwise change will not happen.

I agree with his analysis, and my posts have attested to that fact time and time again. Therefore using his categories, it is clear that I would be considered an innovator, since I have been advocating implementing medical travel into workers’ comp.

Workers’ comp needs to take risks, and medical travel affords them of one of those risks.

Yet, those who have derided my idea, or who have not paid any attention to what I am saying, are ignorers, and there may even be people who would see to it that medical travel never becomes part of workers’ comp.

So I would like to add a fourth category to this list. Call them defenders of the status quo, or preventers, or even saboteurs, if it ever got that far.

So what is this change Mr. North is talking about? Is it real change, or just change for the sake of change? And what does real change look like?

Real change is not keeping injured workers and the system locked in a padded cell, wrapped in a straitjacket.

Real change is not buying up smaller companies and cornering the market, so that the very idea of competition is tossed on the dustbin of history.

Real change is not doing the same things over and over again and expecting different results.

Real change is not being afraid to look outside of one’s comfort zone, and outside of one’s national borders at a time when your industry is facing challenges from the expansion of out-out legislation that threatens to destroy workers’ comp, rising medical costs, physician shortages, questions of the constitutionality of exclusive remedy, negative media reports, changes in technology and diversification, and other “seismic shifts”.

Real change is becoming a learner, and I am looking for learners to work with. Real change is being fearless and recognizing that Americans are not the only ones who are able to provide quality medical care.

Real change is going with the flow of change in the world today and joining the globalized world; otherwise you stagnate and die. Time is running out. Real change is possible, but you must go after it.

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

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.

Medical Tourism Resume

Richard Krasner, MA, MHA
7151 Summer Tree Drive
Boynton Beach, FL 33437
561-738-0458
561-603-1685, cell
richard_krasner@hotmail.com
http://www.linkedin.com/in/richardkrasner
Skype: richardkrasner
Blog: https://richardkrasner.wordpress.com

Professional Profile

Detail-oriented, Insurance and Risk Management Generalist transitioning into Medical Tourism industry. Over ten years’ experience in Workers’ Compensation Claims Analysis and Claims Management, Risk Management and Property & Casualty Insurance, and RMIS and Insurance Data Processing.

Claims Management/Risk Analysis
• WC, GL and P&C claims management and analysis
• Wrap-up Claims Administration
• Interacted with Adjusters, TPA’s, cost-containment and rehab services, investigation services
• Familiar with WC and Medical Claims Coding (CPT, DRG’s, ICD-9)

Risk Management/P & C Insurance
• Risk Management Consulting
• Client Account
• Brokerage
• Knowledge of Risk Management and Insurance terms, concepts, policies
• Interacted with various Risk Management, Insurance, Legal and Medical personnel

RMIS/Insurance Data Processing
• @Venture, Corporate Systems, Dorn, POINT, Tropics, WINS, ModMaster
• WC Statistical Reporting
• Data Analysis
• Data Gathering
• Data Management
• Data Reporting Core Skills

• Strong financial, organizational, written and verbal communication skills.
• Strong analytical and problem solving skills.
• Strong database management and quality assurance skills.
• Able to respond to complex questions from internal and external customers.
• Able to work independently; team player; self-motivated.
• MS Office, Windows.

Education

Florida Atlantic University, Boca Raton, Florida
Master’s in Health Administration

New York University, New York, New York
M.A., History

SUNY Brockport, Brockport, New York B.A.,
Liberal Arts

Professional Experience

Blogger, Transforming Workers’ Compensation Blog, Boynton Beach, FL            2012 – Present

• Published over 150+ articles to promote the implementation of medical tourism into Workers’ Compensation. Presented “Barriers, Obstacles, Opportunities and Pitfalls” at 5th Mexico Health and Wellness Travel Show in Reynosa, Mexico, November 2014.

Risk Management Consulting Services, Boynton Beach, FL                                                 2002 – 2010

For Strategic Outsourcing, Inc., a professional employment organization (PEO) in Charlotte, NC with more than 830 clients and 33,000 assigned employees.
• Performed detailed risk and loss analysis on all lines of property & casualty coverage, with emphasis on workers’ compensation and general liability.
• Worked on the design and analysis to create internally or purchase an effective Risk Management Information System (RMIS).

For Environamics, Inc., a commercial construction company in Charlotte, NC.
• Worked with the Human Resources Manager and insurance broker to create fully developed losses in all lines of insurance and loss development factors.
• Developed the analysis to determine the best levels of self-insurance and deductibles. Created fully functional loss spreadsheets.

For the Fredrick C. Smith Clinic, one of the largest physician-owned medical clinics in Ohio.
• Conducted detailed risk and loss analysis in their workers’ compensation program.
• Developed the criteria to use to select a third party claims administrator.
• Designed an effective strategy to reduce frequency and severity of workers’ compensation claims.

For Bonitz, Inc., a commercial construction company (sub-contractor) in Columbia, SC, with over 1000 associates (employees), with 16 locations in 6 states, specializing in ceiling, drywall and flooring.
• Under supervision of Director of Human Resources, designed a more effective safety program with special emphasis on Workers’ Compensation claims and claims costs.
• Assisted in the set-up and implementation of claims database system (RMIS).
• Worked on wrap-up claims, policies and programs on an as needed basis.

Sr. Specialist/Data Mgmt., Aon Risk Services of TX, Inc., Houston, TX                         2001 – 2002
• Responsible for processing internal/external client requests for data.
• Analyzed changes in clients’ Experience Modification Factors.

Risk Management Consultant, Dallas, TX                                                                              1995 – 2001
Various assignments in Texas and Florida in Risk Management, Claims Administration and Data Management.

Data Analyst, Stirling Cooke, Dallas, TX
• Responsible for data integrity; data and system reconciliation; running claims and policy reports; running monthly loss runs; coordinating and compiling TPA claims data; responsible for month-end processing.

BPO Compliance Analyst, PMSC, Sarasota, FL
• Gathered, analyzed, defined and implemented requirements and procedures for electronic reporting of WC data.
• Documented data reporting requirements. Developed and executed test plans.
• Compiled, analyzed and verified WC exposure, premium and claims data for statistical bureau reporting.
• Tested and analyzed data reporting software. Coordinated resolution of programming issues with programmers.

Data Services Consultant, NCCI, Inc., Boca Raton, FL
• Analyzed, researched and resolved issues for all data types, requests and collection systems for all data reported to company.
• Responded to complex questions and data requests from internal and external customers.
• Researched and resolved carrier appeals to ensure equitable application of data reporting incentive programs.
• Participated in internal carrier visitations and end-user training.

Underwriting Data Analyst (Contract), Allstate, Boca Raton, FL
• Performed data analysis and data management tasks to support underwriting operations.

Additional Experience

Claims Coding Supervisor, Reliance National Insurance Company, NY, NY
• Supervised work of coding staff. Assisted in testing of database software during data conversion process from current database to new database.

Claims Administrator, Hamond & Regine Inc., Mineola, NY
• Managed and improved administration of Construction/Maintenance OCIP “wrap-up” claims program (WC, GL, and Builders’ Risk) for retail insurance
broker, resulting in improved operational and insurance program analysis.
• Created and generated Loss Control Analysis Reports, improving risk analysis and exposure identification.
• Interacted with Loss Control/Safety personnel to improve monitoring of claims and incidents. Reduced errors and omissions by more than 50%.
• Investigated, analyzed and coordinated correction of claims data discrepancies, saving client over $100,000 in additional premium.
• Conducted periodic claims file reviews and audits. Gathered and prepared claims data for renewal process.

No-Fault Claims Supervisor, American Colonial Insurance Company, NY, NY
• Administered Automobile No-Fault claims unit.

WC Claims Examiner, Greater New York Mutual Insurance Co., NY, NY
• Processed, investigated and paid WC & Disability claims.

Publications

Medical Tourism and Workers’ Compensation: What are the barriers? Medical Travel Today.com, PERSPECTIVES, published online on November 14, 2012.
http://medicaltraveltoday.com/medical-tourism-and-workers-compensation-what-are-the-barriers/

Implementing international medical providers into the U.S. workers’ compensation system, Part 1, Insurance Thought Leadership.com, published online November 12, 2012.
http://www.insurancethoughtleadership.com/index.php/risk-transfer/healthcare/articles/implementing-international-medical-providers-
into-the-u.s.-workers-compensa/#axzz2C24xFI2P

Implementing international medical providers into the U.S. workers’ compensation system, Part 2, Insurance Thought Leadership.com, published online November 15, 2012.
http://www.insurancethoughtleadership.com/index.php/risk-transfer/healthcare/articles/implementing-international-medical-providers-
into-the-u.s.-workers-com/#axzz2CJE7Uukv

Implementing international medical providers into the U.S. workers’ compensation system, Part 3, Insurance Thought Leadership.com, published online November 28, 2012.
http://www.insurancethoughtleadership.com/index.php/risk-transfer/workers-compensation/articles/implementing-international-
medical-providers-into-the-u.s.-workers-com1/#axzz2EcQHmlo3

Implementing international medical providers into the U.S. workers’ compensation system, Part 4, Insurance Thought Leadership.com, published online December 4, 2012.
http://www.insurancethoughtleadership.com/index.php/risk-transfer/workers-compensation/articles/implementing-international-
medical-providers-into-the-u.s.-workers-com2/#axzz2EcQHmlo3

Implementing international medical providers into the U.S. workers’ compensation system, Part 5, Insurance Thought Leadership.com, published online on December 14, 2012.
http://www.insurancethoughtleadership.com/index.php/risk-transfer/benefits-long-term-care/articles/implementing-international-
medical-providers-into-the-u.s.-workers-com3/#axzz2F2z8jZwY

Implementing Medical Tourism into Worker’s Compensation, CASE STUDY, Medical Travel Today.com, published online on January 2, 2013.
http://medicaltraveltoday.com/newsletter/v7-1.html#IndustryNews2

The Stars Aligned: Mexico as a medical tourism destination for Mexican-born US workers under Workers’ Compensation, PERSPECTIVES, Medical Travel Today.com, published online on January 16, 2013.
http://medicaltraveltoday.com/richard-krasner-the-stars-aligned-mexico-as-a-medical-tourism-destination-for-mexican-born-us-
workers-under-workers-compensation/

Immigration Reform On The Horizon: What It Means For Medical Tourism And Workers’ Compensation, Insurance Thought Leadership.com, published online February 10, 2013.
http://www.insurancethoughtleadership.com/index.php/risk-transfer/healthcare/articles/immigration-reform-on-the-horizon-what-it-
means-for-medical-tourism-and-wor/#axzz2KYcHw6HV

Immigration Reform on the Horizon – What it Means for Medical Tourism and Workers’ Compensation, PERSPECTIVES, Medical Travel Today.com, published online February 13, 2013
http://medicaltraveltoday.com/richard-krasner-immigration-reform-on-the-horizon-what-it-means-for-medical-tourism-and-workers-
compensation/

Spinal Fusion Outcomes in Washington State, PERSPECTIVES, Medical Travel Today.com, published online February 27, 2013.
http://medicaltraveltoday.com/richard-krasner-spinal-fusion-outcomes-in-washington-state/

Implementing international medical providers into the U.S. workers’ compensation system, Part 1, Costa Rica Medical Tourism, Inc. published online on March 2, 2013.
http://www.medtourismcr.com/blog/2013/03/02/Implementing-International-Medical-Providers-Into-The-US-Workers-Compensation-
System-Part-1.aspx

Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation, TBD Consulting.com, published online on March 4, 2013.
http://tbd-consulting.typepad.com/healthcare_talent/2013/03/employee-vs-employer-choice-of-physician-revisited-additional-
commentary-on-how-best-to-incorporate-.html

Rising Hospital Costs: What they mean for Workers’ Compensation and Medical Tourism, TBD Consulting.com, published online on March 13, 2013.
http://tbd-consulting.typepad.com/healthcare_talent/2013/03/rising-hospital-costs-what-they-mean-for-workers-compensation-and-
medical-tourism.html

Legal Barriers to Implementing International Providers into Medical Provider Networks for Workers’ Compensation: A White Paper, WordPress.com, published online on March 15, 2013.
http://wp.me/p2QJfz-ap

What I Learned at the 5th World Medical Tourism & Global Healthcare Congress, and Why It Matters to the Workers’ Compensation Industry, TBD Consulting.com, published online on March 20, 2013.
http://tbd-consulting.typepad.com/healthcare_talent/2013/03/what-i-learned-at-the-5th-world-medical-tourism-global-healthcare-
congress-and-why-it-matters-to-the.html

A ‘Case Study’ in Implementing Medical Tourism into Workers’ Compensation, TBD Consulting.com, published online on April 3, 2013.
http://tbd-consulting.typepad.com/healthcare_talent/2013/04/a-case-study-in-implementing-medical-tourism-into-workers-
compensation.html

What Can Medical Tourism Do about Pain Medication Abuse?, Medical Tourism Today.com, published online on April 5, 2013.
http://medicaltourismtoday.com/what-can-medical-tourism-do-about-pain-medication-abuse/

Medical Tourism and Workers Compensation: What are the Barriers?, TBD Consulting.com, published online on April 10, 2013.
http://tbd-consulting.typepad.com/healthcare_talent/2013/04/medical-tourism-and-workers-compensation-what-are-the-barriers.html

Point/CounterPoint: A Virtual Dialogue on the Merits of Implementing Medical Tourism into Workers’ Compensation, Part 1, TBD Consulting.com, published online on April 17, 2013.
http://tbd-consulting.typepad.com/healthcare_talent/2013/04/part-1-pointcounterpoint-a-virtual-dialogue-on-the-merits-of-
implementing-medical-tourism-into-worke.html

Point/CounterPoint: A Virtual Dialogue on the Merits of Implementing Medical Tourism into Workers’ Compensation, Part 2, TBD Consulting.com, published online on April 18, 2013.
http://tbd-consulting.typepad.com/healthcare_talent/2013/04/part-2-pointcounterpoint-a-virtual-dialogue-on-the-merits-of-
implementing-medical-tourism-into-worke.html

Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is, Medical Sea.org, published online on April 22, 2012.
http://www.medicalsea.org/ensuring-patient-safety-making-sure-medical-tourism-puts-its-money-where-its-mouth-is/

Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is, OPINION, Medical Travel Today.com, published online on April 24, 2013.
http://medicaltraveltoday.com/ensuring-patient-safety-making-sure-medical-tourism-puts-its-money-where-its-mouth-is/

Ten Years On: Medical Tourism Industry a decade out, Medical Tourism Today.com, published online on May 24, 2013.
http://medicaltourismtoday.com/ten-years-on-medical-tourism-industry-a-decade-out/

Healthcare Transparency, Healthcare Talent Transformation.com, published online on June 6, 2013.
http://www.healthcaretalenttransformation.com/2013/06/07/healthcare-transparency/

Surgical Shenanigans: How Workers’ Compensation is being ripped off, Medicalsea.org, published online on June 24, 2013.
http://www.medicalsea.org/surgical-shenanigans-how-workers-compensation-is-being-ripped-off/

My Defense of Implementing Medical Tourism into Workers’ Compensation, Healthcare Talent Transformation.com, published online on July 8, 2013.
http://www.healthcaretalenttransformation.com/2013/07/08/my-defense-of-implementing-medical-tourism-into-workers-
compensation/#more-947

The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible — and not a Pipe Dream, PERSPECTIVES, Medical Travel Today.com, published online on July, 17, 2013.
http://medicaltraveltoday.com/the-faith-of-my-conviction-integrating-medical-tourism-into-workers-compensation-is-possible-and-not-
a-pipe-dream/

Surgical Shenanigans: How Workers’ Compensation is being ripped off, Healthcare Talent Transformation.com, published online on July 22, 2013.
http://www.healthcaretalenttransformation.com/2013/07/22/surgical-shenanigans-how-workers-compensation-is-being-ripped-off/

On the Bright Side, Medicasea.org, published online on August 4, 2013.
http://www.medicalsea.org/on-the-bright-side/

And Now For Something Completely Different, Medicalsea.org, published online on August 9, 2013.
http://www.medicalsea.org/and-now-for-something-completely-different/

Founding Fathers and the ACA, Healthcare Talent Transformation.com, published online on August 26, 2013.
http://www.healthcaretalenttransformation.com/2013/08/26/founding-fathers-and-the-aca/

Lessons, Medicalsea.org, published online on August 28, 2013.
http://www.medicalsea.org/lessons/

Addendum

Publications

Far In Front of the Crowd, Medicalsea.org, published online on August 30, 2013.
http://www.medicalsea.org/far-in-front-of-the-crowd/

Medical Tourism Industry a Decade from Now: Part 1, Healthcare Talent Transformation.com, published online on October 9, 2013.
http://www.healthcaretalenttransformation.com/2013/10/09/medical-tourism-industry-a-decade-from-now-part-1/

Medical Tourism Industry a Decade from Now: Part 2 Outpatient Costs, Healthcare Talent Transformation.com, published online on October 16, 2013.
http://www.healthcaretalenttransformation.com/2013/10/16/medical-tourism-industry-a-decade-from-now-part-2-outpatient-costs/

Medical Tourism Industry a Decade from Now: Part 3 Consolidation of US Hospitals, Healthcare Talent Transformation.com, published online on October 18, 2013.
http://www.healthcaretalenttransformation.com/2013/10/18/medical-tourism-industry-a-decade-from-now-part-3-consolidation-of-us-
hospitals/

“Have I Got A Deal For You?” — The Medical-Device Tax Shuffle and Medical Tourism, Medicalsea.org, published online on October 20, 2013.
http://www.medicalsea.org/have-i-got-a-deal-for-you-the-medical-device-tax-shuffle-and-medical-tourism/

Medical Tourism Industry a Decade from Now: Part 4 Cost to Employees, Healthcare Talent Transformation.com, published online on October 23, 2013.
http://www.healthcaretalenttransformation.com/2013/10/23/medical-tourism-industry-a-decade-from-now-part-4-cost-to-employees/

Medical Tourism Industry a Decade from Now: Part 5 Immigration Reform, published online on October 25, 2013.
http://www.healthcaretalenttransformation.com/2013/10/25/medical-tourism-industry-a-decade-from-now-part-5-immigration-reform/

Medical Tourism Industry a Decade from Now: Part 6 Technology, published online on October 30, 2013.
http://www.healthcaretalenttransformation.com/2013/10/30/medical-tourism-industry-a-decade-from-now-part-6-technology/

Interview, SPOTLIGHT, Medical Travel Today.com, published online on October 31, 2013.
http://medicaltraveltoday.com/richard-krasner-medical-tourism-blogger/

Ten Years On: One Person’s View of Where the Medical Tourism Industry Will be a Decade from Now INDUSTRY NEWS, Medical Travel Today.com, published online on October 31, 2013.
http://medicaltraveltoday.com/ten-years-on-one-persons-view-of-where-the-medical-tourism-industry-will-be-a-decade-from-now/

Medical Tourism Industry a Decade from Now: Observations and Conclusion, Healthcare Talent Transformation.com, published online on November 1, 2013.
http://www.healthcaretalenttransformation.com/2013/11/01/medical-tourism-industry-a-decade-from-now-observations-and-
conclusion/

Cross-border Workers’ Compensation A Reality In California, Medicalsea.org, published online on December 3, 2013.
http://www.medicalsea.org/cross-border-workers-compensation-a-reality-in-california/

Knee Surgery in Costa Rica — A Less Expensive Alternative, Medicalsea.org, published online on December 31, 2013.
http://www.medicalsea.org/knee-surgery-in-costa-rica-a-less-expensive-alternative/

Cross-border Workers’ Compensation A Reality In California, Medicalsea.org, published online on January 22, 2014.
http://www.medicalsea.org/cross-border-workers-compensation-a-reality-in-california-2/

What to know before providing Medical Tourism Services, Medicalsea.org, published online on February 14, 2014.
http://www.medicalsea.org/what-to-know-before-providing-medical-tourism-services/

Can Medical Tourism Relieve Stress in Workers’ Comp?, Medicalsea.org, published online on February 19, 2014.
http://www.medicalsea.org/can-medical-tourism-relieve-stress-in-workers-comp/

Beware the IRS: What to Know Before Using Medical Tourism for Group Health Plans, Medicalsea.org, published online on February
25, 2014.
http://www.medicalsea.org/beware-the-irs-what-to-know-before-using-medical-tourism-for-group-health-plans/

Statutes are not Statues ― Why Workers’ Comp Must Open up and Be Flexible, Medicalsea.org, published online on
April 8, 2014.
http://www.medicalsea.org/statutes-are-not-statues-%E2%80%95-why-workers-comp-must-open-up-and-be-flexible/

ACA to Lead to Physician Shortages ― Possible Effects for Medical Tourism in Work Comp, Healthcare Talent Transformation.com,
published online on April 14, 2014.
http://www.healthcaretalenttransformation.com/2014/04/14/aca-to-lead-to-physician-shortages-%E2%80%95-possible-effects-for-
medical-tourism-in-work-comp/

Why Medical Tourism for Workers’ Comp is an Idea Whose Time Has Come, U.S. Domestic Medical Travel.com, published
online on April 16, 2014.
http://www.usdomesticmedicaltravel.com/email/v1-10.html#story8

Why Medical Tourism for Workers’ Comp is an Idea Whose Time Has Come, Medical Travel Today.com, published online
on May 1, 2014.
http://medicaltraveltoday.com/newsletter/v8-1.html#

Miami Beach: Fun, Sun and Medical Tourism, Medicalsea.org, published online on May 14, 2014.
http://www.medicalsea.org/miami-beach-fun-sun-and-medical-tourism/

Travel expense may be reimbursed under certain conditions, Medicalsea.org, published online on July 3rd, 2014
http://www.medicalsea.org/travel-expense-may-be-reimbursed-under-certain-conditions/

“We’re Not No. 1!” We’re No. 11, Healthcare Talent Transformation.com published online on July 17, 2014.
http://www.healthcaretalenttransformation.com/2014/07/17/were-not-no-1-were-no-11/

From Pariah to Player: South Africa’s Journey towards Becoming a Medical Tourism Destination, Medicalsea.org, published online on July 21, 2014.
http://www.medicalsea.org/from-pariah-to-player-south-africas-journey-towards-becoming-a-medical-tourism-destination/

Corruption Not Limited To US Health Care, Medicalsea.org, published online on July 21, 2014.
http://www.medicalsea.org/corruption-not-limited-to-us-health-care/

Top 10 Causes of Workplace Injuries: How Medical Tourism Can Save Employers Money, U.S. Domestic Medical Travel.com, published online on September 15, 2015. http://www.usdomesticmedicaltravel.com/email/v2-2-full.html#story5

Paralysis by Analysis: Or the Only Thing We Have to Fear Is, Fear Itself, U.S. Domestic Medical Travel.com published online on October 20, 2015. http://www.usdomesticmedicaltravel.com/email/v2-3-full.html#story2

Follow-up Visits After Surgery: Telehealth, Medical Travel and Workers’ Comp, U.S. Domestic Medical Travel.com published online on October 20, 2015. http://www.usdomesticmedicaltravel.com/email/v2-3-full.html#story3

Interview, SPOTLIGHT, Medical Travel Today.com, published online on November 3, 2015. http://www.medicaltraveltoday.com/newsletter/v8-19-full.html#story1

Lost-Time Medical Costs Approaching $30K: When Will You See the Light?

Introduction

For the past five years I have been keeping track of the Average Medical Cost per Lost-Time Claim, as reported every year in May at the NCCI Annual Issues Symposium in Orlando, Florida.

The Chief Actuary for NCCI, Kathy Antonello, presented the 2015 State of the Line Report to the Symposium’s attendees this morning.

That is where many folks in the workers’ comp industry are today and tomorrow, including fellow bloggers, David De Paolo and Joe Paduda.

It is thanks to Joe that I was able to find the slides presented today at the Symposium.

Much of what the State of the Line discusses has to do with the financial health of the workers’ comp industry from the standpoint of premiums and other cost drivers.

But it is the Average Medical Cost per Lost-Time Claim that has always grabbed my attention, and what I have cited in my original paper for my MHA degree program class on Health Law and my White Paper.

In addition, I have cited it in my previous posts, Average Medical Claim Costs Still Rising for Workers’ Compensation and Average Medical Claim Costs Still Rising for Workers’ Compensation: 2014 Edition.

What you will notice in the following article is that the Average Medical Cost per Lost-Time Claim is still rising, despite the fact that from year to year, there may be a slight decrease, but on the whole, the Average Medical Cost is slowly approaching $30,000.

What that means as far as actual cost of medical care for each and every claimant is unclear from the data NCCI provides. For example, does that include the cost of surgery? Does it include the total hospital bill for each patient, because we all know that hospital bills can run into six figures.

What it does not include, and that is made very clear at the bottom of the slide, is any high-deductible policies.

So the Average Medical Cost per Lost-time Claim is only an estimate of the average workers’ comp claim that is reported to NCCI. And bear in mind, that not all fifty states report data to NCCI. Some states only report to state bureaus, and only report to NCCI on interstate rated policies, so again it is not completely accurate.

To illustrate just how bad things have gotten, I am going to show you the previous five Average Medical Cost per Lost-time Claim slides, plus this year’s slide, and my own chart with a trendline that shows the medical cost continuing to rise.

I could have done this for all of the past five years, but even without a trendline, the reader can tell that costs are going up. After all, this is not rocket science, and after having worked at NCCI and doing workers’ comp statistical reporting, I can tell you that there are no geniuses there.

So since this is not rocket science, and since going to the Moon is way more complex than sending workers’ comp claimants to medical tourism facilities abroad where the costs are cheaper, but the quality is equal to or better, then it will be quite clear that the trendline will not change until an alternative is found. That alternative is medical travel.

Average Medical Cost per Lost-time Claim 2009

At the 2010 Annual Issues Symposium, the Average Medical Cost per Lost-time Claim was estimated to be $27,200. As you will see in the slide below, the annual change from years 1991 to 1993 was +1.9%, from 1994 to 2001, it was +8.9%, and from 2002 to 2008, it was +6.6%.

The Average Medical Cost in 1991 was just over $8,000, and by 2009, the preliminary figure was nearly $28,000, which was an increase of 232%. That is a big increase in less than twenty years.

Chart 1

NCCI SOTL_0001

Medical losses amounted to 58% of all total losses in 2009, as seen in Chart 2, and had increased since 1989. For those of you not familiar with workers’ comp. Indemnity refers to the payments made to claimants for lost wages.

What this means is that for each claim, the medical costs represent more than half of the total of the entire claim payments. Lost wages are no longer the main cost driver for the increasing costs of claims.

Chart 2

NCCI SOTL_0002

Average Medical Cost per Lost-time Claim 2010

The following year, the Average Medical Cost per Lost-time claim went up slightly to $27,700, a 70% increase from 1991, or a modest 2% from 2009, as seen on the chart.

The Annual Change for years 1991 to 2001 showed no change, but did show a tenth of a percent increase for the years 2002 to 2008.

Chart 3

NCCI SOTL_0003

Average Medical Cost per Lost-time Claim 2011

One year later, NCCI reported that the Average Medical Cost had a slight increase in 2011, and had reached $28,000. This was a 71% increase from 1991.

The Annual Change decreased for the years 2002 to 2010, to +6.0%, a .6% decrease.

Chart 4

NCCI SOTL_0004

 Average Medical Cost per Lost-time Claim 2012

2012 saw the Average Medical Cost inched up a bit to $28,500, however, the Annual Change for years 2002 to 2011  decreased .3%, probably due to lower year by year rise in medical costs from 2010 to 2012.

Chart 5

NCCI SOTL_0005

Chart 6

Chart 5

Average Medical Cost per Lost-time Claim 2013

Starting in 2014, NCCI dropped the years 1991 to 1994 from the State of the Line report data on Average Medical Cost per Lost-time Claim. There was no explanation given, but there was a moderate increase in the medical claim severity, and medical cost was estimated at $28,800,

Chart 7 and Chart 8, the chart I used in my post, Average Medical Claim Costs Still Rising for Workers’ Compensation: 2014 Edition, are shown below, and with the aid of the treadline, you can see that medical costs are not showing any signs of decline, despite the minor year to year increases.

Annual Change from 1995 to 2012 went up +6.7%.

Chart 7

NCCI SOTL_0006

Chart 8

Chart 6

To drive home the point about the numbers and the slower increase year by year, I provided the reader with the following example:

Doctor:       “Good news, Mr. Jones. We’ve managed to slow the progression of your disease.”

Mr. Jones:   “What’s so good about that? I’m still dying, only slower.”

Average Medical Cost per Lost-time Claim 2014

Finally, we have today’s data, as reported by Kathy Antonello, and we can see that the Average Medical Cost per Lost-time Claim has risen to $29,400, an increase of 69% from 1995, and overall, the Annual Change from 1994 to 2013 has been a whopping +226.7%.

Chart 9

NCCI SOTL_0007

Chart 10

Chart 4

Obviously, something is terribly wrong here, and it is obvious that whatever the workers’ comp industry is doing is not working. Medical costs are still going up, and from the trendline, will continue to go up even further, eventually passing $30,000, perhaps as soon as next year.

Joe Paduda even reported today that the President and CEO of NCCI, Steve Klingel said that there may be storm clouds in the near future for work comp, and his comment was predicated on the reports earlier this year by ProPublica/NPR and OSHA.

Even with all of this data, folks in the workers’ comp world, their employer clients, and many others, refuse to see what is staring them in the face: MEDICAL CARE IN THE US IS TOO EXPENSIVE.

Yet, they refuse to seek out alternatives to high-cost medical care. And what would be so terrible if they did so?

Would they lose money on it? Perhaps the leeches who are draining the system or who have wrapped both the claimants and the system itself in a straitjacket, thrown them both into the padded cell called “workers’ comp” won’t be able to profit from the unfortunate injured workers who are being subjected to all kinds of horrible experiences, as evidenced by the ProPublica/NPR and OSHA reports, by my articles, and by articles by people like David De Paolo, who are bringing to light the dark side of workers’ comp.

The prospect of opt-out on the horizon is a double-edged sword. It promises to save money for employers, but as has been stated by Mother Jones and others, it could be worse for the employee. Like David De Paolo, I too, almost drank the kool aid on opt-out, but still believe that if it is fair to both the employer and the employee, it offers the opportunity to provide better medical care at lower cost to their employees.

But the attendees at this week’s two conferences, and all the other workers’ comp and insurance conferences will go on ignoring the truth, ignoring reality, will drink their favorite cocktails, tell funny stories, play a round or two of golf, etc.; yet, will not listen to me or anyone else when we tell them how things really are.

It is a case ‘see no evil, hear no evil, speak no evil’, but that only means that they are deaf, dumb and blind to the truth. It doesn’t have to be that way. It can be better.

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

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 and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.