Category Archives: Consolidation

A Little Disruption is a Good Thing

Staying on the topic of single payer, this time discussing its impact on workers’ comp, David De Paolo wrote an article today that describes Colorado’s Amendment 69 as a disruption of the status quo, and he points out that the tech industry has disrupted business models and industries for several decades and that the work comp industry needs to be disrupted as well.

He goes on to say that ColoradoCare (Amendment 69) is a debate and idea that is long overdue. The arguments against the idea, De Paolo writes, of a single payer system strikes him as simply entrenched interests seeking to protect their turf and business models.

Earlier this week, Workers’ Comp Insider published an article, “It’s A Colorado Rocky Mountain Low” that opposed the approval by Colorado voters this November of the amendment, using the reasons David cites in his piece, and some of the usual misleading distortions that only confuse voters on substantive issues such as this.

Readers will recall my previous two posts, the first, “Colorado Gets Real on Workers’ Comp and Health Care” which introduced the Amendment and the push to bring the two silos of workers’ comp and health care together, and the second, “Colorado “Single Payer” in Health Care Industry’s Sights” which described the health care industry’s attempts to derail the amendment’s approval.

The issue of combining the two silos was brought up by yours truly in an earlier post, “Betting the Farm“, and as I wrote then, not an original idea of mine. Yet, by reading David’s post, and the one by LynchRyan, you get the feeling that the only reason not to combined the two is greed and protection of vested interests.

Yet, in the business world, mergers happen all the time. And while it is true that some are not approved by the Justice Department or other government agencies, most mergers do take place.

The argument about issues like return to work being the purview of insurance companies under work comp is specious at best, because if we consider two patients, both of whom injure the same body part and require the same surgery to repair that injury, one must be put in a return to work program because he is covered for his injury under work comp; the other does not because his injury is not work-related, but did cause him to miss time from work. Does that make sense? Doesn’t the second patient also need to get back to work?

It is not logical to divide injured individuals by who picks up the check. It is more logical to treat all injuries the same, and to treat all medical issues the same, no matter if they are work-related or not. Getting cancer from occupational exposure to carcinogenic chemicals is no different than getting cancer from smoking, or being genetically predisposed as in breast cancer, or other types of cancer. They both are going to be seen by an oncologist, maybe even the same one if they live in the same area.

So keeping workers’ comp and health care separate and unequal, like education and social accommodations once did to African-Americans, is not only stupid, it is wrong. ColoradoCare is one way this can be accomplished, and as David points out, “Nobody really knows how all of this will play out.”

Maybe it is time we find out.


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.

Will accept invitations to speak or attend conferences.

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.

The Technological Revolution and Health Care: On the Same Track?

Yesterday, I ran across an interview on Truthout.com by Mark Karlin. Mr. Karlin was interviewing the two authors of a new book, People Get Ready, by Robert W. Mc Chesney and John Nichols.

Mr. Karlin’s first question, answered by Mr. Mc Chesney, intrigued me and got me thinking of what is happening in workers’ comp, as well as what is happening in health care.

As I mentioned briefly in my last post, automation and artificial intelligence will have a significant impact on the future of workers’ comp, and this is emphasized in Mc Chesney and Nichols’ book. There have been other books and articles recently on the subject, so this is nothing new.

But what got me thinking is that Mr. Karlin addressed the main question the book raises — namely that the conventional wisdom has always been that the more advanced technology becomes, the more beneficial it will be for humans.

Mr. Mc Chesney responded that convention wisdom said that new technologies will disrupt and eliminate many jobs and industries, and that they would be replaced by newer industries and better jobs.

Mc Chesney also said that they argue the idea that technology will create a new job to replace an old one is no longer operative; nor that the new job will be better than the old one.

According to Mr. Mc Chesney:

Capitalism is in a period of prolonged and arguably indefinite stagnation. There is immense unemployment and underemployment of workers, which we document in the book, taken from entirely uncontroversial data sources. There is downward pressure on wages and working conditions, which results is growing and grotesque inequality. Workers have less security and are far more precarious today than they were a generation ago; for workers under the age of 30, it is a nightmare compared to what I experienced in the 1970s.”

Likewise, Mr. Mc Chesney, continued:

there is an immense amount of “unemployed” capital; i.e. wealthy individuals and US corporations are holding around $2 trillion in cash for which they cannot find attractive investments. There is simply insufficient consumer demand for firms to risk additional capital investment. The only place that demand can come from is by shifting money from the rich to the poor and/or by aggressively increasing government spending, and those options are politically off-limits, except to jack up military spending, which is already absurdly and obscenely high.

Contemporary capitalism is increasingly seeing profits generated, he adds, not by its fairy tales of entrepreneurs creating new jobs satisfying consumer needs, (remember Mitt Romney’s ‘job creator’ line of bs?) — but by monopolies, corruption and by privatizing public services.

Finally, Mr. Mc Chesney states that:

Capitalism as we know it is a very bad fit for the technological revolution we are beginning to experience. We desperately need a new economy, one that is not capitalistic — based on the mindless and endless pursuit of maximum profit — or one where capitalism has been radically reformed, more than ever before in its history. It is the central political challenge of our times.

They are not the only ones arguing for such reform or revolution, Senator Sanders notwithstanding. In previous posts, I have mentioned the biopsychosocial theory, Spiral Dynamics, and the book by Said W. Dawlabani, MEMEnomics The Next-Generation Economic System.

Other authors such as Richard Wolff, and Robert Reich have written books about this subject, and like Mc Chesney and Nichols have reached similar conclusions. Yet, Dawlabani, accessing the Spiral Dynamics model, goes much deeper into why we got here and what we need to do to get out of it.

Such a future version of capitalism has been called by many different names that I have come across in the past decade or so. Natural Capitalism, conscious capitalism, and so on, to name a few. But the main point is as Mc Chesney and Nichols points out in their book, the technological revolution, rather than liberating humans and making our lives better, as Mc Chesney says in the interview, may have the perverse effect of reinforcing its stagnating tendency.

An issue related to automation and artificial intelligence and its impact on the future of work, is if we are all replaced by machines and software, how will people be able to live? How will the goods and services produced by automation be sold, and to whom? Only those who are fortunate to have employment in jobs that machines cannot do? Or will we have to go back to a time when money was only the purview of those who had it?

The answer to these questions have also been raised by those in the tech world, and one suggestion they have come up with is a national basic income (NBI), and naturally has already been shot down as a bad idea by those on the Right. I guess they really want people to be poor.

But this idea should be kept on the back burner for now, as given the political climate in this country, that idea will be dead on arrival. Yet, while many have acknowledged what Mc Chesney, Nichols and others have said is happening, the other side — namely the current Speaker of the House and others in his party, have doubled down on their stubborn adherence to the rantings of a two-bit novelist, Ayn Rand and Ayn Randism.

Which brings me to the other point I wish to discuss, and that bears on what happens in the overall economy at large.

If automation and artificial intelligence will lead to elimination of many, if not all jobs, and if that will require a new economy as Mc Chesney and Nichols, and others have argued, what does that mean for the health care industry that seems to be going in the opposite direction?

Even before the enactment of the ACA, health care has become more centralized, bureaucratic, consolidated and more profit-driven than ever. The ACA in many ways has accelerated this process, and the direction it is headed is towards a more consumer-driven form of health care, and one where large hospital systems have integrated physicians and insurance services into their business plan.

The move among some physicians and physician practices towards concierge medicine, also is a sign that health care is moving towards a more capitalistic health care, in that it creates two classes — those who can afford concierge medicine, and those who cannot.

The transition to a new economy will not happen overnight, and may not happen for some time, especially if the forces aligned against it remain strongly opposed to reform. But if the health care system collapses, as I mentioned previously in articles last week, then along with the stagnation of capitalism generally, there will be an opportunity to move in that direction in health care as well.

Calling for ‘Medicare for All’ now with firm opposition to anything that spends government money or has a social benefit other than producing profit for a few, is only a waste of time and a con job.

There are only two ways an economic system and its attendant political system changes; by revolution or evolution. One is violent and bloody, the other happens because the old is replaced by the new so seamlessly that no one gets too emotional when it happens. An election does not do that, especially when the opposition is headed toward fascism.

That issue is for another time and place, and the rest of Mc Chesney and Nichols’ book discusses the current presidential campaign. I wanted to discuss the dichotomy between where capitalism is headed and where health care is headed, and at some point, health care will have to fall in line with the new capitalism.


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.

Will accept invitations to speak or attend conferences.

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

Transforming Workers’ Blog is now viewed all over the world in 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.

Colorado Gets Real on Workers’ Comp and Health Care

A shout out today to David DePaolo of Workers’ Comp Central for publishing an article today about a subject I discussed about a year ago, the combining of the silos of workers’ comp and general health care.

Voters in Colorado, the first state to legalize pot (talk about a real ‘Rocky Mountain High’) will decide in November on a ballot initiative that would create ColoradoCare,  a state-run program that will would pay for medical treatment provided to all residents of the state, including those who are hurt on the job.

According to the initiative, “ColoradoCare shall assume responsibility for payment of all reasonable and necessary medical expenses incurred by workers who suffer injuries or illnesses arising out of and in the course of their employment after the date ColoradoCare assumes responsibility for health care payments,”

The law, David writes, will levy (must be Jewish?)  a 3.33% payroll tax on workers and a 6.67% payroll tax on employers, as well as a 10% health care premium tax on non-payroll income to raise $25 billion to pay for medical care.

A 21-person board of trustees would be created to oversee the program. And, employers would still have to carry workers’ comp insurance to cover indemnity benefits (lost wages).

This would be something left up to legislators to figure out, says DePaolo, because the law is only intended to consolidate health care and eliminate the myriad of silos that create delay, confusion and ultimately heath care consumer angst.

It is David’s opinion that the measure will pass, but that is up to the voters of Colorado to decide (are you listening, Maria?).

So what this will mean is this: should the measure pass in November, it is possible that injuries sustained on the job that requires surgery could be achieved through medical travel, since what is possible now under health care would also be possible in workers’ comp (see my post, “Medical Tourism and Workers’ Comp: What’s Good for the Goose is Good for the Gander“).

When it passes, the following warning should be issued to all potheads in Colorado:

Before going abroad for surgery under the provisions of ColoradoCare, should they allow you to do so, please leave all of your “medicine”, in whatever form you take it in, and the paraphernalia that goes with it home, or else you will end up like Billy Hayes in a Turkishmaninacanstan prison.

But the hospitals in Turkishmaninacanstan are much better, and that is one reason why you are going there in the first place. For world-class health care at a lower cost.

Challenges Facing Work Comp

In three weeks, members of the medical tourism industry will gather in Puerto Vallarta, Mexico to attend the 6th Mexico Medical Tourism Congress.

You may recall that I was invited and attended the Congress last year, and was invited again this year. However, due to personal and financial reasons, I am not attending this year.

I am however, posting my PowerPoint presentation below for your viewing, with narration by yours truly. I hope you find it interesting and informative.

Challenges Facing Workers’ Comp (PowerPoint)

Challenges Facing Workers’ Comp (video)

 

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.

Consolidation Rolls On In Work Comp

Consolidation was mentioned in the last post as one of the areas of concern over physician payment reform.

Yet, consolidation is also a concern in workers’ compensation, as Joe Paduda reports this morning.

Joe has been keeping tabs on all of the acquisitions occurring in the workers’ comp sphere for a very long time, and one of the main companies involved in these transactions has been Apax Partners, owners of One Call Care Management and GENEX Services.

GENEX has itself been bought or bought other companies in the past three years that I am aware of, thanks to Joe’s reporting.

Reuters, Joe says, reported that Apax is preparing a bid close to $2 billion for peer Helios. Helios is the product itself of a merger between Progressive Medical and PMSI, and is the largest workers’ comp Pharmacy Benefit Manager (PBM).

PMSI was bought by H.I.G. Capital some years back for about $40 million, Joe states, then purchased for probably 8-10 times that figure a couple years ago and merged with Progressive, and there are countless other companies in the work comp service sector that have gone through similar mergers, acquisitions, purchases, etc.

Given the consolidation in the health care sector with hospitals, insurers, and physician practices, especially the development of ACOs, the consolidation on the work comp will also lead to higher cost for services or cuts to services provided.

Competition was supposed to be a good thing in a capitalist society, but as we have seen before in many other industries, leveraged buyouts, mergers and acquisitions, and hostile takeovers have shrunk the competitive sphere, so that in these industries, only a handful of large corporations remain.

Banking, insurance, and financial services, especially Wall Street brokerage firms, have all been consolidated in one form or another, so that now, a company like Goldman Sachs dominates the market after the financial collapse of a few years ago.

Health care and work comp are no different. Perhaps one day, the world of “Rollerball” will become reality, and all companies will be combined into their own industries, headquartered in different cities around the world, as was in that groundbreaking film.

Who knew the highest form of capitalism was really monopoly?

Challenges Remain in Physician Payment Reform

Following up on my post yesterday about shared savings, John O’Shea writes today in the Health Affairs blog, that challenges remain with regard to physician payment reform, now that President Obama has signed the Medicare Access and CHIP Reauthorization Act (MACRA) in April.

MACRA repeals the Sustainable Growth Rate (SGR) mechanism of updating fees to the Physician Fee Schedule (PFS).

The SGR has been blamed for causing instability and uncertainty among physicians for over a decade, and that led to 17 overrides of scheduled fee cuts, at a cost of over $ 150 billion.

The passage of MACRA, O’Shea wrote, raises new questions about where the US health care system is headed in the post-SGR world of payment and delivery reform.

Yet, before MACRA was signed into law, HHS Secretary Burwell announced a major initiative calling for 30 % of Medicare payments to be value-based through the use of alternative payment models (APMs) by 2016, and 50% by 2018.

HHS also set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016, and 90% by 2018.

O’Shea reported there are reasons for caution. These policy changes, following calls to move from the current volume-based, fee-for-service (FFS) system to a value-based system that pays for patient outcomes, rather than for individual services, present major challenges to achieving the goal of value-based health care, the goal of any real health reform initiative.

One of the APMs O’Shea discussed is Value-based purchasing (VBP), which is the concept behind APMs, includes a broad set of performance-based payment strategies that attempt to use financial incentives to influence provider performance, such as the Shared Savings Program mentioned yesterday.

Another APMs is the Merit-Based Incentive Payment System (MIPS) [don’t you just love how the government comes up with these abbreviations?], a modified FFS system, which is basically a Pay-for-Performance (P4P) program.

The overall early results of these initiatives, as well as possible flaws, make the long term viability of these models uncertain.

With regard to P4P programs, a 2014 RAND report looked at 49 studies examining the effect of P4P on process and intermediate outcome measures, and found that the overall results were mixed, and that any identified effects were relatively small.

According to the lead author of the study, Cheryl Damberg, “The evidence from the past decade is that pay for performance had modest effects on closing the quality gap.” A basic flaw in the model is the reality that meaningful patient-centered outcome measures remain elusive.

ACOs, as I wrote about yesterday, are another APM; and O’Shea reported that their ability to generate savings to share with participants is so far not encouraging. He points to early results from the Pioneer ACO program that determined that of the 23 ACOs that participated in 2013, only 11 earned any shared savings, which totaled about $41 million. Six ACOs lost a total of $25 million. The results from a similar study in 2014 showed improvement, but the long-term outlook is still unclear.

What is the impact on the practice of medicine?

What O’Shea found was that physicians currently labor under an increasingly burdensome and often meaningless number of reporting requirements that take time away from patients, and fail to help them improve quality of care.

Accordingly, a commentary O’Shea cited from the New England Journal of Medicine said that, “the quality-measurement enterprise in US health care is troubled.”

A recent CMS report, O’Shea mentioned, said that 40% of Medicare providers will face 1.5% cuts for failing to submit data to the Physician Quality Reporting System.

Because of this, many public and private payers are tying larger amounts of provider payments to a growing number of largely meaningless measures.

O’Shea said that there are two areas of concern, given the plethora of payment and delivery reform initiatives: the administrative burden on physicians, and the push towards greater consolidation.

Nearly half, or 46% of doctors who reported said that they felt burned out in 2014. A main reason cited by the physicians was the increasing administrative burden.

What does the mean?

Well, having slogged through an online Health Care Quality course as part of my MHA degree program, the myriad abbreviations mentioned in Mr. O’Shea’s article does not surprise me. CMS and HHS has for years developed all kinds of initiatives and programs to influence and alter behavior of all stakeholders in our health care system.

As “Uncle” Walter Cronkite once said, “America’s health care system is neither healthy, caring, nor a system.” And that was before the passage of the ACA.

But for the purposes of this blog, and in keeping with the point of the last article where it was said that what happens in health care affects workers’ comp. then I think you can agree that these initiatives and programs, while well-meaning, may make things worse in the future, but not because the idea behind the ACA or the law itself is bad, but because we Americans cannot do anything right until we try everything else, a la Winston Churchill.

If that is the case, then believing that by doing the same things over and over again, that by following everyone else off the cliff of unregulated, employer-based, multi-payer health care, and by not opening the workers’ comp system to real alternatives, especially for surgery, then nothing will ever change.

We will continue to see more new initiatives and programs from CMS, and the results will be dismal, and the impact on workers’ comp will be felt eventually. That is, unless you open up your minds to new ways of thinking.

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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.