Category Archives: Workers’ Comp

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.

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Medical Travel/Health Care Thought Leader Seeks Opportunities

 

Medical Travel/HealthCare Thought Leader and Blogger, seeks opportunities to speak, write, and collaborate on projects to bring about greater participation of patients to global medical travel facilities.

NOTE: I am not a physician, nor do I have patients or clients to refer to you. I am seeking persons already engaged in medical travel who want to expand into a new market. I offer my services in an administrative or managerial capacity.

Experience:

Over five and a half years experience creating, maintaining, and analyzing current issues in Medical Travel, Health Care, and other topics.

Over six years research into the Medical Travel industry.

Promoted the implementation of medical travel into Workers’ Compensation insurance industry.

Analyzed the cost of healthcare and the options of alternative treatments abroad.

Presented White Paper to Medical Travel conference in Mexico in Nov. 2014.

Extensive experience in Insurance and Claims Management, especially in medical-related claims (Workers’ Compensation).

Strong administrative and financial skills.

Education:

Master’s in Health Administration, 2011

Interested in working remotely, willing to travel, willing to write and speak at conferences, has valid US passport.

Resume can be found here.

Blog: richardkrasner.wordpress.com

Phone number: +1 561-603-1685 (mobile)

 

Growing General Surgeon Shortage

On the heels of my recent post, Free Medical School Tuition Could Solve Physician Shortage, comes a new article about the shortage of general surgeons.

Friday, Reuters Health reported about a new study in the US that projected that the shortage of general surgeons in the US will get worse as the number of doctors entering the workforce fails to keep pace with population growth.

The study’s researchers predicted shortages based on their estimates of population growth by 2050, and by the number of medical schools and hospital-sponsored general surgery trainee positions.

  • By 2050, there will be a deficit of 7,047 general surgeons nationwide
  • That is higher than the shortage of 6,000 they predicted a decade ago based on the pace of population growth and new surgeons entering the job market at that time.

The lead study author, Dr. E. Christopher Ellison of Ohio State University, was quoted as saying, “Leaders in surgery have predicted a pending shortage in the general surgery workforce for more than 10 years.”

Dr. Ellison also said that, “the impact of the general surgeon shortages on patients is measured in the timeliness of care and the consequences of delays in care.”

The study was published in the journal Surgery, and the researchers noted that there should be about 7.5 general surgeons for every 100,000 people, to maintain acceptable access to surgical care.

According to the study, the number of general surgery resident positions and the number of residents completing their training has been rising in the US, but these increases have been insufficient to maintain the ideal number of surgeons for the population.

The authors stated, that if anything, the projected shortage is an underestimate.

Dr. Ellison: “We have not considered the impact of the aging population on the surgeon’s workload…Patients 65 years and older are more likely to need general surgery services, and as that segment of the population increases, there will be a corresponding increase in the demands for general surgeons.”

Ellison also added, that because most general surgeons practice in metropolitan areas, the impact of the shortage will be more keenly felt by rural communities.

The researchers assumed, in calculating the projected shortage, that some young trainees would choose subspecialties like vascular or transplant surgery, instead of general surgery. They assumed, also, that general surgeons would work for 30 years before retiring.

Two possibilities can be reached from the findings of the study: one, it is possible that the researchers have over- or under-estimated how many general surgeons will enter the profession each year and how many years they will remain on the job; and two, it is also possible that population growth estimates might change again, altering the shortage projections.

Dr. Anupam Jena, a Harvard Medical School researcher and a physician at Massachusetts General Hospital said the following: “Because there are fixed high costs to developing a general surgical practice in a more remotely populated area, we observe fewer practices in these areas. I wouldn’t call this a shortage per se, but I do think it’s a problem that as a society we need to figure out solutions to.”

Dr. Jena was not part of the study. Two solutions offered by Dr. Jena, however, were identifying ways for rural patients who need surgical care to be promptly evaluated and treated at medical centers several hours away, or it might involve encouraging graduates of both American and foreign medical training programs to work in remote parts of the country.

I’ve discussed the projected shortage of physicians in the past, but this is the first time, a specific specialty of physicians has been studied for a projected shortage specifically. And as in the past, I have suggested that medical travel could alleviate the shortage, especially in workers’ compensation.

Either we follow the suggestions of Dr. Jena and others, or we consider looking abroad for the solution to a growing problem — a shortage of general surgeons.

 

Major Surgery Wait Times for Workers’ Comp: Can Medical Travel Assist?

Last week, the Workers’ Compensation Research Institute (WCRI) released their FlashReport — Time from Injury to Medical Treatment: How States Compare, and I requested a copy.

While the report is rather lengthy, covering slightly more than fifty pages, I decided to focus on one aspect of the report that related to the length of time from injury to medical treatment with major surgery.

The report examined the time from injury to treatment in 18 states, and each of the services studied were ranked by median number of days from injury to medical service for each service. The report looked at claims from 2015/2016 with more than seven days lost time.

I wanted to make the medical travel industry aware that major surgery under workers’ compensation was not something that happened immediately after an on-the-job injury, and to alert the industry to figure out how they can improve the wait times for such surgeries.

Here is the summary of key findings from the report:

  • Considerable variation across states in the time from injury to first treatment for physical medicine and “specialty” services such as major radiology and pain management injections across injury types.
  • Patterns in time to first medical treatment were fairly consistent for some states; that is, some states tended to show shorter or longer time to first treatment across injuries and services.
  • Little variation in time to first medical treatment for “entry” services (such as emergency, office visits, and minor radiology) for most injury types.
  • Initial medical treatment was slightly faster for objective injuries (like fractures) than for subjective injuries (like sprains and strains).
  • Timing of medical services varies by type of injury, likely a reflection of different treatment patterns.

Based on the analytical approach WCRI used for other services, they identified Indiana, New Jersey, Pennsylvania, Virginia, and Wisconsin as having a shorter median number of days to the first major surgery.

California, Georgia, Iowa, North Carolina, and Texas had the longest median number of days to first major surgery and was based on the number of days average in rank order. Arkansas and Louisiana were excluded due to small cell size.

Major surgery was ranked third by type of non-entry service by maximum number of days from injury to first medical service: 118 days. Major surgery was ranked sixth by percentage of claims receiving medical services by maximum number of days at: 36.5%. Indiana had that distinction.

Major surgery was defined by WCRI as including invasive surgical procedures, as opposed to surgical treatments and pain management injections. The most frequent surgeries in this service group include, but are not limited to, arthroscopic surgeries of the shoulder or knee, laminectomies, laminotomies, discectomies, carpel tunnel surgeries, neuroplasty, and hernia repair.

Five types of injuries had the maximum medium number of days from injury to first major surgery: Neurologic spine pain, Inflammations, Upper extremity neurologic, Other sprains and strains, and Knee derangements.

The table below illustrates the maximum for each injury with the corresponding minimum, in order of maximum number of days.

Type of Injury

Maximum

Minimum

State

Neurologic spine pain

187

105

CA

Inflammations

173

96

CA

Upper extremity neurologic

169

85

CA

Other sprains and strains

140

69

CA

Knee derangements

133

52

CA

What does this mean?

This report is by no means conclusive as it relates to length of time for major surgery in the other states that were not analyzed. Yet, it is instructive to both the workers’ comp industry and the medical travel industry that given predicted shortages of both physicians and nurses, it would be prudent to explore other avenues so that the maximum wait times can be lowered, which would enable the injured employee to return to work faster.

Not doing so will be more expensive in the long run and will be detrimental to the well-being of the patient.

To purchase a copy of the report, click here.

Ten Most Reported Worker’s Compensation Injuries – Machine Safety Blog

Back in March of 2015, I wrote about the top 10 causes of workplace injuries. I posited the idea that medical tourism (medical travel) could save employers money so that the workers’ comp industry would take medical travel seriously as an option for injured workers. The same holds true for the medical travel industry, as they seem to be AWOL when it comes to workers’ health.

Here is an updated report on the Machine Safety Blog from Rockford Systems, LLC:

Last year in America 2.9 million employees (U.S Bureau of Labor Statistics) suffered a workplace injury from which they never recover, at a cost to business of nearly $60 billion (Liberty Mutual Insurance). These statistics are staggering. To help gain a better perspective on the realities of workplace danger, we have compiled a list of […]

Source: Ten Most Reported Worker’s Compensation Injuries – Machine Safety Blog

Cayman Islands Hospital Delivers Lower Cost Care

This morning’s post by fellow blogger, Joe Paduda, contained a small paragraph that linked to an article in the Harvard Business Review (HBR) about a hospital in the Cayman Islands that is delivering excellent care at a fraction of the cost.

Joe’s blog generally focuses on health care and workers’ comp issues, and has never crossed over into my territory. Not that I mind that.

In fact, this post is a shoutout to Joe for understanding what many in health care and workers’ comp have failed to realize — the US health care system, which includes workers’ comp medical care, has failed and failed miserably to keep costs down and to provide excellent care at lower cost.

That the medical-industrial complex and their political lackeys refuse to see this is a crime against the rights of Americans to get the best care possible at the lowest cost.

As I have pointed out in previous posts, the average medical cost for lost-time claims in workers’ comp has been rising for more than twenty years, even if from year to year there has been a modest decrease, the trend line has always been on the upward slope, as seen in this chart from this year’s NCCI State of the Line Report.

The authors of the HBR article asked this question: What if you could provide excellent care at ultra-low prices at a location close to the US?

Narayana Health (NH) did exactly that in 2014 when they opened a hospital in the Cayman Islands — Health City Cayman Islands (HCCI). It was close to the US, but outside its regulatory ambit.

The founder of Narayana Health, Dr. Devi Shetty, wanted to disrupt the US health care system with this venture, and established a partnership with the largest American not-for-profit hospital network, Ascension.

According to Dr. Shetty, “For the world to change, American has to change…So it is important that American policy makers and American think-tanks can look at a model that costs a fraction of what they pay and see that it has similarly good outcomes.”

Narayana Health imported innovative practices they honed in India to offer first-rate care for 25-40% of US prices. Prices in India, the authors state, were 2-5% of US prices, but are still 60-75% cheaper than US prices, and at those prices can be extremely profitable as patient volume picked up.

In 2017, HCCI had seen about 30,000 outpatients and over 3,500 inpatients. They performed almost 2,000 procedures, including 759 cath-lab procedures.

HCCI’s outcomes were excellent with a mortality rate of zero — true value-based care. [Emphasis mine]

HCCI is accredited by the JCI, Joint Commission International.

Patient testimonials were glowing, especially from a vascular surgeon from Massachusetts vacationing in the Caymans who underwent open-heart surgery at HCCI following a heart attack. “I see plenty of patients post cardiac surgery. My care and recovery (at HCCI) is as good or better than what I have seen. The model here is what the US health-care system is striving to get to.

A ringing endorsement from a practicing US physician about a medical travel facility and the level of care they provide.

HCCI achieved these ultra-low prices by adopting many of the frugal practices from India:

  • Hospital was built at a cost of $700,00 per bed, versus $2 million per bed in the US. Building has large windows to take advantage of natural light, cutting down on air-conditioning costs. Has open-bay intensive care unit to optimize physical space and required fewer nurses on duty.
  • NH leverage relations with its suppliers in India to get similar discounts at HCCI. All FDA approved medicines were purchased at one-tenth the cost for the same medicines in the US. They bought equipment for one-third or half as much it would cost in the US.
  • They outsourced back-office operations to low-cost but high skilled employees in India.
  • High-performing physicians were transferred from India to HCCI. They were full-time employees on fixed salary with no perverse incentives to perform unnecessary tests or procedures. Physicians at HCCI received about 70% of US salary levels.
  • HCCI saved on costs through intelligent make-versus-buy decisions. Ex., making their own medical oxygen rather than importing it from the US. HCCI saved 40% on energy by building its own 1.2 megawatt solar farm.

And here is the key takeaway:

The HCCI model is potentially very disruptive to US health care. Even with zero copays and deductibles and free travel for the patient and a chaperone for 1-2 weeks, insurers would save a lot of money. [Emphasis mine]

US insurers have watched HCCI with interest, but so far has not offered it as an option to their patients. A team of US doctors came away with this warning: “The Cayman Health City might be one of the disruptors that finally pushes the overly expensive US system to innovate.”

The authors conclude by stating that US health care providers can afford to ignore experiments like HCCI at their own peril.

The attitude towards medical travel among Americans can be summed up by the following from Robert Pearl, CEO of Permanante Medical Group and a clinical professor of surgery at Stanford: “Ask most Americans about obtaining their health care outside the United States, and they respond with disdain and negativity. In their mind, the quality and medical expertise available elsewhere is second-rate, Of course, that’s exactly what Yellow Cab thought about Uber. Kodak thought about digital photography, General Motors thought about Toyota, and Borders thought about Amazon.”

Until this attitude changes, and Americans drop their jingoistic American Exceptionalism, they will continue to pay higher costs for less excellent care in US hospitals. More facilities like HCCI in places like Mexico, Costa Rica, the Caymans, and elsewhere in the region need to step up like HCCI and Narayana Health have. Then the medical-industrial complex will have to change.

Hospital Outpatient Payments Rising — Again

The Workers’ Compensation Research Institute (WCRI) released a study today that indicated that hospital outpatient payments were higher and growing faster in states with percent-of-charge-based fee regulations or no fee schedules.

This study is an annual study that compares hospital payments for a group of common outpatient surgeries in workers’ compensation across 35 states from 2005 to 2016.

According to WCRI’s executive vice president and counsel, Ramona Tanabe, “Rising hospital costs continue to be a focus for public policymakers and system stakeholders in many states.”

The study found that states with percent-of-charge-based fee regulations had substantially higher hospital outpatient payments per surgical episode than states with fixed-amount fee schedules.

Percent-of-charge-based states were 30 — 196% higher than median of the states with fixed-amount fee schedules in 2016.

States without fee schedules also had higher payments per episode; 38 — 143% higher than the median of fixed-amount states in 2016.

Lastly, WCRI found that hospital payments per episode in most states with percent-of charge-based fee regulations or no fee schedules, grew faster than states with fixed-amount fee schedules.

The study also compared payments for workers’ comp with Medicare rates for the most common group of surgical procedures across states. The following chart highlights the variation in the difference between average workers’ comp payments and Medicare rates. The variation was as low as 38%, or $2,012 below Medicare in Nevada, and as high as 502%, or $21,692 above Medicare in Alabama.

Source: WCRI

So, what does this mean?

It means that hospital outpatient payments for the most common group of surgical procedures in Workers’ Comp are not decreasing, and are likely adding to the slow, but steady rise in the overall total average medical cost for lost-time claims, a development I have followed for some time now with the release of NCCI’s State of the Line Reports.

This is not the first time I have discussed this topic, and probably won’t be the last, as I keep reminding you that surgical costs for most common workers’ comp surgeries are a fraction of the cost here in the US in countries that provide medical travel services.

If this study is right, wouldn’t you rather pay for a surgical procedure in Costa Rica, for example, that costs $12—$13,000, than paying $21,692 in Alabama? Eighteen out of thirty-five states listed on the above chart have higher payments than the median of 100. This represents 51.4% of all the states examined in the study. Just more than half.

And this idea of medical travel is stupid, ridiculous, and a non-starter? Ok, keep shelling out more money for hospital outpatient procedures. After all, it ain’t your money, is it?

To download this study, visit WCRI’s website at https://www.wcrinet.org/reports/hospital-outpatient-payment-index-interstate-variations-and-policy-analysis-7th-edition.