Tag Archives: Physician Shortage

Travel Ban to Affect Physician Shortage: What Medical Travel Can Do

The following post, from fellow blogger, Joe Paduda, who has a guest post from former WCRI CEO, Dr. Rick Victor, states that the current political regime in Washington’s ban on travel from certain countries and ban on allowing a certain religious minority into the country will further exacerbate the already projected physician shortage that this writer had previously discussed in earlier posts on the subject.

Here is the link to Joe’s and Dr. Victor’s posts.

If there ever was a good enough reason for the implementation of medical travel into general health care, and into workers’ comp medical care, this is it.

Do you really want to see injured workers go without treatment or without needed surgeries because there aren’t enough US-born physicians and surgeons, because some narcissistic, egomaniacal, billionaire con artist has banned needed foreign-born physicians from entering the country?

Who knows? Maybe one of these doctors has a revolutionary new treatment or therapy that can bring relief to millions of Americans, or can cure a terrible disease?

Banning them only makes America weaker, not Great Again.

P.S. Here is a follow-up post from Peter Rousmaniere’s Working Immigrants blog.

 

Average Medical Costs in Work Comp Leveling Off

Once again it is time to look at the average medical costs for lost-time claims in workers’ comp. as reported last week in the NCCI State of the Line Report at the 2016 Annual Issues Symposium.

Those of you who have read my White Paper, or have followed this blog for sometime, know that this is an annual meeting of industry people in Florida to look at what is happening in workers’ comp.

It is not a conspiracy meeting of insiders looking to harm injured workers, as one deranged individual has suggested. [Emphasis added]

But rather, it is one way in which insurance personnel can understand where the workers’ compensation insurance market is headed. And the word this year, from Joe Paduda’s reporting last week is “Transitioning”.

Workers’ comp is transitioning and what it is transitioning into has been discussed previously by both Joe and Peter Rousmaniere, and that I have described in earlier posts.

One aspect of this transitioning has to do with automation and the development of artificial intelligence that will make many current jobs obsolete [remember that Twilight Zone episode with Burgess Meredith and Fritz Weaver where the State declared them both ‘obsolote’?]

Another part of this transitioning relates to the so-called ‘gig economy’ of companies like Uber and Lyft, Airbnb, etc., as well as the move of some jobs to part-time from full-time status, whatever the reason given.

But let’s move on to the issue at hand, which is, what is the average medical cost for lost-time claims this year. As you will see in the first chart, the average medical cost for lost-time claim dropped 1% from 2014, where there had been an increase from 2013 of 3%.

Chart 1.

Avg Med Cost 2016

Unlike past charts, this year’s chart shows that there are two years of preliminary data, 2014 and 2014. Compare that to last year’s chart, found here, as well as the two previous years, 2014 and 2015.

In 2014, the average medical cost per lost-time claim was $28,800; in 2015, the average medical cost dropped a mere $300 to $28,500, not very significant, but perhaps signalling a leveling off. You will notice in my previous articles and in my White Paper that I included a trendline that always showed the cost increasing, but it is apparent by looking at this year’s chart that there seems to be a flattening occurring.

According to Kathy Antonello’s report, the two key takeaways are:

  •  Medical severity change has moderated in recent years
  • The 2015 average medical cost is 1% lower than the 2014 value

Another factor to consider is how much of the total claim cost does medical payments per claim represent. As shown in the second chart, medical costs have remained at 58% of total claim cost, with indemnity (lost wages) representing the rest.

Chart 2.

Ind Med Split

As you can see, medical costs have risen significantly since 1981. Another way to view the change in average medical cost and its apparent leveling off can be seen in the third chart.

Chart 3.

WC Ave Med Cost

Chart 3 indicates that the cumulative change in excess of medical care inflation from 1995 to 2015 has joined the cumulative change in average medical cost from 1995 to 2015p in leveling off.

What this means, according to Ms. Antonello, is that workers’ comp medical costs per claim have risen at a much faster pace than indemnity over the past thirty years, medical inflation has outpaced wage growth, medical lost-time severity has increased 214% since 1995, and the corresponding increase in medical lost-time severity over and above the increase in medical price inflation is 55%.

What this also indicates is that workers’ comp is changing, and many predict that in a few years, workers’ comp as we have known it will disappear. Then perhaps treating injuries to certain body parts as knees, backs, shoulders, etc., common to both workers’ comp and general health care won’t be separated into different silos, but rather paid for as one medical expense under an employer’s health plan or even a single payer plan.

Either way, medical travel, given the predicted shortages of physicians and nurses, may present itself as a viable alternative, and not be subjected to antiquated laws and statutes that restrict an injured worker from getting medical care wherever they want to. And if predictions about artificial intelligence and automation are correct, then it won’t really matter, since very few individuals will be hurt on the job in the future.

There is an old Chinese curse: “May you live in interesting times.”


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.

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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)

 

Influx of Newly Insured Not Impacting Primary-Care Physicians

Readers of this blog will recognize the following three previous posts, “Will Medical Tourism Relieve the Doctor Shortage Due to Obamacare?” from 2013, “Affordable Care Act to Lead to Physician Shortages ― What it Could Mean for Medical Tourism in Work Comp” from 2014, and “New Report on Doctor Shortage: What it could mean for Workers’ Comp and Medical Tourism” earlier this year, in which I discussed the potential impact of the Affordable Care Act (ACA), more commonly referred to as “Obamacare” on the predicted shortage of primary-care physicians.

Today, Drew Altman, president and CEO of the Kaiser Family Foundation, and David Blumenthal, president of the Commonwealth Fund, wrote an article in the Wall Street Journal titled, “ How Primary-Care Physicians Are Handling the Influx of Newly Insured.

According to Altman and Blumenthal, most physicians in primary-care said that their ability to provide high-quality care had not changed since January 2014.

Altman and Blumenthal included a graph showing the percentages of physicians who were polled by Kaiser and the Commonwealth fund on their ability to provide high-quality care.

BN-KJ094_ACApri_G_20150917182430

The survey found that, so far, the fears of problems have largely not come to pass. However, physicians did report increased demand for services under the ACA; four in ten (44%) said that the total number of patients they see had increased since January 2041.

Six in ten, or (59%), reported an increase in the number of patients who were newly insured or covered by Medicaid, but this was not swamping their practice.

The chart shows that 59% said their ability to provide care had stayed the same, 20% said that it had improved and gotten worse.

Altman and Blumenthal concluded their article by saying that not yet two years into the coverage expansion of the ACA, it is still too early to know what effect will be, long-term, on the demand for services.

It could also be, they said, that the net increase of 16 million newly insured is less of a burden than expected; however, they concluded by saying that primary-care providers have been able to keep up demand without any negative impact.

Whether this remains so, is yet to be determined, but so far, it appears that there is no nationwide crisis.

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.

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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.

Failure to Expand Medicaid Could Lead to Cost-Shift to Work Comp

Joe Paduda wrote this morning on his blog about the failure to expand Medicaid in several states, and its impact on workers’ comp.

This is not the first time Joe has written about the reluctance of politicians in states like my current state of Florida, Texas, Virginia, Wisconsin and others.

As Joe rightly has pointed out in each of his articles, the government is paying for all of the additional cost for another two plus years, and the vast majority of the cost thereafter; and the savings to the states for uncompensated care will be anywhere from $4 to $9 billion.

Health care providers in non-expansion states are in dire straits due in large part to the “non-expansion”, according to Joe.

With regard to my current state of Florida, our walking male appendage of a governor (who stole millions when CEO of HCA), is not only suing the federal government for money, but just returned from Washington empty-handed.

According to an article in today’s Palm Beach Post, Gov. Rick (rhymes with D***) Scott, traveled Wednesday to Washington to meet with U.S. Health and Human Services Secretary Sylvia Burwell, who he sued last week.

Scott alleges that the Obama administration is attempting to coerce Florida into expanding Medicaid or face losing $1.5 billion in funding for hospitals and other health providers treating uninsured patients. The governor is demanding that Florida continue collecting that money without expanding Medicaid.

Typical Rick Scott.

After the meeting, HHS reiterated its view that these so-called low income pool dollars are an “optional, time-limited demonstration program” that won’t be continued in its current form. And the agency also made the case for Medicaid expansion as a way for hospitals to cover the cost of uncompensated care.

As reported in the Post, Scott exited the meeting Wednesday saying that the state is in a “time crunch” and needs a quick answer from HHS, with the state budget in limbo.

As far as Joe sees it, there are a host of problems with the position Scott and other GOP governors are taking. These problems are due to two things, Joe says.

In the short term, the cost pressure placed on facilities and health systems and the fallout therefrom to will lead to increased pressure to cost shift to work comp.

Long term, the 6.4 million adults who remain uninsured will be less healthy, will have more incentive to get care under workers’ comp, and will heal more slowly with more complications if they do get injured on the job, according to Joe.

It is Joe’s contention, however, that the states will expand Medicaid, because the financial pressure will force them to.

So what does this mean for worker’ comp and medical travel?

It will mean that there will need to be an alternative to the current system of providing medical care to injured workers in the event that these states never expand Medicaid, or at some future date after doing so, and the citizens of those states balk at the expense of paying for health care for poor people.

My last post dealt with lowering litigation costs and experience modification factors, which is used to determine the premiums employers are charged for workers’ compensation policies.

If you consider the cost-shifting to work comp that Joe mentions, and the shortage of physicians predicted to impact all of health care, and many other challenges and problems workers’ comp will face in the coming years, then it is imperative that workers’ comp look for a way to alleviate the pressure that cost-shifting, physician shortages and other challenges Joe, David De Paolo, myself, and others have been writing about.

The conversations I had earlier this week gave me the confidence to say that such an alternative already exists and will become a reality all across the US. It is only a matter of time.

The choice is yours. Do nothing and reap the consequences, or do something about it now, before the you-know-what hits the fan.

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

Hospital Closures Due to Failure to Expand Medicaid

As a follow-up to my last post, Nothing is Impossible, a small item in Joe Paduda’s Managed Care Matters blog post this morning caught my eye.

It is important to note what Joe is saying, because those individuals I mentioned in my previous post who mock my idea, do not realize this one fact that Joe so rightly points out and may be the way medical travel for work comp can be accomplished.

Joe posed the question on his blog “What is happening in Health Care?” , and cites an article in Fierce Health Finance.com about hospitals struggling in Kansas, Louisiana and Kentucky.

According to Joe, the ACA reduced Medicare and other funding for hospitals, on the anticipation that it would be replaced by increased Medicaid and private health insurance coverage, as well as a concomitant reduction in indigent care.

However, Joe goes on to say, when Kansas, and many other states rejected the expansion of Medicaid, the hospitals were left hanging. In Kansas alone, the drop in hospital revenue is almost a half-billion dollars.

In another article that Joe cites, the latest data suggests that 283 mostly-rural hospitals are in financial trouble; and that since 2010, 48 have closed.

He does not attribute this solely to a failure to expand Medicaid, but believes it certainly plays a major role.

This may have the potential to cost shift  to private insureds and workers’ comp in non-Medicaid expansions states, Joe adds, which brings me to my point about medical travel and workers’ comp.

If the articles from Fierce Health Finance.com and Kaiser Health News are correct, then it would seem that injured workers needing surgeries for orthopedic injuries such as knees, hips, shoulders and back, as well as for repetitive injuries such as carpal tunnel will be unable to find qualified, open hospitals to perform those surgeries.

And coupled with the projected physician shortage, which is more acute in rural areas than in urban areas, and the increase number of people covered by the ACA, and seeking medical, alternatives such as medical travel will not only be practical, but an absolute necessity to provide quality care to those under-served regions of the country.

This is where medical travel would be of tremendous value to workers who live in those areas, as was the case with the employees of HSM, the company mentioned in the ABC News report I cited in my post, US Companies Look to ‘Medical Tourism’ to Cut Costs as well as in the Business Insurance article by Joanne Wojcik, back in December 2013.

So before anyone says it is too complicated and impossible, think about what I said in my last post and consider what I’ve said here. Nothing is impossible. It only seems that way because the wax in their ears has migrated to their brains.

And an additional shout out to Joe, here in South Florida, the weather is fine…today a balmy 80 degrees and partly sunny.

For those of you who are celebrating a holiday this weekend, A zisn Pesach and a Happy Easter.

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I am willing to work with any broker, carrier, or employer who is sick and tired of being bled by the Wall Street vulture capitalists and the entire medico-legal system known as workers’ comp, to save money, and to provide the best care for their injured workers or their client’s employees, while at the same time, helping to break the monopoly of the American health care cartel.

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.