Tag Archives: ProPublica

Foreign Patients Get Liver Transplants in US Hospitals First

ProPublica, those lovely folks who published several articles some time back on workers’ comp, are at it again.

This time, they are focusing their ire on how foreign patients are getting liver transplants at some US hospitals ahead of Americans waiting for such transplants.

The story, published yesterday, was co-published with a local Fox station in New Orleans.

From 2013 to 2016, New York-Presbyterian Hospital gave 20 livers to foreign nationals who came to the US solely for a transplant, essentially exporting the organs and removing them from the pool of available livers to New Yorkers.

Dr. Herbert Pardes (I was familiar with his name from living in NY), wrote that, “Patients in equal need of a liver transplant should not have to wait and suffer differently because of the U.S. state where they reside.”

Dr, Pardes was the former chief executive, and is now the executive vice president of the board at New York-Presbyterian.

Yet, according to the story, Dr. Pardes left out NY-P’s contribution to the shortage, as stated above from 2013 to 2016.

These 20 livers represent 5.2 percent of the hospital’s liver transplants during that time, which was one of the highest ratios in the country.

ProPublica reported that unknown to the public, or to sick patients and their families, organs donated domestically are sometimes given to patients flying in from other countries, who often pay a premium. Some hospitals even seek them out.

A company from Saudi Arabia said it signed an agreement with Ochsner Medical Center in New Orleans in 2015.

The practice is legal, according to the story, and foreign nationals must wait their turn in the same way as domestic patients. The transplant centers justify this on medical and humanitarian grounds, but at a time when we have an Administration touting “America First”, this may run counter to the national mood.

The  director of the transplant institute at the Mount Sinai Hospital in New York, Dr. Sander Florman, said he struggles with “in essence, selling the organs we do have to foreign nationals with bushels of money.”

Between 2013 and 2016, 252 foreigners came to the US purely to receive livers at American hospitals. In 2016, the most recent year for which there is data, the majority of foreign recipients were from countries in the Middle East, including Saudi Arabia, Kuwait, Israel and the UAE. Another 100 foreigners staying in the US as non-residents also received livers.

At the same time, more than 14,000 people, nearly all Americans, are waiting for livers, a figure that has remained very high for decades, they report. By comparison, fewer than 8,000 liver transplants were performed last year in the US, an all-time high. National median wait time is more than 14 months, and in NY, the time is longer.

In 2016. more than 2.600 patients were removed from waiting lists nationally, either because they died or were too sick to receive a liver transplant.

All this is happening at a time when the party in power is seeking to take health care away from those who recently received care for the first time in a long time from the ACA, and at a time when the medical travel industry is focused not on transplant surgeries, but on boutique treatments and surgeries for wealthy or upper middle class Americans to go abroad for bariatric, plastic or reconstructive surgery, knee surgery, dental care, etc.

And yet, when the very idea of medical travel is broached in the medical community, it is disparaged and discouraged by physicians and others as unsafe, impractical, and not worth the effort, Obviously, it is well worth the effort on the part of foreign patients to come here and take organs meant for Americans, so why not allow Americans to take their organs?

Is it because the hospitals that supply these organs to foreign patients are making huge sums of money, and the poor schnook American with liver disease (or kidney disease, as in the case of yours truly) must die so that an American hospital can improve its bottom line?

It is high time to cut the crap and promote medical travel the right way and for the right reasons, not only for those who can afford it, but those who need transplants and can’t get them here.

That is the true nature of the globalization of healthcare…a two-way street.

 

Deaf, Dumb and Blind

It’s time once again for a rant. This rant is courtesy of my fellow blogger, Joe Paduda, who wrote an article today that criticizes members of the workers’ comp industry for not publicizing the positive things they do, but complain about all the negative press they have been getting.

As Joe writes, “Yep, it’s your fault that the popular press smacks you around, citing a few examples of alleged insurer screw-ups as proof that you’re all a bunch of cold-hearted, nasty, lazy incompetents motivated only by profit.

Joe was referring to reports from ProPublica, NPR, plaintiff lawyers, muckraking journalists and bloggers (including yours truly, as well as two women I have previously written about, and who are injured workers themselves), and calls for the industry to stop their bitching.

Most industry professionals may not realize that workers’ comp came into existence due to the writing of early twentieth century muckrakers as Upton Sinclair (The Jungle), Ida Tarbell, Lincoln Steffens, and many others.

He takes them to task for not publishing a case of the month, sending out a press release honoring an employee for going above-and-beyond in helping out an injured worker.

Joe says it is their fault because the reasons they don’t promote their good works are short-sighted, ignorant, and indefensible; in short, you are deaf, dumb and blind to reality.

From the day Edward Lloyd opened his coffee house in London in the 17th century, the insurance industry, and specifically, the workers’ comp industry has been dominated by Lloyd’s fellow countrymen and co-religionists.

The same holds true here in the US, but American pluralism (of a kind) has allowed some minorities to make it in the industry, but it is still mostly a white male, majority religion club (certain exceptions such as Saul Steinberg and Maurice Greenberg notwithstanding).

I know people in my family and in our extended social circle who have worked for insurance companies, and the highest level they have attained has been below that of the top executives. My first job in workers’ comp was with a company whose executives were not members of that club, but my boss was, and that was a reason some of us claims people were mistreated by him. Sheer resentment that he was not a member of the tribe and thus the board of directors. Let’s not pretend it does not exist. Why do you think some companies are called, “white shoe” companies?

Here is my take on this:

  1. You are resistant to change unless the change comes slowly, and from sources you trust and can control or dominate.
  2. As evidenced by Joe’s writing, you are unwilling to accept criticism from anyone who is not a member of the club or is from the lower ranks, or even someone who is on the outside looking in, as I am.
  3. You refuse to offer those with a passion for making workers’ comp better and opportunity to do so, and have laid off the best, brightest and hardest working people to save money on employee benefits, to cut payroll, costs, or because everyone else is laying people off, so why should you be any different. One of my LinkedIn connects writes a lot about millennials going into insurance, and many of you have complained online that you can’t find talented people. That’s because they are out looking for work.
  4. You refuse to accept any new idea, no matter who gives it, no matter what it is, and even have the nerve to criticize the idea and the person who promotes it. You continue to do the same things over and over again, and expect different results.
  5. You have elevated the laws, regulations, rules and statutes to the level of sacrosanctity, and that has frozen the industry in time, if not in place.
  6. Not one of my LinkedIn connections in the industry or in the insurance and risk management arena, who are hiring managers or executives have ever complimented me personally, save Joe, on my knowledge, my writing, or my passion for improving workers’ compensation. Crickets…
  7. You must dump the adversarial attitude pervasive among carriers, TPA’s, service providers, physicians, and employers. Not all injured workers are crooks. Treat them accordingly, and help those who really need help. Get emotional when you hear a sad story and work to fix it.
  8. STOP USING MEDICAL PROVIDERS WHO DELIBERATELY INJURE WORKERS, BOTH MEDICALLY AND EMOTIONALLY BY LYING TO THEM, DENYING THEM TREATMENT, OR JUST BEING GREEDY. Punish them by refusing to pay them or turning them into the legal authorities.
  9. Lastly, listen to the outsiders, even though they don’t have a job title, or are publishing anecdotal evidence of how bad some workers have been treated. Resist the snake-oil salesmen of opt-out like ARAWC and ALEC, whose agenda is both political and economic. They believe in an economy much like that when Edward Lloyd opened the coffee house. Ever wonder why Texas, and now Oklahoma are the only two states with opt-out? Because they are both states whose leaders in business and politics believe in laissez-faire, free market (free to the capitalist) capitalism. Don’t believe me? Here’s what Dwight Eisenhower said to his brother in a letter in 1954:

“Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history. There is a tiny splinter group, of course, that believes you can do these things. Among them are H. L. Hunt (you possibly know his background), a few other Texas oil millionaires, and an occasional politician or business man from other areas. Their number is negligible and they are stupid.”

The Koch Brothers are just like the Hunts were back then, so be careful about opt-out expansion. It is a ploy to abolish the progressive reforms the muckrakers helped to create.

That’s all I have to say. It’s up to you to change course and make things better, but know this, we are not your enemies. We want to help, and I want to help you now.  Don’t be deaf, dumb an blind to us.


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.

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Workers’ Comp Plans Can Be Dumped in TX and OK

To follow up on previous posts about the opt-out option in workers’ comp, a shout-out goes to JJ Schmidt, Senior Vice President at WellComp for bringing the following NPR report to my attention.

Here is the link to the NPR report and audio:

http://www.npr.org/2015/10/14/448544926/texas-oklahoma-permit-companies-to-dump-worker-compensation-plans

I have already said that opt-out is not all that its proponents say it is, but as we get more into the motivation behind the expansion of the option through various state legislatures, where the actual legislation is being written by an organization called ARAWC (A-Rock), it is not hard to see that workers’ comp is under serious threat from the right-wing, anti-union, anti-worker, Corporatists who are funnelling huge sums of money into this expansion.

This is something that was not brought up in last night’s Democratic debate, but should be on the minds of all those who want to protect the rights of workers.

Workers’ Comp at a Crossroads: Where Does it Go from Here?

Two roads diverged in a wood, and I— 
I took the one less traveled by, 
And that has made all the difference.

Robert Frost

Robert Frost’s poem, “The Road Less Traveled” is symbolic of where the workers’ comp industry stands today as it enters its second hundred years, as I intend to point out in this article, and especially in light of recent reports that indicate that the system is failing, and failing miserably to adapt to changes in the workforce, in technology, and to deal with an ever globalizing world.

You might say that workers’ comp is a Mac in an ever increasing Wintel world. In other words, workers’ comp has a closed architecture, whereas general health care has an open architecture, and like all modern electronic devices with an open architecture, it can change its parts and add new features with not that much difficulty.

But workers’ comp cannot, or will not open itself to other parts, and that is why it is failing.

To begin with, I wrote an article last week entitled, “Hospital Outpatient Costs Still Rising Says New Study”, in which I mentioned a study by the Workers’ Compensation Research Institute (WCRI). This report was one of the topics discussed this morning at their annual conference in Boston. The WCRI report stated that hospital outpatient costs are still rising, and that:

  • States with percent-of-charge-based fee regulations or no fee schedules had the highest payments to hospitals for outpatient surgical episodes for knee and shoulder surgeries. In particular, states with no hospital outpatient fee schedules had 60 to 141 percent higher hospital outpatient payments per episode compared with the typical state with fixed-amount fee schedules.
  • There was tremendous variation in the rates of change in hospital payments per surgical episode across states. From 2006 to 2013, South Carolina saw a reduction of 31 percent in this metric while in Alabama the average hospital payment per surgical episode grew by 81 percent. States with percent-of-charge-based fee regulations or no fee schedules had more rapid growth in hospital outpatient payments per episode than states with other regulatory approaches. In particular, most percent-of-charge-based fee regulation states that did not have updates to the reimbursable percentage of charges experienced growth in hospital payments per surgical episode that was 157–286 percent faster than the median of states with fixed-amount fee schedules.
  • States with cost-to-charge ratio fee regulations had similar levels and growth rates in hospital outpatient payments per episode to states with fixed-amount fee schedules. Hospital outpatient payments per episode in states with cost-to-charge ratio regulations grew 10–25 percent from 2006 to 2013.

The second half of that article discussed a report written by Peter Roumaniere, “Seismic Shifts: An Essential Guide for Practitioners and CEO’s in Workers’ Comp“. Peter’s report examined how technology and demographics will impact workers’ comp from the present day through 2022. One of the factors Peter identified was the shift from a manufacturing to service economy. By the 1960’s, the service sector began to eclipse manufacturing, and employment in services climbed from 55% to 85% of total employment.

He illustrated how jobs as a share of the national employment in three occupation groups from 1950 to 2005 declined. These occupations are: hand craft production; transport, construction, mining and farming; and machine operators and assemblers. He also said that manufacturing employment was much safer, and as an example, stated that in 1994, for every ten work injuries in manufacturing requiring one day’s lost time, there were eight such injuries in the service sector. In 2012, for every two manufacturing lost-time injuries, there were ten service sector injuries

Peter provides four most likely reason for the decline in injuries and claims in workers’ comp:

  1. Workers may be reporting and claiming less out of intimidation or unhappiness with the benefit package which has shrunk in past decades.
  2. Employment sector shifts
  3. Employers are devoting more attention to work safety
  4. Employers are pushing down lost-time claims by stay-at-work arrangements, or expediting return-to work.

The report goes on to discuss how the workers’ comp industry is shrinking and the opportunities for growth that practitioners need to be aware of, but that are out of the scope of this discussion.

Next, a post earlier this week by David De Paolo prompted me to write another article, this one entitled, “STOP THE MADNESS”, in which I decried the disgusting way that employers, their insurance companies and third party administrators are treating injured workers, in this case, a man named Glenn Johnson, who along with his wife, was arrested for allegedly filing a fraudulent workers’ comp claim, but the charges were dropped and the case never went to trial.

Mr. Johnson is not the only aggrieved injured worker in this country. There are many thousands of men and women who are treated inhumanely and unfairly by employers, insurers, and the rest of the workers’ comp system.

As a follow-up to his first post, David wrote a second post the next day in which he suggested, and rightly so, that if employers could be allowed to opt-out of the workers’ comp system, so should employees such as Glenn Johnson and his wife, so they can get the satisfaction of justice they deserve. I heartily agree, and said so in my post, ”Let Our (Working) People Go”.

Then came another report, this time by the Association of American Medical Colleges, in an article by Healthcare Finance News.com, that said that by 2025, there would be a shortage of doctors around 90,000, of which 12,500 to 31,000 would be primary care physicians, and between 28,000 to 63,700 would be non-primary care physicians.

But the really devastating reports, at least as far as workers’ comp is concerned, that came out this week and on the same day, was one report by ProPublica called “The Demolition of Workers’ Compensation” and another by the Occupational Health and Safety Administration (OSHA) called “Adding Inequality to Injury: THE COSTS OF FAILING TO PROTECT WORKERS ON THE JOB”.

Both David and Joe Paduda commented about these reports in their respective blogs today. David’s article is called “Cost of Being Society” and in it he said that both reports came to the same conclusion: workers’ comp… fails in its basic state mission too often, and consequently is pushing the cost of taking care of injured workers onto government benefit systems, ergo costing the general tax paying public to take up the slack.

He cites the OSHA report as saying: “Changes in state based workers’ compensation insurance programs have made it increasingly difficult for injured workers to receive full benefits (including adequate wage replacement payments and coverage for medical expenses) to which they are entitled. Employers now provide only a small percentage (about 20%) of the overall financial cost of workplace injuries and illnesses through workers’ compensation. This cost-shift has forced injured workers, their families and taxpayers to subsidize the vast majority of lost income and medical care costs generated by these conditions.”

It is David’s opinion that these reports are evidence that not only have the times changed, but that more change is necessary, and on a grander scale. Joe’s article is called “ProPublica’s demolition of workers’ comp”, and offers a critique of the report.

David De Paolo’s posts this week, and the two reports about the demolition of workers’ comp and the cost of failing to protect workers, are not mere coincidences of publication. They are a warning sign that something terrible is happening in this country.

As I mentioned in a comment in response to the ProPublica report, we are witnessing the recrudescence of 19th century capitalism, where if a worker got hurt, he lost his job, had to rely on charity from friends, neighbors, family, the church, while the owner of the business went right on making a profit. Too many Americans have been duped by slick politicians and ideologues to believe that workers have no rights, so why should they get benefits when they get hurt through no fault of their own.

So that brings us back to Robert Frost and the poem, “The Road Less Traveled”.

For that is exactly where workers’ comp, and coincidently, my writing about workers’ comp and medical tourism are, on a road less traveled. In the case of workers’ comp, it is at a crossroads as to which road to take, and I have already decided, as Frost points out, to travel the road less traveled, because I wanted to blaze a trail where no one else had been.

Workers’ comp, on the other hand, wants to go down the same old road it have been going down now for nearly a century, and expecting that the woods would be different. So while much of the industry is bundled up in snowy, cold Boston, trudging down that same old road, I am choosing another path, and that has made all the difference, because my mind is open to new possibilities, while theirs is closed, xenophobic, and rife with American Exceptionalism.

I am sure they are learning a lot about the state of workers comp while they are talking among themselves and fiddling while Rome burns, but if they were smart, they would admit that the road more traveled on is fraught with serious problems that only gets more and more serious each and every day.

All is not lost, however. There is still time for them to see a better way, to choose the road less traveled on, and one way to do that is to open the system’s architecture and let in new ideas and new possibilities, especially with medical travel.

In the nearly two and a half years that I have been writing this blog, and in the four years since I first wrote my paper on implementing medical tourism into workers’ comp, I have met dozens of men and women, highly educated and highly intelligent from all over the world, Europe, Africa, Asia, the Caribbean, Central America, South America and other parts of North America, and none of those outside of Europe or the Americas are witch doctors with bones in their noses. These people are ready, willing and able to provide high quality health care to anyone who needs it, and at a reasonable cost. They want our business, and are not concerned about whether it comes from general health care or workers’ comp.

And yet, the very idea of globalizing workers’ compensation is dismissed, is ridiculed, and shunted to the sideline. Well, I am not about to be shunted to the sideline or dismissed, or told to stop writing, as one Okie said earlier this week. I am going to keep on writing and advocating for change, not because I want to, but because I have to. The stakes for all workers, injured or not, is too great. Globalization is a two-way street. Jobs can go abroad, and so should the workers, injured or not.

It’s up to you…take the road less traveled on, or take the road that isn’t less traveled. And that makes all the difference.

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I am willing to work with any broker, carrier, or employer who is looking to save money, 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. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with and follow me on LinkedIn and my blog. Share this article, or leave a comment below.