MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'comp'. Sat, 03 Sep 2011 02:26:05 +0100 http://www.medworm.com/index.php?rid=5159428&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002151.html Three speakers in the final IAIABC session focused on the future of workers comp and factors affecting same. Allen Hunt of the University of Wisconsin started out discussing the factors contributing to the current deficit. In a nutshell, he doesn't... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5159428 Wed, 24 Aug 2011 23:00:00 +0100 5159428 http://www.medworm.com/index.php?rid=5159427&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002152.html The last two speakers at IAIABC were Safety National's Mark Walls and IAIABC Executive Director Greg Krohm. Mark's major concern is health reform will lead to access problems, especially with specialists such as orthopods and neurosurgeons. This may lead to... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5159427 Wed, 24 Aug 2011 23:00:00 +0100 5159427 http://www.medworm.com/index.php?rid=5159430&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002148.html OK, vacation's over, and mail box is (almost) cleaned out. So here's what's happening this week. The annual IAIABC conference is underway in Madison Wisconsin. The International Association of Industrial Accident Boards and Commissions is the trade group for the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5159430 Mon, 22 Aug 2011 23:00:00 +0100 5159430 http://www.medworm.com/index.php?rid=5118802&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002145.html I've been working on a project for a client that involves, among lots of other things, determining the volume of new and legacy claims in each state. Its been rather eye-opening. For example, Ohio - which has pretty good reporting,... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5118802 Tue, 09 Aug 2011 23:00:00 +0100 5118802 http://www.medworm.com/index.php?rid=5086352&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002140.html The healthplan company's Q2 earnings were released last week. If you were looking for any insights into their comp business, the Coventry release wasn't the place to look; there was no mention of workers comp results - this despite the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5086352 Sun, 31 Jul 2011 23:00:00 +0100 5086352 http://www.medworm.com/index.php?rid=5077865&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002139.html WCRI's just published another in their excellent series of reports benchmarking workers comp costs and outcomes in key states. This latest, entitled "PRESCRIPTION BENCHMARKS, 2ND EDITION: TRENDS AND INTERSTATE COMPARISONS", provides additional insight into the difference in cost between drugs... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5077865 Thu, 28 Jul 2011 23:00:00 +0100 5077865 http://www.medworm.com/index.php?rid=5069644&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002130.html One big reason - physician dispensing of repackaged drugs. Two stories, seemingly unrelated, appeared in the last week or so that, when read together, clearly lay out the problem. One described the costs borne by Florida's employers, costs much higher... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5069644 Mon, 25 Jul 2011 23:00:00 +0100 5069644 http://www.medworm.com/index.php?rid=5050904&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002134.html On the list of successful uses of social media in workers comp, one has to put Mark Walls' LinkedIN Work Comp Analysis Group at the very top. Mark's group just passed 10,000 members. Yes, that's ten thousand members - a... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5050904 Tue, 19 Jul 2011 23:00:00 +0100 5050904 http://www.medworm.com/index.php?rid=5050905&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002135.html Work comp PT network company AligNetworks has been sold to private equity investor General Atlantic. While terms weren't disclosed, sources indicate the company went for a premium well above the 'usual' 6-7 multiple of EBITDA. Butch Hofstetter and his team... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5050905 Sun, 17 Jul 2011 23:00:00 +0100 5050905 http://www.medworm.com/index.php?rid=5028697&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002128.html From our friends on the west coast comes a story that demands much more discussion - the California State Fund's (SCIF) decision to change its contracts with treating physicians in SCIF's Medical Provider Network. [membership required] To read the response... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5028697 Mon, 11 Jul 2011 23:00:00 +0100 5028697 http://www.medworm.com/index.php?rid=5008445&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002126.html In the last couple weeks there's been a wealth of new reports, analyses, and studies released about various aspects of the work comp world. Too many to give each the attention it deserves, so a synopsis of a few will... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5008445 Tue, 05 Jul 2011 23:00:00 +0100 5008445 http://www.medworm.com/index.php?rid=5008446&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002124.html When Congress reaches agreement on a deal to increase the debt limit, there will almost certainly be parts that significantly affect workers comp. Medicare and Medicaid are on the table, with both likely to lose hundreds of millions in funding... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=5008446 Mon, 04 Jul 2011 23:00:00 +0100 5008446 http://www.medworm.com/index.php?rid=4984571&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002075.html The former head of North Dakota's state workers comp fund has been - and continues to be - vilified by a few people who obviously don't know the guy. (more on the appeal in a future post). Prosecuted for 'misuse... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4984571 Wed, 29 Jun 2011 23:00:00 +0100 4984571 http://www.medworm.com/index.php?rid=4984572&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002122.html I'm in DC for a couple of meetings focused on the use, abuse, and impact of narcotics in workers comp. To say this is starting to get major traction would be an understatement; payers, policymakers, employers, and pharma are all... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4984572 Tue, 28 Jun 2011 23:00:00 +0100 4984572 http://www.medworm.com/index.php?rid=4953125&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002108.html is that of claims adjuster. Whether you know them as adjusters, examiners, file handlers, or claims case owners, these women and men are the ones who write the checks out of the checkbook - both literally and figuratively. What they... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4953125 Mon, 20 Jun 2011 23:00:00 +0100 4953125 http://www.medworm.com/index.php?rid=4953127&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002118.html Employers and insurers decry the recent reform instituting PPOs in Illinois as 'California Lite'. Plaintiff attorneys claim it will lead to undertreatment and negative consequences for claimants. What's the real impact? The right answer is it's a bit early to... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4953127 Thu, 16 Jun 2011 23:00:00 +0100 4953127 http://www.medworm.com/index.php?rid=4934539&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002117.html Today's Insurance Journal arrives with this bit of positive news: while rates for most lines of property and casualty insurance are still soft, work comp premiums are firming, driven in part by increasing rates in California, and for the first... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4934539 Mon, 13 Jun 2011 23:00:00 +0100 4934539 http://www.medworm.com/index.php?rid=4902548&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002114.html The major changes in Illinois' workers compensation system are stirring much conversation, modeling, and debate among stakeholders. One of the least-understood (at least by me) provisions of the reform legislation dealt with the adoption of impairment guidelines. The person who... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4902548 Sun, 05 Jun 2011 23:00:00 +0100 4902548 http://www.medworm.com/index.php?rid=4893674&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002113.html With the passage of major work comp reform in Illinois, there's lots of interest in determining exactly what was passed, and more importantly what it means. First, the bill. It's not easy to find it, as it is 'hidden' on... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4893674 Wed, 01 Jun 2011 23:00:00 +0100 4893674 http://www.medworm.com/index.php?rid=4893675&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002112.html Late last night the Illinois House passed major work comp reform legislation, legislation that will dramatically affect workers' comp providers, significantly reduce medical cost, and tighten up several key issues related to claim duration. While most are focusing on the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4893675 Tue, 31 May 2011 23:00:00 +0100 4893675 http://www.medworm.com/index.php?rid=4883741&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002107.html In the online edition of Risk and Insurance, fellow work comp consultant Maddy Bowling authored a piece focused on a rapidly growing segment of the work comp managed care industry - drug testing. Maddy's a very experienced, and very knowledgeable... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4883741 Mon, 30 May 2011 23:00:00 +0100 4883741 http://www.medworm.com/index.php?rid=4883740&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002111.html The Brits finally threw in the towel. After several years of working diligently to make a go of the US TPA market, Xchanging cut its losses, selling what used to be known as Cambridge Integrated Services to Sedgwick for a... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4883740 Mon, 30 May 2011 23:00:00 +0100 4883740 http://www.medworm.com/index.php?rid=4872253&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002110.html Peter Rousmaniere's piece in Risk and Insurance outlines precisely what needs to be done to reduce unnecessary medical costs in comp. To date, most 'managed care' programs have had little real impact; most just shift costs around and develop phantom... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4872253 Thu, 26 May 2011 23:00:00 +0100 4872253 http://www.medworm.com/index.php?rid=4853008&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002103.html A well-placed industry exec shot me a note late last week re yet another TPA deal; Ohio-based Avizent will buy FARA, a Louisiana-based TPA. Terms weren't available, but there's a bit of an outcry over the deal from some folks... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4853008 Sun, 22 May 2011 23:00:00 +0100 4853008 http://www.medworm.com/index.php?rid=4841727&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002100.html From the "shameless commerce division" of Health Strategy Associates, LLC - a Webinar reporting on our First Annual Survey of Workers Comp Claims IT Systems is coming up later this week - Thursday from 1:30 - 2:30 pm eastern, to... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4841727 Mon, 16 May 2011 23:00:00 +0100 4841727 http://www.medworm.com/index.php?rid=4820994&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002098.html While there weren't a plethora of deals announced at RIMS last week, that's not due to a lack of activity. The pending changes to tax rates (without another extension, capital gains will go up at the end of 2012) make... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4820994 Thu, 12 May 2011 23:00:00 +0100 4820994 http://www.medworm.com/index.php?rid=4803319&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002091.html To show just how much I need to get a life, one of the more interesting talks at NCCI las week was a very-well attended general session focused on legislative and regulatory reform. It began with an examination of federal... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4803319 Sat, 07 May 2011 23:00:00 +0100 4803319 http://www.medworm.com/index.php?rid=4794945&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002093.html Frank Schmid had the honor of conducting the final report at the 2011 NCCI Annual Issues Symposium, and he was well worth the wait. Dr Schmid discussed physician fee schedules, price levels, and 'price departure'. Schmid reported not results, but... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4794945 Thu, 05 May 2011 23:00:00 +0100 4794945 http://www.medworm.com/index.php?rid=4794944&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002092.html I'm going to skip over two am speeches - while I could indulge my inner pundit and discourse on Charles Krauthammer's highly selective use of data in his conservative monologue/analysis of President Obama's psyche and disuss the insights of Arthur... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4794944 Thu, 05 May 2011 23:00:00 +0100 4794944 http://www.medworm.com/index.php?rid=4789444&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002088.html Last week Coventry released their Q1 2011 earnings report, and things are looking good. First, the workers comp results. Revenues were up slightly, to $191.6 million, a 4% increase over the prior year's quarter. For the last few months, Coventry's... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4789444 Wed, 04 May 2011 23:00:00 +0100 4789444 http://www.medworm.com/index.php?rid=4789442&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002090.html After this morning's sobering announcement of a 115 combined ratio for work comp, things didn't get much more rosy in Bob Hartwig's presentation on the "post-crisis world". Since 2005, work comp net written premiums have dropped from about $50 billion... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4789442 Wed, 04 May 2011 23:00:00 +0100 4789442 http://www.medworm.com/index.php?rid=4789445&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002087.html After my post yesterday, I received a couple of 'what are you smoking' messages from industry colleagues reacting to my note on firming pricing for work comp premiums. (in fairness, I was reporting on a MarketScout study...) Well, here are... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4789445 Tue, 03 May 2011 23:00:00 +0100 4789445 http://www.medworm.com/index.php?rid=4780385&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002086.html A family matter required my full attention last week, which was why you didn't see any new posts on Managed Care Matters. A lot happened which we'll reprise here quickly. Alex Swedlow of CWCI published another report on the ongoing... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4780385 Mon, 02 May 2011 23:00:00 +0100 4780385 http://www.medworm.com/index.php?rid=4768250&cid=t_235281_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FEKnIm6NQuKw%2F Another working week is about to draw to a close. And not a moment too soon. This is, of course, the signal to daydream about weekend plans. Our modest agenda includes a family gathering, mowing the lawn (wish us luck) and promenading with the official Pharmalot mascots. What about you? Does spring cleaning beckon? How about finding recession-era bargains at a garage sale? Or maybe take a moment to think big thoughts? Whatever you do, have a great time. And see you soon… Merck Profits Top Estimates (Bloomberg News) Woman Severely Hurt By Abbott Labs Truck (Lake County News-Sun) Johnson & Johnson Prostate Cancer Drug Approved By FDA (Bloomberg News) Generic Lipitor Ruling Expected Next Week (Dow Jones) FDA Panel Recommends Vertex Hepatitis C Drug (Boston Globe) Wolter Kluwers Buy... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4768250 Fri, 29 Apr 2011 11:48:24 +0100 4768250 http://www.medworm.com/index.php?rid=4734328&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002083.html Conditions look ripe for a hardening of the workers comp market later this year. I've been known to get just a bit ahead of myself in my predictions about lots of things - and this time may be no different.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4734328 Wed, 20 Apr 2011 23:00:00 +0100 4734328 http://www.medworm.com/index.php?rid=4714890&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002078.html The current political and cultural divide over health reform is not new - in fact, a century ago a very similar debate took place, and the result may be instructive. At the turn of the century courts were stuffed full... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4714890 Wed, 13 Apr 2011 23:00:00 +0100 4714890 http://www.medworm.com/index.php?rid=4704783&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002074.html The annual property and casualty conference/gathering of the tribes known as RIMS is slated for Vancouver BC the first week in May. A great city, terrific restaurants, and lots to do around town. I'll miss it this year - too... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4704783 Mon, 11 Apr 2011 23:00:00 +0100 4704783 http://www.medworm.com/index.php?rid=4696740&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002073.html For over two years I've been following - with a strong sense of outrage and disgust - the travails of Sandy Blunt as he's been pilloried by the prosecuting and investigatory authorities in North Dakota. At long last it appears... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4696740 Sun, 10 Apr 2011 23:00:00 +0100 4696740 http://www.medworm.com/index.php?rid=4653456&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002064.html We usually find out about things first when there's a report out of California; growing facility costs, surgical implants, physician repackaging, compound meds, narcotic usage are among the cost drivers that received wide-spread attention after publicity in California. Yesterday's news... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4653456 Mon, 28 Mar 2011 23:00:00 +0100 4653456 http://www.medworm.com/index.php?rid=4642774&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002057.html A couple weeks ago I started a three-part series on what's going to affect workers comp in 2012. After a few diversions and current-events-driven-interruptions, we're finishing up today with the impact of MSAs Pharmacy costs - and CMS' treatment of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4642774 Sun, 27 Mar 2011 23:00:00 +0100 4642774 http://www.medworm.com/index.php?rid=4626915&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002060.html This morning's WorkCompCentral had a piece by Greg Jones noting complaints by medical specialty groups about the study on physician prescribing of opioids recently released by CWCI. I received a copy of the letter as well, and frankly was surprised... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4626915 Wed, 23 Mar 2011 00:00:00 +0100 4626915 http://www.medworm.com/index.php?rid=4622367&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002056.html Today's post concludes the four-part discussion of the 'Fedealization of Workers' Comp'. And we'll go out not with a bang, but rather a whimper... There have been a couple of relatively recent developments that appear to have excited some concern... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4622367 Tue, 22 Mar 2011 00:00:00 +0100 4622367 http://www.medworm.com/index.php?rid=4615260&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002055.html This morning we're back at it. Now that we've talked about the political landscape, reviewed the OSHA Act and National Commission and discussed the progress, albeit rather minor, of workers comp in the several states, it's time to dive into... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4615260 Mon, 21 Mar 2011 00:00:00 +0100 4615260 http://www.medworm.com/index.php?rid=4605928&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002054.html This evening we'll dig into some of the history of Federal activities related to workers comp, activities that some view as somehow connected, a series of events leading to some greatly expanded role for the Feds in workers comp. Me,... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4605928 Thu, 17 Mar 2011 00:00:00 +0100 4605928 http://www.medworm.com/index.php?rid=4600670&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002053.html This afternoon I was a lunch time speaker at the IAIABC Conference in St Louis, where I was asked to opine on the chances of a major Federal incursion into the (mostly) state regulated world of work comp. I've noted... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4600670 Wed, 16 Mar 2011 00:00:00 +0100 4600670 http://www.medworm.com/index.php?rid=4600671&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002052.html I'm up at zero-dark-thirty this am to catch a flight to St Louis, where the International Association of Industrial Accident Boards and Commissions (IAIABC) is hosting a meeting addressing many of the biggest issues confronting workers comp. The three-hour session... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4600671 Tue, 15 Mar 2011 00:00:00 +0100 4600671 http://www.medworm.com/index.php?rid=4580979&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002051.html I received this comment from a reader in response to my post about ExamWorks and their recent financials. It is quite thorough and well worth consideration on its own merits. Thanks Joe for a very interesting post. The market is... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4580979 Sun, 13 Mar 2011 00:00:00 +0100 4580979 http://www.medworm.com/index.php?rid=4575136&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002048.html My post earlier this week re three major trends that will affect work comp in 2012 generated a few comments from friends and readers. One of the more pointed was from a claims exec, who noted he's seen "a major... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4575136 Fri, 11 Mar 2011 00:00:00 +0100 4575136 http://www.medworm.com/index.php?rid=4566214&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002047.html ExamWorks' latest financials were published last week. After taking a quick look, and reflecting back on a couple conversations with folks who know their business, I'm a bit puzzled. For those unfamiliar with the company, ExamWorks is a relatively new... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4566214 Tue, 08 Mar 2011 00:00:00 +0100 4566214 http://www.medworm.com/index.php?rid=4560434&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002049.html Yesterday I posted on the most recent CWCI study on Opioids in the California Work Comp system, noting that fewer than a hundred docs were responsible for prescribing 42% of the narcotic spend. If that isn't troubling enough, in an... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4560434 Tue, 08 Mar 2011 00:00:00 +0100 4560434 http://www.medworm.com/index.php?rid=4560436&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002046.html I did a talk last week at the National Association of Mutual Insurance Companies on the impact of reform and other factors on workers comp. It got me thinking about something a bit more specific - what's on the horizon... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4560436 Mon, 07 Mar 2011 00:00:00 +0100 4560436 http://www.medworm.com/index.php?rid=4560435&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002045.html The Pareto Principle states that 20% of the causes generate 80% of the effects. The Pareto Principle doesn't apply to physicians prescribing opioids, at least not in California. It's far worse than that. CWCI just released a report that indicates... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4560435 Mon, 07 Mar 2011 00:00:00 +0100 4560435 http://www.medworm.com/index.php?rid=4545071&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002042.html The good folks at NCCI just released a study that, among other things, compares medical cost drivers from the nineties to those earlier in the 'oughts. [opens pdf] The study, authored by Tonya Restrepo and Harry Shuford, indicates that the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4545071 Thu, 03 Mar 2011 00:00:00 +0100 4545071 http://www.medworm.com/index.php?rid=4536193&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002041.html Last year we completed the first annual Survey of Workers Comp Claims Systems; the report was published last fall, and Sandy Blunt's interview with PropertyCasualty360 on the survey is now up and available. Here are three of the highlights from... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4536193 Tue, 01 Mar 2011 00:00:00 +0100 4536193 http://www.medworm.com/index.php?rid=4532375&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002040.html A colleague posed an interesting question last week -"does the proliferation of 'new' blogs, newsletters, and other internet-enabled communications vehicles pose a threat to the 'brand' and 'market share' of Managed Care Matters?" No. In fact, the pie is growing,... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4532375 Mon, 28 Feb 2011 00:00:00 +0100 4532375 http://www.medworm.com/index.php?rid=4501684&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002035.html That's a question I'm hearing more often these days, often one of the first voiced by payers wondering why their medical cost trends are escalating. I'm not sure that's the right question to ask in most instances, but the answer... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4501684 Mon, 21 Feb 2011 00:00:00 +0100 4501684 http://www.medworm.com/index.php?rid=4495321&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002034.html Good friend and colleague Bob Laszewski once used an analogy that has stuck with me -"It's like the dog chasing the school bus; what's it going to do if it catches it? I'm often reminded of Bob's aphorism when state... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4495321 Fri, 18 Feb 2011 00:00:00 +0100 4495321 http://www.medworm.com/index.php?rid=4482873&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002030.html Narcotic manufacturer Cephalon is back in the news, once again facing an investigation focused on the use of Fentora, a Schedule II narcotic, in workers comp cases. Fentora is only FDA approved for breakthrough cancer pain - a condition quite... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4482873 Wed, 16 Feb 2011 00:00:00 +0100 4482873 http://www.medworm.com/index.php?rid=4460048&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002028.html From WorkCompCentral comes this entertaining news - one of the 'stars' of the TV show AxMen got busted for work comp fraud. [sub req] No, he wasn't spotted hosting a Mensa meeting. The alleged fraudster, one Jimmy Smith, has been... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4460048 Thu, 10 Feb 2011 00:00:00 +0100 4460048 http://www.medworm.com/index.php?rid=4455360&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002027.html Didn't hear anything in Coventry's earnings call yesterday about workers comp - even though it accounts for about three-quarters of a billion dollars in revenue and somewhere's north of $85 million in margin - for Coventry. Turns out I didn't... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4455360 Wed, 09 Feb 2011 00:00:00 +0100 4455360 http://www.medworm.com/index.php?rid=4433191&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002022.html For your entertainment pleasure, I bring you Jon Coppelman's post on an Illinois workers comp arbitrator who - fell on courthouse steps, injuring most of his extremities - filed a claim for "post-traumatic carpal tunnel" - anyone have the ICD... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4433191 Thu, 03 Feb 2011 00:00:00 +0100 4433191 http://www.medworm.com/index.php?rid=4429107&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002020.html Today's NCCI report on the near-term future of workers comp should be required reading for work comp execs. Here are the soundbites. - indemnity costs will continue to rise, but very slowly. - frequency will likely not increase. - medical... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4429107 Tue, 01 Feb 2011 00:00:00 +0100 4429107 http://www.medworm.com/index.php?rid=4419276&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002018.html WorkCompCentral's [sub req] Greg Griggs reported the Division of Workers' Comp's public hearing last week was dominated by providers complaining about moves to reduce reimbursement for Ambulatory Surgery Centers (ASCs) and spinal implant hardware. I have a [very] tough time... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4419276 Mon, 31 Jan 2011 00:00:00 +0100 4419276 http://www.medworm.com/index.php?rid=4405884&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002017.html At the end of this year, Greg Krohm, currently Executive Director of IAIABC, will be retiring. I've come to know Greg over the last few years, and am only sorry it has taken this long to cross paths. Greg is... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4405884 Thu, 27 Jan 2011 00:00:00 +0100 4405884 http://www.medworm.com/index.php?rid=4394588&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002016.html The oft-maligned State Compensation Insurance Fund, aka California state fund, is back in the news again, this time for terminating the Fund's long-time Medical Director, Gideon Letz. Dr Letz was at the Fund for over two decades, was an active... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4394588 Tue, 25 Jan 2011 00:00:00 +0100 4394588 http://www.medworm.com/index.php?rid=4382855&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002014.html After my post earlier this week re PMSI naming Pat Sullivan to lead their Ancillary Services DIvision, I was contacted by Gould and Lamb (currently the leading MSA vendor) who took exception to my characterization of their recent history, to... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4382855 Fri, 21 Jan 2011 00:00:00 +0100 4382855 http://www.medworm.com/index.php?rid=4372130&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002011.html Last week's post on guidelines elicited quite a bit of discussion - both public and private, with many vendors/suppliers/writers weighing in on the subject of what works; the practicality of guidelines and the various research methodologies and their validity. I... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4372130 Wed, 19 Jan 2011 00:00:00 +0100 4372130 http://www.medworm.com/index.php?rid=4361135&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002010.html I've been remiss in not congratulating Pat Sullivan on his new position as head of PMSI's Ancillary Services Division. [opens pdf] Pat's a long time friend and colleague, and is one of those people universally respected for his business acumen,... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4361135 Mon, 17 Jan 2011 00:00:00 +0100 4361135 http://www.medworm.com/index.php?rid=4338106&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002008.html A commenter (thanks Greg) on my post yesterday re NCCI's research on physician dispensing noted "Going after the physicians, who are making efforts to recoup their steadily declining reimbursements, does not seem like the best strategy." Greg's got a good... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4338106 Wed, 12 Jan 2011 00:00:00 +0100 4338106 http://www.medworm.com/index.php?rid=4338107&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002007.html The good folks at NCCI just released research which focuses attention on what looks to be the fastest growing part of the work comp medical dollar - drugs dispensed by physicians. The lead sentence in their annual update[opens pdf] on... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4338107 Tue, 11 Jan 2011 00:00:00 +0100 4338107 http://www.medworm.com/index.php?rid=4331112&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002005.html Last week several of the folks responsible for managing new business and existing clients for Aetna's Work Comp unit were laid off. Not exactly a great way to start 2011. This came after a year plus in which AWCA's network... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4331112 Mon, 10 Jan 2011 00:00:00 +0100 4331112 http://www.medworm.com/index.php?rid=4331111&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002006.html My post earlier today re the changes at Aetna Workers' Comp Access inspired several calls and emails from employers seeking information on the folks who were laid off, as they may have skills, experience, and expertise needed by work comp... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4331111 Mon, 10 Jan 2011 00:00:00 +0100 4331111 http://www.medworm.com/index.php?rid=4318431&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002003.html The investment community's fascination with the work comp services space resulted in a half-dozen deals over the last couple of months, on top of several more earlier in 2010. Which has led some to ask? Why this industry and why... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4318431 Thu, 06 Jan 2011 00:00:00 +0100 4318431 http://www.medworm.com/index.php?rid=4309729&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002001.html The investment community finished 2010 in a frenzy of deal making - Odyssey sold York Claims to ABRY, Progressive Medical was bought by Stone Point, Genex bought Intracorp from CIGNA for stock, Sedgwick is buying SRS, Humana bought Concentra -... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4309729 Tue, 04 Jan 2011 00:00:00 +0100 4309729 http://www.medworm.com/index.php?rid=4300619&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001997.html So, how'd my predictions for 2010 turn out? Well, I won't e jumping for joy - or out any windows either. Here's what I predicted back in January for 2010, and a (mostly) objective assessment of the accuracy thereof. 1.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4300619 Thu, 30 Dec 2010 00:00:00 +0100 4300619 http://www.medworm.com/index.php?rid=4298716&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001996.html A lot happened in the work comp world in 2010 - here are the top issues discussed here on MCM. Mergers, acquisitions, and buyouts This has been a very busy year for the financial folks. OneCall Medical, Intracorp, Sedgwick, SRS,... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4298716 Mon, 27 Dec 2010 00:00:00 +0100 4298716 http://www.medworm.com/index.php?rid=4275423&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001992.html In an announcement a few minutes ago, Third Party Administrator (TPA) Sedgwick announced it will be buying SRS from the Hartford for $278 million in cash, with the deal scheduled to close early next year. SRS, like many TPAs, was... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4275423 Mon, 20 Dec 2010 00:00:00 +0100 4275423 http://www.medworm.com/index.php?rid=4272419&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001991.html For those who were following with bated breath the efforts of many to forestall the end of PBMs in Texas, Friday brought official confirmation of the rumors that we reported last week: the Division of Workers Comp published emergency regs... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4272419 Mon, 20 Dec 2010 00:00:00 +0100 4272419 http://www.medworm.com/index.php?rid=4266001&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001990.html The week is almost over, and none too soon for your faithful reporter. In addition to new client work, deliverables for current clients, and trying to keep MCM up to date, we've also been dealing with the Texas...situation. Word is... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4266001 Fri, 17 Dec 2010 00:00:00 +0100 4266001 http://www.medworm.com/index.php?rid=4253259&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001986.html After mulling over Texas Attorney General Greg Scott's just-released opinion [opens pdf] on the use of PBMs in workers comp, I'm still confused. That wouldn't be so bad, except so is everyone else. The opinion appears to contradict itself, with... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4253259 Mon, 13 Dec 2010 00:00:00 +0100 4253259 http://www.medworm.com/index.php?rid=4253200&cid=t_235281_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F12%2F12%2Fdo-your-panic-attacks-ever-grow-rosy-in-retrospect%2F Photo Credit: gavinmusic The other night, I found myself obsessively listening to a unique crowd-sourced brand of music at OneHelloWorld. OHW is — well, think Postsecret, but for your ears. The site’s creator (who doesn’t identify himself by name) asks the world to call his phone and leave a three-minute narrative voicemail. Then, he creates a musical composition for the background that’s inspired by the content of your message. (“Call it a soundtrack for your thoughts,” the site describes it.) The result? An intriguing amalgam of personal stories and instrumental melodies. The completed tracks are moving. Some are inspirational; some are depressing. Always one to take part in the novelty of experimental projects on the internet, I called OHW’s ph... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4253200 Sun, 12 Dec 2010 23:06:16 +0100 4253200 http://www.medworm.com/index.php?rid=4249135&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001983.html Here, in no particular order, are a few of the more interesting goings-on in the work comp space these days. Eileen Auen, CEO of PMSI, was named one of Business Insurance's Women to Watch for 2010. I first met Eileen... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4249135 Fri, 10 Dec 2010 00:00:00 +0100 4249135 http://www.medworm.com/index.php?rid=4241828&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001980.html Yesterday SwissRe published their analysis of the impact of health reform on workers comp. The full report is available here [opens pdf] It's good to see an international player in the workers comp market consider the potential direct and indirect... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4241828 Wed, 08 Dec 2010 00:00:00 +0100 4241828 http://www.medworm.com/index.php?rid=4238007&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001978.html The Texas Division of Workers Comp (DWC) recently released proposed rules for work comp pharmacy billing. Along with the rules are what can perhaps best be described as an 'extensive' list of data elements DWC is looking to collect, a... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4238007 Tue, 07 Dec 2010 00:00:00 +0100 4238007 http://www.medworm.com/index.php?rid=4225446&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001976.html Gosh, since the judge in Sandy Blunt's case rejected his request for a new trial, a lot has happened. As winter settles in on the plains, allow me, dear reader, to separate the wheat from the chaff (a bit of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4225446 Fri, 03 Dec 2010 00:00:00 +0100 4225446 http://www.medworm.com/index.php?rid=4197208&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001969.html WorkCompCentral's Mike Whiteley has the scoop [subscription required] of the month; he reported this morning Governor-Elect Rick Scott of Florida has renewed his promise to cut employers' work comp costs by 35% . (That was one of the lead lines... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4197208 Tue, 23 Nov 2010 00:00:00 +0100 4197208 http://www.medworm.com/index.php?rid=4168077&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001961.html An interesting confluence of events occurred this week in the Sunshine State, one that will keep employers' costs up while enriching politicians and physician dispensers. First, the Florida Legislature was going to meet and vote on a measure to override... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4168077 Mon, 15 Nov 2010 00:00:00 +0100 4168077 http://www.medworm.com/index.php?rid=4159339&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001959.html Here in no particular order is what I can recall (and am allowed to post) from the last couple days at the comp conference. First off, more activity, more smiles, more enthusiasm than I've seen in several years at the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4159339 Fri, 12 Nov 2010 00:00:00 +0100 4159339 http://www.medworm.com/index.php?rid=4152008&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001957.html And getting ready for the annual re-connect, see-who's-where, find-out-what's-new, separate-the-fluff-from-the-real confab. Before diving into the meetings, presentations, and exhibit hall, here's the first impression. Mark Walls' Work Comp Analysis Group is more than a presence here; Mark has done an... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4152008 Wed, 10 Nov 2010 00:00:00 +0100 4152008 http://www.medworm.com/index.php?rid=4139347&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001953.html In what has to go down as the worst-kept secret in the investment community 'EH-ver' (say out loud like a 14 year old female), Genex announced today that they will buy Intracorp's workers comp business from CIGNA. I'm particularly pleased... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4139347 Thu, 04 Nov 2010 00:00:00 +0100 4139347 http://www.medworm.com/index.php?rid=4133990&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001952.html A source in the Lone Star State indicated that Commissioner Bordelon will shortly release a statement concerning the use of voluntary networks after 1/1/11. Loyal readers will recall a post a few days ago that encouraged all to NOT implement... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4133990 Thu, 04 Nov 2010 00:00:00 +0100 4133990 http://www.medworm.com/index.php?rid=4133991&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001951.html The next Governor of Florida will be Rick Scott. Democratic candidate, and current state CFO Alex Sink just conceded defeat, and her loss bodes ill for Florida's workers comp insurers and employers. Recall that Sink was a major supporter of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4133991 Wed, 03 Nov 2010 00:00:00 +0100 4133991 http://www.medworm.com/index.php?rid=4125128&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001683.html Yes, it's true. And if he wasn't a half-bubble off plumb when he started, he certainly was after spending a few years behind his desk at a workers comp insurer. Franz Kafka worked for the Workers Accident Insurance Company, and... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4125128 Mon, 01 Nov 2010 00:00:00 +0100 4125128 http://www.medworm.com/index.php?rid=4119360&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001947.html I've been tracking the spinal implant business for several years now, watching with interest - and growing dismay - as more and more patients have been getting more and more hardware implanted into their backs. Why dismay? Well, there have... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4119360 Thu, 28 Oct 2010 23:00:00 +0100 4119360 http://www.medworm.com/index.php?rid=4119364&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001945.html Had an interesting series of conversations with a client regarding the impending 'sunset' of the Texas voluntary workers comp provider networks. It seems one of the network vendors is claiming the sunset is much ado about nothing; that the expiration... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4119364 Mon, 25 Oct 2010 23:00:00 +0100 4119364 http://www.medworm.com/index.php?rid=4105835&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001944.html I'm part way through the Seventh Annual Survey of Prescription Drug Management in Workers Comp, and have a couple of initial impressions worth sharing. First, and no surprise, is the increased concern about the growth of narcotic opioid usage in... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4105835 Sun, 24 Oct 2010 23:00:00 +0100 4105835 http://www.medworm.com/index.php?rid=4098194&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001943.html Two things - facility costs and pharmacy. We'll get to pharmacy next week (I'm finishing up the Seventh Annual Survey of Prescription Drug Management in Workers Comp), but for now here's a couple quick hits on the growing problem in... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4098194 Thu, 21 Oct 2010 23:00:00 +0100 4098194 http://www.medworm.com/index.php?rid=4098195&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001935.html Now that the Mitchell - Ingenix deal is in the open, the rumor mill - and the fact mill as well - is rife with discussion of pending acquisitions, investments, and mergers in the work comp managed care business. Tops... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4098195 Wed, 20 Oct 2010 23:00:00 +0100 4098195 http://www.medworm.com/index.php?rid=4086387&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001942.html The official announcement was released a bit ago, and there aren't many more details than we shared yesterday. I would note that there are several allusions to the new entity being the 'market share leader'; in a subsequent conversation with... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4086387 Tue, 19 Oct 2010 23:00:00 +0100 4086387 http://www.medworm.com/index.php?rid=4086388&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001941.html Tomorrow morning Mitchell Medical will announce it has acquired the Ingenix medical bill bill review systems business from United HealthGroup. The deal, which has been tightly held, may also include the assets employed in developing state workers comp fee schedules,... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4086388 Mon, 18 Oct 2010 23:00:00 +0100 4086388 http://www.medworm.com/index.php?rid=4077395&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001939.html What happens when uniquely unqualified people run workers comp insurers? Nothing good. Exhibit One, the disaster in North Dakota, as their IT systems overhaul is now well over budget, behind schedule, and so obviously mismanaged that there's no date certain... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4077395 Sun, 17 Oct 2010 23:00:00 +0100 4077395 http://www.medworm.com/index.php?rid=4074235&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001938.html Those of us who spend a good deal of time buried in the world of work comp sometimes need to look up and out, to see where we 'fit' in the larger world. There's so much to do, and so... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4074235 Thu, 14 Oct 2010 23:00:00 +0100 4074235 http://www.medworm.com/index.php?rid=4065474&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001937.html The answer is probably YES. When surgical implants are defective or implanted incorrectly, the patient has to go back in for more surgery. And the Work Comp insurer or healthplan or self-insured employer or reinsurer has to pay. The only... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4065474 Tue, 12 Oct 2010 23:00:00 +0100 4065474 http://www.medworm.com/index.php?rid=4040663&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001919.html Last week WorkCompCentral's [subscription required] Bill Kidd wrote about the battle in Illinois over reimbursement for surgical implants. The quick-and-dirty is hospitals are resisting a reduction in compensation for the devices themselves from 65% of billed charges to the manufacturer's... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4040663 Wed, 06 Oct 2010 23:00:00 +0100 4040663 http://www.medworm.com/index.php?rid=4031365&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001923.html Mike Whitely of WorkCompCentral's piece [subscription required] this morning about Miami-Dade Schools' solution to the high cost of repackaged drugs should be required reading for any employer or insurer operating in the Sunshine State. As noted here and elsewhere, a... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4031365 Mon, 04 Oct 2010 23:00:00 +0100 4031365 http://www.medworm.com/index.php?rid=4023030&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001920.html Automated Healthcare Solutions, their execs and affiliates contributed $1.7 million to political campaigns over the last two years. If anyone has any doubts about the financial returns enjoyed by the physician dispensing business, yesterday's report in Health News Florida should... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4023030 Thu, 30 Sep 2010 23:00:00 +0100 4023030 http://www.medworm.com/index.php?rid=4018264&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001917.html I've gotten a number of calls and emails from friends and colleagues interested in - and concerned about - the news that AHCS has filed suit against me and my consulting firm for defamation etc. Here's where things stand. 1.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4018264 Tue, 28 Sep 2010 23:00:00 +0100 4018264 http://www.medworm.com/index.php?rid=4013342&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001916.html If you want to get a detailed copy of HSA's first Annual Survey of Worker Comp Claims IT Systems, time is running out. Respondents will receive a detailed version of the Survey Report; non-respondents will recieve an executive summary version.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4013342 Mon, 27 Sep 2010 23:00:00 +0100 4013342 http://www.medworm.com/index.php?rid=3994111&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001912.html Health Strategy Associates' First Annual Survey of Workers Comp Claims IT Systems is well underway, and we're well on our way to reaching our goal. Respondents will be receiving a detailed copy of the Survey Report. We're using SurveyMonkey to... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3994111 Tue, 21 Sep 2010 23:00:00 +0100 3994111 http://www.medworm.com/index.php?rid=3976581&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001908.html Good friends and colleagues Frank Pennachio and Susan Toussaint's WorkComp Advisory Group is conducting their annual get together at the Blackstone Hotel in Chicago (scene for much of the movie 'The Untouchables'. (Remember the scene with the baseball bat in... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3976581 Wed, 15 Sep 2010 23:00:00 +0100 3976581 http://www.medworm.com/index.php?rid=3973005&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001906.html Earlier this week I attended the Maine Workers Comp Summit; spoke on the impact of health reform on workers' comp. One of the sessions pertained to coding medical bills, and some of the intricacies thereof. For one (me) who spends... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3973005 Tue, 14 Sep 2010 23:00:00 +0100 3973005 http://www.medworm.com/index.php?rid=3965543&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001907.html Under the radar, there's increasing evidence that employment is up, hiring is up, and the economy is recovering - and with it, the workers comp industry. I had several conversations today that validated what I've been hearing for several weeks... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3965543 Mon, 13 Sep 2010 23:00:00 +0100 3965543 http://www.medworm.com/index.php?rid=3965545&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001904.html Health Strategy Associates' First Annual Survey of Work Comp Claims IT Systems is underway. The Survey seeks input from front-line folks and execs in claims and IT, and we'll be comparing and contrasting responses to see if - or perhaps... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3965545 Sun, 12 Sep 2010 23:00:00 +0100 3965545 http://www.medworm.com/index.php?rid=3957972&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001903.html It's not a crime for North Dakota state employees to use taxpayer funds to fly first class; run up hundreds of dollars in bar bills; pay for hotel rooms - then not use them; spend thousands to go to Tony... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3957972 Thu, 09 Sep 2010 23:00:00 +0100 3957972 http://www.medworm.com/index.php?rid=3929323&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001894.html If there's one area of work comp pharmacy management that's making payers crazy, it's physician dispensing (followed closely by compounding). The number of physicians and clinics dispensing drugs is growing; as one state seeks to reel in abusive practices, the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3929323 Wed, 01 Sep 2010 23:00:00 +0100 3929323 http://www.medworm.com/index.php?rid=3924989&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001896.html There's been a lot going on in New York's work comp system; heated discussions over adoption of disability and medical treatment guidelines, an uproar over assessments for self insured groups, and ongoing actions and attempted actions regarding the pharmacy fee... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3924989 Tue, 31 Aug 2010 23:00:00 +0100 3924989 http://www.medworm.com/index.php?rid=3915144&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001895.html Summer is ending next week, and favorable tax treatment will sunset not much later. With the end of vacation season fast approaching, investors will likely step up the pace, while owners looking to maximize their take-home are motivated to get... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3915144 Sun, 29 Aug 2010 23:00:00 +0100 3915144 http://www.medworm.com/index.php?rid=3911779&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001893.html That's the question North Dakota prosecutor Cynthia Feland should be asked by Judge Bruce Romanick if and when she appears in front of him to discuss Sandy Blunt's request for a new trial. The tortured history of Feland's prosecution of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3911779 Thu, 26 Aug 2010 23:00:00 +0100 3911779 http://www.medworm.com/index.php?rid=3902998&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001892.html Yesterday I discussed the ongoing debate about potential changes to California's work comp fee schedule. In case my position was too subtle, I've got grave reservations about using RBRVS (Medicare) as the basis for a work comp physician fee schedule.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3902998 Tue, 24 Aug 2010 23:00:00 +0100 3902998 http://www.medworm.com/index.php?rid=3899501&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001891.html There's a lot going on in California's workers comp system - medical costs zooming up and driving premium increases along the way, narcotic usage skyrocketing, a dramatic increase in scripts for medical foods and compounds, judges upholding controversial decisions, and... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3899501 Mon, 23 Aug 2010 23:00:00 +0100 3899501 http://www.medworm.com/index.php?rid=3895990&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001890.html In the course of my consulting practice, I see a lot of work comp medical bill review 'savings' reports. Over the last fourteen years (since founding Health Strategy Associates in 1996) I've collected, reviewed, and analyzed scores of savings reports... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3895990 Sun, 22 Aug 2010 23:00:00 +0100 3895990 http://www.medworm.com/index.php?rid=3889172&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001889.html It's hard to overstate the importance of the claims IT system in workers comp. Systems directly, and materially, affect: productivity; compliance; claimant and policyholder satisfaction; medical costs; litigation rates, expenses, and outcomes; administrative expense (both unallocated and allocated); claims cost;... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3889172 Thu, 19 Aug 2010 23:00:00 +0100 3889172 http://www.medworm.com/index.php?rid=3880971&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001887.html The good folks at CWCI just published a research report (The Cost and Utilization of Compound Drugs, Convenience Packs and Medical Foods in California WC) documenting the rise in spend on medical foods, repackaged drugs, and compound drugs from 2006... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3880971 Tue, 17 Aug 2010 23:00:00 +0100 3880971 http://www.medworm.com/index.php?rid=3876782&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001886.html A new report documents the impact of the recession on the health care system, and for many Americans, the news is proof of what they know all too well - higher deductibles and copays are reducing their ability to access... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3876782 Mon, 16 Aug 2010 23:00:00 +0100 3876782 http://www.medworm.com/index.php?rid=3827186&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001880.html There's been a lot of 'under the radar' activity in the work comp space of late, with much of it coming from the Medicare Set Aside sector. As 'unique' as the workers comp services sector may be, there's no niche... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3827186 Wed, 04 Aug 2010 23:00:00 +0100 3827186 http://www.medworm.com/index.php?rid=3790796&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001873.html As I reported Saturday, the prosecutor who charged former North Dakota state fund CEO Sandy Blunt with felony 'theft of services' is herself under investigation for allegedly withholding exculpatory evidence from Blunt's defense attorney. Cynthia Feland's case has been heard... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3790796 Sun, 25 Jul 2010 23:00:00 +0100 3790796 http://www.medworm.com/index.php?rid=3786189&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001872.html Last Friday the news couldn't have been much worse for ex North Dakota state work comp fund CEO Sandy Blunt: the state's Supreme Court affirmed his felony conviction on charges of theft. I spoke with Sandy that day, and can... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3786189 Fri, 23 Jul 2010 23:00:00 +0100 3786189 http://www.medworm.com/index.php?rid=3776491&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001869.html The good folks at NCCI just released a report [opens pdf] detailing workers comp medical cost drivers; there are two 'headline' findings; severity is increasing at a slower rate, and the price of medical services is becoming a larger contributor... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3776491 Tue, 20 Jul 2010 23:00:00 +0100 3776491 http://www.medworm.com/index.php?rid=3761508&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001866.html There's a good bit of activity on the regulatory front as states with work comp pharmacy fee schedules consider possible changes to address the myriad issues inherent in AWP. A little background will help frame the issue. First, it's important... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3761508 Thu, 15 Jul 2010 23:00:00 +0100 3761508 http://www.medworm.com/index.php?rid=3757978&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001865.html There's a bit of confusion in the comp pharmacy management space, as there appears to be contradictory evidence from two respected sources about the use of narcotic opioids in workers comp. First, everyone agrees there's just far too many claimaints... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3757978 Wed, 14 Jul 2010 23:00:00 +0100 3757978 http://www.medworm.com/index.php?rid=3753937&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001864.html The work comp pharmacy benefit management industry is growing increasingly sophisticated, and the release of PMSI's Annual Drug Trends Report this morning adds to the trend. Many of the larger work comp PBMs produce similar reports, providing deep insights into... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3753937 Tue, 13 Jul 2010 23:00:00 +0100 3753937 http://www.medworm.com/index.php?rid=3746852&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001862.html In the work comp world there's an oft-used term used to describe medical costs - 'severity'. I'm beginning to think that word itself is a problem, and perhaps is part of the reason the work comp payer community has proven... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3746852 Sun, 11 Jul 2010 23:00:00 +0100 3746852 http://www.medworm.com/index.php?rid=3740699&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001861.html Today's WorkCompCentral edition [sub req] reported on an emergency revision to Illinois' state workers comp fee schedule that will change the methodology for repricing surgical implant devices. The move is a response to what the Illinois Workers Comp Commission described... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3740699 Thu, 08 Jul 2010 23:00:00 +0100 3740699 http://www.medworm.com/index.php?rid=3729973&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001859.html Coventry Health will be taking a $278 million charge against earnings to cover the company's fine plus interest and legal costs resulting from last week's Louisiana appellate courte ruling in a workers comp PPO network case. On a per-share basis,... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3729973 Mon, 05 Jul 2010 23:00:00 +0100 3729973 http://www.medworm.com/index.php?rid=3721860&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001858.html Yesterday's Louisiana appellate court ruling against Coventry's First Health work comp network is a major blow to comp insurers, employers, and networks in Louisiana, with potential impact in other states as well. The ruling is here. The court's finding supported... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3721860 Thu, 01 Jul 2010 23:00:00 +0100 3721860 http://www.medworm.com/index.php?rid=3718520&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001857.html Anecdotal information indicates the comp injury rate is heading up just a bit. In email conversations with Jim Greenwood, CEO of Concentra, Inc., the nation's largest occ/urgent care clinic company, Jim sounded encouraged by the upward trend in the company's... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3718520 Wed, 30 Jun 2010 23:00:00 +0100 3718520 http://www.medworm.com/index.php?rid=3699595&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001853.html Newsday broke a story yesterday about a former Islip, NY parks workers who was busted for insurance fraud. But this isn't your typical "out on TTD, moonlighting as a handyman" gig. Nope, John Livingston, out of work due to a... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3699595 Thu, 24 Jun 2010 23:00:00 +0100 3699595 http://www.medworm.com/index.php?rid=3687223&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001849.html Yesterday's post about Mass General's mishandling (to be kind) of a woman's procedure and reimbursement thereof elicited a thoughtful email from the former CEO of a major work comp insurer. Here's what he said (identifying details removed to protect the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3687223 Mon, 21 Jun 2010 23:00:00 +0100 3687223 http://www.medworm.com/index.php?rid=3676768&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001846.html Broadspire, one of the largest TPAs in the country, has announced a new network strategy which goes by the acronym BOLD, that is notable as much for what's missing than what's present. There's no mention of Coventry in the list... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3676768 Thu, 17 Jun 2010 23:00:00 +0100 3676768 http://www.medworm.com/index.php?rid=3671871&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001845.html I attended a meeting of work comp insurance execs in DC yesterday that addressed, among other topics, the dynamic situation in Texas, fee schedules for drugs, pending Federal legislation and the potential impact on comp, and the Gulf oil spill... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3671871 Wed, 16 Jun 2010 23:00:00 +0100 3671871 http://www.medworm.com/index.php?rid=3659049&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001843.html I was talking at length with a good friend who works for a large payer last week, discussing the process of getting the organization to make significant, and very much needed, improvements to their managed care program. This got me... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3659049 Sun, 13 Jun 2010 23:00:00 +0100 3659049 http://www.medworm.com/index.php?rid=3648662&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001841.html According to Bill Kidd's piece [sub req] in WorkCompCentral this morning, several states are attempting to address the rapidly growing problem of surgical implant device fees via regulation or legislation - by basing reimbursement on the manufacturer's invoice. While it... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3648662 Wed, 09 Jun 2010 23:00:00 +0100 3648662 http://www.medworm.com/index.php?rid=3621818&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001835.html Three items of interest from North Dakota - one quite positive, the others puzzling at best. First, the good. Sandy Blunt, former CEO of the NoDak work comp insurance fund, gave an excellent presentation on the current state of the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3621818 Tue, 01 Jun 2010 23:00:00 +0100 3621818 http://www.medworm.com/index.php?rid=3617950&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001834.html Mike Whitely of WorkCompCentral's article [sub req] on Florida Governor Charlie Crist's veto of the bill limiting reimbursement for physician-dispensed repackaged drugs illustrates just how confusing the weird world of work comp can be to the uninitiated - like Mr... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3617950 Mon, 31 May 2010 23:00:00 +0100 3617950 http://www.medworm.com/index.php?rid=3599570&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001831.html As states take on the growing problem of surgical implant costs - the latest (and arguably greatest) effort by certain providers to reap huge profits from workers comp payers and employers, it's time to delve into the problem - and... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3599570 Tue, 25 May 2010 23:00:00 +0100 3599570 http://www.medworm.com/index.php?rid=3585713&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001827.html My post on Monday about the internal memo released by CMS regarding MSA allocations triggered a round of name-calling, motive-assumption, and general nastiness by people in the MSA business furious that I awarded PMSI much of the credit for the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3585713 Thu, 20 May 2010 23:00:00 +0100 3585713 http://www.medworm.com/index.php?rid=3577504&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001825.html Following RIMs, it was off to NCCI for their conference, then a furious few days to catch up and follow up and get a couple deliverables out. Now that there's a few minutes to go back thru my notes from... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3577504 Tue, 18 May 2010 23:00:00 +0100 3577504 http://www.medworm.com/index.php?rid=3569960&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001824.html When you get a call late on a Friday, it's usually good news - if it was bad, they'd usually wait till Monday rather than ruin your weekend. The call I received from Kent Takemoto, MD, President of PMSI Settlement... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3569960 Sun, 16 May 2010 23:00:00 +0100 3569960 http://www.medworm.com/index.php?rid=3560354&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001818.html I've been somewhat reluctant to write this post, as it takes issue with one of the key presenters at a workers comp conference that I believe is consistently the best I've attended. It's here for one reason: it illustrates how... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3560354 Wed, 12 May 2010 23:00:00 +0100 3560354 http://www.medworm.com/index.php?rid=3556225&cid=t_235281_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001821.html Not if your case is highly visible, politically sensitive and focuses on unethical and possibly illegal activity by an Assistant State's Attorney. I'm referring to Sandy Blunt's pending appeal before the ND Supreme Court. Blunt has been waiting - and... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3556225 Tue, 11 May 2010 23:00:00 +0100 3556225