Insight, analysis & opinion from Joe Paduda


Getting smarter about PT.

Why do some patients need more PT than others?

Why does a therapist’s treatment duration vary for patients with the same diagnosis?

What conditions have the most impact on patient recovery?

Thanks to WCRI’s Vennela Thumula PharmD; Randall Lea MD; and Te-Chun Liu there are answers.

WCRI’s latest research based on FOTO data digs into just how big an impact mental and physical health co-morbidities – and other factors – have on improvements in functional status.

The methodology is robust indeed, the data solid as it gets, and the insights provided by the researchers quite valuable.

Using FOTO’s 100 point scale, their research indicates patients with both physical health and mental health comorbidities see about 20% less improvement in functional status than patients with no comorbidities.

courtesy WCRI

Co-morbidities – aka health conditions a patient has in addition to the one you’re focused on – may be physical – think obesity, hypertension, arthritis – or mental – depression, anxiety/panic attacks, sleep dysfunction.

Quick takeaways…

About two-thirds of patients have a physical or mental health comorbidity, and these comorbidities definitely affect the patient’s ability to recover.

The more comorbidities a patient has, the greater the impact on recovery.

More troubling still, the more likely these patient would have “very limited” function at the end of therapy.

The researchers also looked at the same metrics for non-work comp patients…and found comorbidities had similar if not more impact on recovery.

And…it isn’t just comorbidities.

Quicker access to PT had an even greater impact on recovery than physical or mental health complications. The details are on page 43 of the study. If you’re not a WCRI member, become one to get access to all their great work at no charge.

Non members will have to pony up a few bucks to learn more.

What does this mean for you?

Great research is really useful…use this to help injured workers get better faster. 




Customer service, bean counters, and Too Big to Care

During another holiday week a few years back I penned a terrific post on customer service. If I do say so myself, and I do.

Customer service comes to mind as I sit on a transcontinental flight from NYC to Singapore to attend our son’s wedding.

For once I did the smart thing…my lovely bride and I are on Singapore Air, consistently the top-rated airline for customer service. Oh my what a difference between this airline and any other I’ve flown in the past several decades. And I’ve flown a LOT.

Singapore Airlines is…fabulously wonderfully totally about its customers.

One incredibly tiny example…I got up to use the restroom, and an impeccably polite steward very diplomatically noted that cabin service had been halted due to turbulence and perhaps I should stay in my seat unless my sojourn was of utmost importance. I aborted the trip and returned to my seat.

Five minutes later anther flight attendant came by to inform me that things were back to normal and I could safely walk about the cabin. A tiny thing, totally insignificant and yet a blindingly clear demonstration of how serious these people take customer service.

Management clearly gets it. And I will fly Singapore whenever I possibly can. Because any time a flight attendant is that focused on customer service, it is because the entire enterprise is – most importantly top management.

Allow me to reprise the post from 2018, as it is even more topical today.

To that point, here’s an example of a huge business that completely misses the point.

This summer (back in 2018) American Airlines allowed flight attendants to give little things to passengers upset about delays or other problems. Frequent flyer miles, drink coupons, seat upgrades, stuff that didn’t cost AA anything but made angry passengers feel that AA cared about the problems the airline caused.

Then, some genius at HQ decided this was a bad idea.

This from Forbes:

Every time some bright young marketing executive tried to make American (or some other airline) more responsive, and more quickly responsive to passengers’ dissatisfaction by empowering front-line workers to offer some form of compensation, the bean counters back at headquarters quickly noticed that the cost of such empowerment escalated rapidly. The result, alas, always has been the dramatic reduction or elimination of front-line workers’ authority to solve customer service issues at the point of contact.

Instead of fixing the problem, the corporate knuckleheads tried to deal with the fallout – but stopped when it cost too much. 

update – American is currently rated #82 out of the world’s best airlines. Well behind RyanAir (!!!), Air Mauritius and Azerbaijan Airlines, This isn’t due to American’s front line workers, rather management decided service is about #82 on their list of important things.

This is exactly what killed US manufacturing, autos, and many other businesses. At the end of their assembly lines, GM, Ford, and Chrysler diverted many just-built cars with manufacturing defects to another mini-factory.

Auto worker using hammers to straighten a hood on a just-built car…

There, very skilled and very expensive workers diagnosed and fixed cars that had just been built. These guys are yesterday’s American Airlines flight attendants, tasked with fixing problems caused by management.

Clearly senior management didn’t understand that if they spent the time and energy and dollars to do it right the first time, they wouldn’t have to a) fix problems with cars they just built, and b) deal with pissed-off customers.

Yes, it takes that time and energy and dollars. But the results are measured in customers kept, service problems eliminated, and extra costs avoided.

Or, you can just wait for your businesses’ version of Honda to come in and eat your lunch.

What does this mean for you?

Find out what your customers want, and do it right the first time. They will love you and reward you for it.


Forbes’ “rating” of workers comp insurers is…

A farce.

Ok folks, I’m gonna get snarky here.

First, there’s the title. I think they meant “insurers” not “insurance”… the latter is quite consistent across all insurers

A while back PropertyCasualty360’s reported on a “rating” of workers’ comp insurers by Forbes Advisor, an entity which doesn’t appear to take its ratings very seriously.

Everyone loves lists – done right they can reward the best and force others to up their game while helping consumers pick the best offerings. Done poorly they mislead, provide zero value, and result in buyers making decisions based on useless/misleading/wrong criteria.

In this instance, Forbes’ understanding of what makes for a “good” insurer is about as deep as my understanding of quantum mechanics.

In fact, the article looks like it was created by a beta version of ChatGPT with zero editing by anyone who passed a high school English course. (I did try to contact the author but there’s no link or contact info other than a name on Forbes’ website, and I’m not going to waste even more of my time trying to track this guy down)

okay, the details.

From PropertyCasualty360 (who really ought to know better):

Forbes Advisor based 90% of the scores [sic] the level of upheld complaints made to state insurance departments and collected by the National Association of Insurance Commissioners. The remaining 10% of the scores were based on the financial strength assigned to the company by AM Best.

Well. I’ll spare you, dear reader, my minor criticisms and focus on the major ones.

  1. What??? 90% of the “rating” is based on complaints which have little to nothing to do with how good a business partner a carrier is.
  2. What about cost, dividends, time to first report of injury, claim closure rate, claim frequency, sustained return to work…Jesus there’s about a million criteria more important than complaints to regulators.
  3. That said, a major driver of complaints would be certainly driven by claim volume…so the bigger the insurer, the more likely they would a) have complaints and b) the more complaints there would be. No discussion of this in the “survey.”
  4. Sometimes people complain because they don’t want to go back to work, don’t like having to go to specific providers, want brand drugs instead of generics, and on and on. Sure some of these complaints would likely be dismissed by regulators, but others would likely not be “dismissed.”
  5. Financial strength – well, given many carriers are A, A – or A+ rated, how useful is this? Might as well say “hey, only buy WC insurance from an A rated carrier!”
  6. What about:
    1. customer satisfaction?
    2. injured worker satisfaction?
    3. broker rating (be careful, but a whole lot more useful than “complaints”)
    4. claim closure rate?
    5. medical provider satisfaction?
    6. Net promoter score?
    7. employee rating of their employer e.g. Glassdoor?
    8. best places to work ratings?

The result is a wholly useless exercise which may encourage clueless buyers to make bad decisions based on a “survey” which looks like nothing more than clickbait.

I’ve seen better/more useful/more credible ratings for the top home margarita blender kits, highest rated shoelaces and best pencil erasers.

What does this mean for you?

Another sign of the impending apocalypse. 



Good news Friday, inflation is deflating

In what can only be described as excellent news, inflation is down to 3.2%.

Further good news – ahead of the heavy Thanksgiving travel week fuel prices are continuing to drop… in 11 states average prices are below $3 a gallon.

And there’s this really wonderful story about a gay professional hockey player’s journey...the response to his coming out announcement has been overwhelmingly positive – especially from other pros.

Gotta love the love.



Wildly off-topic…Reasons to support Ukraine, Part One

Some think we should not be helping Ukraine protect itself and its people from Russia and the Russian invasion.

They note it is expensive, the battle is far from our shores, it isn’t any of our business, we have other priorities.

Here’s why it is most definitely in our best interest to help Ukraine.

  1. The world is a dangerous place, and enemies large and small – Iran, North Korea, the Taliban, jihadists, and frenemy China – are always looking for signs of American weakness.

    If we had not provided aid and arms to Ukraine, Russia would have taken Kyiv (the capital of Ukraine) and own Ukraine today…and Iran, North Korea, the Taliban, jihadists and their ilk would be plotting attacks on us. 

    Instead, those enemies are watching a large and once-powerful country – Russia – get its ass kicked by a much smaller country, in no small part because we are supporting Ukraine. That ass kicking is most certainly giving would-be attackers nightmares… thanking whatever entity they worship they didn’t do something as blindingly stupid as taking on an ally of the US. 

  2. War prevention – specifically Taiwan. As very/extremely conservative commentator Marc Thiessen notes:

    how much…would U.S. weakness in Ukraine embolden Chinese dictator Xi Jinping? The risk of war over Taiwan would skyrocket. And, unlike the war in Ukraine, it could very well involve U.S. troops. [emphasis added]

    Think of Xi’s calculation: If the United States won’t stand fast for Ukraine, an internationally recognized sovereign state, how likely is a stalwart defense of Taiwan, which is not? And if the United States is not willing to spend money to defend Ukraine, is it really going to risk American lives to defend Taiwan?

    China’s military is massive, has thousands of missiles, will soon have the largest navy in the world, and is increasingly belligerent.

    Chinese ship attacking Vietnamese coast guard ship

    After pushing around small countries like Vietnam and the Philippines and doing its damndest to illegally expand its territory, many of its leaders are were wildly over-confident. Watching as Russia’s battle-tested, quite experienced, once well-equipped and still very large army gets hammered by a much smaller country allied with the US is undoubtedly forcing Xi and his generals to think a lot harder about screwing with America and our allies.

  3. The elimination of one of our two most dangerous enemies cost exactly no American lives.
    Putin is an extremely dangerous dictator and Russia is our enemy.
    Presiding over a country with very serious financial, demographic, ethnic and economic issues, Putin did what most dictators in that situation do – pick a fight with a supposedly weak neighbor.

    For Putin, the result has been catastrophic, eliminating Russia as a threat to  the US and our European allies. More than half of Russia’s armored vehicles and hundreds of aircraft have been destroyed, stocks of missiles and rockets have dramatically shrunk, hundreds of thousands of soldiers have been killed or grievously wounded, its Navy has lost much of its war-fighting capability.

    Russia’s military infrastructure is in deep trouble…every day there are new reports of factories making munitions, armored vehicles, explosives and missiles mysteriously exploding.

    a “fireworks” factory is now rubble…

As brutal and awful as it is, we are much safer because hundreds of thousands of Ukrainians have died, millions have lost their homes, and hundreds of towns, villages, and cities have been destroyed.

What does this mean for you?

Thanks to the Ukrainians, the world is less dangerous today – which is a good thing indeed.


The worst job ever.

Has to be nursing in a health system or hospital.

There’s bullying of young nurses by “more senior” nurses…

Management dismissing nurses’ complaints about sexual harassment, groping, violence and abuse.

Awful hours,

Having to ask if you can go to the bathroom

Seemingly endless shifts

Forced overtime

Working next to – and training – a travel nurse with half your experience who makes twice what you do.

And lest we forget, dying in droves during the early days of COVID.

Here in the Upper Valley in New Hampshire, I recall signs and posters and cheering for nurses and other staff in the early days of COVID.

This lasted about 2 months…followed by COVID deniers using, screaming at, hitting, and abusing nurses.

From heroes to scapegoats, the fall was catastrophic and all too real. This wasn’t unique to northern New England.

Several family members lived through this hellscape, and it isn’t getting any better.

The net is this – our healthcare system is collapsing and the very people who are desperately trying to keep it – and us – functioning are being served poorly by management.

What does this mean for you?

Thank every nurse you know, see, meet, or encounter. They really, really need and serve it.

And call out those – including management – that don’t acknowledge, protect and respect nurses.

note – this very likely applies to many if not all those who work in healthcare facilities…I limited it to nurses because I have first-hand knowledge of their plight.



Good news Friday – unemployment and wages are up…inflation is DOWN!

Sometimes the experts get it wrong – really wrong.

Which can be very good news indeed.

Exhibit 1 – Surprising many economists, the “soft landing” – reducing inflation WITHOUT super high unemployment – is real.

A key indicator shows the inflation rate is now lower than it was 2 years ago.

Now…you will hear some caterwauling that this or that measure is wrong because it isn’t what people actually buy. Okay, let’s look at what people actually spend their money on – a metric called the “Harmonized Index of Consumer Prices” – it’s the green line in the graph below.

As of July 2023, that rate is a paltry 2.5% – right in line with the Fed’s desired inflation rate.

Make no mistake, engineering a soft landing defined as fixing inflation without high unemployment – is rare indeed…Those of us who remember the early eighties recall mortgage rates of 17%, unemployment in the high single digits, and a job market that was horrible/awful/lousy…(I graduated college in 1980…)

The other part of this is wages…which have gone up by about the same amount as inflation – except for nonsupervisory workers.

Those workers have seen “considerably” higher wage increases. The recent strike settlements will make those workers even happier…which will drive consumer spending…which drives the economy…which increases tax revenue…which lowers the deficit.

For some reason a lot of folks don’t believe things are going well…in fact, a recent poll “found that 51% wrongly believe that unemployment is nearing a 50-year high rather than those who believe it’s actually low (49%).” [emphasis added]

When you’re in a funk it can be tough to believe there’s good news…but things will get even better.

Over the next decade, the Inflation Reduction Act, CHIPS Act and other legislation will create another 1.5 million jobs – per year. Source is Moody’s Analytics)

What does this mean for you?

The economy is good – and getting better – and this is very good news indeed.




When you’ve seen one state…

The brainiacs at NCCI have a must-read post detailing physician services’ costs and utilization in most states.

Gotta say this is one of the most useful and insightful analyses I’ve seen from anyone. Kudos to NCCI.

Couple highlights…

  • VERY wide range of physician costs – on a service year basis, state costs range from $800 to almost 4 times that.
  •  Using NCCI’s utilization metric (units), utilization varied almost as much – from fewer than 1000 to more than 2500 units.
  • one of the most insightful learnings is about the factors contributing to variations in utilization…

  • “service intensity” is the most important driver of variation; NCCI’s definition is the “collection and type of physician services rendered on average for a claim given its diagnosis and whether there was a major surgery.”

What does this mean for you?

Your medical management strategy MUST be state-specific. 


CompScope is up…medical costs are not.

It’s that time of year…when the brilliant minds at WCRI release the latest CompScope report.

The top finding…is likely to surprise many…

Couple observations:

  • yes, this was during COVID….medical costs during COVID were LOWER, not higher than previous in previous years. Those who understand medical care delivery anticipated this, alas that is a very small group.
  • no, medical costs in comp are NOT increasing significantly. Haven’t been for years.
  • That’s because we’re still benefiting from the opioid hangover effect.

Warning – Medicaid disenrollment aka “screw the poor folks” will push facilities and healthcare systems in many states to look for revenue replacements.

And, because work comp is pathetically awful at controlling facility costs, we can expect facility costs to increase – which will increase medical costs.

You can register for WCRI’s  webinar highlighting findings from this year’s report here….tune in November 16, 2023 @ 2 pm eastern.

What does this mean for you?

It is long past time to start preparing for higher medical spend.


Here’s some of the good stuff happening these days…

The number of workers with paid sick leave has jumped…lowest-wage workers’ access to paid sick leave has nearly doubled from 20% to 39% since 2010 – driven by more states enacting paid sick leave laws, according to a new Economic Policy Institute report. Overall, almost 4 out of 5 U.S. private-sector workers have paid sick leave, up from 3 of 5 in 2010.

Home care workers’ pay is going up...almost every state has bumped up wages for home care workers, a long-needed change that might help ease the hone care staffing crisis.

Know those yellow pill bottles that have been around forever…and will be around almost forever? Almost 200 billion are added to landfills and trash every year… CabinetHealth is pioneering recyclable – and refillable – glass pill containers…a way better way to get your meds.

Ok, leaving aside the obvious positivity – this is definitely facepalm worthy…there’s this NEW THING among Gen Z’ers...a “silent walk”…aka going for a walk without your phone!!

Who woulda thunk it? Just…walking? And yes, a TikTok’er discovered this revolutionary new idea, and it is…trending!!!

Next up…Silent Walking athleisure wear, shoes, hats, and rain gear, maybe logo that says “don’t disturb – Silent walking”.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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