Insight, analysis & opinion from Joe Paduda


What’s different now?

Nine months into the pandemic and well into the third wave, it’s time to see what’s changed – and for how long.

  1.  Remote is here to stay.
    Whether you are a claims professional, case manager, executive or manager,, clinician or administrative worker, its likely most if not all of your work is now being done outside the “office”.
    I don’t see that changing – many employers are going to maintain an at-home workforce. While IT and cyber issues and costs are significant, savings in real estate and associated costs are real. And quality of life is higher and cost of life is less; no hours spent commuting, more time with family, and no need for that extra car, parking spot, train pass, and business lunch.
  2. Selling and servicing is changing
    Service companies looking to sell their services or service accounts are working hard to figure out how to ply their trade remotely. Zoom calls, DoorDash lunches, virtual wine tastings and sports watching are just a few of the things we do today that would have been incomprehensible just 10 months ago
    I don’t see that changing anytime soon. With budgets slashed and travel risks high, business travel is over. As the economy tries to claw its way out of a very deep hole and companies look for any and every way to save dollars, expect financial folks to keep travel budgets near $0.00. One exception…
  3. Conferences will likely return
    The proliferation of conferences was getting overwhelming, with way more conferences than people to attend or sponsors to fund.  Hopefully the less valuable ones will disappear, and the key ones will continue – after revamping their business models.
    Pay to play has to go; it’s gotten to the point that at many events, conference sponsors get speaking slots regardless of the quality of the speaker or salience of the topic.
    Exhibitors are paying gazillions to stare at each other across empty aisles.
  4. Insurers are cutting back
    With premiums dropping precipitously, insurers are laying off staff, cutting IT projects, putting off investments and consolidating operations. If anything that’s going to accelerate as the winter looks long and dark, and the most optimistic projections indicating fall as the time things start to get back to what we once thought of as normal.
  5. Consolidation will accelerate
    As companies of all sizes and types face declining revenues, those that are stronger financially will win. There will be horizontal and vertical mergers (companies buying others in their business, and buying companies in different businesses).
    There are billions of dollars burning holes in investors’ bank accounts, desperately seeking acquisition targets. While investors will be cautious, expect them to seek out attractive targets.

What does this mean for you?

Adapt and succeed. A minute complaining about reality is a minute not used well.


Despair, anger, or action

Winter here in northern New England is long and cold, with short days too often grey. Sunday night sleet driven by  howling winds pounded the house, leaving a layer of ice on everything.

We are all facing a northern New England winter – long, cold, dark, with far too little sunlight. 

Which leaves each of us with a choice – we can rail against nature, furious that our lives are disrupted, mad at the world. We can scream at each other, curse each other, denigrate and demean, as if this is going to solve anything or be in any way remotely helpful.

Or, we can succumb to lethargy, going through the motions in survival mode, making no difference, taking no responsibility, endlessly waiting for…something.

Or, we can make that something happen.

We can do something positive, something helpful, something neighborly, something kind. Like…

Get takeout, and tip way too much.

Add a few extra things to your shopping list and drop them off at the local food pantry.

Shop for an elderly neighbor, get their mail, shovel their driveway.

Smile at everyone you see – not to worry, they’ll see it in your eyes.

Buy $5 gift cards from local merchants and give them to teachers, aides, neighbors.

Be extra patient.




COVID facts and implications

This is getting real.

I woke this morning to the news that COVID has infected well over 10 million of us and killed almost a quarter million of our mothers, fathers, daughters, siblings, and grandparents.

Worse, the infection rate in the Midwest and Great Plains is exploding

As is the overall US infection rate…

If anything, the trend line is worse than it appears, as it is an average of the last 7 days. With daily new case counts rising rapidly (Wednesday’s count was 142,755), this third wave is looking more like a tsunami.

Latest research

The CDC is finally putting on its big boy pants…

CDC recommends community use of masks, specifically non-valved multi-layer cloth masks, to prevent transmission of SARS-CoV-2.

Wow…who would’ve thunk it??

Research determined that wearing masks protects the wearer as well as those around them. From CDC:

An investigation of a high-exposure event, in which 2 symptomatically ill hair stylists interacted for an average of 15 minutes with each of 139 clients during an 8-day period, found that none of the 67 clients who subsequently consented to an interview and testing developed infection. The stylists and all clients universally wore masks in the salon as required by local ordinance and company policy at the time.

Make sure your masks:

  • have multiple cloth layers and/or
  • are made of silk or
  • polypropylene.

Vaccine progress

The NYTimes’ excellent – and constantly updated – vaccine progress tracker reports there are:

  • no vaccines currently approved for wide use;
  • 6 vaccines approved for early or limited use; and
  • 11 more in large scale efficacy (does it work?) testing.

Pfizer’s vaccine shows a lot of promise, with early results from a large study indicating it was 90%+ effective in “preventing the disease in individuals with no prior history of the disease.”

The vaccine has some significant logistical challenges which will make distribution tricky indeed; it:

Notably, Pfizer did not take any taxpayer money to fund its research, and its executives specifically stated the company is not participating in “Operation Warp Speed.”

Hospitals in ten high-infection states are at or beyond capacity.  From the Atlantic;

According to local news reports, hospitals are already on the brink of being overwhelmed in IowaKansasMinnesotaMissouriMontanaNorth DakotaTexasUtah, and Wisconsin,


Expect a return to limited availability of facility-based medical services. Hospitals are going to have to cut back on elective services to maintain capacity.

More states will mandate restrictions on group gatherings and business operations. New York has already done so, along with North Dakota and I’m sure several others.

There will be significant economic effects.

What does this mean for you?

If everything goes well, by spring 2021 – that’s late March – there may be enough of us vaccinated to slow the virus’ spread.

Be responsible. Wear a mask.






Updates on the ACA

With the GOP attorneys general’s case to overturn the ACA pending before the Supreme Court, you may want a refresher on what the ACA is, where it is working and when it isn’t, what the problems are.

And more importantly how we can fix it.

One of the nation’s leading experts on the ACA- Charles Gaba – will cover all that stuff tomorrow in a webinar.

The Milbank Quarterly will also be publishing experts’ views on the ACA.

As I mentioned last week, Biden will likely be limited to administrative orders, as the GOP-run Senate (pending the Georgia runoff) is not likely to help him implement structural improvements.

What does this mean for you?

A lot of boring wonktalk about the ACA which is nonetheless really important.



Friday catch up

Election week in America – the never-ending show continues…

Here’s what else happened this week.

Online registration for the CompLaude awards opened up; you can sign up here for the December 3 virtual event. Congratulations to all the nominees.

The fine folk at WCRI continue to pump out relevant research; I have a lot of catching up to do but did manage to dive into their analysis of New York’s work comp systems and the results thereof. Quick takeaways:

  • Medical inflation has been pretty flat since 2014, driven by decreasing costs for non-hospital providers. You read that right; costs dropped by about 1 percent per year from 2014 – 2019.
  • Hospital outpatient payments per claim went up 2 percent per year over that period
  • Drug costs in the Empire State have dropped by 9 – 12 percent per year, driven by
  • a 48% drop in morphine equivalents per claim, and a 23 point decrease in the percentage of claims with an opioid script.

Way to go New York.

Addiction treatment

A great piece in WaPo about contingency management, a treatment approach that is yielding promising results. Essentially it rewards drug users with money and prizes for staying abstinent. Some folks don’t like it on moral grounds; they feel its wrong to reward addicts for staying clean.

I’m no ethicist, but this strikes me as a reasonable objection. However, it has to be balanced against the good that comes from helping people recover. Critics’ high morals kind of pale in comparison to keeping people alive.

For now, only the VA is paying for this. It’s long past time private insurers and Medicare/Medicaid stepped up.

All things COVID

I haven’t been paying nearly enough attention to the eruption of COVID; will do a couple posts next week to catch up.  In the meantime, here’s treatment news.

From MedScape, good news; it appears the risk of cardiovascular problems in young athletes recovering from COVID isn’t as high as once thought.

Okay, that’s the good news. The not-good news is the most common version of the virus has mutated and is now more contagious. However, we appear to have dodged a bullet – this version of the virus also mutates much more slowly than other common viruses. It’s really hard to attack a virus that’s constantly changing as scientists are constantly playing catch up.  A relatively stable virus means the development of vaccines and treatments should be a lot more productive.

Lastly, there’s been a lot of misinformation that doctors and hospitals are over-counting COVID cases because they make more money. In a word, that’s a lie. Hospitals do not receive extra funds when patients die from COVID-19. 

Miscoding patients and deaths would be fraud and could result in criminal prosecution.

For the relatively small percentage of patients that don’t have health insurance, there is Federal money available, HOWEVER, healthcare providers can only submit claims that list covid-19 as a patient’s primary diagnosis. Patients with COVID often die of sepsis and other conditions; in those cases providers get paid nothing.

Net – there is zero evidence to support that assertion. None whatsoever.

I find this incredibly offensive; one of our daughters is a nurse working in a major hospital and her husband is a clinician at a VA facility. 1700 healthcare workers have died of COVID – 200 of them are nurses.

These lies are reprehensible.


Enough obsessing…here’s what the election means for healthcare.

Like many, I’ve been spending far too much time obsessing over election results.

It’s a waste of time and energy…and completely useless; rather than dive into Maricopa County absentee ballot trends, time is far better spent figuring out the election’s implications.

I’ll stipulate that come January there will be a Democrat in the White House, a Democratic majority in the House of Representatives, and probably a very narrow Republican majority in the Senate (although that depends on Georgia’s Ossoff – Purdue results and the Warnock – Loeffler runoff).

Here’s what this means for healthcare.

The ACA is here to stay – whether it gets fixed is up to the Senate.

The Affordable Care Act needs work, but gridlock may keep it stumbling along.

Biden’s wish list includes:

  • lowering the eligibility age for Medicare to 60,
  • allowing the federal government to negotiate with pharmaceutical companies over prescription drug prices,
  • spending $775 billion on caregiving to address the need for home health,
  • expanding financial assistance for health insurance,
  • creating a “public option” government health plan, and
  • changing the individual mandate to ensure folks are incentivized to get health insurance.

Without a Democratic Senate, much of the list (lowering Medicare age, public option, $ for caregiving) is unlikely to happen...but Biden can use Executive Orders to address some key problems.

Expect a slew of Orders on issues including:

  • expanding family planning services;
  • expanding value-based care to – perhaps – include pharma (a backdoor way to partially address drug costs);
  • free and expanded testing for COVID,
  • transparency on medical billing, and
  • a mechanism to address surprise bills.

A Biden Administration will double down on the opioid crisis, taking much more aggressive action to make profiteers such as Purdue pay huge penalties. Criminal charges may well be levied against those profiteers along with efforts to reclaim dollars parked overseas by the Sackler family (owners of Purdue).

Of course, this depends on the Georgia runoff, scheduled for January 5 with early voting starting December 20.

What does this mean for you?

Its a lot more productive to focus on the implications and how they may affect you, your family, your community and your business than to worry about stuff we can’t control.


here’s hoping this ends soon.

We interrupt this healthcare blog to bring you a few moments of humorous relief…

Here’s for enthusiastic voters…

Gotta love Steve Schmidt et al…

Colbert is always so helpful!

Yeah, I don’t get it either…


And calls, and posters, and signs, and…



What does this mean for you?



It’s not a good time to be a hospital.

Lots happening this week, much of which was lost in the pre-election madness.

From Becker’s, a list of the 16 rural hospitals that shut their doors this year; over the last decade 133 have closed.  Most are in the South.

States that didn’t expand Medicaid figure prominently, accounting for 12 of the 16 closures. More than two dozen hospitals in Kentucky are at risk; the state’s decision to expand Medicaid took effect in June of this year, but the years of financial hardship will prove to be too much of a burden for some.

Expect more closures in the coming months.

One small contributor; now that PPE manufacturing is moving stateside, facilities’ costs will increase. That adds another straw to the camel’s back.

What does this mean for you?

Longer drives to get care if you live in a rural area, and hospitals looking everywhere for revenue to make up for losses.


The Sturgis Superspreader Event

Increasing evidence points to August’s Sturgis motorcycle rally as a major contributor to the big increase in infections throughout the upper midwest.

With 400,000 folks spending days talking, drinking, eating, recreating, socializing, dancing, singing, and generally having a great time – mostly without masks, sanitizer and obviously with no social distancing, this should come as no surprise.

Sturgis’ Meade County has experienced a major jump in case infection rates, helping to steepen South Dakota’s infection curve.

Using phone tracking data, researchers found:

counties that contributed the highest inflows of rally attendees experienced a 7.0 to 12.5 percent increase in COVID-19 cases relative to counties that did not contribute inflows.

Sturgis’ location in South Dakota was problematic as the state has done little to encourage responsible behavior, choosing to allow individuals and local entities to decide on public health measures.

The study has been met with some criticism, however other reports indicate outbreaks linked to Sturgis attendees happened in Colorado, Minnesota, Washington, New Jersey, North Dakota and other states.

One can argue about the validity of this study or pick apart specific issue, but one cannot justify 400,000 maskless people mashing together in the midst of a pandemic.

None of us like to be told what to do – me included. The idea of someone telling me what to wear, where I can and cannot go, things I can and cannot do…is why I’ve worked for myself for 25 years.

With that freedom comes responsibility, and the freedom-loving folks who went to Sturgis likely robbed thousands of others of their freedom to live COVID-free.

What does this mean for you?

We are all in this together – for good or ill.

Thanks to Pete for inspiring this post.




More hospital consolidation = higher prices

The only demonstrable impact of facility consolidation is higher prices.

There’s also solid evidence that more concentrated health care markets are associated with lower health care quality.

While the number of deals dropped by about 21% in the first half of this year as everyone’s attention focused on COVID and the impact thereof, a number of transactions still took place.  Conversely, several deals in process totaling around $23 billion were abandoned, victims of a variety of challenges.

Consolidation may actually accelerate as facilities hammered by the financial impact of COVID19 seek safe harbors.

The latest consolidation is in the north-central part of the nation, with 2 not for profit systems working on an a deal driven in large part of a desire to help the systems expand their footprint.

I’d expect more, although the increasing number of facility closures may well put a damper on deals as some run out of time.

This is particularly damaging in rural areas, where over a hundred hospitals have shut their doors over the last decade.

From Bob Shepard, UAB

What does this mean for you?

There will be fewer hospitals tomorrow than today, which likely means higher prices.

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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