Insight, analysis & opinion from Joe Paduda

Oct
22

COVID update – where we are today v2

Had a posting issue yesterday; email notifications did not go out to all subscribers – reposting this  – apologies if you already received this.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
21

COVID update – where are we today.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
20

WCRI’s latest and greatest

For decades WCRI’s CompScope reports have provided deep insights into workers compensation in many states. The information is germane not only to those focused on specific states, but for anyone looking to understand what works and what doesn’t, how regulatory changes affect stakeholders, and how systems adapt to those changes.

The latest versions are the 21st edition, adding new depth and detail. Streamlined access to specific information and data via quick tabs is a big plus.

I took a deep dive into WCRI’s Florida report, and came away with two key takeaways.

  • If you are a facility, you should love the fee schedule.
  • If you are a medical provider, you should hate it.

Medical providers – docs, PTs, specialty providers – are paid about 30% less than the median state, with PTs at 28% less, E&M codes at 21% less, and x-rays reimbursed at a rate 45% less than the median.

Hospitals are making huge bucks off workers comp – especially for inpatient visits.  Recent data indicates well over half of all inpatient episodes are “outliers”. Once claims incur more than $59k in charges, reimbursement switches from per diem to percent of charges, more accurately known as “license to steal.”

I get why hospitals are desperate to make huge dollars charging Florida’s employers and taxpayers outrageous amounts: the state didn’t expand Medicaid and has the second highest percentage of non-elderly folks without health insurance (Texas is tops).

Florida hospitals have to treat a lot of folks without health insurance, and they are looking to workers’ comp to help pay for that treatment.

Oh, and COVID’s fallout is adding to hospitals’ financial woes. (take the info above with a grain of salt; it was put out by the Florida Hospital Ass’n.)

The result – hospitals are getting killed financially.

What does this mean for you?

Make time to read and understand solid research. It will determine your future.


Oct
16

COVID update – statistics, your state, treatment, and misinformation

It’s been a while since we dove into the latest research on COVID. Here’s a summary of where things stand.

“Cures”

Today there are no “cures” for COVID19. More accurately, no drugs or treatments have been proven to “cure” the disease.

A just-released study found that four drugs commonly used to treat hospitalized patients – anti-viral Remdesivir, hydroxychloroquine, Interferon, and Lopinavar:

appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay.”

The study was international in scope, used a randomized control format (a rigorous and well-regarded methodology), and enrolled over 11 thousand patients. Note the study has NOT yet been peer-reviewed

Gilead – manufacturer of remdesivir – disputed the study’s findings, which found:

no drug or combination reduced mortality, the chances that mechanical ventilation would be needed, or time spent in the hospital, compared with the patients without drug treatment. (NYTimes)

There are some indications that remdesivir may provide some benefit if administered early in an infection where it can tamp down the body’s immune response – which can be counter-productive.

Data

The US has administered over 119 million tests. About 8 million of us have been infected.  And 210,000 have died.

Black people are dying at more than twice the rate of White people. Other minorities are also dying at a far higher rate.

You can track infections, tests, and deaths in your state here.

The infection rate is climbing – again – especially in the Dakotas, Montana, Nebraska, Wyoming, Rhode Island, and New Mexico. (the darker the color, the higher the infection rate)

Debunking the claim that COVID death rates are “inflated”

Some have claimed that COVID death rates are inflated as many folks that died of COVID had other major health conditions – COVID deniers have been spreading this lie in an attempt to downplay the disastrous effects of COVID.

The CDC’s definition of the underlying cause of death is “the condition that began the chain of events that ultimately led to the person’s death.”

Think of it this way – if a person infected with COVID gets hit by a truck and killed, the cause of death will be listed as Motor Vehicle Accident – NOT COVID.

Similarly, if a person with COVID, hypertension and diabetes falls down the stairs and dies, the cause of death will be listed as “accidental fall”, NOT COVID

So, if a person with COVID, hypertension and diabetes dies after being admitted to the hospital, placed on a ventilator, given remdesivir, and administered oxygen dies, the cause of death will be listed as COVID.

What does this mean for you?

Wear a damn mask. Wash your hands.


Oct
14

Hospitals – it’s not just about the cost

All hospitals are NOT alike – and there’s a quick and highly credible way to identify the facilities highest-rated for quality – and those on the other end of the scale.

The Center for Medicare and Medicaid Services (CMS) has an online tool that allows you to review hospitals’ overall Star ratings. CMS uses a 1-5 star rating metric with the more stars the better.

Here’s how hospitals within 25 miles of Tampa FL stack up.

The overall rating is based on a set of specific ratings that address key measures including:

  • clinical outcomes;
  • patient safety;
  • patient engagement; and
  • cost.

There are a number of “sub-measures” that make up each category, one of particular interest may be facility-associated infections and other safety indicators. Information on timeliness and effectiveness of care is here.

You can download data on each and every hospital reporting to CMS or just pick the facilities of interest; the data is here.

CMS just completed a broad and deep assessment of patient impressions of hospital outpatient services and Ambulatory Surgery Centers; you can find results for individual outpatient facilities here and ASCs here.

For those seeking highly credible data on hospital costs, RAND’s latest research makes data highly accessible.

What does this mean for you?

If you aren’t assessing facilities’ quality, you should be.


Oct
12

What healthcare costs and what you pay

Individuals and families will spend about a trillion dollars on healthcare costs this year. 

Most of those dollars pay for out-of-pocket costs and your share of employer-sponsored health insurance costs.

For those with employer-sponsored health insurance, annual premiums in 2020 averaged $7,470 for individuals; $21,342 for families.

Average premiums went up 4% this year, continuing the long-term trend of healthcare inflation significantly exceeding overall inflation.

Over the last five years, premiums increased 22%, more than twice the overall inflation rate (10%).

Then there’s out of pocket costs.

Most families with high deductible plans will have to cough up (no pun intended) more than $4,000 before their insurance plan starts paying.

What does this mean for you?

Every year, more and more of your income goes to healthcare.

 


Oct
6

Opioids – Deaths up, Sacklers likely to escape justice

Three news items hit the desk, ranging from bad to awful.

More than 73,000 of us died of drug overdoses in the 12 months ending February, 2020. That’s four thousand more deaths than the previous year.

(note graph below is for a slightly different time period)

And it is getting worse.

Preliminary data indicates the death count is up 13% so far this year.

The number of non-fatal overdoses in Vermont tripled this year, with almost 9 out of 10 involving fentanyl.

Meanwhile, the drug dealers directly responsible for much of the horror are about to escape with most of their billions in ill-gotten gains intact.

The drug dealers are the Sacklers, owners of Purdue Pharma. Purdue developed and marketed OxyContin; A recent study,  authored by the Wharton School, Notre Dame, and RAND reported “the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.”

This from a New Yorker article:

Behind the scenes, lawyers for Purdue and its owners have been quietly negotiating with Donald Trump’s Justice Department to resolve all the various federal investigations in an overarching settlement, which would likely involve a fine but no charges against individual executives. [emphasis added]

A lawsuit indicated over the last few years, the Sackler family has transferred billions of dollars offshore, effectively protecting those assets from the US justice system. This from the New Yorker:

In a deposition, one of the company’s own experts testified that the Sacklers had removed as much as thirteen billion dollars from Purdue.

The states have asserted in legal filings that the total cost of the opioid crisis exceeds two trillion dollars. Relative to that number, the three billion dollars that the Sacklers are guaranteeing in their offer is miniscule. It is also a small number relative to the fortune that the Sacklers appear likely to retain, which could be three or four times that amount. [emphasis added]

This country has jailed millions of poor people for decades for drug-related crimes; the Trump Administration appears poised to let the white-collar drug dealers most responsible for the opioid crisis walk away with billions of dollars they made addicting America.

What does this mean for you?

The Sacklers should rot in hell, but they will likely live on in unimaginable luxury. We should all be outraged.

 


Oct
5

COVID and work comp in the Sunshine State

WorkCompCentral hosted a webinar last week (you can watch at no cost) diving into key issues related to Florida’s experience with COVID19 and workers’ comp. Moderated by Rafael Gonzalez (one of the nicest people you’ll ever meet), the panel included a defense attorney, judge, and managed care executive providing different perspectives on COVID’s impact.

Most of the discussion focused on solutions; we’ll touch on the ongoing issue of claim acceptance before highlighting some of the solutions discussed by the panelists.

Claims filed v accepted

Judge David Langham noted that about 7,000 of roughly 17,000 COVID claims filed have been partially or completely denied, yet to date only a handful have filed petitions seeking benefits. (A petition would lead to a formal hearing.)

Ya’Sheaka Williams, a defense attorney, spoke at length about healthcare workers’ exposure, indicating that in her experience claims filed by these workers weren’t contested. She provided good insight into differences between “essential” vs “non-essential” workers, noting sanitation workers are even more important now than ever as it is critical to safely dispose of potentially contaminated materials.

Langham also noted that 96% of accepted cases have resulted in payments <$5,000; the average is <$1,000. (consistent with data Mark Priven and I previously reported)

Of course, as Langham indicated we do NOT know what the long-term impact of COVID19 on individuals will will be; there’s evidence that some individuals have lasting chronic conditions, some of which can be quite debilitating.

Langham averred “in the United States, we aren’t reporting who has recovered, whatever that means.” That surprised me, as a slide displayed earlier in the same presentation specifically reported recoveries in the US. (the picture below is from the same site, captured this morning)

In defense of Judge Langham, I hasten to add that in fact that while there is some reporting of “recoveries”, there’s no universally-accepted definition of “recovery”, nor is the reporting of recoveries consistent across states or even counties within states.  For example, Texas has reported 680,000 “recoveries”, while New York  – a state with much higher infection counts – has only reported 77,000, and California and Florida have not reported ANY recoveries. (at least as reported by JHU)

The lack of clear and specific definitions and guidance from the Federal Government – and a Federal mandate that reporting entities stick to those definitions and guidance – is highly problematic.

Matthew Landon, Chief Strategy Officer of MTI America, suggested employers ensure they are using the same processes, procedures, and strategies to evaluate COVID19-related claims that they use for all claims. Consistency is critical to demonstrate objectivity.

Lessons learned

Judge Langham noted that virtual hearings are proving we can use technology to speed up hearings, engage with claimants more effectively, and get to resolution quickly despite the inability to get together in person. He also encouraged all of us to “protect ourselves mentally and physically” so we can help others.

Kudos to Judge Langham for reminding us that before one can help others, one has to take care of oneself.

Landon identified telephonic translation services a key tool speeding up claims handling and ensuring the right care is getting to workers with language limitations. He also noted care within medical offices seems to be more effective as patients are seen more quickly with lower waiting times; office managers are working to keep the number of patients in offices as low as possible.

More care is being delivered in the home of late, a response to workers’ desire to avoid medical facilities.

Ms Williams reported Tampa Airport is partnering with BayCare Health Systems to provide passengers coronavirus tests on-site at no cost to the passenger, highlighting one example of companies working together to come up with creative solutions to reduce risk and personal stress levels.

She also was encouraged that the delays in accessing care experienced by many injured workers seem to have abated somewhat, a promising development as more clinical practices open up for on-site care and more providers adopt tele-medical solutions.

What does this mean for you?

Good information from folks with deep knowledge of Florida’s experience, much of it applicable to other states as well.

note MTI America is an HSA consulting client


Oct
2

Trump tests positive – initial takeaways

President Trump has tested positive for the coronavirus; we’ll divert from our usual focus on healthcare matters to highlight what we know now, and potential implications.

It is important to understand that most people with coronavirus have no symptoms or  relatively mild cases. Statistics favor a positive outcome for the President.

Infection source

We do not know how the President become infected. We do know that one of his closest advisers, Hope Hicks, tested positive. Reports indicate Hicks has multiple daily encounters with the President, traveled with him on Air Force One, and accompanied him on his latest trips.

The President’s health

Implications

CDC data indicates that one out of ten people in their 70’s with positive diagnoses of COVID19 died. The report did not separate data by sex; it is likely men are at higher risk of death. (note there are no credible reports that Trump has COVID19 – he has tested positive for the coronavirus which may lead to COVID19.)

The same study indicated almost one out of three COVID19 patients 70-79 with an underlying medical condition died; note that obesity was not specifically identified as a medical condition.

Near-term implications

First, the President will suspend his campaign schedule during a two-week quarantine period. Events will be canceled for the time being as his campaign awaits developments.

If his health is severely impaired, his powers as President can be delegated to the Vice President under the 25th Amendment to the Constitution until such time as he is able to resume those duties.

Worst-case implications

If a sitting President dies at any time during his/her term, the Vice President assumes the Presidency.

If a major political party’s candidate dies after being nominated by her/his party, and during the election campaign, that candidate’s political party would nominate a replacement candidate. The process differs by party; for the GOP, the Republican National Committee would oversee the process which gives each state the same number of votes it has at the party convention.

[Note the Democratic Party’s process is generally similar]

It is unclear what happens if the Party’s candidate is medically incapacitated at the time of the election.

There is no Constitutional provision to delay a Presidential election in the event of a candidate’s illness, incapacity, or death after nomination and before the election.

For more information on the latest details on COVID19 treatment, click here.

What to watch for

There will be a lot of political maneuvering and posturing , most of it just noise.

Rely on credible news sources – the major broadcast networks, NPR, and major newspapers – and ignore nonsense from YouTube, twitter, and the like.

And there are already lots of ridiculous conspiracy theories – ignore them too.

 

 

 


Sep
29

If the Supreme Court kills “Obamacare”

With President Trump’s nominee for the Supreme Court all but confirmed, there are huge implications for healthcare. If the Court rules the ACA/Obamacare is unconstitutional, “a host of provisions may be eliminated” including:

  • protections for people with pre-existing conditions,
  • subsidies to make individual health insurance more affordable,
  • expanded eligibility for Medicaid,
  • coverage of young adults up to age 26 under their parents’ insurance policies,
  • coverage of preventive care with no patient cost-sharing, and
  • lower drug costs for seniors using Medicare’s drug benefit.

Today, a brief summary of the court case and analysis of two major implications.

A week after the election the Court will hear the Trump Administration and Republican State Attorneys General argue that the entire ACA/Obamacare must be struck down. Health policy nerds (guilty!) will recall that lower courts ruled that Congress’ elimination of the individual mandate killed the entire ACA; this is the Trump/Republican AGs’ argument.

Democratic Attorneys General have argued that the mandate can and should be separated from the rest of the ACA.

We don’t know how the Court will rule. We do know that after Barrett’s confirmation, the Supreme Court will have a 6-3 supermajority of conservative justices. According to HealthAffairs, writing about the lower court’s ruling, Judge Barrett “does not clearly state her own view but signals support for the dissent’s view (full invalidation of the ACA).” [emphasis added]

Seniors and Hospitals will be dramatically impacted if the Supreme Court overturns the ACA/Obamacare (we’ll address other implications tomorrow).

Seniors

Ending the Medicaid expansion will eliminate benefits for seniors and others in Medicaid expansion states with incomes just above the poverty line.

The ACA closed the “doughnut hole” in the Medicare drug plan, saving a million seniors about $3,200 each. If it is overturned, seniors with high drug costs to treat chronic diseases such as MS, hepatitis C, some cancers, and some autoimmune diseases will see much higher costs.

Hospitals

Many hospitals are already in financial distress, especially in rural areas and states that did not expand Medicaid.

Tennessee and Texas lead the nation in hospital closures, with one-fifth of the Lone Star State’s rural hospitals already closed or close to it. Just north, a grassroots movement in Oklahoma driven by closure of a half-dozen rural hospitals, is gaining traction.

While Becker’s reports all but one of the hospitals going belly up are in states that didn’t expand Medicaid. 

If the Court overturns the ACA/Obamacare, many more rural and smaller hospitals will shut down, leaving healthcare deserts behind.

(Work comp is also affected – albeit indirectly)

What does this mean for you?

If you are a senior concerned about the cost of drugs, and/or live in a rural area, the Court’s decision will have real consequences.

 


Joe Paduda is the principal of Health Strategy Associates

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