The American healthcare system is approaching a breaking point that will have profound implications for employers and workers' compensation insurers. As healthcare costs spiral out of control and insurance becomes increasingly unaffordable, a growing number of workers are entering the workplace with untreated medical conditions that will significantly amplify the severity and cost of work-related injuries.
Showing posts with label Medical Costs. Show all posts
Showing posts with label Medical Costs. Show all posts
Thursday, November 13, 2025
Saturday, May 24, 2025
NJ Workers' Compensation Cost Trends
The New Jersey Compensation Rating and Inspection Bureau (NJ CRIB) has released its 2024 annual report, offering a crucial look into the trends shaping the state's workers' compensation landscape. Understanding these trends is paramount for businesses operating in New Jersey, as it helps manage costs and ensure compliance. This analysis delves into the report's key findings, focusing on the cost of medical treatment relative to indemnity payments and overall claim trends.
Thursday, December 12, 2024
The High Cost of Injury
The National Council on Compensation Insurance (NCCI) recently released a comprehensive study examining "mega claims" in workers' compensation insurance. These are claims with reported losses exceeding $2 million, representing a small fraction of total claims but a significant portion of total loss dollars. The study covers accident years 2001-2021, providing valuable insights into trends and patterns within this high-cost category.
Sunday, July 22, 2018
Medical Fees: Does One Price Fit All?
The Federal government has proposed a simplified medical billing process that may impact workers' compensation billing practices going forward. Most workers' compensation fee medical fee schedules are linked either directly and indirectly the to Federal Medicare model and a proposed Rule published last week in the Federal Register proposes a single fee for all office visits.
Sunday, October 8, 2017
NASI Study: Employers & Employees Lose With Workers' Compensation
WASHINGTON, D.C. – Workers’ compensation employer costs as a share of payroll declined in 2015, reversing a four-year trend, and benefits as a share of payroll fell for the fourth straight year, according to a new report from the National Academy of Social Insurance (the Academy).
Monday, April 18, 2016
Creating a Competitive Economy: The Verizon Strike
 |
| President Barack ObamaPhoto credit: Wikipedia |
On Friday President Obama issued an Executive Order to increase competition in the markets including healthcare and broadband. Most obviously directed to the issues raised by the Verizon strike over low wages, monopolistic activity, stifling technological
Wednesday, August 12, 2015
Workers’ Compensation Benefits for Injured Workers Continue to Decline While Employer Costs Rise
Study Finds Benefits as a Share of Payroll Approach Lowest in Three Decades
Workers’ compensation benefits as a share of payroll for injured workers continue to decline even as employment grows and overall employer costs increase, according to anew report from the National Academy of Social Insurance (the Academy).
Wednesday, April 22, 2015
Single Payer: State v Federal
Does the demise of the Vermont Single Payer system signal that change is on the horizon on a national level for a more sweeping program? The medical costs of state workers' compensation programs have become so profitable for cottage industries that are directly and ancillary connected to the delivery of work related medical care that the system is our of balance. One has to look seriously at the comments by John E. McDonough in the NEJM.
"At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans. If advanced by the right leaders at the right time, the logic of consolidation may become glaringly evident and launch us on a new path. If such consolidation is to occur, like it or not, I believe it will happen federally and not in the states — and no time soon."
The Demise of Vermont's Single-Payer Plan
John E. McDonough, Dr.P.H., M.P.A.
N Engl J Med 2015; 372:1584-1585 April 23, 2015 DOI: 10.1056/NEJMp1501050
"At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans. If advanced by the right leaders at the right time, the logic of consolidation may become glaringly evident and launch us on a new path. If such consolidation is to occur, like it or not, I believe it will happen federally and not in the states — and no time soon."
The Demise of Vermont's Single-Payer Plan
John E. McDonough, Dr.P.H., M.P.A.
N Engl J Med 2015; 372:1584-1585 April 23, 2015 DOI: 10.1056/NEJMp1501050
Sunday, January 11, 2015
High Compensation Medical Costs Raises Concern in New Hampshire
Medical costs now constitute a huge percentage of every workers' compensation claim. A recent editorial published in New Hampshire asserts that soaring and unequal medical costs have broken the workers' compensation system. Today's post is shared from concordmonitor.com/
Lawmakers should make 2014 the last year that doctors and other health care providers are guaranteed payment no matter how much they charge when a worker is injured on the job. The workers’ compensation system is broken.
The state, and the employers who pay into its workers’ compensation fund, have been paying two and three times the going rate for medical services when the patient is a workers’ compensation recipient. On average, surgeons charge 156 percent more, according to a report by the state’s Department of Insurance. Bills for radiology are 107 percent higher, 95 percent higher for occupational therapy and for something as simple as an ice pack, 300 percent more.
The extra paperwork required to document workers’ compensation cases and perhaps the added severity of the average injury, probably explains some of the price difference. But, human nature being what it is, it’s likely that, when the bill has to be paid no matter what the provider charges, the temptation to pad it can be irresistible, especially when providers can rationalize the surcharge by using it to offset underpayments in areas such as Medicare or Medicaid.
Lawmakers should make 2014 the last year that doctors and other health care providers are guaranteed payment no matter how much they charge when a worker is injured on the job. The workers’ compensation system is broken.
The state, and the employers who pay into its workers’ compensation fund, have been paying two and three times the going rate for medical services when the patient is a workers’ compensation recipient. On average, surgeons charge 156 percent more, according to a report by the state’s Department of Insurance. Bills for radiology are 107 percent higher, 95 percent higher for occupational therapy and for something as simple as an ice pack, 300 percent more.
The extra paperwork required to document workers’ compensation cases and perhaps the added severity of the average injury, probably explains some of the price difference. But, human nature being what it is, it’s likely that, when the bill has to be paid no matter what the provider charges, the temptation to pad it can be irresistible, especially when providers can rationalize the surcharge by using it to offset underpayments in areas such as Medicare or Medicaid.
Tuesday, January 6, 2015
Selecting the right surgeon is a big deal
Workers' Compensation was designed to provide the best available medical treatment possible. A good surgical results benefits all stakeholders. The patient has a better outcome, the employer gains an employee who is productive in the workplace, and the insurance company ultimately pays less indemnification by way of permanent disability and a reduced cost for medical follow up care.
Over the decades since its original enactment 1911, the issue of cost of medical care has come to the forefront. Some states, such as New Jersey, prohibit an employee's free selection of a medical provider. Additionally, some employers and their insurance companies have contractually negotiated a best price fee with medical providers and have an established medical care networks, consequently restricting the employee's free selection.
A recent article authored by Peter Scardino is the chief of surgery at Memorial Sloan Kettering Cancer Center (MSK) focuses on the need to select the best surgeon in order to obtain the best outcome.
“You can think of surgery as not really that different than golf.” Peter Scardino is the chief of surgery at Memorial Sloan Kettering Cancer Center (MSK). He has performed more than 4,000 open radical prostatectomies. “Very good athletes and intelligent people can be wildly different in their ability to drive or chip or putt. I think the same thing’s true in the operating room.”
The difference is that golfers keep score. Andrew Vickers, a biostatistician at MSK, would hear cancer surgeons at the hospital having heated debates about, say, how often they took out a patient’s whole kidney versus just a part of it. “Wait a minute,” he remembers thinking. “Don’t you know this?”
“How come they didn’t know this already?”
In the summer of 2009, he and Scardino teamed up to begin work on a software project, called Amplio (from the Latin for “to improve”), to give surgeons detailed feedback about their performance. The program—still in its early stages but already starting to be shared with other hospitals — started with a simple premise: the only way a surgeon is going to get better is if he knows where he stands.
Vickers likes to put it this way. His brother-in-law is a bond salesman, and you can ask him, How’d you do last week?, and he’ll tell you not just his own numbers, but the numbers for his whole group.
Why should it be any different when lives are in the balance?
Over the decades since its original enactment 1911, the issue of cost of medical care has come to the forefront. Some states, such as New Jersey, prohibit an employee's free selection of a medical provider. Additionally, some employers and their insurance companies have contractually negotiated a best price fee with medical providers and have an established medical care networks, consequently restricting the employee's free selection.
A recent article authored by Peter Scardino is the chief of surgery at Memorial Sloan Kettering Cancer Center (MSK) focuses on the need to select the best surgeon in order to obtain the best outcome.
“You can think of surgery as not really that different than golf.” Peter Scardino is the chief of surgery at Memorial Sloan Kettering Cancer Center (MSK). He has performed more than 4,000 open radical prostatectomies. “Very good athletes and intelligent people can be wildly different in their ability to drive or chip or putt. I think the same thing’s true in the operating room.”
The difference is that golfers keep score. Andrew Vickers, a biostatistician at MSK, would hear cancer surgeons at the hospital having heated debates about, say, how often they took out a patient’s whole kidney versus just a part of it. “Wait a minute,” he remembers thinking. “Don’t you know this?”
“How come they didn’t know this already?”
In the summer of 2009, he and Scardino teamed up to begin work on a software project, called Amplio (from the Latin for “to improve”), to give surgeons detailed feedback about their performance. The program—still in its early stages but already starting to be shared with other hospitals — started with a simple premise: the only way a surgeon is going to get better is if he knows where he stands.
Vickers likes to put it this way. His brother-in-law is a bond salesman, and you can ask him, How’d you do last week?, and he’ll tell you not just his own numbers, but the numbers for his whole group.
Why should it be any different when lives are in the balance?
Click here to read the entire article: "Making the Cut: Which surgeon you get matters — a lot. But how do we know who the good ones are?"
Sunday, December 14, 2014
California Medical Review: STEVENS WRIT GRANTED
| Containment of medical costs remain a major issue in all workers' compensation programs. The California process of "independent medical review" has turned into a nightmare for injured workers, their families and their advocates. The long awaited constitutional challenge to the process is slowly making its way through the California judicial system. Time will tell whether the judicial resolution will emerge as a solution to what was just terrible legislation. Today's post is authored by Julius Young and is shared from workerscompzone.com/ Could the California courts finally be ready to rule on the constitutionality of Independent Medical Review? We may be on the verge of seeing that issue decided. On December 3, 2014, the California Court of Appeal First Appellate District Division One granted the petition for writ of review filed San Francisco attorney Joseph Waxman on behalf of Frances Stevens (the case is Frances Stevens, Petitioner, v. WCAB and Outspoken Enterprises/State Compensation Insurance Fund ADJ1526353). In June 2014 the Court of Appeal had summarily denied a petition for a writ filed by Waxman in April 2014. At that time Waxman had not exhausted his administrative remedies. Waxman did so and then refiled for the writ, which was then granted. The basis facts in the case are important. Stevens had been found permanently and totally disabled (100%) by the workers’ comp judge. Her condition required use of a wheelchair and defendant had provided assistance by a home health aide.... |
Saturday, August 2, 2014
$1,000 a pill: Will that kill or cure workers' compenstion
| Hepatitis is an occupationally related illness and treatment for the disease may now even become more expensive in the short run. How this impacts the system may predict the future of pharmacuetical costs. This post is shared from thehill.com CVS Caremark is siding with the pharmaceutical industry over the rising costs of specialty drugs. In an editorial in the Journal of the American Medical Association, Troyen Brennan, chief medical officer at CVS, and William Shrank, the company’s chief scientific officer, defended Gilead’s hepatitis C drug Sovaldi, which costs $1,000 a pill. Brennan and Shrank say the drugs value should include its effectiveness compared to other treatments, how it improves quality of life for patients and how it can reduce the overall cost of healthcare. “While a daily oral medication that costs $1,000 per pill gains attention, the more important issue is the number of people eligible for treatment,” they said. They point out previous hepatitis C treatments had terrible side effects and were less effective, leading doctors to hold back from prescribing them. They also note that while Sovaldi has a monopoly on the market right now, a half dozen new hepatitis C drugs are excepted to be available in the next 4 years and will likely drive down the cost of the drug as competition increases. One regiment of the drug can cost well over $84,000 and 3.2 million people in the U.S. are estimated to have hepatitis C. Sovaldi has... |
Thursday, October 10, 2013
Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending
A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. A 55-year-old Mississippi man with severe hypertension and kidney disease is repeatedly hospitalized for worsening heart and kidney failure; doctors don't know that his utilities have been disconnected, leaving him without air conditioning or a refrigerator in the sweltering summer heat. A 42-year-old morbidly obese woman with severe cardiovascular problems and bipolar disorder spends more than 300 days in a Michigan hospital and nursing home because she can't afford a special bed or arrange services that would enable her to live at home.
 Sometimes known as super-utilizers, high-frequency patients or frequent fliers, these patients typically suffer from heart failure, diabetes and kidney disease, along with a significant psychiatric problem. Some are... |
Saturday, August 31, 2013
AMA President Optimistic About A Fix For Medicare’s Doctor Payment Formula
Known as the “sustainable growth rate” or SGR, the formula routinely threatens double-digit payment reduction to doctors until Congress steps in at the last minute to stop the cuts. Currently a 25 percent cut looms Jan. 1 unless Congress takes action again. An admitted optimist, Hoven says she sees plenty of evidence to support her view that Congress is prepared to pass a permanent SGR fix this year. The AMA president points to wide bipartisan support in both chambers. She notes that the House Energy and Commerce Committee passed SGR legislation before the August break — well before the usual end-of-the-year scramble that has been the usual path to a short- term SGR fix. The House Ways and Means and Senate Finance panels are also actively working on a solution. “This is different. This is palpably different,” Hoven says in an interview. According to the Congressional Budget Office, replacing the SGR would cost about $140 billion, down from earlier estimates as high as $300 billion. But in this era of deficit reduction, it’s unclear where Congress can find that much cash for anything, let alone to pay for the doc fix. Expect a big battle if lawmakers, as they have in the past, turn to other Medicare providers, such as hospitals, home health... |
Related articles
- Changes to California Insurance Don't Help (workers-compensation.blogspot.com)
- Why Overturning DOMA Is a Win for Employee Rights (workers-compensation.blogspot.com)
- UPS Won't Insure Spouses Of Some Employees (workers-compensation.blogspot.com)
- Administration Urges Rate Changes for US FELA Benefits (workers-compensation.blogspot.com)
- Garlock testimony switches to financial liability (workers-compensation.blogspot.com)
- Asbestos Bankruptcy: Judge denies motion to keep Garlock trial open (workers-compensation.blogspot.com)
Wednesday, August 28, 2013
Jobs are coming back, but they don't pay enough
The good news as Labor Day approaches: Jobs are returning. The bad news: Most of them pay lousy wages and provide low, if not nonexistent, benefits. The trend toward lousy wages began before the Great Recession. According to a new report from the Economic Policy Institute, weak wage growth between 2000 and 2007, combined with wage losses for most workers since then, means that the bottom 60 percent of working Americans are earning less now than 13 years ago. This is also part of the explanation for why the percentage of Americans living below the poverty line has been increasing even as the economy has started to recover — from 12.3 percent in 2006 to around 14 percent this year. More than 35 million Americans now live below the poverty line. Many of them have jobs. The problem is that these jobs just don't pay enough to lift their families out of poverty. |
Wednesday, August 21, 2013
Workers' Compensation Benefits, Employer Costs Rise with Economic Recovery
After declining in the wake of the recession, workers’ compensation benefits paid to injured workers and costs borne by employers increased in 2011 as the U.S. economy continued to recover, according to a new report by the National Academy of Social Insurance (NASI).
Total benefits rose by 3.5 percent to $60.2 billion. The benefits include a 4.5 percent rise in medical care spending to $29.9 billion and a 2.6 percent rise in wage replacement benefits to $30.3 billion. Total costs to employers rose by 7.1 percent to $77.1 billion.
"Workers’ compensation often grows with the growth in employment and earnings,” said Marjorie Baldwin, chair of NASI’s Workers’ Compensation Data Panel and Professor of Economics in the W.P. Carey School of Business at Arizona State University. When benefits and costs are measured relative to total covered wages, then benefits remained unchanged, and costs to employers rose very modestly (to $1.27 per $100 of wages) after declining in the previous five years.
[Click here to see the rest of this post]Total benefits rose by 3.5 percent to $60.2 billion. The benefits include a 4.5 percent rise in medical care spending to $29.9 billion and a 2.6 percent rise in wage replacement benefits to $30.3 billion. Total costs to employers rose by 7.1 percent to $77.1 billion.
"Workers’ compensation often grows with the growth in employment and earnings,” said Marjorie Baldwin, chair of NASI’s Workers’ Compensation Data Panel and Professor of Economics in the W.P. Carey School of Business at Arizona State University. When benefits and costs are measured relative to total covered wages, then benefits remained unchanged, and costs to employers rose very modestly (to $1.27 per $100 of wages) after declining in the previous five years.
| Workers’ Compensation Benefits, Coverage, and Costs, 2011 | ||
| Covered workers (in thousands) | ||
| Covered wages (in billions) | ||
| Workers' compensation benefits (in billions) | ||
| Cash benefits | $30.3 | 2.6% |
| Employer costs (in billions) | $77.1 | 7.1% |
| Amounts per $100 of covered wages | ||
| Cash payments to workers | ||
| Source: National... | ||
Friday, July 26, 2013
The 10 Highest Medical Cost Jurisdictions for Medicare
A recent study highlights the nation's disparity on the cost of medicine. The study also recommends that Medicare continue to pay varying medical fees by jurisdiction. In many states, workers' compensation medical fees are based upon Medicare guidelines.
"For over three decades, researchers have documented large, systematic variation in Medicare fee-for-service spending and service use across geographic regions, seemingly unrelated to health outcomes. This variation has been interpreted by many to imply that high spending areas are overusing or misusing medical care. Policymakers, seeking strategies to reduce Medicare costs, naturally wonder if cutting payment rates to high cost areas would save money without adversely affecting Medicare beneficiary health care quality and outcomes.
"For over three decades, researchers have documented large, systematic variation in Medicare fee-for-service spending and service use across geographic regions, seemingly unrelated to health outcomes. This variation has been interpreted by many to imply that high spending areas are overusing or misusing medical care. Policymakers, seeking strategies to reduce Medicare costs, naturally wonder if cutting payment rates to high cost areas would save money without adversely affecting Medicare beneficiary health care quality and outcomes.
Wednesday, July 24, 2013
Shifting the Blame: Doctors Look To Others To Play Biggest Role In Curbing Health Costs
Blame for increased medical costs is getting tossed around like a political football. Those deeply entrenched into the system are pointing their finger at "the other" party to shift responsibility. This reminds one of when CMS in 1980 urged the passage of the Medical Secondary Payer Act.
As this process continues, ultimately the US Government will be the final authority as Medicare ultimately rules the medical billing field and outcome based medicine seems to be the new goal.
Workers' Compensation system will ultimate adapt or be subsumed by the Medicare protocols in one fashion or another. Special interests will have little opportunity to cut out their specialized markets.
Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org
In a study, published Tuesday in the Journal of the American Medical Association, Mayo Clinic researchers surveyed more than 2,500 doctors to assess their views of different approaches to rein in the nation’s health care costs. The doctors were randomly selected from an American Medical Association database.
When it comes to controlling the country’s health care costs, doctors point their fingers at lawyers, insurance companies, drug makers and hospitals. But well over half acknowledge they have at least some responsibility as stewards of health care resources.Based on their findings, 59 percent of doctors believed they have some responsibility in holding down health care costs. Only 36 percent thought they have a major role.
Monday, June 17, 2013
Proposed Medicare Payment Reductions Will Impact Workers' Compensation Costs
A government Medicare advisory panel reported on Friday that sweeping changes should be implemented to reduce increasing medical costs, including higher costs associated with hospital purchased physician practices. The impact of those proposed adjustments will significantly impact the national workers' compensation systems because of both direct and indirect links between the two programs, including medical fee schedules, and Medicare Secondary Payment reimbursements.
The Medicare Payment Advisory Commission (MedPAC) releases its June 2013 Report to the Congress:
Medicare and the Health Care Delivery System.
According to Commission Chair Glenn Hackbarth, “This report can inform a dialogue about future
directions for the Medicare program, as well as about technical refinements to existing Medicare
payment policy. Whether broad or narrow, the Commission’s work aims to balance the interests of
Medicare beneficiaries, health care providers, and tax payers.”
Redesigning the Medicare benefit. In the report, the Commission continues its discussion of
possible ways to redesign the Medicare benefit by focusing on the concept we refer to as competitively
determined plan contributions (CPC). Under CPC, Medicare beneficiaries could receive care through
either a private plan or traditional fee-for-service (FFS), but the premium paid by the beneficiary might
vary depending on the coverage option they choose. How much the federal government pays for a
beneficiary’s care would be determined through a competitive process comparing the costs of available
options for coverage. The report identifies key issues to be addressed if the Congress wishes to pursue a
policy option like CPC. These include how benefits could be standardized for comparability, how to
calculate the Medicare contribution, the role FFS, and the structure of subsidies for low-income
beneficiaries.
Reducing Medicare payment differences across sites of care. Medicare’s payment rates often
vary for similar services provided to similar patients, simply because they are provided in different sites of
care. For example, Medicare pays 141 percent more for one type of echocardiogram when done in a
hospital outpatient department than when it is done in a freestanding physician’s office. If Medicare pays a
higher rate for a service in one setting over another, program spending increases and beneficiaries pay
more in cost sharing without a corresponding increase in quality of care.
The Commission previously recommended reducing the rate Medicare pays for basic office visits from the
payment rate in the outpatient setting to the physician office rate. Using similar criteria, this report identifies
additional services that may be eligible for equalizing or narrowing payment differences across settings.
Bundling post-acute care services. Each year, about one-quarter of Medicare beneficiaries receive
care following a hospitalization from a post-acute care provider, such as a skilled nursing facility, home
health agency, or inpatient rehabilitation facility. However, nationwide the use of these services varies
widely, for reasons not explained by differences in beneficiaries’ health status. Under traditional
Medicare, the program pays widely varying rates for different settings and—characteristic of FFS—pays
based on the volume of care provided, without regard to quality or resource use.
Medicare has begun to explore the possibility of bundling services as a way to encourage providers to
coordinate and furnish needed care more efficiently. In this report, the Commission explores the
implications for quality and program spending for different design features of the bundles, such as the
services included, the length of time covered by the bundle, and the method of payment.
Reducing hospital readmissions. In 2008, the Commission recommended a hospital readmissions
reduction program to improve patient experience and reduce Medicare spending. In 2012, Medicare
began such a program, penalizing hospitals that have high rates of Medicare beneficiaries being
readmitted to the hospital within 30 days of discharge. The readmission penalty has given hospitals a
strong incentive to improve care coordination across providers, and for that reason Medicare should
continue to implement the policy. In this report, the Commission suggests further refinements to
improve incentives for hospitals and generate program savings through reduced readmissions rather than
higher penalties.
Payments for hospice services. The Medicare hospice benefit provides beneficiaries an important
option for end-of-life care. At the same time, the Commission has identified several problems in the way
Medicare pays for hospices that may lead to inappropriate use of the benefit. The report presents
information on the prevalence of long-stay patients and the use of hospice services among nursing home
patients—both of which may inform policy development in the hospice payment system in the future. It
also presents further evidence to support the Commission’s March 2009 recommendations to revise the
hospice payment system.
Improving care for dual-eligible beneficiaries. Beneficiaries eligible for both Medicare and
Medicaid—many of whom have complex medical and social needs—often have trouble accessing
services and receive little care coordination, resulting in poorer health outcomes and higher spending
relative to other beneficiaries. Programs that coordinate dual-eligible beneficiaries’ Medicare and
Medicaid benefits have the potential to improve care for this population. In the report, the Commission
notes that federally qualified health centers and community health centers may be uniquely positioned to
coordinate care for dual-eligible beneficiaries because they provide primary care, behavioral health
services, and care management services, often at the same clinic site.
Mandated reports. The report includes three chapters that fulfill Congressional mandates: one on
Medicare ambulance add-on payments, a second on geographic adjustment of fee schedule payments for
the work effort of physicians and other health professionals, and a third on Medicare payment for
outpatient therapy services. In each case, the Commission considers the existing policies—which are not
permanent statutory provisions—and examines the effect of their continuation or termination on
program spending, beneficiaries’ access to care, and the quality of care beneficiaries receive, as well as
their potential to advance payment reform.
The three congressionally mandated reports are described in further detail in separate fact sheets, posted
on MedPAC’s website. The full report can be downloaded from MedPAC’s website:
http://medpac.gov/documents/Jun13_EntireReport.pdf
Read more about Medicare and Workers' Compensation
The Medicare Payment Advisory Commission (MedPAC) releases its June 2013 Report to the Congress:
Medicare and the Health Care Delivery System.
According to Commission Chair Glenn Hackbarth, “This report can inform a dialogue about future
directions for the Medicare program, as well as about technical refinements to existing Medicare
payment policy. Whether broad or narrow, the Commission’s work aims to balance the interests of
Medicare beneficiaries, health care providers, and tax payers.”
Redesigning the Medicare benefit. In the report, the Commission continues its discussion of
possible ways to redesign the Medicare benefit by focusing on the concept we refer to as competitively
determined plan contributions (CPC). Under CPC, Medicare beneficiaries could receive care through
either a private plan or traditional fee-for-service (FFS), but the premium paid by the beneficiary might
vary depending on the coverage option they choose. How much the federal government pays for a
beneficiary’s care would be determined through a competitive process comparing the costs of available
options for coverage. The report identifies key issues to be addressed if the Congress wishes to pursue a
policy option like CPC. These include how benefits could be standardized for comparability, how to
calculate the Medicare contribution, the role FFS, and the structure of subsidies for low-income
beneficiaries.
Reducing Medicare payment differences across sites of care. Medicare’s payment rates often
vary for similar services provided to similar patients, simply because they are provided in different sites of
care. For example, Medicare pays 141 percent more for one type of echocardiogram when done in a
hospital outpatient department than when it is done in a freestanding physician’s office. If Medicare pays a
higher rate for a service in one setting over another, program spending increases and beneficiaries pay
more in cost sharing without a corresponding increase in quality of care.
The Commission previously recommended reducing the rate Medicare pays for basic office visits from the
payment rate in the outpatient setting to the physician office rate. Using similar criteria, this report identifies
additional services that may be eligible for equalizing or narrowing payment differences across settings.
Bundling post-acute care services. Each year, about one-quarter of Medicare beneficiaries receive
care following a hospitalization from a post-acute care provider, such as a skilled nursing facility, home
health agency, or inpatient rehabilitation facility. However, nationwide the use of these services varies
widely, for reasons not explained by differences in beneficiaries’ health status. Under traditional
Medicare, the program pays widely varying rates for different settings and—characteristic of FFS—pays
based on the volume of care provided, without regard to quality or resource use.
Medicare has begun to explore the possibility of bundling services as a way to encourage providers to
coordinate and furnish needed care more efficiently. In this report, the Commission explores the
implications for quality and program spending for different design features of the bundles, such as the
services included, the length of time covered by the bundle, and the method of payment.
Reducing hospital readmissions. In 2008, the Commission recommended a hospital readmissions
reduction program to improve patient experience and reduce Medicare spending. In 2012, Medicare
began such a program, penalizing hospitals that have high rates of Medicare beneficiaries being
readmitted to the hospital within 30 days of discharge. The readmission penalty has given hospitals a
strong incentive to improve care coordination across providers, and for that reason Medicare should
continue to implement the policy. In this report, the Commission suggests further refinements to
improve incentives for hospitals and generate program savings through reduced readmissions rather than
higher penalties.
Payments for hospice services. The Medicare hospice benefit provides beneficiaries an important
option for end-of-life care. At the same time, the Commission has identified several problems in the way
Medicare pays for hospices that may lead to inappropriate use of the benefit. The report presents
information on the prevalence of long-stay patients and the use of hospice services among nursing home
patients—both of which may inform policy development in the hospice payment system in the future. It
also presents further evidence to support the Commission’s March 2009 recommendations to revise the
hospice payment system.
Improving care for dual-eligible beneficiaries. Beneficiaries eligible for both Medicare and
Medicaid—many of whom have complex medical and social needs—often have trouble accessing
services and receive little care coordination, resulting in poorer health outcomes and higher spending
relative to other beneficiaries. Programs that coordinate dual-eligible beneficiaries’ Medicare and
Medicaid benefits have the potential to improve care for this population. In the report, the Commission
notes that federally qualified health centers and community health centers may be uniquely positioned to
coordinate care for dual-eligible beneficiaries because they provide primary care, behavioral health
services, and care management services, often at the same clinic site.
Mandated reports. The report includes three chapters that fulfill Congressional mandates: one on
Medicare ambulance add-on payments, a second on geographic adjustment of fee schedule payments for
the work effort of physicians and other health professionals, and a third on Medicare payment for
outpatient therapy services. In each case, the Commission considers the existing policies—which are not
permanent statutory provisions—and examines the effect of their continuation or termination on
program spending, beneficiaries’ access to care, and the quality of care beneficiaries receive, as well as
their potential to advance payment reform.
The three congressionally mandated reports are described in further detail in separate fact sheets, posted
on MedPAC’s website. The full report can be downloaded from MedPAC’s website:
http://medpac.gov/documents/Jun13_EntireReport.pdf
Read more about Medicare and Workers' Compensation
May 18, 2013
A NJ Superior Court deemed a proposed Medicare Set-Aside Agreement to be satisfactory to protect Medicare's interests and granted a Motion to Enforce a Pending Settlement. This action by the Court was taken after CMS ...
Mar 29, 2013
A new Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available to be downloaded on the CMS (Centers for Medicare & Medicad Services) website.
Jan 11, 2013
"The legislation changes the way Medicare collects money from people whose negligence caused a patient to incur medical bills. Murphy said the new law will streamline an outdated process, making it easier to close cases ...
Monday, February 11, 2013
Jobs, Growth & Universal Healthcare
Robert Reich, in a 3 minute video, states the reasons why jobs, growth and universal healthcare are needed to expand the US economy.
This is reflective of the issues plaguing the nation's workers' compensation system, especially soaring medical delivery costs (administrative, clinical and pharmaceutical).
Read more about "universal healthcare" and workers' compensation:
Feb 01, 2013
Medical care afforded by workers' compensation delivery systems will ultimately be merged into a universal national program, despite all the opposition along the way. My friend, and cycling inspiration, who keeps me trying to ...
Nov 09, 2012
Going forward it is imperative that a universal medical program be established to provide medical treatment for all work-related occupational injuries and exposures. The delay and denial of medical benefits to those who suffer ...
Jul 05, 2012
Those efforts demonstrate a commitment to bring the nation ever closer to a universal care medical program incorporating the entire patchwork of workers' compensation medical delivery systems. The US Supreme Court has ...
Mar 05, 2011
Vermont Universal Health Care to Embrace Workers Compensation. A two-stage bill in Vermont is geared to establishing a single-payer medical health care system that would include medical for workers' compensation ...
Subscribe to:
Comments (Atom)