Hospital Controlled Physician Access and Workers' Compensation

As hospital consolidation of physician practices by acquisition continues, the question of the impact on control of the cost workers' compensation medical delivery remains uncertain.

Hospitals, supported by private equity, are now buying physician practices at a greater pace than ever before making choices for physician care more limited and at a higher cost. The New York Times reports that physicians who sell their practices hospitals find that they are under pressure to meet economic challenges of hospital targeted fees and are restricted in the referral of patients.

"....the consolidation of health care may be coming at a hefty price. By one estimate, under its current reimbursement system, Medicare is paying in excess of a billion dollars a year more for the same services because hospitals, citing higher overall costs, can charge more when the doctors work for them. Laser eye surgery, for example, can cost $738 when performed by a hospital-employed doctor, compared with $389 when done by an unaffiliated doctor, according to national estimates by the independent Congressional panel that oversees Medicare. An echocardiogram can cost about twice as much in a hospital: $319, versus $143 in a doctor’s office."

Read the complete article:  A Hospital War Reflects a Bind for Doctors in the U.S.

Read more about "medical Costs" and workers' compensation

Workers' Compensation Jeopardy: Romney and Medical Costs

Nov 01, 2012

Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...

http://workers-compensation.blogspot.com/

Report: Poor Health Costs Cost US $576 Billion Yearly

Nov 22, 2012

A report issued by NCCI concludes that medical costs in Workers' Compensation were higher in some instances than in Group Health Plans. The main findings were: For comparable injuries, when WC pays higher prices than ...

http://workers-compensation.blogspot.com/

Workers' Compensation: The Costs and Complications of The Other ...

Nov 15, 2012

“While the average medical cost for a workers compensation claim is approximately $6,000, the medical cost of an individual claim can be a few hundred dollars or millions of dollars. In 2010, an NCCI study found that claims ...

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Workers' Compensation: A Single Payer System Will Solve the ...

Nov 29, 2012

The perpetual cost generator that continues to rage out of control in workers' compensation programs is the medical component. Medical costs are crashing the system to failure across the country, with no hope in sight for ...

http://workers-compensation.blogspot.com/

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The "New Normal," Special Compensation Funds and Viability

An Arizona Appeals Court has ruled that Special Funds [Second Injury Fund] used to pay workers' compensation benefits and fund the administrative agency, can be transferred to the state’s general treasury and used to fund the state’s general liabilities.

The Court , in allowing $4.7 Million to be transferred by the state Legislature to the general treasury, held that the special fund was funding source subject to legislative review and appropriation.  “….Because the legislature set the  percentage rate of premiums from the  State  Compensation Fund and private carriers to be placed in the Special Fund, the funds are public monies,” and is therefore a public fund.

Second Injury Funds have been phased out throughout the US. Major industrial states have eliminated them over the past several decades, a move historically supported as employers, insurance companies and the American Bar Association.

New Jersey still has such a fund, ie., The Second Injury Fund. It has been decimated economically after the economic downturn and a series of similar repeated raids by the legislature. While a constitutional amendment has been enacted to prohibit raids, the economy has not increased enough to withstand the fiscal challenges.

Other states face similar problems. Missouri’s fund has not been able to pay beneficiaries for decades as it heads for extinction. New York’s fund has been challenged since assessments are soaring beyond what Industry feels are sustainable in the week economy.

The real challenge facing the nation’s patchwork of workers’ compensation programs is how to fund them generally in light of increased medical costs, lack of premiums due to unemployment and the “new normal” now emerging across  the nation.

Read the decision: Industrial Commission of Arizona, et al. v. Janice K. Brewer, Governor, et al. , 1 CA-CV 11-0119 , (AZ App 2012), decided 11/23/2012.

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Workers' Compensation Jeopardy: Romney and Medical Costs

Mitt Romney

Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers’ compensation medical treatment. Proposed changes to the Federal program will indirectly impact the patchwork of workers' compensation programs by removing federally mandated fee regulation embraced under Obamacare.

Directly or indirectly, most workers' compensation programs have medical treatment and pharmaceutical pricing costs that are geared to Federal payment schedules regulated by the Medicare and Medicaid systems. Additionally, the Medicare Secondary Payer Act mandates reimbursement to the Federal, and State administered, and in many instances the Federal costs are less than the customary payments under workers’ compensation systems. Therefore the Federal programs, even if conditionally paid, result in lower payments eventually by employers and workers' compensattion insurance companies who in term are required to reimburse the Federal agency.

Additionally, the elimination of the Federal controls, that put a lid on the cost of benefits, would adversely affect the workers' compensation programs by creating havoc by eliminating the certainty of reduced costs, especially where future costs are concerned, ie. catastrophic care scenarios and latent diseases, ie. asbestosis.

Paul Krugman (NYTimes) points out, “But one thing is clear: If he [Romney] wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.”

The Romney agenda to dismantle the present medical benefit program will only further jeopardize the economic stability of the nation’s workers’ compensation system. 

....
Jon L.Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). 
Read More About Romney and Medical Care

Workers' Compensation: Romney, Regulation & Risk of Cancer

Oct 07, 2012

The Chemical Lobby, and those who advocate of their behalf for less regulation, including presidential candidate Mitt Romney are now advocating for less regulation and the elimination of the semi-annual publication The ...

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Workers' Compensation: Mitt Romney Plans to Cut Benefits to ...

Dec 26, 2011

"Romney and his aides have designed his rhetoric to define pretty much all spending on entitlements, including provisions for the injured, unemployed, sick, disabled or elderly as benefits to the poor who, Romney implies, are ...

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Merit-Based Workers Compensation: The Romney-Gingrich Plan

Feb 01, 2012

While both leading Republican candidates are throwing darts at each other on many points, the basic philosophy of both Mitt Romney and Newt Gingrich is to extinguish the so-called "entitlement society." They claim Barack ...

http://workers-compensation.blogspot.com/

Clint Eastwood at the 2012 Republican National Convention

Sep 04, 2012

Mr. Eastwood is a former businessman and, according to Republican nominee Mitt Romney, that is an essential qualification for President. So maybe that's why Eastwood was given such a prominent role before Romney ...

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Health Care Continues to Eat Away at Employee Earnings

Family Health Premiums Rise 4 Percent to Average $15,745 in 2012, National Benchmark Employer Survey Finds

Throughout the nation Workers' Compensation systems have been impacted by health care costs that now take a large piece of the premium dollar. Traditional health care offered by employers mirrors the same problem of economic stress. Running two parallel systems creates added costs and  delays the delivery of medical care. The recent Kaiser Survey just released for 2012 reports that costs in the health care field continue to outpace employee compensation. 

Annual premiums for employer-sponsored family health coverage reached $15,745 this year, up 4 percent from last year, with workers on average paying $4,316 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2012 Employer Health Benefits Surveyreleased today.

This year’s premium increase is moderate by historical standards, but outpaced the growth in workers’ wages (1.7 percent) and general inflation (2.3 percent). Since 2002, premiums have increased 97 percent, three times as fast as wages (33 percent) and inflation (28 percent).

“In terms of employee insurance costs, this year’s 4 percent increase qualifies as a good year, but it still takes a growing bite out of middle-class workers’ wages, which have been flat or falling in real terms,” Kaiser President and CEO Drew Altman, Ph.D. said.

“Premium growth is at historic lows, which greatly benefits workers. Continuing to ensure that Americans have coverage options that are affordable is vitally important for our nation’s health,” said Maulik Joshi, Dr.P.H., president of HRET and senior vice president for research at the American Hospital Association.

The 14th annual Kaiser/HRET survey of more than 2,000 small and large employers provides a detailed picture of trends in employer-sponsored health insurance costs and coverage. In addition to the full report and summary of findings being released today, the journal Health Affairs is publishing a Web First article with select findings, and Dr. Altman authored a “Pulling It Together” column reflecting on this year’s results.

The survey reveals significant differences in the benefits and worker contributions toward family premiums between firms with many lower-wage workers (at least 35 percent of workers earn $24,000 or less a year) and firms with many higher-wage workers (at least 35 percent of their workers earn $55,000 or more a year).

Workers at lower-wage firms on average pay $1,000 more each year out of their paychecks for family coverage than workers at higher-wage firms ($4,977 and $3,968, respectively). This occurs even though the firms with many lower-wage workers on average pay less in total premiums for family coverage than firms with many higher-wage workers ($14,694 and $16,427, respectively).

In addition, workers at lower-wage firms are also more likely to face high deductibles than those at higher-wage firms. Specifically, 44 percent of covered workers at firms with many low-wage workers face an annual deductible of $1,000 or more, compared with 29 percent of those at firms with many high-wage workers. Across all employers, a third of covered workers (34 percent) face a deductible of that size, including 14 percent with deductibles of at least $2,000 annually.

“This year’s survey suggest that working families at the low end of the wage scale face significant out of pocket costs for coverage,” said study lead author Gary Claxton, a Kaiser Vice President and director of the Foundation’s Health Care Marketplace Project. “Firms with many lower-wage workers ask employees to pay more out of pocket than firms with many higher-wage workers even though the coverage itself tends to be less comprehensive.”

Health Reform and Employers

The survey estimates that 2.9 million young adults are currently covered by employer plans this year as a result of a provision in the 2010 Affordable Care Act that allows young adults up to age 26 without employer coverage of their own to be covered as dependents on their parents’ plan. That’s up from the 2.3 million in the 2011 survey. Young adults historically have been more likely to be uninsured than any other age group.

The survey also finds that 48 percent of covered workers are in “grandfathered” plans as defined under health reform, down from 56 percent last year. Grandfathered plans are exempted from some health reform requirements, including covering preventive benefits with no cost sharing and having an external appeals process. To retain this status, employers must not make significant changes to their plans to reduce benefits or increase employee costs.

Employer Expectations for 2013

In addition to the comprehensive survey conducted in the spring, employers were asked in August whether they had information about the change in premiums (or total cost for self-funded plans) for their current health plan with the largest enrollment. The average increase reported by employers who had received information for their current plan is 7 percent.

These early reports may not match what employers and workers ultimately end up paying next year, as firms can raise deductibles or otherwise change the health benefits and plans they offer to lower premiums. This year, for example, more than half (54 percent) of employers who offer health benefits reported that they had shopped around for new coverage. Of that group, significant shares switched carriers (18 percent) or changed the type of plans they offer (27 percent).

Other findings from the study include:
Worker-only coverage. Premiums for worker-only health coverage increased 3 percent in 2012 to reach $5,615 annually. Workers on average pay $951 toward this coverage.
Offer rate. This year, 61 percent of firms offer health benefits to their workers – statistically unchanged from last year. 

Cost-sharing for office visits, emergency care and drugs. Covered workers facing co-payments for in-network physician office visits on average pay $23 for primary care and $33 for specialty care. For emergency-room visits, average co-pays are $118. For drug plans with three or more tiers, average co-pays are $10 for generic drugs, $29 for preferred brand-name drugs, $51 for non-preferred brand-name drugs, and $79 for specialty drugs.
Domestic partner benefits. In 2012, 31 percent of employers offer health benefits to same-sex domestic partners, up from 21 percent three years earlier. This year 37 percent of firms offer such benefits to unmarried opposite-sex partners, up from 31 percent in 2009.
Flexible Spending Accounts and Pre-Tax Premiums. Large employers are more likely than small ones to allow workers to pay their share of premiums with pre-tax income (91 percent, compared to 41 percent) and to contribute pre-tax dollars to Flexible Spending Accounts (76 percent, compared to 17 percent).

Now in its 14th year, the survey is a joint project of the Kaiser Family Foundation and the Health Research & Educational Trust. The survey was conducted between January and May of 2012 and included 3,326 randomly selected, non-federal public and private firms with three or more employees (2,121 of which responded to the full survey and 1,205 of which responded to a single question about offering coverage). A research team at Kaiser, HRET and NORC at the University of Chicago, led by Kaiser’s Gary Claxton, designed, conducted and analyzed the survey. For more information on the survey methodology, please visit the Survey Design and Methods Section at http://ehbs.kff.org.

....
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

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Clint Eastwood at the 2012 Republican National Convention

Sep 04, 2012

While both Democrats (79%) and Republicans (52%) agree that the nation's health care system is "poor," both Democrats (46%) and Republicans (28%) agree that it does not need to be completely rebuilt. Both parties content ...

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Healthcare Budget Double Talk and the Walker Recall

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NIOSH Alerts Home Healthcare Workers About Latex Allergies

Feb 15, 2012

NIOSH (The National Institute for Occupational Health and Safety) has published a booklet to educate Home Healthcare Workers about preventing latex allergies. Latex products are made from natural rubber, and sensitivity...

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Home Hospitalization

An innovated path to medical care is the concept of home hospitalization. It provides both both patient comfort and cost saving. This approach, facilitated by the advent of telecommunications, is being advance in  is now being expanded in many jurisdictions including: Illinois, Rhode Island, New York, Florida and Minnesota. 


With the soaring cost of workers' compensation payments now exceeding 50% of payments, new and innovative approaches are being advanced.


Click here to read more: Some Patients Can Choose To Be Hospitalized At Home

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Unsustainable

NCCI, a national workers' compensation rating company, reported yesterday that the workers' compensation industry is in trouble and that "NCCI's current analysis shows that the combined ratios for workers compensation remain at unsustainably high levels, and investment returns are not high enough to generate operating returns near the cost of capital." One on the major soaring costs was reported to be medical costs.

Click here to read the entire report: Complete State of the Line Presentation from AIS 2012

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