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2024 WCRI Conference Posted Live – Day One

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2024 WCRI Conference – I will try to post this live.  No guarantees about posting everything. Please excuse typos, etc.

Day One Keynote: Prof. David Cutler, Harvard University

A very disturbing chart – people with college degrees or with more money tend to live much longer.

 Tue Mar 5, 2024
 8:45 AM – 10:00 AM
Audience Survey – Healthcare will
A.  will improve – 0%
B.  stay the same – 70%
C. will crash  – 30%
Non-COVID healthcare fell off a cliff – healthcare has not fully recovered.
 Demand Side
Telehealth converted 2/3 back to in-person medical visits
Psychiatry and Psychology had many more visits in telehealth since COVID
Supply Side
Acute Care Beds are in low supply
The number of Hospitals is down 20%
Prior Authorization is a large trend – health insurers
5000 prior authorization codes 
Healthcare investors treat  hospitals/clinics like ATM
Private Equity Firms are heavily into the healthcare markets – hospitals, dentists – and can manipulate supply to inflate pricing
Death of Hahnemann Hospital
Most calls to hospitals are the directions to enter into their GPS – wow!

Presnter’s Outlook

Survey – Healthcare will
A.  will improve – 40%
B.  stay the same – 40%
C. will crash  – 20%
Capitated Payment System Question –
Preventative Care – Medicare spending slowdown – by condition – single biggest condition – Acute Heart Care -Anti-hypertensive and Statins may have been the reason for Heart Care decrease in spending
The metrics of healthcare are a mixed bag.
Workers Compensation – surveys may not be the best measure – if a patient wants an MRI, then they will get one.
How do we deal with the less-educated having worse health outcomes?  This is a very difficult question to answer.   Deaths of Despair and the *** of Capitalism.  Targeted health interventions might work. The Ryan White Act – obesity reduction and smoking cessation.
Patient Outcome Tools – smartphones may be a key to future health monitoring

Medical Payments in Workers’ Compensation During the Recent Inflationary Period

 Tue Mar 5, 2024
 10:30 AM – 11:15 AM
Speaker

Senior Policy Analyst
WCRI

Economist
WCRI
Moderator

VP of Research
WCRI

From WCRI –

The steep growth in consumer prices for energy, food, and housing over the last few years created concerns about potential rising inflation in medical care. This session examines to what extent the recent sizable price growth for all goods and services spread to the healthcare sector in general and to workers’ compensation in particular.


A picture is worth 1,000 words so I thought it was best to add in a few slides from the presentation.  As with the NCCI studies, medical price inflation was lower than CPI.

As I have written very often, fee schedules provide medical care at a lower cost.  I have not seen where the level of care was reduced due to medical providers not treating workers comp patients due to the fee schedules.
The following chart shows that CMS (Medicare) increased its Medicare Fee Schedules due to inflationary changes
The four things that will increase Workers Comp medical payments in the future:
  • Inflation – check the chart above, as many states use the Medicare Fee Schedules as a basis for setting their WC fee schedules
  • Hospital Payments – the main driver of medical cost growth in Workers Comp and other markets
  • Utilization – Workers Comp medical growth will occur after recovering from the pandemic
  • WC Fee Schedules – see the first point – Medicare price inflation = Workers Comp medical treatment inflation that will take time to register in the fee schedule changes over time.

The consolidation of medical care facilities and practices –

  • Increased 8% in fee schedule states
  • Increased 10 – 14% in non-fee schedule states

 

2024 WCRI Conference – Psychological Risk Factors and Functional Recovery

 Tue Mar 5, 2024
 11:15 AM – 12:00 PM
Speaker: Dr. Vennela Thumula
Moderator: Randall Lea
There is little empirical data on this subject.
From WCRI –
This session provides insights into the prevalence of psychological risk factors, including fear avoidance or negative coping skills—often termed “yellow flags”—among physical therapy patients with low back pain. It also offers estimates on the impact of these factors on the functional recovery of injured workers, as well as a comparison with the recovery of non-workers compensation patients with similar conditions
___________________
What two words best describe the prevalence and impact of High-Risk Psychosocial Factors (PFs) on WC patients?
High: One-third to one-half of the injured workers
Important: High-risk PFs in WC result in less functional improvement (40% less) when compared with other workers who do not have high-risk PFs

2024 WCRI Conference – Day One Afternoon

Employer Panel
 Tue Mar 5, 2024
 1:30 PM – 2:30 PM
Location: America Ballroom
Speaker: Michele Maffei (Publix Supermarkets), Sharon DelGuercio, (Disney World), Charles Kyles (Duke University),  Moderator: Kathy Fisher (WCRI)
Please join this employer panel for a lively discussion of their key areas of focus in their workers’ compensation programs such as labor shortages, access to care, return to work, and legislative/judicial activity they are keeping a close eye on.

Labor Shortages

Sharon – all-time low turnover now, stabilized

Michele – a large number of part-time employees, increase in minimum wage, ESOP program successful, stabilized workforce

Charles – massive nurse burnou,  post-offer  testing program was eliminated due to barriers in hiring

Drug Testing

Sharon – no drug testing

Michele – no drug testing

Charles – limited drug testing

Claims Model

Michele – advocacy-based workers comp claims program

Sharon – 100 people in their claims department, team up with the safety department,

Access to Care Issues  – Behavioral Health

Charles – access to care issues, recent providers declining to see workers comp patients

Sharon/Michele – had issues with the  number of behavioral health providers

Return to Work

Michele  – very strong return to work program, will return anyone to work, even amputees

Charles – strong return to work program that has been very successful

Sharon – robust return-to-work program, transitional-duty return-to-work program, 400 positions for transitional duty

Primary Focus

Charles – employee-centered program, workplace violence, rising concern patient or visitor violence, physical assault, workplace violence taskforce, hard security screening program, 300 weapons were found in the first year.  High level of low-severity violence in hospitals and urgent care clinics

Sharon – not a huge concern with violence

Legislation Affecting Their Programs

Michele- physician dispensing

Charles – 500-week TTD soft cap being challenged in court

Trends in Claims

Complex Claims and Recessionary Issues?

Michele/Charles/Sharon – Claim frequency is down, and claim severity is up due to claim complexity

Questions

  1. Return to work – no matter the restrictions return them to work or list of jobs to see if any fit the restrictions Charles – Duke does both, Sharon – tell us what they can do
  2. Access to care issues –  Michele – workers comp claims can be complex, so providers will not want to see people due to the paperwork. Sharon – Florida has paper overhead, much more complicated than group health, and will pay extra for Workers Comp medical care, Charles – medical providers do not want to enter into a legal system

 

Impact of Vertical Integration on the Utilization of Care

 Tue Mar 5, 2024  3:00 PM – 3:30 PM
Speaker: Bogdan Savych
Moderator: Eric Harrison
Medical markets are increasingly concentrated. This means that patients are more likely to be treated by physicians at sites owned by hospitals and health systems. This raises a policy concern that the increasing concentration of medical providers may lead to higher payments for medical care without corresponding improvements in patient outcomes, as well as changes in utilization.

In this session, we will examine how the growing consolidation of medical providers affects care delivered to workers with injuries.

The large percentage of vertically integrated physicians increased from 37% to 48%.  That level of growth is amazing.  This growth has had quite an effect on medical pricing.

The vertically integrated medical providers increased the number of providers significantly.  The percentage of providers per claim grew by 19%.

Excessive Heat and Work-Related Injuries

 Tue Mar 5, 2024
 3:30 PM – 4:30 PM
Speaker: David Bonauto, Sebastian Negrusa
As spells of excessive heat have become more increasingly frequent over the last few years, an emerging body of research is pointing to a substantial relationship between excessive heat and the frequency of work-related injuries. This session will provide an overview of recent research, offer the latest insights from WCRI work, and provide opportunities for a discussion of policy implications
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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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