Tag Archives: joe paduda

Who’s Going to Pay for the Opioid Crisis?

Insurers are loosening policy language to allow more treatment for opioid addiction. Treatment centers and providers are opening, expanding and increasing services to meet growing demand. Workers’ comp requires treatment for those addicted to or dependent on opioids, leading to higher costs for employers, insurers and taxpayers. Medicaid will be saddled with much of the burden, as addicts often lose their jobs and have no other coverage – so we taxpayers will foot the bill.

We know who’s going to be writing the checks – ultimately you and me and our nations’ employers, in the form of higher insurance premiums, higher taxes and lower earnings for employers.

That’s wrong. And not just-kinda-sorta-of-that’s-too-bad wrong, but ethically, morally and maybe even legally wrong.

See also: How to Attack the Opioid Crisis  

The purveyors of this poison have made billions by lying, deceiving and killing our fellow citizens. By crushing families, destroying towns, bankrupting businesses, ripping apart our social fabric.

And we’re left paying the bill in dollars, deaths and soul-searing pain.

I have a modest proposal.  Make the pill-pushers pay.

Congress should pass a bill, and the president should sign it, making the opioid industry pay for its sins — treatment coverage, a flat amount for each person who died on their poison and reimbursement for all past costs incurred by individuals, families, taxpayers and employers.  Bankrupt the industry, take every penny the owners have and use it to help those they’ve harmed.

Let’s call it the Corporate Opioid Responsibility Payment Service Establishment Act. CORPSE, for short

Make the bastards pay.

Drones Reducing Accidents on Job

One of the most dangerous jobs in America is power-line maintenance. More than 330 people were killed last year due to falls and electrocution while working on power lines, and thousands more were injured. Now one energy company is employing sophisticated drones to monitor power lines, allowing workers to trade the sometimes-scary task of climbing way up a swaying tower in possibly lousy weather to check out a junction for a ground-based drone control and monitoring job.

According to an AES exec: “We find that using drones, we can reduce the number of hazardous hours that it takes to do certain types of maintenance. And we can also enhance the efficiency of the business.”

And AES is not just focused on aerial drones to reduce occupational risks. It recently announced a program seeking unmanned methods of evaluating energy production and transmission equipment. The risk here is intense heat; when something goes awry, it often takes considerable time for the site to cool down enough for a human to enter and figure out what’s happened. AES is looking for ways to use “unmanned technology” to get in quickly, assess the problem and fix it.

See also: What Is the Future for Drones?  

Measure is the company working with AES; Measure is deep into multiple ways to use drones in heavy industry. For example:

  • shipboard workers using drones to check on container stability, possible fuel leaks, wiring and hoses
  • firefighters using drones’ heat-mapping capabilities to identify hotspots, vulnerable areas and trapped people
  • tower workers using drones to keep nesting birds at bay

What does this mean for you?

Fewer accidents, lower risks for workers, reduced workers’ comp premiums. 

And this is just the start.

Work Comp’s Future Is Not What You Think

Employment drives workers’ comp. More specifically: payroll, industry type and claim frequency.

Employment is the end-all, be-all of workers’ comp — for premiums and policies on the front end and for getting workers’ comp patients back to work when claims do happen.

So when a whole lot of jobs in a bunch of industries appear to be disappearing, we workers’ comp folks need to take notice.

If you insure, manage claims for, provide services to or otherwise work in the transportation/logistics industry, you’d best be watching developments in Pittsburgh and keeping your eye on Otto, the self-driving-truck company that Uber just bought for $680 million.

See also: States of Confusion: Workers Comp Extraterritorial Issues 

Uber is experimenting with self-driving cars in the Steel City, a big step on the way to fully automated driverless cars.

self-driving-uber

Ford is heavily involved and plans to have a self-driving car on the market in five years. Sign me up! As someone who spends way too much time behind the wheel, I’m all over this. Work, read, etc. while being transported to client meetings? Heck, yes!

The giant ride-sharing company is also behind Otto, an effort to automate long-haul trucking.

Photo below from the SF Chronicle//Testing of a Volvo truck by engineer Nic Munley.

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Unlike competitor Lyft, Uber doesn’t seem to care that its current drivers are going to be left ride-less in the not-too-distant future, nor is Uber bothered that, if when Otto and its lookalikes are successful in removing drivers from trucks, those 900,000 truck drivers will not have jobs.

And without truck drivers, truck stops won’t be selling much food or other necessities. Motels won’t be providing showers or rooms. Body shops won’t be needed as much, either.

Uber contends that the 24/7 usage of driverless vehicles will mean more jobs for mechanics, but that’s speculative, at best. In fact, as these vehicles will just be replacing miles driven by vehicles currently piloted by people and not adding more vehicle miles, I don’t see why any more mechanics will be needed. Actually, less maintenance may be the norm because of constant monitoring of vehicle systems.

See also: 25 Axioms Of Medical Care In The Workers Compensation System  

So…

  • fewer truck drivers
  • fewer support staffs
  • fewer jobs in service stations and motels
  • fewer “taxi-type” drivers
  • fewer accidents –> less work for body shops, less demand for auto parts and paint and less need for auto claims adjusters

For workers’ comp…

  • much lower premium volume
  • far fewer claims to service
  • far fewer jobs to return injured drivers to
  • possibly more claims in the near future as drivers see the writing on the wall

Therapy Charges Are Being Inflated

Your physical therapy (PT) costs may be $15 to $19 per visit higher than they should be. Here’s what’s going on:

It’s common for therapists to perform multiple procedures at the same time on a single body part. Under nationally accepted standards (under the Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative), the therapist is to be reimbursed for only one of these procedures. Sometimes, it is appropriate for the PT to bill for multiple procedures — for example, if two procedures commonly done simultaneously are performed at separate times. But, unless the therapist adds a special modifier to the procedure code, only one will be reimbursed.

If multiple procedures are to be reimbursed, the “59 modifier” is added to the end of the CPT code, and the treating provider documents the reason for the variance in coding in the medical notes. The 59 modifier should be on about 11% to 15% of lines on PT bills.

But some payers are seeing 59 modifiers on almost ALL BILLS. It appears the 59 modifiers were not added by the therapist; they were added by a PT network company.

There’s no explanation in the treatment notes for this billing practice; no evidence the affected procedures were actually performed at separate times; no indication the PT network company reviewed the treating provider’s notes prior to upcoding. No documentation, no record, no history.

It appears that the intermediary was adding the 59 modifier as an automated system edit without reviewing the treatment notes. The systemic upcoding has resulted in higher costs for payers.

You should look at bills processed between 2009 and 2014:

  • If more than 20% of lines on your PT bills have the 59 modifier, you MAY have a problem.
  • If more than 40% of the lines on your PT bills have this modifier, you DO have a problem.

For the full blog from which this is excerpted, click here.