It’s the hap…happiest time of the year! For healthwonks, start your holidays off early with this w(rapped) Health Wonk Review!
Article source:Managed Care Matters
OK, a bit of hyperbole – but only a bit.
Here’s how the Trump Tax Bill will affect healthcare…
With fewer people covered by insurance, and higher rates for those that are, we’re likely to see more insurers drop out of more markets.
The greatest impact will be seen several years down the road, when the overly-optimistic growth projections prove to be just that. Already, experts predict the Trump Tax Bill will add over a trillion dollars to our national debt. When that happens, there are going to be calls for massive cuts to ALL services – including Social Security, Medicare, and Medicaid.
What does this mean for you?
I’m thinking Medicaid for all by 2027.
Article source:Managed Care Matters
At Reveal, Amy Julia Harris and Shoshana Walter investigate retired Oklahoma Judge Thomas Landrith, who started the first rural drug court in the country. About 10 years ago, Landrith also started a rehab work camp — Southern Oklahoma Addiction Recovery or SOAR — where defendants had to work full time for no pay at a Coca-Cola plant and other companies under threat of imprisonment.
Coca-Cola guidelines prohibit forced labor and in response to the Reveal investigation, the Oklahoma bottling plant in question has already severed ties with SOAR. Harris and Walter write:
Reveal spoke with more than a dozen men who attended the SOAR program. All but one said the program was more concerned with work than their recovery. Cody Evans called it “the worst experience of my life.” Dustin Barnes called the people who run SOAR “crooks.”
“‘If you can’t work, your ass should not be here.’ They tell you that when you first get there,” said Lee Purdy, who was court-ordered to SOAR and worked at Leachco (a factory that makes pregnancy pillows). “This ain’t the place for you if you can’t work.”
If men got hurt or were too sick to work, the program often kicked them out, they said. Some worked despite being injured.
“It made me mad and feel like I really wasn’t worth nothing,” said Lucas Allen, one of the men Landrith sent to SOAR in 2015. He said he was forced to work with an injured hand. “It’s like they didn’t care what happened to me.”
Read the full story, which is part of a larger investigative series into rehab programs that funnel free labor into private industry, at Reveal.
In other news:
Huffington Post: Dave Jamieson reports that with a new conservative majority on the National Labor Relations Board, its members are considering scrapping worker-friendly union election reforms adopted under President Obama. Earlier this week, Jamieson writes, the agency published a Federal Register notice asking whether it should keep current union election rules in place, change them or get rid of them — the board’s three Republican members approved the notice, while the two Democratic members disapproved. The agency’s staff had spent thousands of hours “carefully” updating the election rules in 2014. In a dissent, board member Mark Gaston Pearce described the new Federal Register notice — known officially as a “Notice and Request for Information” — as a “Notice and Quest for Alternative Facts.” Jamieson writes: “Pearce’s Democratic colleague, Lauren McFerran, wrote that the timing of the board’s request suggests the majority is interested not in ‘objective data,’ but in ‘manufacturing a rationale’ for rolling back the rules now that Republicans are in power.”
KPCC: Leslie Berestein Rojas writes about the effects of California’s wildfires on farmworkers still reporting to work in the fields of Southern California. She spoke to advocates with Central Coast Alliance United for a Sustainable Economy, which reported a number of farmworkers in the fields without protective masks during the “worst of the smoke and ash.” KPCC contacted other growers who said they had given workers facemasks and the option of leaving the fields. Last week, the California Department of Industrial Relations issued an advisory, saying employers “must consider taking appropriate measures” from wildfire smoke, however when and which measures to take are up to employers. Critics, such as state legislator Judy Chu, who previously worked to protect farmworkers from heat illness, says such wildfire protections need to be stronger. Rojas quoted Chu, who said: “Certainly we see extraordinary hazards now because of these fires. And so there needs to be a renewed effort toward getting protections for our outdoor workers.”
NPR: Samantha Raphelson reports on growing concerns about worker safety inside the so-called gig economy, starting the article with the story of 19-year-old Antawani Wright-Davis, who was struck and killed by a dump truck while delivering food on his bike for DoorDash, another app that classifies its workers as independent contractors. Because he wasn’t considered an employee — which allows gig economy employers to sidestep a number of labor protections — Wright-Davis’ family wasn’t eligible for workers’ compensation. Fortunately, as the gig economy grows, some states, such as New York and Washington, are considering new protections for independent contractors. Raphelson quoted Jessica Martinez, co-executive director of the National Council for Occupational Safety and Health, who said: “It’s essentially the Tinder economy. When a temp worker is done with his or her shift, the boss swipes left and claims to have no further obligation.”
The Stranger: Heidi Groover reports that domestic workers and elected officials in Seattle have kicked off a campaign calling for a new set of labor protections for domestic workers. In particular, workers and advocates with Working Washington as well as members of the Seattle City Council are urging the city to create a Domestic Workers Bill of Rights that would require written contracts for domestic workers and ensure such workers are covered by local labor protections. The Seattle campaign follows in the footsteps of worker efforts in a number of other states, including California, New York and Illinois. Groover writes: “If recent history is any indication, the bill of rights stands a good chance at Seattle City Hall. Working Washington is a labor advocacy group funded in part by Service Employees International Union Local 775. SEIU 775’s president helped negotiate Seattle’s $15 minimum wage, and Working Washington advocated for secure scheduling and unionization for rideshare drivers. Both passed the city council unanimously despite business concerns.”
Article source:Science Blogs
The world didn’t stop while we were meeting, learning, and socializing in Las Vegas at NWCDC. Here’s what happened…
Sedgwick is getting bigger – again. The acquisition of Cunningham Lindsey makes Sedgwick the largest TPA in the land, with about 20,000 employees handling various aspects of claims and related functions.
Pharmacy and related topics
California’s work comp formulary goes into effect in 3 weeks. Make sure you’re ready by hearing from those who know it best – the folks at CWCI. Their webinar is available here (free to CWCI members, $50 for non-members)
An excellent primer on handling opioid treatment issues – specifically effective ways to end opioid treatment – comes from Coventry’s Nikki Wilson, PharmD via WorkCompWire. It’s simple, clear, and concise.
Sticking with drugs, Adam Fein reminds us “In 2016, U.S. net spending on outpatient prescription drugs was $328.6 billion, up only 1.3% from the 2015 figure.” [emphasis added] In contrast, CompPharma’s latest Survey of Prescription Drug Management in Workers’ Comp shows a drop of 11 percent year over year.
Employment is going to change – a lot – over the next decade. A thought-provoking report by McKinsey includes this prediction:
One result – “the share of the workforce that may need to learn new skills and find work in new occupations is much higher: up to one-third of the 2030 workforce in the United States” – with major implications for worker retraining, potential claiming behavior, and re-employment.
A reminder about the unseen consequences of the gig economy: airport revenues are dropping as passengers increasingly use ride-sharing services instead of paying for parking, renting cars or using cabs. I’ve reduced my use of rental cars; even if Lyft is occasionally more expensive, the hassle reduction factor plus the ability to work in the car to and from the airport are compelling.
A total of $5.8 billion was collected by airports from cab companies, parking, and rental car fees, more than they get from hotels, shops and restaurants combined.
Auto mechanic employment is also going to change – as more people switch to electric cars, there’s going to be a LOT fewer problems for mechanics to fix and even regular maintenance is limited to tires and wiper blades. We have an electric BMW i3; it has needed zero maintenance other than tires.
Takeaway – the downstream effects of the “gig economy” are far reaching indeed.
Article source:Managed Care Matters
A few of the recent pieces I recommend reading:
And because there’s so much good, important work right coming out right now about workplace sexual harassment and assault, I’ve collected some of the pieces that I’ve found most useful and memorable. I’d love to hear from commenters who have additional pieces to recommend.
Article source:Science Blogs
An investigation by the Government Accountability Office (GAO) of the U.S. meatpacking and poultry industry validates long-standing concerns raised by workers. GAO investigators said workers expressed fear of being punished or losing their jobs if they report safety or health problems; reported being denied access to the bathroom; and experienced problems receiving proper medical care for work-related injuries.
GAO’s investigation included interviews with individuals in Arkansas, Delaware, Georgia, Minnesota, Nebraska, North Carolina, Texas and Virginia who work in the industry or are government officials. More than 480,000 workers in the U.S are employed in the meat and poultry slaughtering industry. Many are minorities, immigrants, and refugees, and a significant number are women. The industry is dominated by several firms, including Tyson Foods, JBS USA, Cargill Meat Solutions, Smithfield Foods, and Hormel.
Workers and their allies say GAO’s report could not come at a better time. The Trump Administration is considering two proposals that would exempt poultry and meat processors from current regulations that limit production line speeds. One stems from a petition submitted to USDA in September from the National Chicken Council. The trade group wants the Food Safety Inspection Service to grant waivers to poultry plants that want to run processing line speeds in excess of 140 birds per minute.
The other is a draft proposed rule to “modernize” swine slaughter by relinquishing key inspection responsibilities from USDA inspectors to company employees. In exchange, pork processing companies can increase slaughtering line speeds to 1,300 hogs per hour.
“A startling number of meatpacking and poultry workers develop permanent and crippling repetitive-motion injuries because of the relentless speed of the production lines,” said Omaid Zabih, Staff Attorney for Nebraska Appleseed’s Immigrants & Communities Program. Zabih added:
“The Administration must abandon its reckless plan to increase line speeds and privatize swine inspections, and should instead work to lower line speeds to a safe level.”
In 2009, Nebraska Appleseed issued a report entitled “The Speed Kills You” which surveyed 455 Nebraska meatpacking workers who pointed to the dangerous speed of the processing line as the main cause of injuries. As follow up surveys have revealed, meat and poultry workers make 15,000 to 20,000 motions per shift on the low end, and up to 40,000 to 100,000 or more motions per shift on the high end.
The GAO investigation identified other worker safety problems in the meat and poultry slaughtering industry, including the use of chemical agents to reduce salmonella and other pathogens. The anti-microbial agents are considered safe for consumers to eat, but the chemicals are sprayed widely in the plants and workers experience respiratory symptoms from the airborne exposure. GAO said there are serious information gaps on how the chemicals affect workers health and a lack of coordination among relevant agencies including USDA, NIOSH, and OSHA.
Congressman Bobby Scott (D-VA) noted another important part of GAO’s report:
“…during 2016, 15 meat and poultry plants –all in the southeast—have refused OSHA access to expand complaint inspections to cover additional recognized hazards; this development has impaired OSHA’s ability to protect workers, and should compel the Department of Labor to vigorously defend its statutory authority to enter plants ‘without delay’.”
Six of the denials took place in Georgia, five in Alabama, and two each in Florida and Mississippi. The companies’ move to demand warrants occurred after OSHA initially commenced an inspection in response to a complaint and then moved to expand the scope of the inspection based on evidence of additional health or safety problems. The poultry industry’s strategy to obstruct OSHA inspections began following a serious injury incident at Mar-Jac poultry in Gainesville, GA.
Data released last month by the U.S. Bureau of Labor Statistics shows that beef and pork slaughtering has the highest incidence rate of occupational illnesses than any other industry. Poultry processing was not far behind (ranked 12th) with an illness rate that is worse than the rates for firefighting and coal mining. (Illness cases include musculoskeletal disorders, skin diseases, and respiratory illnesses.) The illness incidence rate in animal slaughtering (excluding poultry) is 251.4 cases per 10,000 workers and in poultry processing the rate is 88.3. This compares to the rate of 14.1 per 10,000 for all private sector industries.
As I’ve written before, the data from BLS’s Survey of Occupational Injuries and Illnesses (SOII) is just the tip of the iceberg. The SOII relies on employers to self report their injury data which understates the magnitude of work-related injuries. It’s a problem examined by numerous public health researchers (e.g., here, here, here) and acknowledged by both BLS and OSHA.
A delegation of poultry and meatpacking workers, along with faith and labor allies are holding a press event and demonstration on December 12 in front of the U.S. Department of Agriculture. The groups include the Northwest Arkansas Workers Justice Center, the Labor Rights Center (Bryan, TX), Western North Carolina Worker Center, and the Retail Wholesale Department Store Union.
Article source:Science Blogs
Frank Pennachio is one of those people every industry really needs. He’s blunt, outspoken, deeply insightful and completely unafraid to challenge established practices.
Especially when those practices need to be challenged. Thursday at NWCDC, Frank and Denise Algire discussed the ways employers pay for managed care services, and how those are often disconnected entirely from the quality of the care delivered to patients.
Frank’s key question is this; do managed care programs improve care or create revenue for intermediaries?
My take is both. I’d also echo Frank’s view that employers and brokers are just as culpable, if not more so, than claims payers and managed care companies. Employers’ desire for simplistic fee arrangements and unwillingness or inability to dive deeper into fee arrangements force (or allow, depending on your perspective) TPAs to seek revenues elsewhere.
Transparency is what’s missing; contracts between and among TPAs and employers don’t allow employers to see the financial relationships between the TPA and managed care companies and providers and understand the motivations and incentives inherent in those relationships.
Fee arrangements are the key to the puzzle. TPAs charge employers a flat per claim fee or a loss conversion factor (losses x X.XX%) to cover the cost of handling claims, and that’s pretty much the only thing the employer looks at or cares about. Thus, allocated loss adjustment expenses are rarely addressed. What employers should be paying attention to are undisclosed side agreements and Allocated Loss Adjustment Expense bucket, where those fees end up charged to the file.
Frank showed a report from an employer that identified bill review fees of over $500,000 for some 4600 bills. Of course, this was based on a fee structure using a percentage of savings below billed charges – an arrangement that like vampires just won’t die. Frank noted that many bill review companies are quite willing to charge a flat per-bill fee that includes networks, medical management, and other “savings”. (I have a somewhat different perspective and believe the price per bill should be considerably higher, but fundamentally agree with Frank)Part of me is stunned that we are still talking about this. This has been a subject of conversation many times over many years, and yet, here we are. And here we’ll stay until and unless employers demand something different – and
Albertson’s is one of the few large employers challenging this paradigm. Denise shared Albertsons’ network contracting strategy, and of particular interest were the outcomes measures they use. Albertson’s is quite willing to pay for better outcomes, and is diligent in tying outcomes to providers.
So what can you do?
Article source:Managed Care Matters
On the day before World AIDS Day, the White House put out a statement saying “we reaffirm our ongoing commitment to end AIDS as a public health threat.” Advocates are waiting — and hoping for —that same sentiment to materialize into policy.
Despite President Trump’s encouraging language, his administration’s global HIV funding proposals would likely lead to millions of additional HIV infections and seriously imperil more than a decade of progress in turning back the global HIV/AIDS epidemic. In fact, a new report from ONE, a global advocacy organization working to address extreme poverty and preventable disease, warns that if White House funding cuts came to fruition, it would be akin to “surrender” in the global fight against HIV/AIDS.
Trump’s FY 2018 federal budget proposal calls for cutting $800 million from bilateral HIV/AIDS efforts — including the President’s Emergency Plan for AIDS Relief (PEPFAR) — and cutting $225 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Cuts like that, according to the ONE report “Red Ribbon or White Flag?: The Future of the U.S. Global AIDS Response,” would mean dramatically fewer people having access to treatment and a “reverse course in a successful drive to end this epidemic.”
Right now, members of the U.S. House and Senate look like a lifeline — leaders in both chambers have fully restored funding for PEPFAR and the Global Fund in their appropriations, said Sean Simons, press secretary at ONE. Still, Simons said, advocates are worried that longer-term, more sustainable funding for global HIV work is now at risk and they’re “raising the alarm” that years of life-saving progress are on the line. The ONE report cautioned that if Trump’s proposed budget cuts ever became a reality, it could mean nearly 300,000 deaths, more than 1.75 million new infections annually, and one-third fewer people added to treatment rolls each year. Three years of funding at proposed White House levels, the report stated, would put global progress back by nearly a decade.
Since President George W. Bush first launched PEPFAR in 2003, the program has saved 11 million lives and supports more than half of all people receiving treatment worldwide. Globally, according to the ONE report, the program has had a direct hand in helping more than 2 million babies avoid mother-to-child HIV transmission and contributed to a 47 percent decrease in AIDS-related deaths since 2003. For the first time, more than half of the world’s people living with HIV are getting life-saving treatment.
“It’s amazing how far we’ve come in such a relatively short time,” Simons told me. “When PEPFAR first launched, 5,000 people were dying of AIDS every single day, treatment options were almost nonexistent in many places, and people who could access treatment faced insane financial costs. At its core, PEPFAR brought hope to so many places.”
In a Nov. 30 release from the U.S. State Department, where PEPFAR is housed, officials presented new data that “(PEPFAR) has reached historic highs through its rapid acceleration of HIV prevention and treatment efforts, driven by transparent, accountable, and cost-effective investments.” In particular, officials reported that PEPFAR had achieved “landmark levels” in expanding access to treatment, now supporting more than 13 million men, women and children in receiving antiretrovirals. The program is also providing support for more than 6.4 million orphans, vulnerable children and caregivers affected by the epidemic. And for the first time, according to federal officials, PEPFAR data show significant declines in new HIV diagnoses among young girls and women.
Such promising numbers show it is possible to curb the HIV epidemic with sustained commitment and support as well as achieve global targets of reducing the number of new infections to 500,000 by 2020 (there were about 1.8 million new HIV infections in 2016). However, such progress likely wouldn’t survive the kind of proposed cuts coming out of the White House.
“Epidemiologically, it is simply not possible to stop the spread of the disease without increasing the number of people added to treatment and preventing a higher number of infections each year, especially in the hardest-hit countries,” said the report’s lead author Jenny Ottenhoff, director of global health policy at ONE, in a news release.
Simons told me: “It’s really hard to overstate just how devastating a cut like that would be to our efforts. We’re right at a point where we’re slowly getting ahead of the disease or at least keeping on pace with where we need to be. Taking our foot off the gas now would really throw off the timeline in which we can get our hands around this virus.”
And there’s “no replacement for U.S. leadership” on the global HIV/AIDS front, he said. In fact, the ONE report describes the U.S. role as “irreplaceable,” arguing that its investment and progress in HIV/AIDS prevention and treatment is one of America’s greatest global legacies in the last two decades.
But implementing the Trump budget cuts, according to the report, would likely lead to the first global increase in new HIV infections since 1995. Report authors Ottenhoff, Spencer Crawford, and Emily Huie write: “Over the past 15 years, Congress has invested billions of dollars in the epidemiological infrastructure – the supply chains, scientific expertise, and professional training – and treatment levels necessary to bring within reach the real opportunity to control the global AIDS epidemic. And it has been just that – an investment. Reducing funding for PEPFAR in the way that the Trump administration has proposed would mean abandoning that investment just as it is paying off.”
Just a couple days before World AIDS Day, observed Dec. 1, more than 35 global health and AIDS organizations — such as amFAR, the Infectious Diseases Society of America and Save the Children — wrote to leaders in Congress with “profound concern” for the potential direction of U.S. global HIV/AIDS efforts, calling on policymakers to at least support PEPFAR and the Global Fund at current funding levels.
“Today, the countries most impacted (by HIV/AIDS) are contributing more than ever before, but there’s still no replacement for U.S. leadership,” Simons told me. “The global fight against HIV/AIDS is winnable, but the U.S. must continue its leadership.”
For a copy of the “Red Ribbon or White Flag?” report, visit ONE.
Article source:Science Blogs
This is a non-healthcare post.
The GOP tax bill is a mess, riddled with math errors, ucontradictory language, and un-implementable directives.
One is a huge and possibly un-fixable problem for the GOP – unfixable without ignoring requirements to keep the deficit-increasing impact of the bill within strict limits..
Late Monday night, the news that drafters made a $289 billion mistake hit the wires, infuriating the very corporate bigwigs the bill was supposed to reward.
Without getting too far into the weeds, a last-minute addition to the bill in the Senate added the Corporate Minimum Tax back to the bill, which effectively killed a bunch of other incredibly popular tax breaks – like the Research and Development credit. That will raise costs by perhaps $289 billion.
Here’s what one totally pissed off Republican CEO said:
Robert Murray,C.E.O. of Murray Energy Corp., angrily estimated that his company’s tax bill would increase by $60 million. “What the Senate did, in their befuddled mess, is drove me out of business and then bragged about the fact that they got some tax reform passed,” Mr. Murray said in an interview. “This is not job creation. This is not stimulating income. This is driving a whole sector of our community into nonexistence.”
But both the House and Senate have passed the bill, you say, so they’ll figure it out in the Conference Committee.
Not so fast.
To “fix this”, conferees will have to find the same amount of revenue from other sources. So, other taxes are going to go up – a lot. Or the AMT for companies will have to disappear. And given the very tight timeline to get this done, and the intransigence of the “freedom caucus”, and the furor over many other provisions, the longer this thing is in the public’s eye, the less chance it has of becoming law.
And the less damage it does to health insurance companies, Medicare recipients, doctors and hospitals.
Which is a very good thing.
Folks, this stuff is complicated. We live in a very, very complex world, and there are NO simple solutions to the really knotty problems we have. It’s time to take a set aside the sound bites and get to governing.
Article source:Managed Care Matters
We’ve written before about some of the problems with Republicans’ tax bills that would slash taxes for corporations while harming our collective wellbeing (see here, here, and here). One provision that’s gotten less attention is what The American Prospect calls a “paid family leave fig leaf” in the Senate bill.
The paltry proposal is from Nebraska Senator Deb Fischer, and comes in the form of a tax credit for employers. They can get tax credits for continuing to pay workers with salaries below $72,000 while those workers are on family leave — 12.5% of the wage amount if they pay 50% of workers’ wages, and 25% if they cover 100%. TAP’s Justin Miller explains why this is not advancing the cause of paid leave:
But it’s a far cry from an effective national paid leave policy. In reality, the plan is just one more corporate giveaway in a bill that’s chock-full of them. It’s entirely unclear whether tax credits are a credible way to incentive companies to enact paid family leave. As critics point out, a 25 percent tax credit is probably nowhere near enough to convince companies that don’t provide paid parental leave—either because they legitimately can’t afford it or just don’t want to—to provide it.
On top of that, the tax credit sunsets in 2019 (which would hardly give companies a chance to enact paid leave polices).
“It essentially subsidizes large corporations who already provide paid family leave,” says Ellen Bravo, co-executive director of Family Values @ Work, an advocacy group that supports universal paid family leave. “It’s one more giveaway to large corporations.”
The beneficiaries could include prominent companies that have all recently enacted generous paid family leave policies—among them, Ikea, Coca-Cola, Campbell’s, 3M, and Nike, all companies that will already benefit from the bill’s lucrative cut in the corporate tax rate.
A family leave policy that truly benefits workers would look more like what California, Rhode Island, and New Jersey have set up, where tax-funded pots of money help replace the salaries of those on leave, regardless of who their employers are. (New York and DC have passed laws for leave programs scheduled to start in 2018.) This kind of social insurance mechanism is also what’s involved in the FAMILY Act, which Senator Kirsten (D-NY) and Representative Rosa DeLauro (D-CT) reintroduced earlier this year.
Paid leave is good for public health, which is why the American Public Health Association has adopted a policy statement calling on the US Congress to pass legislation “making paid medical and family-caregiving leave available to all workers regardless of employer size or sector.” The GOP’s fig leaf doesn’t fit the bill.
Article source:Science Blogs