Clinical Compensation Consultants

Elective Procedures and the Post COVID-19 Surge: What Happens Next?

Now that the COVID-19 quarantine is gradually being lifted, many hospitals and insurance providers are resuming elective procedures that were postponed due to the virus. According to the experts at Healthcare Bluebook, a leading provider of transparency data, 37 states canceled elective procedures during the peak of COVID-19 to conserve beds and resources for infected patients, postponing approximately 30% of all elective procedures across the country. 80% of these procedures are expected to be completed this year. But at what cost?? "When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense..." -American Society of Anesthesiologists and the Association of PeriOperative Registered Nurses In the wake of the COVID-19 pandemic, many insurers and hospitals will most likely try to recoup their financial losses without regard to appropriate treatment or costs to the employee. After resuming elective procedures, the main patient concern will be "How soon can I get in?" and providers seeking volume will reschedule as quickly as possible, regardless of price. This surge in elective procedures could lead not only to increased volume but also higher prices and premiums as insurers and providers attempt to recover from the COVID-19 [...]

Elective Procedures and the Post COVID-19 Surge: What Happens Next?2020-06-02T22:45:54+00:00

Independent Medical Review cuts costs!

Senior executives from some of the top California workers’ compensation carriers identified emerging trends that are of great importance to California employers at the 2015 California Workers’ Compensation and Risk Conference. Panelists were: Moderator: Pamela Ferrandino, national casualty practice leader at Willis North America Mike Mulray, chief underwriting officer at Everest National John Dickey, regional president at Liberty Mutual Mike Hessling, chief client officer at Gallagher Bassett Glen-Roberts Pitruzzello, vice president of workers’ compensation, group benefits claim strategy and clinical operations, at the Hartford The WCIRB projects the estimated average medical cost-per-claim will be the lowest since 2007. What do you think are the key drivers behind this improvement? The independent medical review (IMR) process. IMRs are being upheld in favor of the employer – around 90% of the time. That is showing that evidence-based protocols are being followed. Medical inflation has decreased. Effective utilization review (UR) programs have had a positive effect on controlling medical costs. Will the greater use of generic drugs in the California drug formulary materially lower workers’ compensation costs? Texas is a good example. We have not seen any major pushback from what Texas has done. Texas communicated to the providers, so they know how [...]

Independent Medical Review cuts costs!2018-09-21T17:29:44+00:00

Opioid Overdose Survivors are Prescribed more Opioids

Examining a national database of health insurance claims, researchers found that 91 percent of patients who suffered a nonfatal overdose of prescription opioid painkillers continued getting prescriptions for opioids following the overdose. The findings, published in the Annals of Internal Medicine, follow news earlier this month from the Centers for Disease Control and Prevention that drug overdoses, opioid overdoses in particular, have reached epidemic levels. Read Full Story

Opioid Overdose Survivors are Prescribed more Opioids2018-09-21T17:29:44+00:00