August 27, 2014

 

A stake through the heart.

That's what it felt like yesterday when Allstate published its 10th annual America's Best Drivers Report and awarded Worcester and Boston, two Massachusetts cities 38 miles apart, with the gold and silver medals, respectively, for most car crashes per capita in the nation.

Upon learning of this dubious distinction, local television stations instantly knew that such a story cried out for "man in the street interviews," and we got plenty of those. Maybe there were people interviewed who were horrified, but most interviewees who made the cut for broadcast seemed to treat it as if it were a badge of honor.

Frankly, I felt a bit like Claude Rains in the film Casablanca who, just prior to collecting his winnings, exclaimed "I'm shocked, shocked to find that gambling is going on here."

Boston drivers are legendary in their demolition derby attitudes. The driving Zeitgeist has forever treated traffic rules as purely advisory. A green light means "go," and a yellow light means "go like hell." Pedestrian crosswalks might as well not be there. If you're riding a bike, you'd better have good radar. So, one learns early on that driving in Boston is not for the faint of heart.

And right now it's at its worst as 152,000 college students return to 35 colleges for the next school year. Thirty-seven thousand live on campus in the heart of the city. Another 50,000 live in apartments around the city. The rest are commuters. The majority of the commuters ride the oldest-in-the-nation transit system. Boston University, alone, has more than 31,000 students.

So, I can absolutely understand Boston, a city I love, winning the trophy for 2nd place. But, geez, Worcester? Really? The most dangerous city in the America for car crashes? Worcester's like a home town to me (so is Boston, by the way, so I'm doubly hurt).

Worcester has 181,000 people spread out over about 38 square miles. There are ten colleges in the city, not 35. Students total less than 35,000. Worcester never seems to have the driving hyperactivity one finds in Boston. Although the two cities are connected by the Massachusetts Turnpike umbilical cord, they are like yin and yang. They don't even have the same water supply. It's true that Worcester has a lot of traffic lights, so the yellow light "go like hell" possibility exists, but the traffic density is so much less than Boston's that one rarely sees the Boston mania. Friends from Boston visit Worcester and think they've gone to the land of Zen.

Right now, you may be asking, "So, where's the safest place to drive in America?" That, according to the driving gods at Allstate, would be Fort Collins, Colorado, a city of more than 56 square miles with a population nearly 30,000 less than Worcester's. A city of two, count 'em, two colleges, one a community college, the other Colorado State University. A city with 30,000 college students, and I'm assuming that most of them always wear a smile and speak kindly of everyone.

Actually, Fort Collins looks like a beautiful place where everyone rides bikes without a worry and where the average blood pressure is so low that nobody has to worry about getting life insurance. Congratulations, Fort Collins.

The question I'm left with is this: How did Worcester, the city of the seven hills, home to the Hanover Insurance Group (and everyone knows that insurance employees are good drivers) earn Allstate's first place, bottom of the bird cage award? Beats me. I'm stumped and, yes, shocked. My Great Mandala has been poleaxed.

I'm going out for a drive.

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August 26, 2014

 

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Workers' compensation benefits rose by 1.3 percent to $61.9 billion in 2012, while employer costs rose by 6.9 percent to $83.2 billion, according to a report released today by the National Academy of Social Insurance. The Academy notes that this reflects the continued economic recovery as employment and earnings rise, and that despite the uptick, program spending as a share of covered payroll remains below historical levels. Employers' costs as a share of covered wages increased by $0.03 in 2012, to $1.32 per $100 of covered wages; benefits paid to injured workers decreased by $0.03, to $0.98 per $100 of covered wages.

You can view and download the full report from the Academy site for state-by-state detail -- REPORT: Workers' Compensation: Benefits, Coverage, and Costs, 2012 -- along with a press release and an infographic, from which we've illustrated this post. The Academy notes these highlights from the state-by-state results, which show that between 2010 and 2012:


  • The number of covered workers and amount of covered wages increased in all jurisdictions

  • Benefits per $100 of covered payroll decreased in 39 jurisdictions.

  • Employers' costs per $100 of covered payroll increased in 42 jurisdictions.

  • In 2012, medical benefits exceeded cash benefits in 33 jurisdictions.

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August 14, 2014

 

Are you feeling a little out of touch on your health policy wonkery over the summer? Wondering how things are progressing with ACA and other health policy issues? Catch up on your reading at Health Wonk Review: August Recess Edition. Brad Wright posts a substantive issue at Wright on Health - check it out!

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August 13, 2014

 

Summer reading! Here's a roundup of links to a variety of recent studies and reports that we find noteworthy - some that haven't received wide circulation.

Mathematica: Risk Factors Associated with Disability Following Work-Related Injuries (PDF)
Nan L. Maxwell and Nathan Wozny of Mathematica Policy Research have issued a study on work-related disability using a previously untapped database -- administrative data on claims filed under the Federal Employees' Compensation Act (FECA) -- to show how risk factors underlying disability following a work-related injury differ across groups defined by demographics, employment characteristics, and injury type (that is, injury or illness). Differences exist in three areas: the probability of incurring an injury, the probability of incurring a disability once an injury has occurred, and the size of the association between a risk factor and the probability of incurring a disability. This heterogeneity was previously undetected in narrower data sources and highlights the importance of tailoring efforts to identify and support individuals at - risk of disability to the population of interest.

NASI: State Policies on Provider Market Power (PDF)
The National Academy of Social Insurance (NASI) and Catalyst for Payment Reform (CPR) issued a comprehensive evaluation of state laws addressing the power of health care providers to negotiate higher prices, cataloging the laws and regulations state governments are using to maintain or increase competition in health care markets, which the recent wave of mergers among hospitals and other consolidation among providers has significantly reduced. See the press release for a summary.

Health Affairs: Price Transparency For MRIs Increased Use Of Less Costly Providers And Triggered Provider Competition
Covered by Sarah Kliff in Vox, When health care prices stop being hidden, and start getting real
"That lack of transparency in health prices partially explains why there is huge variation in what doctors charge for the exact same service. An appendectomy can cost anywhere between $15,000 and $186,000. Doctors don't usually feel the need to make their prices competitive when shoppers can't see them.
Over the past two years the Blue Cross and Blue Shield health plans have been running a quiet experiment, to see what would happen if prices became available in some cities but not others. And they found that just the act of making prices available can have a really dramatic impact on what they had to spend to get patients a very basic procedure."

AECOM: Alcohol Use Disorders Linked to Decreased 'Work Trajectory'
Workers with alcohol use disorders (AUDs) are more likely to have a flat or declining "work trajectory," reports a study in the July Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

The Influences of Obesity and Age on Functional Performance During Intermittent Upper Extremity Tasks
Journal of Occupational and Environmental Hygiene, Lora A. Cavuotoa* & Maury A. Nussbaumb. In this study, the main and interactive effects of obesity and age on functional performance were assessed during intermittent exertions involving the upper extremity.

Multiple jobholding in states in 2013
Monthly Labor Review presents data on the multiple-jobholding rate, or the percentage of individuals who hold more than one job, by state and region.

And two not-to-be missed reports we've previously noted:

NCCI: Workers Compensation Claim Frequency--2014 Update
According to preliminary estimates, workers compensation lost-time claim frequency declined by a relatively modest 2% in Accident Year 2013. The Great Recession of 2007-2009, which was the most serious and long lasting economic contraction since the Great Depression, had a considerable effect on claim frequency changes. Frequency increased in Accident Year 2010 and has declined in each subsequent accident year.

WCRI: 8 revealing state studies on workers compensation
WCRI has issued eight new state-specific studies identified new predictors of worker outcomes that can help public officials, payors, and health care providers improve the treatment and communication and injured worker receives after and injury - leading to better outcomes.
Bill Coffin looks at data and results of Phase 1, covering Indiana, Massachusetts, MIchigan, Minnesota, North Carolina, Pennsylvania, Virginia and Wisconsin.

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August 7, 2014

 

Catching up on our summer reading post vacation, we have a number of pointers to noteworthy news. First we note that according to a recent RIMS survey, the total cost of risk for businesses rose 2% in 2013. To segue on that, we turn to Cavalcade of Risk - a few of our friends have hosted recent issues: See The Italics and Dot-Dot-Dot Edition of the Cavalcade of Risk at Jaan Sidorov's The Population Health Blog, plus the prior edition Cavalcade of Risk #213 hosted by Jason Shafrin at Healthcare Economist, which kicks off with a great TED video clip on our relationship with fear from Sebastien Foucan.

,,, and here's more recent news in the world of workers comp

NCCI's Workers Compensation Claim Frequency--2014 Update - "According to preliminary estimates, workers compensation lost-time claim frequency declined by a relatively modest 2% in Accident Year 2013. The Great Recession of 2007-2009, which was the most serious and long lasting economic contraction since the Great Depression, had a considerable effect on claim frequency changes. Frequency increased in Accident Year 2010 and has declined in each subsequent accident year."

Frequency, high finance, and the future of work comp managed care - Joe Paduda talks about the impact of the drop in claim frequency on the work comp managed care industry: "Fewer claims = fewer services needed = fewer bills; less need for UR, case management, and related services." He discusses the likey impact, noting that, "Meanwhile the supplier market is consolidating, and managed care vendors are scrambling to capture enough of the shrinking market to survive the coming shakeout."

The Outsourcing Universe - For more on managed care, check out Peter Rousmanier's thoughtful column on specialized work comp services in Work Comp Central: "The workers' compensation insurer is for many the centerpiece of a mature industry. ...Within this industry, however, specialized services as an extension of claims management grew since 1990 from about $4 billion in total costs to about $18 billion today. This service universe expanded dramatically and changed repeatedly in products, organization, and leadership. Let's review this evolution and ask if two decades-plus of growth is coming toward an end."

8 revealing WCRI state studies on workers compensation - Bill Coffin of PropertyCasualty360 notes: "The studies measure five specific worker outcomes: recovery of physical health and functioning, return to work, earnings recovery, access to medical care, and satisfaction with medical care.
These metrics are measured to help public officials, payors and health care providers, among others, to identify how state-level systems are performing, and identifying where and what kinds improvements or reforms they might need."

Paying for Detox - At Risk & Insurance, Roberto Ceniceros notes that in response to the opioid crisis, workers comp payers are increasingly turning to detoxification programs and other multidisciplinary treatment modalities to address the problem. He discusses the opportunities and challenges in substance abuse treatment.

Zero PPE: The Future of Safety in Construction? - Scott Schneider of the The Laborers' Health and Safety Fund of North America issues a safety challenge. He notes that, "too often the first solution proposed to achieve this goal of zero injuries is to put all workers in personal protective equipment (PPE)" but wonders if the emphasis is misplaced: "Personal protective equipment is at the bottom of the hierarchy of controls for a reason."

Obamacare Update: On this topic, we follow Jonathon Cohn's writings, among others - here are two of this noteworthy recent articles: How Much Is Obamacare Raising Your Insurance Rate? Depends on Which State You Live In and Obamacare's Impact on the Uninsured, State by State.

News Briefs:

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LexisNexis Workers' Comp Law Center  LexisNexis Top 25 Blogs for Workers' Compensation and Workplace Issues – 2011 Honorees.  LexisNexis Top 25 Blogs for Workers' Compensation and Workplace Issues – 2012 Honorees. LexisNexis Top Blogs for Workers' Compensation and Workplace Issues – 2013 Honorees.
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