By Joe Paduda, Principal, Health Strategy Associates
Workers’ compensation does not exist in a vacuum. It’s a small – as in less than one percent – fraction of the overall healthcare system, and changes that affect the rest of the system impact workers’ compensation. Here are three:
The Medicaid Cliff
About 15 million people were added to Medicaid’s rolls during the COVID crisis. Now that President Biden has decided to end the public health emergency, states must go back to pre-pandemic Medicaid rules and regulations. Remember Medicaid is state-regulated and eligibility is pretty much state-specific so the coming disenrollment will take different form in different states. All 15 million won’t be disenrolled, but it’s highly like a lot will be.
The two states with the most at risk are Florida and Texas; both did not expand Medicaid under the Affordable Care Act and have the highest percentage of the population uninsured.
People without health insurance aren’t as healthy as the insured, take longer to recover from injuries, and may well have underlying or even worse undiagnosed health conditions that complicate recovery.
And hospitals and doctors that were getting paid by Medicaid to take care of these COVID-era Medicaid patients will now find they are dealing with charity care patients…with pretty nasty effects on providers’ financials.
The COVID Reimbursement Cliff
Facilities that treated COVID patients during the pandemic got a substantial payment boost – as in 20% – for those treatments. Now that the Public Health Emergency is ending, that financial boost will too.
More financial troubles for health systems, facilities and other providers.
The Staffing Cliff
Our “healthcare system” (three lies in one) is suffering from a massive shortage of clinical and support staff. Burnt out nurses, aides, support staff, physicians, and other clinicians are leaving care-giving roles by the thousands, with widespread and sometimes unanticipated impacts.
- Rural hospital closures are accelerating leaving vast swaths of some states in “health care deserts”
- Other facilities are closing inpatient wards, eliminating whole specialties (e.g., obstetrics/gynecology, orthopedics, cardiology, oncology) and even closing emergency departments for want of staff
- Staff left behind are forced to do more work and work for longer hours, sometimes serving in wards/wings/specialties that are woefully understaffed – with obvious implications for patient care
- Our insanely stupid immigration laws are severely limiting hiring of nurses from outside the US. This is particularly problematic for nurses from Muslim countries or Africa who are subject to different and more onerous immigration restrictions than nurses coming in from Europe and non-Muslim Asian countries.
Next time – how this will hurt you and a couple things you can do to lessen the pain.
About Joe Paduda
A nationally recognized expert in medical management and pharmacy, Joe Paduda is the principal of Health Strategy Associates, a consulting firm that works with workers’ compensation insurers, employers, medical and pharmacy management companies, healthcare providers, government entities, and investors. He also conducts industry research and writes the thought-provoking www.ManagedCareMatters.com.
In addition, Paduda is president of CompPharma, LLC, a consulting firm dedicated to analyzing and improving pharmacy programs in workers’ compensation. He has conducted an annual survey of pharmacy benefit management for 16 years.
Before starting his consulting business in 1997, Paduda held executive positions with major insurers, including Traveler’s, United Healthcare and Liberty Mutual. He has a Master of Science degree in Health Management from the American University and earned his bachelor’s from Syracuse University.
Comp Laude recognized Paduda as Industry Leader in 2022. He is also the recipient of the IAIABC’s President’s Award for his work in identifying solutions to opioid misuse in workers’ comp. He is an advisor on a research project comparing the effectiveness of two state payer strategies to prevent unsafe opioid prescribing, which is funded by the U.S. Department of Health and Human Services’ Patient Centered Outcomes Research Institute. Paduda also serves on the Board of Directors of the Commonwealth Care Alliance, a Massachusetts-based not-for-profit healthcare organization serving individuals who are dually eligible for Medicaid and Medicare.
He can be reached at firstname.lastname@example.org or 203-314-2632.
About Health Strategy Associates
Based in Plainfield, New Hampshire, Health Strategy Associates consults with insurers, employers, medical management companies, health care providers, and investors. Its highly customized services encompass research and competitive analysis along with operational, marketing and sales improvements. For more information, please see www.healthstrategyassoc.com.