Cost Containment Solutions For Employers

To help us process your claims more efficiently, we are providing you with a copy of our Workers’ Compensation intake sheet similar to the sheets we use for our PIP Arbitration matters. Please submit this cover sheet completed with your file when you provide our office with the initial files. Please put this sheet first in any PDF that you send to our office. All intakes for Workers Compensation should be forwarded to “Attention: Penelope Rodriquez” at wcfile@massoodlaw.com.

The risk management program in any business, especially in a health care organization is an integral part of its day to day operation. The purpose of the risk management department is summed up by Kavaler & Alexander (2014), “…a program designed to reduce the incidence of preventable accidents and injuries to minimize the financial loss to the institution should any accident or injury occur” (p. 5). Protecting employees, patients, vendors and visitors is an ongoing process and one that needs to be updated when the healthcare organization has deemed necessary. This paper will demonstrate the importance of presenting the risk management program to new employees, compliance with the standards set forth by the American Society of Healthcare Risk Management (ASHRM), propose recommendations or changes needed to further improve the program, as well as examine the administrative process of managing a risk program.

In my role with Liberty Mutual, I drove adoption of Medicare reimbursement models through public affairs involvement with multiple state workers' compensation committees seeking to update their reimbursement schedules in response to the implementation of ICD-10 coding requirements in October of 2015. With the state workers’ compensation authorities seeking to adopt CMS reimbursement type models, my involvement was directed at securing the inclusion of specific CMS rules governing correct coding and reimbursement practices including National Correct Coding Initiative Guidelines (NCCI), Medical Unlikely Edits (MUE), along with the Resource Based Relative Value System (RBRVS) for reimbursement rate setting.

The National Federation of Independent Business (NFIB) agrees that the cost of health insurance is a high ranking concern for business owners. Every year, they conduct a study to see what the top general concerns facing small business owners. From the beginning of the fiscal year of 1986 to the present, every year has concluded that the cost of health insurance is the top burden facing small business owners in America. (Wade, Holly Pg 24, table 5). Another important factor to consider are lost capacity due to employee illnesses or unemployment. Brad Plumer of the Washington post recently did an interesting study to determine the amount of money lost due to inactivity at the workplace. Including businesses in both the public and private sectors, Plumer estimates that over $1.8 trillion dollars per year in lost productivity at the workplace. While the Post acknowledged the idea of lost productivity is not a clear science and can be overvalued this is nonetheless a huge amount of money wasted each year.

Management in healthcare institutions obtains presentations that pertain to workers’ injuries and illness costs. The figures acquire adequate support from the management provided that the data cites credible and the right references. However, researchers lack adequate hard data and research backing to defend direct and indirect cost ratios that they frequently utilize in relation to the safety-related literature.

Employers should offer affordable( employee premium less than 9.5% of employee’s wages) and of minimum value( employers must pay at least 60% of insurance cost) healthcare benefits to their employees depending on factors like number of FTE, number of employees receiving premium tax credits and other complex measurements to calculate the amounts. Employers should also notify employees by written about State exchanges, and advise them that if an employee decides to purchase a health Plan through an exchange, they may lose the employers’

The National Federation of Independent Business (NFIB) has repeatedly stated that the cost of health insurance is a high ranking concern for small business owners. Every year they conduct a study to see what the top general concerns facing small business owners. In each fiscal year since 1986 the cost of health insurance has been shown to be the top burden facing small business owners in America. (Wade, Holly Pg 24, table 5). Another important factor to consider are business which suffer from lost capacity due to employee illnesses or unemployment cost. Brad Plumer of the Washington Post recently conducted a study to determine the amount of money lost due to inactivity at the workplace. Including businesses in both the public and private sectors, Plumer estimates that over $1.8 trillion dollars per year in wasted each year as a result of lost productivity at the workplace (Plumer, Brad). While Mr. Plumer acknowledged the idea of lost productivity is not a clear science and can be overvalued this is nonetheless a huge amount of money wasted each year.

Through the history of health care, the standard of care changed from protecting our patient from injury and illness to a systemic entity to make money for insurance companies. Access to services and clinical outcomes are dependent on what health insurance providers will “pay” for in a clinical or community setting; as a result, patient safety, care and satisfaction has been negatively impacted.

This fundamental transformation of the healthcare industry is led by the Affordable Care Act (ACA). One of the impacts of this legislation was significantly reducing the rate of uninsured – from over 16% at the end of 2013 to under 11% at the start of 2015 (Source: Kaiser Family Foundation) – which has expanded procedure volume, creating a corresponding revenue tailwind for medical devices and Medtronic. To address the increasing costs and inefficiencies, the ACA shifts risk and accountability from payers to providers and other healthcare stakeholders. However, additional policies have also been shifting the way the healthcare industry thinks about reimbursement and cost.

This book takes the reader on a logical and chronological journey of the Canadian workers’ compensation system, beginning with an analysis of the Canadian government’s current injury-prevention efforts, then describing the historical development of Occupational Health & Safety within Canada, further taking a deeper dive into the specifics of workers’ compensation including benefit entitlements and limiting power, and concludes with a challenge to the reader to critically examine the current state of workers’ compensation in Canada. The purpose of the book, to open the reader’s eyes to the actualities of worker’s compensation, is achieved by supporting the author’s opinion with real life examples.

According to the Bureau of Labor, statistics indicate that more than 4.1 million people were hurt or injured on-the-job in 2006 and 5,488 were killed in 2007 (Gomez-Mejia, Balkin, & Cardy, 2010, p. 511). Laws and regulatory requirements are currently in place to standardize and promote workplace safety. Organizations with extensive safety programs have reduced number of accidents, decreased workers’ compensation claims and lawsuits and lesser accident-related expenditures (Gomez-Mejia, et al, 2010, p. 511). This paper discusses the effects of legal, safety and regulatory requirements in

The four key issues that are discuss in this section that will shape the work of compensation and benefits professionals in the future are fallout from the “Great Depression”, rising wages in China, challenges in health care reform, and workforce demographic shifts (Martocchio.2013. p359). Of these four issues my top two are the fallout from the depression and challenges in health care reform. After researching the two, I have concluded that the issue and challenges in health care creates the greatest uncertainty for compensation professional. In 2010 The Patient Protection and Affordable Care Act (PPACA) was signed into law. The purpose of the law is to decrease the number of uninsured people in America. The enacted healthcare reform has influence

The well-being of an individual is what matters the most to bring out the best in them. Thus as an organization or a company, the well-being of the employees should be considered as the 1st priority. Any injury or medical illness caused to the employee by the work done within the organization shall be compensated by WCB. Most employees do not know that there are ways to fight the WCB and appeal decisions. With proper facts, an employee is ultimately able to get the compensation that is deserved.

Most health care analyst believes that health benefits provided by employers are provided as part of the overall compensation paid to workers. Because of the rising cost of the health care benefits, employers’ shares of

Kaiser Permanente is an organization that is successful in dealing with labor relations. In today's challenging