Presentation on theme: "ONE SOURCE FOR MEDICARE SECONDARY PAYER COMPLIANCE The Impact of the Aging Population on WC & MSP Compliance Presented by: Barbara Fairchild, RN, BSN,"— Presentation transcript:
ONE SOURCE FOR MEDICARE SECONDARY PAYER COMPLIANCE The Impact of the Aging Population on WC & MSP Compliance Presented by: Barbara Fairchild, RN, BSN, CLCP, MSCC Vice President, Business Development
Part I: Statistics Part II: Major Economic & Financial Concerns Part III: Effects of Aging Part IV: Effects of Aging on Work Capacity Part V: Employer Issues Part VI: Primary Workplace Safety Objectives Part VII:Three Top Injuries Part VIII: Impact on Claims Handling Presentation Overview
Part I Statistics 3
The aging workforce is not about to go away Older workers – 55+ totaled 17 million in 1998 Reached 27.9 million in 2008 Projected to reach 40 million by 2018 1985-2009 workers ages 45-64 increased by 25-34% Significant increase expected in ages 65-84 4
Number of workers age 65-69, 70-74, & 75 & over, 1998-2012, quarterly Source: US Bureau of Labor Statistics, US Department of Labor; Insurance Information Institute. There are now over 7.4 million senior workers― double the number in 1998. Over the next decade it is expected to double again. ( Thousands) This is the leading edge of the older half of the “baby boom” generation NuQuest/ Bridge Pointe ™
Labor Force Participation Rate, ages 65-69, Q1 1998-Q4 2012 Not seasonally adjusted. Sources: US Bureau of Labor Statistics, US Department of Labor; Insurance Information Institute. The brown bars indicate recessions Labor Force participation rate The switch from DB pension plans (with early-retirement incentives) to DC plans― with later-retirement incentives― might be partly responsible for raising this rate. 1 in 3 in this age group are working― nearly none are “baby boomers”. NuQuest/ Bridge Pointe ™
Labor Force Participation Rate, ages 70-74, Q1 1998-Q4 2012 Source: US Bureau of Labor Statistics, US Department of Labor; Insurance Information Institute. Labor Force participation rate The labor force participation rate for workers 70-74 grew by about 50% since 1998― Growth stalled during and after the Great Recession but has since resumed. Nearly 1 in 5 in this age group is working— 15 years ago it was 1 in 8. NuQuest/ Bridge Pointe ™
Labor Force Participation Rate, ages 70-74, Q1 1998-Q4 2012 Source: US Bureau of Labor Statistics, US Department of Labor; Insurance Information Institute. Labor Force participation rate The labor force participation rate for men 70-74 grew by about 50% since 1998― but for women 70-74 it nearly doubled (from about 9% to about 15.5%). NuQuest/ Bridge Pointe ™
Labor Force Participation Rate, ages 75 & over, Q1 1998-Q4 2012 Sources: US Bureau of Labor Statistics, US Department of Labor; Insurance Information Institute. In the last 14 years, the labor force participation rate for workers 75 & over grew from 4.5% to 7.8%― 92.2% of these people are retired. Labor Force participation rate The labor force participation rate for workers 75 & over will probably hit 10% soon— close to the rate for the 70-74 group a decade ago. NuQuest/ Bridge Pointe ™
Labor Force Participation Rate, ages 75 & over, Q1 1998-Q4 2012 Sources: US Bureau of Labor Statistics, US Department of Labor; Insurance Information Institute. In the last 15 years, the labor force participation rate for men 75 & over grew from 6.9% to 12.1% and for women doubled from 2.9% to 5.5%. Labor Force participation rate NuQuest/ Bridge Pointe ™
11 Fatal Work-Injury Rates improved slightly since 2006 but still climb sharply w. age Source: US Bureau of Labor Statistics, at http://www.bls.gov/iif/oshcfoi1.htm/#2010http://www.bls.gov/iif/oshcfoi1.htm/#2010 The fatality rate for workers 65 + was 5 times that of workers age 25-34. The workplace of the future will have to be completely redesigned to accommodate the surge in older workers. Fatal Work Injury Rate per 100,000 full-time-equivalent workers No improvement in fatal work- injury rate for this age group NuQuest/ Bridge Pointe ™
12 Older workers lose more days from work due to injury or illness Source: US Bureau of Labor Statistics, Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2011 (Table 10), released November 8, 2012. Median Days Away From Work Youngest baby boomer - 49 in 2013 Median lost time of workers age 65+ is 2-3x that of workers age 25-34. These numbers are pretty stable—they haven’t changed much since 2008. Oldest baby boomer - 67 in 2013 NuQuest/ Bridge Pointe ™
13 Percent of days-away-from-work cases, by days lost & age group, 2011 Source: US Bureau of Labor Statistics, Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2011 (Table 11), released November 8, 2012. Over one-third of days-lost cases of older workers involved a month or more away from work― 9 of 10 cases for at least two days― compared to 8 of 10 for the youngest workers. NuQuest/ Bridge Pointe ™
Part II Economic & Financial Concerns 14
Economic & Financial Concerns Longer life expectancies Fewer younger workers Rising healthcare costs Limited opportunities to increase benefits Will elect or need to continue to work 15
Part III 16 Effects of Aging
Aging process is evident by third decade Healthy lifestyle slows process Aging process varies widely across population Aging process : 1)Reduction in visual acuity 2)Gradual hearing loss 17
Effects of Aging Aging process continued: 3) Reduction in lung elasticity 4) Decreased arterial compliance 5) Reduction in lean muscle mass 6) Reduction in flexibility 7) Reduction in bone density 18
Part IV Effects of Aging on Work Capacity 19
Aging and Work Capacity Require increased time to recover Reduction in ability to perform heavy tasks Increased likelihood of injury cumulative tasks Less prone to injuries from catastrophic events More prone to injuries associated with aging 20
Part V Employer Issues 21
Employer Issues Higher average costs per claim More lost time Controlling workers’ compensation costs Accommodating return to work restrictions Prevention of work-related injuries 22
Part VI Primary Workplace Safety Objectives 23
Workplace Safety Objectives 1) Eliminate slips and falls Lighting Even flooring Wipe up spilled substances Avoid ladders or excessive heights 24
Workplace Safety Objectives 2) Reduce physical requirements Use lifting devices or tools Reconfigure work stations Avoid repetitive or above shoulder work Avoid awkward positioning 25
Part VII Three Top 10 Injuries 26
Top injuries 65 + Three injuries become more prevalent with age Carpal tunnel syndrome Lumbar region sprain Rotator cuff sprain NCCI Volume 1- May 2005 27
Part VIII Impact on Claims Handling 28
29 Recognize potential impact on claim values and settlement. Adjust claims handling and settlement practices accordingly: What do I need to be concerned with? Should I make modifications to my settlement approach? Practical Considerations
30 Working with CMS Reducing Costs: Be proactive – employ measures and explore options that may help prior to settlement Institute protocols and special handling requirements MSP Compliance
31 NQBP Can Help! NuQuest/Bridge Pointe has developed several products designed specifically to address the challenge of the high cost of claims: Pre-MSA with Drug Regimen Review and Optional Physician Tele-Consult Medication Regimen Form Off-Label Drug Review Recommendations for Potential Reductions CMS Checklists
32 Pre-MSA with Drug Regimen Review The Pre-MSA with Drug Regimen Review (PMDR) is a comprehensive solution which: Controls the rising cost of drug utilization Reduces medical treatment costs Demonstrate actual weaning/tapering Document changes in frequency or dosing Discontinue off-label use in certain situations NQBP Can Help!
Pre-MSA with Drug Regimen Review (cont.) Expedites case closures and Combines medical analysis with Drug Regimen Review; Provides a unique and complete clinical evaluation of future injury-related medical and pharmacy costs; Allows you to control utilizations and costs prior to CMS submission. NQBP Can Help! 33
34 Medication Regimen Form Form sent to the Claimant’s treating physician(s) to request information regarding the Claimant’s future Medicare Part D drugs in an attempt to reduce or contain the Rx allocation. NuQuest/Bridge Pointe prepares the form as part of the MSA assignment. NQBP Can Help!
35 Off-Label Drug Review c onducted by a pharmacist who reviews the prescribed usage of a drug in comparison to the Compendia utilized by the WCRC. Determined whether or not the drug would be considered not covered by Medicare and therefore excluded from the MSA allocation. NQBP Can Help!
36 Recommendations for Potential Reductions Dedicated section in NQBP MSA reports for recommendations and possible methods for reducing the allocation amount. Information regarding potential reductions include documentation needed to reduce future MSA treatment, procedures and/or future prescription drug utilization. NQBP Can Help!
37 CMS Checklists CMS Checklists: Facilitate the MSP compliance process Help prevent delays Expedite the MSA submission process to CMS If process changes or requirements are identified, we develop and distribute updates, spreadsheets, workflows and checklists tailored the needs of our clients. NQBP Can Help!
ONE SOURCE FOR MEDICARE SECONDARY PAYER COMPLIANCE Thank you for your time and attention Copyright, 2013. All Rights Reserved. NuQuest/Bridge Pointe retains exclusive ownership, proprietary and copyright to this Power Pointe and presentation. Any reproduction, distribution, dissemination or use of this PowerPoint and presentation without the express written consent of NuQuest/Bridge Pointe is strictly prohibited.
Sources Jauquet, Joseph, Ph.D.; Grob, Heather, Ph.D. (December 19, 2005). “The Aging Workforce: Implications for Workers’ Compensation”. Washington State Department of Labor & Industries, Research and Data Services –Information for Informed Decisions, Olympia, WA “Employing older workers and controlling workers’ compensation costs”. Reprinted with permission of The Journal of Workers’ Compensation. Ohio Board of Workers’ Compensation, Retrieved February 5, 2013 from http://www.ohiobwc.com/downloads/blankpdf/OlderWorkersPosPaper.pdf http://www.ohiobwc.com/downloads/blankpdf/OlderWorkersPosPaper.pdf Shuford, Harry, NCCI Chief Economist; Restrepo, Tanya, NCCI Associate Economist. (May, 2005) “Thinking About an Aging Workforce― Potential Impact on Workers’ Compensation”. NCCI Research Brief, Vol.1. 41