one source for medicare secondary payer compliance the impact of the aging population on wc &...
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ONE SOURCE FOR MEDICARE SECONDARY PAYER COMPLIANCEONE SOURCE FOR MEDICARE SECONDARY PAYER COMPLIANCE
The Impact of the Aging Population
on WC & MSP Compliance
Presented by:Barbara Fairchild, RN, BSN, CLCP, MSCCVice President, Business Development
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•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
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3
Part I
Statistics
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Statistics
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
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Number of workers age 65-69, 70-74, & 75 & over, 1998-2012, quarterly
2327
2312 2404
2406
2393 2530
2498 2559 2627
25702632
2627
2562 2674 2859
2896
2723 2842
28723127
2951 3079
3047 3218
3201 3330
3344
3351
33643396
3334 342634803505
35063547 3764
3775
3626 3833 4074
4138
41054213
1027
1022
10261069
1037 1129
1094
1090
1115
1139
11421181
1215
1160
1182
1177
1135
1162
1138
1141
1177
1182
1183
1213
11931244
1250
1314 1375
126213141356
1385
1397
1385
1367
1370 1452
1442
1407
1389 1530
1524
14301495 15801633
15051550
1498 1598
1564
1584 16821726
171917791835
1842
624
636
641686
668718773
758
789
780
775
801
779
792
762815
790
774
802
765 863926
811 919
928
947
969
1039
9741055
1018 1076
1057
1085
1085
1072 1171
1152
1133
11511210
1224
1258
1256
11431190
1206
1198
1166 1279
1243
1185 1267
1280
1302
1311
1301
12841381
2473
20432067
20432083
20192051
2014 2106 22182251
22422283
223422652304
1250
986
500
1000
1500
2000
2500
3000
3500
4000
4500
1998.1
1998.3
1999.1
1999.3
2000.1
2000.3
2001.1
2001.3
2002.1
2002.3
2003.1
2003.3
2004.1
2004.3
2005.1
2005.3
2006.1
2006.3
2007.1
2007.3
2008.1
2008.3
2009.1
2009.3
2010.1
2010.3
2011.1
2011.3
2012.1
2012.3
Age 65-69 Age 70-74 Age 75 & over
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
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Labor Force Participation Rate, ages 65-69, Q1 1998-Q4 2012
25.2%
25.2% 26.3%
26.5%
26.2%
27.9%
27.2%
27.4%
27.9%
27.3%
27.8%
27.6%
26.8% 27.6%
29.3%
29.5%
27.9%28.5%
28.7%
30.8%
29.3% 30.1%
29.1%30.3%
30.1% 30.9%
31.0%
30.7%
31.0%
31.4%
30.9%
31.2%
31.6%
31.3%
31.5%
31.4%32.8%
32.3%
31.1% 32.2%
32.2%
32.5%
31.8%
31.8%
27.0%
22.9%
23.0%
22.8%
23.0%
22.3%
22.5%
22.1%
23.5% 24.4%
24.4%
24.3%24.9%
24.4%
24.4%
24.8%
20%
22%
24%
26%
28%
30%
32%
34%
1998.1
1998.3
1999.1
1999.3
2000.1
2000.3
2001.1
2001.3
2002.1
2002.3
2003.1
2003.3
2004.1
2004.3
2005.1
2005.3
2006.1
2006.3
2007.1
2007.3
2008.1
2008.3
2009.1
2009.3
2010.1
2010.3
2011.1
2011.3
2012.1
2012.3
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”.
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Labor Force Participation Rate, ages 70-74, Q1 1998-Q4 2012
14.2%
13.8%
14.2%
14.0%
14.0%
14.4%
14.4%
14.9%
14.9%15.4%
15.6%
15.3%16.4% 17.0%
15.8%
16.2%16.7%
16.9%
17.2%
17.0%
16.7%
16.8%18.0%
17.5%
17.3%
16.9%
18.6%
18.2%
17.7%
17.9%18.9%
19.2%
18.0%
18.1%
17.4%18.4%
18.0%
18.4% 19.3%
19.5%
19.2%
19.1% 19.9%
19.6%
14.6%
13.1%13.6%
12.4%12.9%
12.4%
12.2%
12.5% 13.1%
13.3%
13.5%
13.6%
13.8% 14.4%
13.7%14.2%
9%
12%
15%
18%
21%
1998.1
1998.3
1999.1
1999.3
2000.1
2000.3
2001.1
2001.3
2002.1
2002.3
2003.1
2003.3
2004.1
2004.3
2005.1
2005.3
2006.1
2006.3
2007.1
2007.3
2008.1
2008.3
2009.1
2009.3
2010.1
2010.3
2011.1
2011.3
2012.1
2012.3
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.
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Labor Force Participation Rate, ages 70-74, Q1 1998-Q4 2012
18.3%
17.5%18.3%
17.7%
16.9% 18.5%18.9%
19.3%
19.6%
19.1%
19.1%
19.6% 21.2%21.7%
20.0%
19.8% 21.1%
21.6%22.4%
21.4%
20.3%
20.2%22.2%
22.1%
21.3%
20.7%22.8%
23.0%
21.9%
22.1%
22.6% 23.6%
22.3%
22.6%
21.1% 22.2%
22.1% 23.5% 24.5%
25.1%
23.5%
23.8%24.7%
24.6%
9.3%8.9%9.0%
10.0%9.7%9.9%9.3%9.7%9.9%9.5%
10.2%10.5%11.0%10.5%11.2%10.9%10.8%10.9%11.1%
11.7%11.1%10.8%
11.4%11.3%11.0%
12.4%12.8%11.9%12.6%13.0%12.3%
13.3%13.1%13.0%13.0%13.4%13.6%
13.9%14.5%13.8%13.9%13.8%
15.1%14.3%14.2%14.5%
15.8%15.5%
14.5%14.3%14.4%15.3%14.6%14.2%14.8%14.7%
15.5%15.2%15.7%15.4%
18.5%
17.8%
18.4%
16.0%
16.6%
16.6%
16.3%
16.5% 17.5%
17.7%
18.3%
17.9%
18.1%
18.6%
17.7%
18.0%
8%
12%
16%
20%
24%
28%
1998
.1
1998
.3
1999
.1
1999
.3
2000
.1
2000
.3
2001
.1
2001
.3
2002
.1
2002
.3
2003
.1
2003
.3
2004
.1
2004
.3
2005
.1
2005
.3
2006
.1
2006
.3
2007
.1
2007
.3
2008
.1
2008
.3
2009
.1
2009
.3
2010
.1
2010
.3
2011
.1
2011
.3
2012
.1
2012
.3
men women
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%).
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Labor Force Participation Rate, ages 75 & over, Q1 1998-Q4 2012
5.4%
5.1%
5.1%
5.2%
5.0%5.5%5.9%
5.8%
5.9%
6.0%
6.1%6.5%
6.1%6.6%
6.3%6.7%
6.4% 6.6%
6.0%6.5%
6.5%7.1%
7.0%
6.9%
6.9% 7.2% 7.4% 7.6%
7.6%
7.0% 7.2%
7.3%
7.3%
6.9%
7.7%
7.5%
7.1%7.5%
7.6%
7.7%
7.6%
7.6%
7.4%7.8%
5.8%
5.4%
5.1%
4.8%5.0%
4.6%
4.6%
4.5%
5.2% 5.4%
5.3%
5.2%
5.3%
5.2%
5.2%
5.1%
3%
5%
7%
9%
1998.1
1998.2
1998.3
1998.4
1999.1
1999.2
1999.3
1999.4
2000.1
2000.2
2000.3
2000.4
2001.1
2001.2
2001.3
2001.4
2002.1
2002.2
2002.3
2002.4
2003.1
2003.2
2003.3
2003.4
2004.1
2004.2
2004.3
2004.4
2005.1
2005.2
2005.3
2005.4
2006.1
2006.2
2006.3
2006.4
2007.1
2007.2
2007.3
2007.4
2008.1
2008.2
2008.3
2008.4
2009.1
2009.2
2009.3
2009.4
2010.1
2010.2
2010.3
2010.4
2011.1
2011.2
2011.3
2011.4
2012.1
2012.2
2012.3
2012.4
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.
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Labor Force Participation Rate, ages 75 & over, Q1 1998-Q4 2012
8.3%
8.0%
7.6% 7.8%
7.2%8.0% 8.4%
8.6%
8.5% 8.6% 9.1% 9.9%
8.8% 9.4%
9.6%9.7%
9.3% 9.9%
9.0%9.7%
9.2%
10.5%
10.3%
9.8%
9.7% 10.3% 10.8%
10.7%
10.1%
9.3%
11.1%
10.8%
10.1%
9.8%10.9%
10.8%
10.1%
10.3%
10.5%
10.8%11.3%
11.1%
10.9%12.1%
2.9%2.9%2.8%3.0%3.1%3.3%
3.4%3.3%3.4%3.8%3.5%3.6%
3.2%3.3%3.3%3.5%3.4%3.5%3.6%3.5%
4.0%4.3%4.1%4.1%4.3%4.3%4.1%
4.4%4.3%4.7%4.2%4.7%4.5%4.4%
4.1%4.5%4.7%
4.8%4.8%5.0%5.1%5.2%5.1%
5.6%6.0%
5.4%
4.7%5.0%5.4%5.0%
5.6%5.4%5.0%5.5%5.5%5.5%
5.1%5.3%4.9%4.9%
7.9%8.3%
8.4%
8.2%
7.9%
7.7%8.5%
8.3%
6.9% 7.3%
7.5% 8.1%
7.4% 7.8% 8.6%
8.4%
2%
4%
6%
8%
10%
12%
14%
1998.1
1998.2
1998.3
1998.4
1999.1
1999.2
1999.3
1999.4
2000.1
2000.2
2000.3
2000.4
2001.1
2001.2
2001.3
2001.4
2002.1
2002.2
2002.3
2002.4
2003.1
2003.2
2003.3
2003.4
2004.1
2004.2
2004.3
2004.4
2005.1
2005.2
2005.3
2005.4
2006.1
2006.2
2006.3
2006.4
2007.1
2007.2
2007.3
2007.4
2008.1
2008.2
2008.3
2008.4
2009.1
2009.2
2009.3
2009.4
2010.1
2010.2
2010.3
2010.4
2011.1
2011.2
2011.3
2011.4
2012.1
2012.2
2012.3
2012.4
men women
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 & overgrew from 6.9% to 12.1% and for women doubled from 2.9% to 5.5%.
Labor Force participation rate
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11
Fatal Work-Injury Rates improved slightly since 2006 but still climb sharply w. age
2.8
2.7 3.
3 3.7 4.
2
5.0
11.2
2.6 3.
0 3.1 3.4 4.
1 4.6
10.2
2.4 2.6 2.7 3.
2 3.7
4.5
12.2
2.5
2.4
2.4 3.
0 3.6 4.
3
12.1
2.8
2.2 2.
7 2.9 3.
6
4.7
11.9
0
2
4
6
8
10
12
14
18-19 20-24 25-34 35-44 45-54 55-64 65+
2006
2007
2008
2009
2010
Source: US Bureau of Labor Statistics, at http://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
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12
Older workers lose more daysfrom work due to injury or illness
56
910
12
15
56
9
1112
13
56
8
10
13
15
56
9
12
14 14
0
2
4
6
8
10
12
14
16
20-24 25-34 35-44 45-54 55-64 65+
2008200920102011
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
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13
Percent of days-away-from-work cases, by days lost & age group, 2011
13.7
12.5
11.0
9.5
8.6
7.2
21.8
20.2
17.0
16.2
15.2
16.6
13.3
12.1
11.8
11.3
11.9
11.1
11.1
11.0
10.6
11.6
11.7
13.8
5.1
5.9
6.4
7.4
7.3
7.0
15.3
22.0
29.8
32.6
34.7
36.37.9
10.7
11.5
13.3
16.4
19.7
0 0 0 1 1 1
20-24
25-34
35-44
45-54
55-64
65+
1 day 2 days 3-5 days 6-10 days 11-20 days 21-30 days 31 days or more
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.
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Part II
Economic & Financial Concerns
14
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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
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Part III
16
Effects of Aging
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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
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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
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Part IV
Effects of Aging on Work Capacity
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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
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Part V
Employer Issues
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Employer Issues
• Higher average costs per claim
• More lost time
• Controlling workers’ compensation costs
• Accommodating return to work restrictions
• Prevention of work-related injuries
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Part VI
Primary Workplace Safety Objectives
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Workplace Safety Objectives
1) Eliminate slips and falls
• Lighting
• Even flooring
• Wipe up spilled substances
• Avoid ladders or excessive heights
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Workplace Safety Objectives
2) Reduce physical requirements
• Use lifting devices or tools
• Reconfigure work stations
• Avoid repetitive or above shoulder work
• Avoid awkward positioning
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Part VII
Three Top 10 Injuries
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Top injuries 65 +
Three injuries become more prevalent with age
• Carpal tunnel syndrome
• Lumbar region sprain
• Rotator cuff sprain
• NCCI Volume 1- May 2005
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Part VIII
Impact on Claims Handling
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• 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
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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
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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
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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!
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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!
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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!
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Off-Label Drug Review
• conducted 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!
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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!
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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!
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QUESTIONS?
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Contact Us!
NuQuest/Bridge Pointe280 Wekiva Springs Road
Longwood, FL 32779
Toll-free: 866-858-7161
www.NQBP.com
Contact Information
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ONE SOURCE FOR MEDICARE SECONDARY PAYER COMPLIANCEONE 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.
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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
• 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.
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