After poring over five years of claims data from the Louisiana Workers’ Comp Corp., a nonprofit mutual insurance company, researchers at John Hopkins School of Medicine found that only 3.7% of physicians accounted for 72% of workers’ comp costs in the state.

These physicians were termed cost-intensive providers (CIPs).

Sure, most of you already knew some workers “doctor shop” — when an injured employee seeks out a doctor whose diagnosis will extend comp benefits — but you probably didn’t know the effects were this bad.

Among the findings about CIPs:

• Their average claim total was more than four times higher than other docs ($46,000 v. $11,000)
• Their claims took more than twice as long to settle (697 days v. 278), and
• 31% of CIPs total claims costs were more than $50,000 compared to just 13% for other docs.

Note: The majority of CIPs incurring high costs were involved in pain management.

The study was published in the Journal of Occupational and Environmental Medicine.

A whopping 71% of employers say they expect higher healthcare costs in general if reform makes it out of Congress, according to a survey by the National Business Group on Health.

Other findings:

• 69% of employers say it’ll boost the cost of their benefits programs, and
• 35% feel it’ll lead to fewer companies providing subsidized coverage.

Employees aren’t happy about it, either

Workers, too, are giving federal healthcare reform the cold shoulder.

According to a second survey by Towers Watson, employees feel reform would:

• result in higher benefit costs (67%)
• reduce available benefits (54%), and
• lower the quality of care (53%).

What’s your stance on federal healthcare reform? Let us know in the Comments Box below.

Begin by looking at everyone else who touches claims, says Laura Clifford, owner of California-based Employers Fraud Task Force.

In a recent interview, Clifford said less than 10% of the comp fraud her firm’s uncovered was committed by employees.

The other 90% was committed by everyone else (lawyers, adjusters, bill review companies, etc.).

First step to take

What can employers do? One tactic Clifford says cuts down on fraud: Sit down with workers with an explanation of the benefits (EOB) they’ve received and go over it with them.

Reason: If just one injured worker looked at his EOB and said, “I only went to the doctor twice, not five times — like it says here,” then the employer could look at that doctor and see what other patients the doc has seen.

Because the House added “pay as you go” budgetary provisions, it now goes back to the Senate for approval. But one of the main provisions made it through the House unscathed.

A payroll tax holiday

The bill would give employers that hire new workers a break from paying the 6.2% Social Security tax on new hires’ wages for 2010.

But there is one catch — to get the tax break, anyone hired must have been unemployed for 60 days or more. Plus, the new hire can’t be related to the business owner and must replace someone who leaves voluntarily or is terminated for cause.

The bill would also provide a $1,000 income tax credit in 2011 for every new employee who stays on the payroll for a least a year.

In a vote that look place largely along party lines, the bill passed by a narrow tally of 217-201. The Senate is expected to take it up again this week.

We’ll keep you posted.

The COBRA subsidy program was set to expire, but President Obama extended for one month the program enacted under the American Recovery and Reinvestment Act. [HR 4691, The Temporary Extension Act of 2010.]

Under the program, eligible individuals pay 35% of their healthcare premiums, and the feds reimburse the employer for the remaining 65% through a tax credit.

The fine print
So why just one month? Congress wants to extend the program through the end of the year but needs to decide how it’ll enact revenue provisions to pay for certain programs (e.g., COBRA subsidy and unemployment benefits programs). The extension buys legislators another four weeks.

To qualify for the subsidy, people must experience a COBRA-qualifying event – i.e., be involuntarily terminated – between 9/1/08 and 3/31/10. Note that the subsidy’s now also available to those who:

• first lose their coverage because of a reduction in hours between 9/1/08 and 3/31/10, and
• are then involuntarily terminated on or after 3/2/10 but by 3/31/10.

The premium reduction applies to periods of health coverage that began on or after February 17, 2009 and lasts for up to 15 months.

Right now, the Senate’s debating HR 4213, which would extend the COBRA subsidy program through the end of the year. We’ll keep you posted.

You’ll find updated COBRA info on the Department of Labor’s Web site.

The deadline for eligibility for the 65% health insurance premium subsidy has now been extended to those who are laid off through March 31. Previously, eligibility only extended to those who lost their jobs through Feb. 28.

Those eligible can still receive the subsidy for 15 months.

Last week, the House passed the one-month extension, but the bill got held up in the Senate until Tuesday. Once it passed the Senate, Obama quickly signed it into law.

The bill also allows thousands of workers whose unemployment benefits expired on Feb. 28 to receive them for another 30 days. The Department of Labor estimated nearly 400,000 could’ve seen their aid cut if Congress didn’t act.

Congress will now consider a much larger bill that would extend the COBRA subsidy and unemployment benefits through the end of the year.

We’ll keep you posted.

Another effect of the lagging economy: Recent research shows cash-strapped employees are cutting back on preventive healthcare measures.

More people are trading nutrition for processed and fast foods, and scaling back the amount of time they spend exercising.

So now’s a great time to refocus on preventive health care. If your company already has a wellness program (or is thinking of starting one), it’s a good idea to consider adding these features:

Claims checks and on-site screenings

Some wellness programs pinpoint at-risk employees by relying solely on the employees’ honesty in responding to health assessments. But let’s face it, employees aren’t always honest with themselves when it comes to their health. As a result, their answers on health assessments aren’t exactly accurate.

A better way to gauge workers’ health: Use a combination of data to determine who is at risk for chronic conditions. Example: Some companies use on-site health screenings and past claims history to assess if an employee is at-risk.

This approach has been found to significantly increase the amount of at-risk employees who are spotted.

Wellness consultants

Wellness program consultants are assigned to a company to help develop its wellness strategy, plan promotions, interpret reports and gauge the overall success of the wellness program.

Benefit: By keeping a close eye on a company’s wellness program, consultants can tweak and fix problems before they become out-of-control cost drivers.

Cross-trained coaches

Wellness coaches take a big-picture approach to helping employees with various lifestyle-related health issues.

Example: Smoking. There are a significant number of people who won’t try to quit smoking simply because they’re concerned about gaining weight.

But a cross-trained coach will help an employee quit smoking, while also making sure he or she makes smart nutritional choices to avoid the all-to-common weight gain that immediately follows kicking the habit.

What’s worked to improve your company’s wellness program lately? Let us know in the Comments Box below.

Give employees more control over their work schedule.

A systematic review of 10 studies by The Cochrane Collaboration assessed the health effects of various work arrangements — and found that employees who have more control over their schedules see improvements in both physical and mental health, which lead to fewer medical claims.

Overall, the research found that workers with flexible work schedules:

• have fewer incidences of high blood pressure
• sleep better
• have better mental health, and
• are more alert than those working more rigid schedules.

Do you think creating more flexible schedules would improve employee health? Let us know in the Comments Box below.

They help boost retention and presenteeism, too.

Forty-five percent of employees said they stay at their jobs because of the wellness benefits their employers offer, found a recent survey by the Principal Financial Group.

What do employee like most about wellness programs?

• On-site fitness facilities (27%)
• Fitness center discounts (23%), and
• Weight-management programs (19%).

Another reason employers may want to consider jumping on the wellness bandwagon: 26% of employees say they miss fewer days of work when they participate.

President Obama couldn’t convince Republicans to take up his health reform proposals, but he has vowed to plow ahead anyway. Here’s where he’s going  with the latest plan.

• Elimination of the special deal for Nebraska calling for the federal government to pay the full cost of a Medicaid expansion for that state. Instead, the President proposed that  federal government help all states absorb the cost of the Medicaid expansion from 2014 until 2017.
• Delaying the excise tax on so-called “Cadillac plans” until 2018 for all taxpayers, not just union members. Still, the excise tax remains a key part of the proposal.
• No “public option.” There is no attempt to revive the idea of a government-backed insurance plan to compete with the private sector.
• Less restrictive language on abortion. The proposal drops the “Stupak amendment,” which would bar insurers from offering abortion coverage to anyone buying a policy with a federal subsidy.
• Keeping the tax on upper-income individuals and families. The Obama approach supprts the increase in Medicare payroll tax for individuals earning more than $200,000 a year and couples earning more than $250,000.
• State-based insurance exchanges. That’s different from the House proposal for a national exchange.
• Lower eligibility for Medicaid. The figure released in the meeting with Republicans set eligibility at 133% of the federal poverty level, instead of the House proposal of 150% of the poverty level.
• Limiting health-premium costs according to income. Under the plan, a family earning about $88,000 a year would pay no more than 9.5% of income toward annual health insurance premiums. Out-of-pocket costs, such as co-payments or deductibles, would have to be paid separately and wouldn’t be included in the 9.5%.

Go the the White House Web site to see the full plan.