“Time flies,” is an oft-used adage but when a new decade beckons, it takes on an added dimension. Most of us remember where we were at 12:00 AM on January 1, 2000. Many breathed a sigh of relief when computers didn’t shut down and the world didn’t come to a screeching halt when Y2K came and went. Of course, many consultants toasted to the millions they earned addressing the threat of Y2K posed to their clients.

Before we look forward, let’s glance backward as evidence that time certainly did fly:

Jared Fogle of Subway “fame” was first referenced on January 26, 2000. Wow, that’s a lot of bad commercials.

The first use of Homeland Security to describe a government agency to combat terrorism was February 1, 2001, seven months before 9/11.

On May 14^th, 2001, the Chicago Tribune first introduced texting to their readers, “which allows users to punch in a brief message that is instantly transmitted to one receiver.”

How about these short descriptions of things that are now part of our daily vocabulary?

Oct. 29, 2001: The “iPod (is) a $400 pocket-size hard drive that carries up to 1,000 songs in a metallic case about the size of a pack of cigarettes.” (Today, an iPod that holds 1,000 songs costs $100 and is the size of a pack of gum.)

June 17, 2002: “Ringtones constitute only the first movement of an entire symphony of new music services mobile network operators and entertainment companies are planning to offer consumers.”

July 14, 2002: “Phones with digital cameras that shoot and e-mail photos are popular in Asia. … Motorola plans to introduce a camera phone in the U.S. at the end of the year, though it’s unclear whether the phones will take off here.” Try finding a phone with out photo capability.

May 31, 2002: ” ‘American Idol: The Search for a Superstar,’ (is) based on a popular series in England. Musical hopefuls will vie for success, with a celebrity panel of judges knocking them off one by one.”

Other dates of first-blips on the screen: Facebook (May 25, 2004); Wikipedia (Jan. 16, 2005); Sudoku (May 25, 2005); YouTube (Dec. 29, 2005); Taylor Swift (Sept. 28, 2006); Twitter (March 14, 2007) green jobs (April 16, 2007); and Lady Gaga (Aug. 6, 2007)

What’s in Store for the Decade to Come

Disability management? Workers’ Compensation? Rather than predict what is to be we’ll focus on what we hope will come. Let’s start with changes to our industry like more transparency between disability management firms, TPAs/insurance firms and employers. Transparency begets trust and that elevates everybody. Better care, tighter controls on expenses and better bottom lines.

Now, what can we expect by way of innovations, popular culture and the economy? Your guess is as good as ours. However, for those of us who were kids in the 1960s and 1970s the decade won’t be a success unless we see something really cool. Flying cars—Jetsons style.

We’ve seen just about everything in our 20 years as disability management specialists—including some disturbing trends. In his recent pull no punches blog, “How to Know if You’re Being Ripped Off,” Health Strategy Associates principal Joe Paduda provides his Top 10 signs that your work comp managed care provider might be ripping you off. We believe every self-insured company should be aware of this list but share it with you along with one significant caveat.

“If the ultimate goal is to safely return the injured workers to the job at the lowest cost to the employers then results are all that matter.  When case managers do their jobs properly and manage each individual case with that key goal in mind versus measuring success by the number of hours billed, they achieve the best outcome as safely and economically as possible.”

In other words, when you partner with resources that measure success not by how much they can bill, but instead on how quickly and safely they can return the worker to the job, then Joe’s list become moot. However, it is definitely a two-way street and you must do your part as well. That means addressing an injury or illness immediately because when you do, everyone wins and your bottom line is the better for it.

Now for Joe’s list in descending order. Please note his caveat that not all TPAs are out to rip you off—we completely agree. But, be on the lookout for those who are.

How to know if you’re being ripped off

In the work comp managed care/claims world, some vendors’ revenue maximization efforts are getting ever more clever. I know, I know, I’ve posted on this several/numerous/multiple times before, but to my never-ending amazement, these practices continue. So here are the top ten warning signs to watch out for (sorry for ending with a preposition…)

Before you start, realize that all TPAs are not out to rip you off, all managed care vendors are certainly not either, and the soft market and unreasonable demands by employers have forced many claims administrators to look for revenue wherever they can get it.

That’s fine, as long as you know where your dollars are going…

10. Your TPA won’t let you use your own managed care vendors.

9. Your TPA won’t offer a bundled price, including all managed care services. Even worse if you never asked for one.

8. Savings reports focus on reductions below charges and don’t show reductions below fee schedule/UCR.

7. The TPA determines which cases ‘need’ case management - and your case management fees continue to grow. sometimes this appears to be OK, as the cost per hour is a deal, but it’s highly likely the hours worked are ever-increasing.

6. The TPA won’t sign any statement like this one (NOTE: See www.joepaduda.com for the referenced statement). Unfortunately, that doesn’t mean the TPA isn’t lying, as some may sign the statement anyway knowing it isn’t true.

5. The TPA won’t provide copies of any contracts with managed care vendors.

4. The TPA agrees to provide a great deal on claims admin services, with the fine print noting that they have complete control over managed care, investigative, legal, and other claims support services.

3. The TPA’s claims admin price is way, way better than the competition’s. There is no free lunch, and if the deal is too good to be true, rest assured you’re getting ripped off.

2. The claims staff you meet during the pre-implementation meetings disappears when claims come in, replaced by inexperienced/non-experienced/completely ignorant ’staff’

1. You are paying for bill review on a percentage-of-savings-below-charges basis, which motivates the vendor to find the highest-billing, highest-utilizing providers and let them run roughshod over your bank account, all the while trumpeting the ’savings.’