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

•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

3

Part I

Statistics

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

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

NuQuest/Bridge Pointe™

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”.

NuQuest/Bridge Pointe™

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.

NuQuest/Bridge Pointe™

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%).

NuQuest/Bridge Pointe™

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.

NuQuest/Bridge Pointe™

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

NuQuest/Bridge Pointe™

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

NuQuest/Bridge Pointe™

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

NuQuest/Bridge Pointe™

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.

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

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

• 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!

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!

QUESTIONS?

38

Contact Us!

NuQuest/Bridge Pointe280 Wekiva Springs Road

Longwood, FL 32779

Toll-free: 866-858-7161

info@nqbp.com

www.NQBP.com

Contact Information

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.

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.

41