"It's tough to make predictions, especially about the future." Legend attributes this pithy observation to Yogi Berra, but we suspect that many wannabee prognosticators have come to the same conclusion. Last week at the Workers' Compensation Research Institute annual meeting (and snow fest) in Boston WCRI's former CEO, Dr. Richard Victor, hazarded a number of predictions about the state of workers' comp in 2030. His vision of a super tight labor market accompanied by a still fragmented health care regime and restricted immigration leads to a number of unsettling conclusions.
First and foremost is a 55% increase in the number of claims with a three-fold increase in total medical costs. He assumes that indemnity costs (inflation adjusted) will remain fairly constant. Even that ray of sunshine leaves us with a gloomy scene. His analysis, right or wrong, focuses our attention on a very important point: the future of comp depends primarily on a number of completely external mega-trends and only secondarily on our parochial "inside baseball" concerns about fee schedules, managed care, state level regulation tinkering, and new claim technology.
Workers' comp is and will remain a reflection of the US workforce writ large. In Dr. Victor's vision, tight labor markets will compel a focus on RTW and SAW as the opportunity cost of absent key employees cuts into margins and deliveries. A failure to solve our healthcare problems will push more medical care into comp, whether it belongs there or not. The final withdrawal of the Boomers from the labor force, combined with immigration restrictions, will be disruptive on many fronts.
Or, using a different crystal ball (like Joe Paduda in Managed Care Matters), the automation of whole fleets of occupations will take comp down a different road where RTW becomes difficult and rare due to a surplus of people looking for work. As "employable" skills change rapidly, RTW becomes more and more problematic as injured workers after a year or two become obsolete workers.
The takeaway is for us is not to get too fascinated by our internal debates or wound up in procedural minutiae. Workers' comp thinks of itself as an island, but it - and we who work in its vineyards - are part of the mainland. Decisions about ObamaCare, immigration, breakthroughs in Artificial Intelligence and related technologies will shape comp as much or more than the next "reform" bill in the state of your choice. Keep a sharp eye on the factors that Dr. Victor and Paduda talk about. Big changes are in the wind.
To Gig or Not to Gig?
One labor force mega-trend which came under scrutiny at the WCRI meeting was the extent (or not) of the "gig" economy. The apparent growth of gig type work clearly has a potentially large impact on comp since most gig workers are independent contractors who do not come under the work comp statutes. More gig workers equals fewer comp claims. Or so we have been thinking.
But in a presentation at WCRI, Erica Groshen, visiting senior scholar at the Cornell University School of Industrial and Labor Relations, and former BLS commissioner, said the data on the workforce as of February 2018, doesn't support the reported growth of the "gig economy," and doesn't support the idea that automation and artificial intelligence will result in a decrease in jobs across the country. On the other hand, Forbes Magazine (no slouch statistically speaking) reported in a January article on the gig economy that some 162,000,000 people are now working in some form of the gig economy between the US and the EU. Perhaps someone is counting the beans incorrectly? Gig workers are often difficult to count, especially since some of them have a "real" job and do gig work on the side - so which column does the researcher tick?
The BLS is running new research currently, so better numbers may soon be available on the gig issue. Meanwhile Ms Groshen also noted, concerning AI and related tech: "As to the impact on the labor market, the techno-optimists and techno-pessimists are both wrong. I think unemployment will rise temporarily, perhaps even for a long time, but we will eventually return to full employment." Are you a techno-optimist or a techno-pessimist? Long term or short term?
The point, dear reader, is that a storm of change is sweeping across the US labor market and our little world of comp is one of many small boats being tossed around with no clear outcomes in sight. Even the best bean counters disagree about how many beans belong in which jar. WCRI, NCCI, and the other industry associations are beginning to do a much better job of tracking and reporting on these external impacts. Stay tuned. Even better, join in the conversation. What's going on in your company, your industry?
Nope - not the latest offering at the sushi bar down the street. Karoshi is the Japanese word for "death by overworking." While the Japanese have been studying this trend for some time (since about 1970, in fact), Americans have only recently looked in the mirror. The result is a new book, Dying for a Paycheck by Stanford professor Jeffrey Pfeffer (full title: Dying for a Paycheck: How Modern Management Harms Employee Health and Company Performance - and What We Can Do About It, new release on Kindle, $14.99).
As the Journal has noted in previous items, you don't have to do a dangerous job - in coal mine or on a construction site, commercial fishing boat, or an oil rig - to endure a health-destroying, possibly life-threatening, workplace. Stress can kill as easily as falling steel. How much of America's obesity epidemic, for example, is caused or reinforced by the relentless pressures of life in the 21st Century? What do we really mean when we talk about "comfort food" and is that phrase cozy - or sinister?
Dr. Pfeffer professes at the Stanford Graduate School of Business, an institution near and dear to your humble editor. This is not fringe science or partisan special pleading. Dr. Pfeffer shows in persuasive detail how American corporations drive employees to unhealthy and even fatal behaviors which, perversely, do little or nothing to enhance the bottom line. He argues effectively that we must wake up to the dangers and costs of today's workplace and recognize how many "wellness" benefits are mere company fig leaves. His book is a challenging read but it goes right to the core of risk management. We may think this is about benefits and those people over in in HR, but it's really about the human factor risks we all tackle every day.
A New Look at Old Technology
Using electrical stimulation of the spinal cord by an implanted device to block various types of pain was first approved by the FDA back in 1984. The technology has been around ever since, but it became a sleepy clinical backwater until the problems with opioids sent pain control specialists and their patients in search of something better and non-addictive. Now the field is bubbling with new thinking and new devices.
The first major change was the introduction of Nevro's first device in 2015, but since then several medical device companies have responded with new, much improved devices of their own. The new devices are based on the latest understanding of how the brain operates. Neuroscience has progressed dramatically since those first stimulators and the new devices reflect this improved understanding of what pain is and how it works.
The bottom line is that injured workers with chronic pain complications now have real alternatives. No opioids need apply. See the CNBC report for more.