Podcast Transcript of John Ruser – Straight Outta Workers' Comp

Dr. John Ruser, President & CEO of the Workers' Compensation Research Institute, joined host Bob Wilson to talk about the recent successful WCRI annual conference as well as early results of some cutting edge research being conducted by his organization. This transcript of their conversation was generated using automated technology. Some grammatical and spelling errors may exist.

You may listen to the full podcast here.

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Bob Wilson (00:02):

Hi, and welcome to Straight Outta Workers' Comp, a podcast for the workers' compensation industry. I am Bob Wilson. Today, we're, we're pretty excited. We've got a very established and significant guest with us. He is president and CEO of Workers Compensation Research Institute, Dr. John Ruser. John, thank you for joining us today. We appreciate you taking time to visit with us.

Dr. John Ruser (00:27):

Happy to be here, Bob.

Bob Wilson (00:28):

All right. Yeah, You had your annual conference in Boston, I believe last week. And we wanted to follow up on some of the information that was covered. Some of the things that you do, it's always a big event, always introducing some of the latest research that you've done. And I think we wanted to talk about some of that today. First, all I will, I will point out how long have you been with WCRI?

Dr. John Ruser (00:53):

I'm closing it on seven years now.

Bob Wilson (00:55):

Seven years, seven years. And prior to that, you were with several positions with the US bureau of labor statistics. Including associate director for regional economics at the us department of commerce. Is that correct?

Dr. John Ruser (01:09):

That's that was the first one. Yep. That Was the first one.

Bob Wilson (01:11):

And then associate commissioner for productivity and technology and assistant commissioner for safety, health, and working conditions. I assume that's two jobs.

Dr. John Ruser (01:20):

Those were two separate jobs. Yes.

Bob Wilson (01:22):

That's good. Cause you would have a terrible time at cocktail parties. If that was one job title, it would just be what do you do for a living? Nothing. It would basically be much easier to say than trying to get all that. So super. Why don't you just take a few minutes if you could you had tell us about how many people attended. I know you have several hundred every year attend this event. This is, is the first live event you've been able to offer. And you probably had the, the distinction of being one of the last workers comp conferences in 2020 before COVID hit. So it was a, a nice return. Tell us a little bit about how many people attended and, and, and overview of the event this year, if you could.

Dr. John Ruser (02:02):

Sure. Bob so, so you're absolutely right. This was for many people, the last live conference that they attended before the shutdown from COVID and for some folks, it was also the first live in person event. They, they attended after, well, we're not past COVID, but COVID is settling down on us. So so this was a, a wonderful conference. We had 368 registrants. Wow, that's great. So far more frankly, than we expected, and I think we were fortunate that the Aron variant subsided and I think folks felt comfortable coming to a live conference. We did some things ourselves to, you know, improve the the comfort level for, of fo but anyway, it was a tremendous event. The, the theme of the conference was emerging and learning from disruption. And you know, it seems like an obvious theme coming out of COVID and all of the disruptions that COVID caused. And so a number of our sessions were focused on the disruptions related to COVID.

Bob Wilson (03:08):

Yeah. You know, it's interesting because so many us, you, you said, you know, COVID is, is, is somewhat past. It's like many of us are over COVID. I mean, we just are, are done with it. No one wants to talk about it, but you can avoid it because it, it, it was such a disruption. I've said this in prior episodes said this in conversations, you know, if you had told me three years ago that the workers' compensation industry would be able to on a dime, turn them to go remote handle normal business, as well as all the new responsibilities being thrown our way over a hand demo. I would've told you we never could have done that. And I think the industry actually did very, very well. But obviously the, the, the pandemic did cause a great a great amount of disruption in many things. And you had a session that was actually called impact of disruption caused by COVID 19 on workers compensation. I believe you had participated in that panel. What were some of the findings that you had from some of the over that topic and the disruptions on the pandemic?

Dr. John Ruser (04:10):

So that was a session that professor Robert Hartwig now of the university of South Carolina gave anybody who's seen Bob Hartwig knows that he is incredibly eloquent in describing economic data. And so he managed to move his way through a lot of economic data to show the impact of the of COVID and, and other features of the past two years on the labor market and on inflation. So showing the big drop in employment and the subsequent growth back in employment showing inflation and some other statistics around labor force participation, the great resignation covered an awful lot of topics about the way the economic landscape changed over the past two years.

Bob Wilson (05:00):

Yeah. Hartwig is of, and this is not a phrase you quite often, these are not words you usually mix, but he's a very entertaining economics presenter. He he's, he makes a, he does an excellent job of, of relaying very detailed information in an entertaining format.

Dr. John Ruser (05:21):

He, he, he absolutely do does. And he also shows the mastery of, of his understanding of the data. I, as you mentioned, I worked at the bureau of labor statistics for many years. And so a bunch of the data that he showed were from the BLS and, and I was just so impressed with his grasp of knowledge of those data and, and being able to describe those data to a lay audience.

Bob Wilson (05:44):

Right. from that, from that discussion, I mean, there was obviously there's so many areas where you can go there was a, I think we saw, and you may have some statistics on this that I don't have a, a drop in claim activity, a significant drop in claim activity for the industry over the last couple years. Now, all of the data of course, may not be in data is always the, the lagging indicator. It seems to what's actually maybe happening. What do you think from the, from that topic, if you had to choose one or two of the biggest disruption that COVID cost caused on the industry, what, what do you think that would be?

Dr. John Ruser (06:22):

Well, there's no doubt that the we've heard about the term, the great resignation. So there, there's no doubt that COVID caused a lot of us to think about what was most important in our lives and whether or not we were really happy in our jobs. And so at, at the, this point in time, the quit rate out of jobs is as high as it's been since a survey has been around to record those kinds of data. And, and so there's just no doubt that the folks leaving their jobs is one of the biggest things that we noticed from COVID.

Bob Wilson (06:54):

Yeah. You know, we've been talking for years about the gray tsunami that would be coming on the workers comp industry as, as oh, this is a an audio program that listeners can't see us, but we could see each other, but you can certainly see that there's been a little graying effect here. I'm, I'm, I'm getting older, everyone's getting, it seems to be aging in the industry. And there's no doubt that the great resignation has suddenly put that upon us. You know, we've been talking, it accelerated a lot of things. COVID seemed to accelerate a lot of things. I mean, I joke with people that three years ago, many people in our industry couldn't even spell telemedicine let alone use it. And it, it, it, I think there's been a big impact from people retiring, any, any in that they, that, that, that some of these people who are resigning, you may not have studied this at all. I'm just this is a danger of talking to me as you end up with all sorts of questions, just popping into my head. Anyway…

Dr. John Ruser (07:49):

They warned me about that.

Bob Wilson (07:51):

That what, who

Dr. John Ruser (07:51):

Warned you, they warn, they warned me about that.

Bob Wilson (07:53):

Did they? That's good.

Bob Wilson (07:56):

Yeah. Well, it's my reputation precedes me. Wonderful. any indication that, that this is a phenomenon that will wa or is it going to continue or some of these people going to come back?

Dr. John Ruser (08:11):

I, I can't really prognosticate on that, Bob, but I can, I, I can mention to you that the great resignation is just not about graying people. Or retiring. It also has to do with younger people who are quitting their jobs, and then presumably they will, you know, end up going back to another job,

Bob Wilson (08:29):

I would think, cuz I'm, I'm not sure how you still manage to pay the bills when you, you know, but there, there's no doubt that as an aside you know, the, the, perhaps as an industry, we need to look at the, a way we position ourselves and present ourselves to attract quality talent, because people are looking for quality as much as a you know, quality of outcome and quality of contribution. It seems they're, they're looking at what matters more. I think you kind of indicated that earlier in one of your comments. So it's interesting. You, you, you had a panel on the state of the worker's compensation system. It I know that judge David Langham was on that panel. You had I'm trying to find it here. Actually. I had my notes. I'm a great note taker, just very disorganized desk. That's the problem we have. But it really was clutter desk looking I'm sorry,

Dr. John Ruser (09:21):

Is that your cluttered desk?

Bob Wilson (09:23):

That's my cluttered desk. It it's true. It's, it's just truth in branding. What can I say? Yeah, you had Alan Pierce, David Langham, Bruce Wood and yourself looking primarily at the, I think basing off the 50 year anniversary of the 1972 commission, federal commission on work men's compensation that was chaired by John Burton. Tell us a little bit about that panel. I heard great things about that panel, the but tell us a little bit about that discussion and where we're at today. Very the 19 essential recommendations. And, and that report in general.

Dr. John Ruser (10:01):

So Bob, I would say that the debate was very lively in the session between, particularly between Alan P and Bruce Wood. So sort of depending on whether or not you think things have approved relative to the national commission report, sort of depends on your perspective. And, and that certainly emerged from the discussion. We actually started the, the panel with a recording brief interview of professor John Burton who's emeritus professor from Rutgers. And he talked about some of the features of, of the system that he believes are still falling short. Some of them probably were not even mentioned in the national commission report because things have changed in the past 50 years. And that's certainly something that judge Langham brought up when he was talking.

Bob Wilson (10:48):

Yeah. Yeah, it is interesting cuz there has been a lot of debate that, you know, there, the, there were 19 essential recommendations. I can't refer 40 some 42 overall recommendations. I can't remember the total number that they made. But there's been a fairly significant amount of debate that we are talking about standards that were set 50 years ago. And that the economy has changed. Societal expectations have changed. But it, it's also probably fair to say of those 19 essential recommendations that some of 'em are fairly fundamental that that don't change. They address they go to, they go to basic needs of injured workers. Would that be a fair statement?

Dr. John Ruser (11:30):

Yeah, that would be a fair statement for sure. They're certainly some of them focused on levels of indemnity benefits, for example.

Bob Wilson (11:36):

Yeah. Okay. Yeah. And that that's been something that's been, I think consistent even though the, the nature of the industries we serve has changed, obviously gig workers are a huge topic. And speaking of gig workers, was there anything discussed or anything brought up related to gig workers and some of the independent contractor realm this year that might be new from you folks?

Dr. John Ruser (11:59):

Interestingly? No, I don't think a lot jumped out in, in the discussion, you know, like the rest of our lives now, so much of it revolved around COVID and something as important as gig workers just didn't get as much coverage this time around.

Bob Wilson (12:13):

Right. Right. I, I get it. I mean, there's it, it's funny, there are things that you just seem to talk, we all talk about, talk about, talk about, and then something happens and we don't talk about it anymore. You know, it's actually to some degree you've got the same thing with the horrible things that are going on in Ukraine right now, suddenly COVID is off the pages. Just doesn't it, it's funny how our attention tends to shift you. You had a session I'm gonna ask you about that was just interesting to me from a personal perspective. I, I am a, a person who has had relatively good success with chiropractic care and lower back problems. I go, you know, occasionally for an adjustment, it just helps free up my back. However, that is also an area and my, my, my analysis is largely anecdotal.

Bob Wilson (13:01):

But it's, it's also an area that can be rife for some abuse. I mean, I have met con co chiropractors who believe they can cure cancer and, and improve eyesight and all sorts of things. I'm not necessarily gonna go that far. You had session and some research on patterns and outcomes of chiropractic care, which is to my knowledge, one of the first times that may have been officially investigated or research to, to the level that you may have applied to it. What, what can you tell us about some of that the, the patterns and outcomes that you found under chiropractic care in terms of utilization? I know you talked about variations from, you know, state based on jurisdiction. What can you tell us about that?

Dr. John Ruser (13:43):

Well, you're right, Bob, this was probably one of the first looks at chiropractic care and workers compensation. It's one of our studies that we gonna be releasing next month. And so we're really out of the of the work we did in this area. One of the things that really jumps out is the interstate variation in the use of chiropractic care. So there are a number of states that had very, very little of it, and there were others where there was a fairly high frequency of the use of high chiropractic care. And this is all for low back pain claims. And one of the factors that correlates with whether or not a chiropractor is, is used is whether or not the employer or the employee as the choice of provider. So in states where the employer or the insurer is, can choose the provider, chiropractors will rarely see however, in other, in the states where the worker had the choice they were much more likely to, to go to a chiropractor. The other factor that tended to correlate particularly with that ladder group of states with higher use of chiropractor was the supply of chiropractors. So in a state where there was a greater supply of, of chiropractors, there was also greater use of chiropractors in those states where the employee could, could make the choice.

Bob Wilson (15:02):

Yeah, that's interesting. I know you'll here in Florida. It's fairly restrictive in terms of chiropractic use. I think they're limited to 17 visits or something under worker's comp. I, I may be wrong on that. But that's really the result of some pretty significant abuses that occurred in the nineties here. You know, one of, one of the, one of the negatives towards chiropractic is that you never get better and some chiropractors will keep you coming three days a week for the rest of your life. I, I, I have known some people who are in that type of environment. I've been very fortunate with the two different chiropractors I've used in my life that I'm very free to come and go as I feel necessary. Did you find or did you, were you able to research what drives, you said availability of chiropractors may make a difference? The employers selection obviously may make a difference. Was there any indication that legislative restrictions may also play a part in some of the states?

Dr. John Ruser (16:01):

Well, we know as you mentioned that in some states there there's some limits on, on how many visits you can, you can take. So we saw a little bit of some, perhaps some evidence of limiting of the number of visits of, and in general though a takeaway of the report was not that there was sort of a large whole scale large numbers of visits to chiropractors. That's something that didn't jump out in the report at all.

Bob Wilson (16:24):

Interesting, interesting. Well, I, I look forward to seeing that report when it's finally issued, because I think it is a, an interesting topic. You know, as I said, you know, from my personal experience, I certainly see some benefit from the practice, but I, as a, as a businessman I certainly understand some of the concerns that business people may have along it. So it's gonna be interesting to see what you find from a utilization and, and outcome perspective. We'll look forward to seeing that report. And I know Andrew will be very good about letting us know when that's out. He's very good at communicating things like that. So Andrew, he will indeed. Yep. He will indeed. Any other issues? I, I'm gonna talk a little bit about Phoenix next year, cause I, I, we might as well give a plug for your, your next conference that you're going to have, or your next big annual event. Any other issues that came up that were striking this year that you think were usual, obviously COVID played a huge role in, in, in much of, of what you had to look at and probably will for some time, because it takes years for some of this data to actually become available in a, in a, in a, in a format or a form, some significant analysis possible. Anything else that, that we haven't touched on that you thought was interesting and unique that was covered in this year's conference?

Dr. John Ruser (17:45):

So we also have done some work on pro provider consolidation and the relationship between that and, and prices and payments for services and workers comp. And so the participants in the conference got a chance to see a preliminary data on the extent up to which there's consolidation in the worker's comp market for. And there were a couple of different forms of that. One is where hospitals acquire other hospitals. So they're, they're sort of, what's called horizontal integration. The other is where hospitals purchase say a primary care practice. So that's, that would be vertical integration. And so the presentation tended to focus on the latter on vertical integration, and it showed the extent to which that's happening, where primary care practices are getting acquired into healthcare systems. Right. And then it was able to relate that back to increases in prices, paid for services.

Bob Wilson (18:42):

Yeah, that's, that's actually fascinating. I I'm just in personal experience again, my, my father-in-law was on the board of directors of our, a local community hospital for 24 years, Sarasota Memorial. It's an elected position. He ran for election every four years, not a paid position. He was chairman of the hospital chain, but their big focus during that time was vertical integration. They, they bought a large several practices and consolidated, they own, they have a very large private practice group. That course the, the theory is they will feed it's like the feeder airlines, it's the commuter airlines that feed traffic into the larger system. And, and it's interesting because, you know, obviously you found that that's happening at a pretty significant level all over the country.

Dr. John Ruser (19:26):

Yeah. So we, we saw the, we saw the acquisitions and at this point in time, the, the work is focused on payments, but we also are going to be looking at exactly what you were describing, which is sort of the, the, the pathways to, to care, to referral patterns and the like, and with the notion being that when a health system acquires primary care practice, most of the referrals are probably gonna happen within the healthcare system, whereas they might not have the, the referrals might not have gone in the same direction, right. When the primary care practice was independent. Right.

Bob Wilson (19:57):

Would that, I mean, and again, this may be outside the realm of what, of, of what you were looking at or studying, you know, would that, would that seem to streamline or inhibit a care? I mean, I think of our own system where my doctor happens to be part of this, this large group owned by the hospital. My records are automatically integrated right into the Sarasota memorials records, so that if I go to the hospital, they've got all the things are computerized and, and integrated which would seem to be a benefit. But there may be other restrictions, limited competitiveness in workers comp of course the rates are often set by the states, the medical rates the reimbursement. So I don't know if that has big impact or not.

Dr. John Ruser (20:40):

No, that I think your observations spot on that there are proponents for the integration because of efficiencies, but there's also concerns about limiting competition, the nail on the head there, so,

Bob Wilson (20:53):

Oh, okay. Well, you know, even a blind squirrel finds a nut once in a while, so I'll chalk that up as a win today. I'm on, I'm on fire. Okay.

Dr. John Ruser (21:00):

So in another thing that we covered at the conference was COVID again in COVID. But it was a presentation, incredibly eloquent presentation by Dr. Sandra Galea, who is the Dean of the Boston university school of public health. And his was a topic focused on the short and long term effects of COVID. And he like Bob Hartwig showed a lot of data, but this time focused on COVID trends across the country, he was able to focus on some of the health disparities showing how certain demographic groups were disproportionately affected by COVID and talked a little bit about what he anticipates we might see in terms of, of long COVID it.

Bob Wilson (21:48):

Yeah, that's, that's fascinating. Particularly when you get into some of the different demographic groups that were so impacted so differently, COVID was a very strange phenomenon in the sense that I've, I don't think we've ever seen a, what became a commonly commonly communicable disease that gave some people the sniffles and killed other people. There there's such a wide and there does appear to be data. And I think from what you just said showing that certain demographic groups are really significantly more impacted, did he indicate what may have caused that? Or is it still too early to tell that's something that needs to be investigated?

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