I will be the first to tell you that those of us engaged in coordinating the Workers’ Compensation Summit have been completely overwhelmed the past couple months. The Summit, if you are unaware, is the ongoing effort driving the “National Conversation” for the workers’ compensation industry, looking to identify weaknesses and promote positive change for the industry. We had our second meeting on August 21st, which was graciously hosted by the Workers’ Compensation Institute during their annual conference in Orlando.
After the Dallas meeting we very quickly published finalized notes and a summary of our results. Unfortunately, this time, life got in the way, and that process has been much, much slower. For that I personally apologize to participants and observers; we are committed to making this effort move forward, and will try to avoid those delays in the future.
We only had 4 hours for the Orlando meeting, and while that is not nearly enough time to allow us to build Rome, we did manage to get a pretty good inventory of the bricks that would be needed for the effort. We spent most of the time discussing the three top priority issues identified in Dallas – Benefits Adequacy, Regulatory Complexity and Delays in Treatment for Compensable Claims.
There were a couple distinct positive results from this gathering. First, the group identified and discussed several distinct ideas that work in certain states around the country in regards to the three priority issues. Secondly, and more importantly, several participants who are expected to be involved in upcoming Florida reforms were able to take these ideas and will attempt to weave them into a solution that will work for Florida.
If they are successful, it means we’ve moved the ball just slightly down the field.
This group and those organizing it have been criticized by some for their efforts. They mocked the findings of Dallas as something more or less a “blinding glimpse of the obvious”. The critics seemed to resent any effort that didn’t result in some major life changing epiphany, and openly mocked the results as inadequate or useless. It was the typical conundrum of people who don’t contribute anything positive to a situation criticizing those who do. The critics simply did not understand what we are attempting here, and therefore were largely incapable of appreciating the long term goals and intentions of the group.
That goal can best be described as the “short game”, moving the ball down the field a bit with every play, but taking care not to fumble and lose possession of the effort. The group ended the Florida meeting stating the desire to continue on as an organization, a sort of “think tank” that can continue analyzing what works and why, and then sharing those findings with jurisdictions in need. It was suggested we meet again during the National Workers’ Compensation and Disability Conference in New Orleans in late November. We are working to put that together now.
Meanwhile, we wanted to release the unedited notes from the Florida Summit Meeting. They should have been out 3 weeks ago – but nevertheless they are now posted below for your review.
Notes From The National Conversation (Florida)
August 21, 2016
We will focus on the three major topics from the meeting in Dallas. All of the critical points are on the WorkersCompensation.com website, as is the description of how the Summit reached its conclusions both in Dallas and through a polling process after.
We have significant questions such as
Are there adequate benefits?
What are the cost of living impacts?
Why do we hear of $5,000 award for a career ending injury?
There are two schools on indemnity. Some compensate disability, others impairment. Georgia and North Carolina are noted as having both in a hybrid format.
Though cost is a consistent point, it is noted that California’s recent increase of benefits did not cause the system to go into crisis financially.
Oklahoma had a debate during reform about what are the best measures of benefits. But the amount to the injured workers, compared to the costs, was not a subject of discussion.
Typically it is the employer perspective driving things legislatively. The perception is that the American labor movement is not engaged and is in decline.
Discussing what is working, it is suggested that Kentucky is a system that is said to be working.
There is also a suggestion that the Federal System can provide guidance
Some express concern that workers can return to work and still be receiving full benefits. Is that the point of the system?
Turning to medical issues
The medical system is a challenge. Labor says that the treatment from the doctors is different if it is “group” compared to WC, same doctor, same patient, but the care is different.
Can we find a way to surgically address problem providers and problem situations in a jurisdiction without broad brush approaches that attempt to “blanket” fix what are actually exceptional and reasonably focused problems?
It is noted that Disney is focused on value-added and recovery while working. Workers are brought back to work, but their labor costs are absorbed at a corporate, not department, level. These are people that are recovering and the business unit is not charged, so it is free labor for the unit. This incentivizes the unit to seek injured workers that wish to return to work. This facilitates recovery and demonstrates a commitment to the human assets.
But is this viable in the rest of WC? Small business is the backbone and many say that there is a deficit for the small employers. For them a state system of rehab and reemploy may be the only vehicle. The systems like Oregon give a discount to the employer (premium) if the employer takes the injured person back. Getting the employer engaged is the key, and money in the pocket is the incentive that is needed.
Vernacular changes may help. Change workers’ “compensation” to workers’ “recovery.” Is the recovery mindset achievable because the vernacular changes?
What are the disincentives in the system. There is no compensation for the quick recovery. The disability and the impairment drive the monetary value and thus recovery. That mindset of maximizing recovery through maximizing impairment or disability drives the attorney and the others involved. The bigger they can make the cases, the bigger the volume of benefits and the bigger the fees (medical or legal).
System complexity
The complexity of the system and the development of the case is driven by the hard questions like “arising out of. “
The reporting and EDI are expensive for employers and carriers and not benefitting the injured workers. How do we shift the emphasis to the employee?
There is a conflict between business and their interest in a report of data. The state wants information, but that cannot come in naturally from the insurance carriers because the carriers are not collecting this information for their purposes. In other words, they are collecting what the state wants, for a purpose unknown (and in some cases unknowable).
States are demanding data, but some states cannot even describe what they want and why they want it.
There is no difference in multiple instances between a 95% compliance with the state demands and an 80% compliance.
There has to be a connect between the need for the data and the purpose has to benefit all. That will drive performance.
Doctors see problems. The issue is preauthorization. They are being forced to seek this blessing before performing services. But this blessing does not guarantee payment after.
There are costs: for form completion, for correspondence, for questions. There is a perception that 90% of procedures in the preauthorization system/process are flowing, but there is a 10% population that creates issues. The preauth process should be eliminated and that would make the system more responsive and effective
There is argument that the system should pay for procedures for the patient, not for the outcome. Others argue that is how it is now, fee for service, and this does not incentivize recovery. Others note that a portion of patients do not seek recovery, just documentation of disability. How do we change the incentive and get the outcome that we all desire.
The employee and the employer are damaged in the medical delivery process and they are the system’s purpose.
There are agents and they operated differently. They may be the right path for information to the small employers.
Need a surgical way to deal with the bad actors in the system. Regulatory oversight is the equivalent now of killing a flea with a sledgehammer.
We know who the bad actors are. We need to get rid of the bad actors, but the question is how?, What is the surgical solution without just broad brushing bigger regulation volumes.
When discussing regulation, state dysfunction and distinction is discussed.
Whose job is it to regulate the doctors? CA experience teaches us it is not DIR, perhaps the state attorney. What about the DOH or the AHCA.
Big pharma is driving care with advertising and promotion, no sanction for the doctors.
Why is there no move to false claims act section in the WC section of state statutes.
Let the doctors treat. Get the doctors out of the concept of litigation.
But the group health is on the same track with reviewers and doctors making the panel decisions.
There is discussion of the illogic of a State auditing the carrier paying above the fee schedule. Why cannot the payers decide to get the best in the system and pay the doctors? Why are carriers punished for doing the right thing. The issue may be the rate setting constriction on cost, and the pass through in terms of rates. States try to control rates, and may have an interest in stability?
Tennessee is a model for regulatory. That is based on the way that its leaders listened to everyone in the formation process for their new system there.
Third issue: Delays in medical care
Can we get a Maine 222 going?
The group health will not like it. But the people present like it.
Give the judges jurisdiction to adjudicate the responsibility between the group and WCC carriers?
Some say there are some states where there is compensation even while the dispute occurs.
When a doctor request authorization, there are carrier penalties if they do not respond. The doctor has to create the right form in the right state. The requests are bureaucratic for the doctor. For the payer, this is putting them under the microscope on both sides, both requiring the forms and then acting on them timely
So is the issue that the carriers have to ask for too much data?
Are the networks set up appropriately and are the providers better? In many networks, the perception is that they do not take WC and they are too far away.
Telemedicine and its involvement is a topic, Getting the right doctors into the system is critical, but with travel and low provider populations, delay is inevitable.
How do we engage the system and educate the injured worker and the employer before injury?
Everyone at the table likes the treatment guidelines. The doctors (good ones) seem to like them, the payers say it speeds processing and authorization, the Texans say that it works and there are no or few disputes. But there is a perception they may lead to “cook book” medicine.
Some merely use them to guide their care. Others use the guides to defend their decision
A third group does not look at the guides but say they are nonetheless “evidence based doctors” and the guides are evidence based, so “I am using them.”
Doctors do not like cookie cutter. Do not like to be told what to do.
A paralysis comes from the difficulty of the decision adjusters are called upon to make. There is a foundational assistance or comfort when the decision maker can look at the guides and has back up and feels covered.
Medical choice when employer directed – need to get employee buy in
Should we have state-by-state or National minimum standards?
Need to further clarify the issues and take back to individual states. Identify
General statement needed from this meeting – simplified system
Secretary Perez using “bully pulpit” to address comp is a concern.
Need to implement positive change
Those involved with Florida task force have this group to fall back on.
This group should continue as a type of “think tank” to analyze what works and what does not work, and share positive ideas for inclusion elsewhere.
We should consider meeting again in New Orleans in November, in conjunction with the NWCDC.