2017 WCRI Conference 2nd Morning Session
Live Blogging – typing it as it happens
STATE OF THE STATES
The start of the 2017 WCRI Conference 2nd morning session will discuss some of the latest findings and trends seen across WCRI’s core benchmark studies, including WCRI’s 18-State CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.
This session will be helpful to stakeholders and public officials who are looking to better manage change and avoid the historic pattern of crisis-reform-crisis that has frequently characterized workers’ compensation in the past.
Carol Telles – WCRI
- Less hospital use in the 18 states WCRI analyzed
- Since 2000 33% increase in outpatient admissions
- 2000 – 2008 increase in hospitalization – then decrease
- Kentucky and Minnesota were the two most significant decreases almost 4%
- New Jersey back surgeries (outpatient) increased but inpatient decreased
- 2000 – 2014 60% increase in ASC’s – ambulatory surgery centers
- North Carolina and Georgia had most significant decreases in inpatient surgeries
- ASC’s are 50% cheaper
- Wisconsin had highest charges for hospital outpatient physical medicine
- Texas has highest decrease in radiological studies outpatient
Will Browder
- Indiana had one of lowest indemnity payments per claim
- North Carolina had one of highest indemnity payments per claim
- Iowa has highest maximum weekly benefit level – $881
- North Carolina House Bill 709
- 500 TTD week cap
- 300 TPD week cap
- Suitable employment definition narrowed
Dr, Rebecca Yang
Attorney Involvement
- Illinois had highest attorney involvement 52%
- New Jersey had 49% attorney involvement
- Wisconsin and Texas had lowest attorney involvement
- Texas
- limits attorney hourly fees to $200
- Limits on lump sum settlements
- Wisconsin
- Clear standards for TD benefits
- Two PPD structure
- New Jersey
- PPD not paid voluntarily
- Illinois
- No standards to PPD ratings
- Lump sums based on multiple factors not just PPD
- PPD benefit is much lower so TTD benefit period lengthened
- Medical experts just one aspect in final determination of PPD
COULD VALUE-BASED HEALTH CARE WORK FOR INJURED WORKERS?
Currently, physicians and hospitals treating injured workers are paid using a fee-for-service approach, which reimburses based on the volume of services provided. Across the country, health plans and health care providers have been adopting the principles of “value-based health care” where providers’ compensation is based on the value of services and their impact on patients’ health and where alternative forms of reimbursement, such as bundled payments or capitation, are employed. Join us as we invite a leading expert on the topic to explain what “value-based health care” is and how it would apply to workers’ compensation.
Dr. Alexandra Page, Principal, Musculoskeletal Health Care Solutions
- Value = Quality/Cost
- Components
- Evidence Based Medicine
- Clinical Practice Guidelines
- Shared Risk
- Outcome Measures – Return to work
- Accountable Care Organizations (ACO’s)
Questions
- Doctors should share risk
- Kaiser at Work
APPRAISING THE “GRAND BARGAIN” IN 2017
The workers’ compensation system was created over 100 years ago, and it has evolved over the years to meet numerous challenges. To lower costs, many states have enacted policies to control care and benefits (e.g., allowing the employer to choose the doctor or tightening eligibility for workers’ compensation benefits). For some, these measures have controlled costs without impeding care or access to benefits. For others, the policies enacted across the country have gone too far in reducing benefits and the amount and quality of care to injured workers, eroding the Grand Bargain and leading to constitutional challenges in some states. Join our diverse and distinguished panel of experts as they discuss whether the workers’ compensation system is still fulfilling its mission or needs revisiting.
Prof. Emily Spieler, Northeastern University School of Law
Dr. David Deitz, Principal, David Deitz & Associates
Dr. David Michaels, Former Assistant Secretary of Labor for Occupational Safety and Health (OSHA)
Mr. Bruce Wood, American Insurance Association
Why is Workers Comp being discussed nationally now?
- Workers compensation has been a flawed system
- PPD compensation
- Many states went to an impairment-based systems
- Used AMA guides – some with modifications
- Raising bar on compensability
- Utilization Review
- TTD caps
- Is the Grand Bargain over?
- Many workers in the Workers Comp system are not doing that well
- No generalized disability system – policy debate
- Employer cost vs. social insurance
- Workers comp credibility as social insurance
- Very complex system
- Oregon ruled that Workers Comp is unconstitutional – became a tort system – no avalanche of tort litigation
- Causation issue becoming very thorny – bottom line is people need care
Do injured workers share a large brunt of the cost of being out of work?
- Injured workers may not want to report an injury
- SSDI takes on quite a bit of the brunt of associated costs
- Are there impediments in the WC system that keep care/benefits/wage loss from being provided
- Case shifting from SSDI to WC?
- 2010 Study – WC does not cause increases to SSDI costs
- NCCI – 12 weeks is average TTD period
- West Virginia – PTD awards-odd lot doctrine – system collapsed due to unsustainability
- What should the comp system pay for?
- Amputation study – 30 – 40% of amputation injuries not reported as WC?
Level and Quality of Medical Care in WC
- Core problem – diverging from direction of general healthcare
- Don Burwick – triple aim – key – how are we delivering quality healthcare
- WC is headed in wrong direction
- Workers Comp medical system – should it be rolled into health? Yes, but not the disability system
Unsafe Employers
- German WC system has many more safety inspectors
- Insurance carriers do bear some of the responsibility for safety
- Better linkage between OSHA and insurance carriers
- Many employers do spend funds on safety
- Insurance carriers reporting to OSHA may not be good idea as injuries may not be reported
- Experience Rating system has an element of confidentiality
Federal Oversight of Workers Compensation System
- Disparity of benefits between state
- Scheduled injuries is only one aspect of system
- Some states have eliminated schedule
- States have done a good job overall to move swiftly in the 1990’s
- All Federal systems in WC (FECA, Longshore, etc.) are very outdated and inefficient
- Lack of consensus may enable attorneys to expand to a tort system
- Indiana increased benefits
- Unemployment insurance is a good example of the Feds working with the states
Questions
- Technology is missing from WC agenda
- Is the safety net gone from the WC system? Possibly with Opt Out
- Subcontractor system has changed the system
- Impact of Fraud? – Fraud is not medical provider centered
- Statistics in Amputation study – OSHA logs – reporting issues? Data did not match – many studies that show amputations are not getting into the system
- How does WC adapt to the future needs of workers? Need to think about TTD of workers that are not in present WC system.
Comments
- Huge gaps in medical care in the Workers Comp system as compared to the healthcare system
- Indemnity benefits should be the focus – cash benefits- inequities across state lines-communication is the critical part as WC is not separate but included in the whole workplace scenario- if you wait until an employee is injured to be nice to employee, that is rather late
- Cannot adjudicate what is not filed in the system, credibility issue – how WC is viewed is critical to its survival
- Opt out is a big concern
- Injury prevention should not be ignored, how can we use the WC system to enhance safety
End of 2017 WCRI conference 2nd Morning Session
End of 2017 Conference
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