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Workers Comp Centers of Excellence – Exciting New Medical Trend

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Workers’ Comp Centers of Excellence Treat The MegaClaims

The Workers’ Comp Centers of Excellence may reach beyond just MegaClaims.   Let us look at the definition of a center of excellence.

pic of DNA Workers Comp Centers of Excellence
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Researching the term uncovered the newness of the term and concept.  According to a recent Risk & Insurance article 

even the definition of centers of excellence remains not a very well-defined area of medical treatment.

According to Ann Perkins, COO, R&Q Health, there is no one set definition of a center of excellence.

But, “one way to look at them is as a center engaged in research. These centers are making contributions to patient health and health care at large. Typically, they treat a large number of patients with the same injury and the results are published and benchmarked with other similar centers,” she said.

In other words, a center of excellence is a team or facility that provides leadership, best practices, research, support and/or training in a specific area, like addiction, spinal cord injuries, heart-related illnesses and the like.

One of the most recognizable centers of excellence seen the most often in claims is the head injury treatment centers or burn centers.  The results from those two types of medical treatment centers rise above just being successful.

According to the R&I article, Centers of Excellence balk at the amount of paperwork involved with Workers’ Comp.  Can anyone debate that point?  (No!)  Workers Comp Centers of Excellence want to treat their patients and not be involved with the denial and approval process involved with what can sometimes be a contentious line of insurance benefit.

The centers of excellence concept hammered out a place in Workers’ Comp over the years.   WCRI and the NWCDC Vegas set aside a webinar and upcoming sessions at their annual conferences on this topic.   One cannot call this concept a fad.    Some of the centers started doing business in the mid-1900’s or earlier.

One could call Workers Comp Centers of Excellence value-based care for the extremely large claims.   Could these medical providers also treat only Workers’ Comp claims over $250,000 (or maybe less?).

A few carriers and big-house agencies borrowed the term over the last two years.   Their concept centers around claims-handling.  No names mentioned here.

If you Google the term, you will notice a sparse amount of articles on CSoE.  Remember that acronym.  WC Centers of Excellence (for medical treatment) will show up in the news within the next year.  I guarantee it.

 

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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