Workers Comp Medical Treatment – Faster is Better

December 16, 2020 By JL Risk Management Consultants

Quick Workers Comp Medical Treatment Key To Cutting Costs

The main Key To Cutting Your Insurance budget remains providing quick workers comp medical treatment for your injured employees. Having a medical network is a critical cost saver even if you are a small employer.

Wikimedia – Paola.navarro.fit

A Goldmine of Workers Comp Medical Treatment Articles

If you wish to read further, click on this search to read many of the articles I have written over the last 12 years on this very subject. You can also print them out or save them for later reading or as a source to quote for your own articles or blogs.

Google decides which articles are more important. J&L has little control over the ranking. Google usually ranks them very well.

Pre-recorded + One Upcoming Conference On Responsive Medical Treatment

Two venerable organizations have recorded or will provide an upcoming videoconference on quick workers comp medical treatment.

WCIRB – Good one from last month – Study Link + Presentation Slides

The study link is here. PDF file.

The presentation slides link is here. PDF File.

Yes, the WCIRB only covers California. Almost all the time I have read medical treatment studies from the WCIRB, they align with the rest of the nation.

Dave Bellusci is one of my favorite Workers Comp prognosticators. Both files deserve at least a quick read.

WCRI – Quick Workers Comp Medical Treatment – Physical Therapy

WCRI provides a great webinar and study on Thursday (12/17) at 2 PM East Coast time. One can look at this more globally as providing rapid medical treatment is a money saver.

I read this study when it was published. You can find it here along with a link to their free Medical Cost Index Study – another one worth reading.

From WCRI – (Sign up here for the webinar) – there may be a charge for non-members

As an increasing number of workers with injuries are receiving physical therapy (PT), this WCRI study finds that for workers with low back pain (LBP) only injuries, early initiation of PT is associated with lower utilization and costs of medical services and shorter duration of temporary disability (TD). The study focuses on claims with LBP-only injuries, recognizing that PT is often used as first-line treatment for LBP and other musculoskeletal injuries before considering opioid prescriptions and invasive procedures.

The webinar will address the following questions:
• How often do workers with LBP-only injuries receive early vs. late PT?
• Does early PT help reduce utilization and costs of medical services and shorten TD duration?
• What factors may have considerable influence on PT timing and outcomes?

This study is based on nearly 26,000 LBP-only claims with more than seven days of lost time from 27 states, with injuries from October 1, 2015, through March 31, 2017, and detailed medical transactions up through March 31, 2018. The 27 states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

The Bottom Line On Quick Workers Comp Medical Treatment

Three venerable organizations – The WCIRB, WCRI, and J&L Risk Management have all shown that with workers comp medical treatment – the faster the better to cutting workers comp costs.

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Workers Comp Medical Treatment Networks – What Studies Are Missing

November 19, 2020 By JL Risk Management Consultants

Workers Comp Medical Treatment Networks – Claims Adjuster’s Different Paradigms

After reading a few studies on workers comp medical treatment networks, one glaring aspect becomes apparent very quickly. As I often have commented on claims studies – “Did they interview any adjusters for input?” The answer remains “no” on most of them.

picture of barber dimes workers comp medical treatment network

On a side note, Rachel Fikes over at Rising Medical out of Chicago did just that earlier this year. Get your free copy of the study here – totally worth a read.

One recent study by NCCI (you can find it here) says that some treatment costs are higher for “in-network” medical treatment.

The one huge consideration is – do the claims adjusters feel the medical provider is one they can work with over the “long haul” and implicitly trust to treat the injured worker that is their claims responsibility?

Of course, (and this has been challenged by non-claims persons), the worker’s comp claims adjusters want the injured worker with a legitimate claim to have the best care possible even if it costs a little more.

The adjusters want to have:

Proper medical care that results in the highest level of care possible
Return to gainful employment as soon as possible
All benefits paid timely
File closure

Proper Care With The Workers Comp Medical Treatment Networks

Very often, workers comp claims adjusters have given a large medical network provided by their employer (carrier or TPA). The informal network that exists can usually operate inside the carrier’s or TPA’s medical network. Sometimes the physicians are non-network.

What physicians and other medical providers are contained in this informal workers comp medical network? Those medical providers are:

Trusted to provide the appropriate conservative medical treatment
Have an industrial background – think workers comp or industrial clinic
Huge one – communicate with the adjusting staff by providing medical notes rapidly
Huge one Part 2 – communicates with the employer on the injured worker’s medical status
Refer the injured worker to more specialized physicians (orthopedists, neurologists, etc.) that the adjuster is used to working with on claims
Return the injured worker to light duty when possible
Another huge one – seeks authorization from the adjuster for certain medical procedures such as surgery, referral to another medical provider, etc.
Avoids giving the adjuster the Twilight Zone Phone Call
Avoid litigation – Ok, – all employees have the right to consult and hire legal counsel.

When I review adjuster file notes, one aspect I see often is the adjuster is willing to work with an “out of network” medical provider if they cover the above bullet points.

Sideways Cost Savings

Is there still a cost-savings element when working with a physician that is not in the carrier’s or TPA’s prescribed network? Yes, any claims staff that is reading this will be nodding their head now.

Most medical networks save approximately 10 – 15%. By working with a medical provider that covers the above points well, the cost savings of an out of work provider can easily cover the 10 – 15%. I will save you all the math today, it does cover the network savings.

If one looks at the studies by WCRI’s Dr. Bogdan Savych, the employees tend to have a better outcome if they trusted the employer before the accident. I think we can add into that equation the trust level of the medical provider whether or not they are in a workers comp medical network.

Who can facilitate many of the above items – one of my favorite risk management techniques, the venerable worker’s comp rehab nurse or case manager.

I am not giving the advice to ignore the prescribed workers comp medical treatment networks. Then again, the cost-benefit tradeoff may be enough to use non-network physicians and according to NCCI, the non-network physicians may be less expensive.

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WCIRB Delayed Medical Treatment Study Backs Up Six Keys Study

November 5, 2020 By JL Risk Management Consultants

WCIRB Delayed Medical Treatment Study Proves What We Knew All Along

The WCIRB Delayed Medical Treatment Study can be found here. The WCIRB (California Workers Comp Rating Bureau) recently published a study on delayed medical treatment due to the recent COVID-19 pandemic.

picture of COVID-19 WCIRB Medical Treatment Delay Study

Public Use License – Maximilian Schönherr

I was hoping the study replicated or at least came close to the numbers that I had published in the late 1990s and early 2000s that showed if an injured worker experiences medical treatment delays, employers pay dearly.

Six Keys And Delayed Medical Treatment

Check out the Six Keys To Workers Comp Savings here. The Six Keys were developed over time as first a workers comp adjuster and then a consultant. I sampled 7,000 public entity claims files in 1998. I performed the same study again in 2008 to confirm my findings.

The Six Keys are:

Timely First Reports
Medical Network
Return To Work Program
How the Employer Treats the Employee
Management Adoption of Keys
Understand your final policy bill or premium audit

My signature presentation subject comes from the first four from the above list. Those four not being put into place costs an employer 400% more on their claims. Looking at it from a cost reduction viewpoint, the total cost saving experienced by providing timely medical treatment equals 75%.

I hoped very intensely that my numbers matched the WCIRB study and report. Some of my numbers had varied from WCIRB’s numbers over the years. WCIRB seemed to back up my numbers in this study.

One exasperating area for the claims department is the Twilight Zone Phone Call. Doing #1 and #2 on the list quickly means not introducing the claim to a claims department with a filing delay mistake. The phone call often causes the adjuster to set the reserves to a much higher level than normal.

In other words, the employer already blew this claim, so the reserves need to be more to cover the increased payments incurred during the lifetime of the claim. Yes, reserves are set that way most of the time.

How The WCIRB Delayed Medical Treatment Study Relates To the Six Keys

Let us look at the WCIRB Study. By the way, you should download a copy of the study. It is worth the read. See the first link in this article to read and download the WCIRB article. Yes, it is worth your time.

The chart that made me feel good about my old (yet still accurate numbers are included in the WCIRB charts below. You may need to click on the chart thumbnail below to see it more clearly. The charts are from pages 9 through 11 from the study.

wcirb medical treatment delay study chart

Please click on the chart to see full size

wcirb delayed medical treatment study graph

The charts show that overall when medical treatment is delayed the medical and indemnity costs increase sharply. These charts are comparing delays due to COVID-19. “Delays are delays” – the numbers bear me out.

Both charts parallel the same time when workers comp adjusters set the final reserves for the life of the claim. Many more charts in the study come to the same conclusion – delayed medical treatment cost employers dearly.

Post-COVID-19 Recommendations

Long after the COVID situation resolves, the numbers on delayed treatment will stay the same. If timely injury reports and medical treatment is provided, the savings are approximately 75% on the overall costs.

The numbers between the WCIRB delayed medical treatment study and the numbers I have seen on file for over 30 years may not match exactly, but they are close enough to cause concern for employers nationwide.

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Workers Comp Medical Network Penetration Increases Utilization Costs

April 2, 2020 By JL Risk Management Consultants

Workers Comp Medical Network Penetration Means Higher Use – NCCI Study

A recent NCCI Study indicates that a higher Workers Comp medical network penetration rate results in a higher rate of utilization. Check out the study here on their website. The study reads as a little complicated, but bear with the study. The details are worth the read and your patience. (NCCI > National Council on Compensation Insurance).

Woman with book Workers Comp Medical Network studying at desk in library

StockUnlimited

Blog and newsletter readers will benefit from reading the whole study and drawing conclusions from it. NCCI verified what I had been saying for over a decade. When the prices of workers comp treatment decrease, such as an adjustment in a state fee schedule, utilization increases.

The definition of network utilization is the quantification or description of the use of services by persons for the purpose of preventing and curing health problems, promoting maintenance of health and well-being, or obtaining information about one’s health status and prognosis.

The focus word here is quantity.

Previous Studies Had Same Conclusion

Many articles have appeared in J&L’s blog over the years on this subject. I have performed studies for physical therapy groups, medical networks, carriers, TPA’s and investment groups on the use of medical networks. One of the by-product conclusions was that utilization offsets price when comparing the two variables.

According to NCCI –

…a higher proportion of in-network claims in a state relates to comparatively greater utilization of services for in-network claims. In turn, this associates greater network penetration with greater utilization of services to treat in-network claims, compared with out-of-network claims.

Missouri Has Highest Network Use At Highest Cost??

Let us see each state’s Workers Comp medical network penetration rates. One of the more interesting states in the below chart is Missouri. Last week, J&L produced an article on the extremely high costs of medical care in the Show Me State. Missouri has the highest use of medical networks in the nation. Why are the costs so high if the Missouri medical network penetration rate is the highest?

My best estimate would be that the medical costs are so high in Missouri (304% above the median state) that the medical network price may still be high. The use of the medical network is very high due to carriers and employers attempting to reduce medical costs. The graph below and the one in the previous article on Missouri medical costs point this out exactly.

Graph of NCCI Chart Workers Comp Medical Network Penetration

Click the chart for a better resolution. The bubble charts on pages 28 and 29 of the NCCI study on workers comp medical network penetration summarize the points very well.

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Workers Compensation Medical Networks – Are You A Drive-by User?

October 16, 2019 By JL Risk Management Consultants

Workers’ Compensation Medical Netwks – Discounts Not Being Useord By Employers

Workers’ Compensation medical network usage tends to be the drive-by type. What do I mean by drive-by?

drive thru workers compensation medical network

Wikimedia Public – Digimint

PPO/MPN/Cost-Savings Network

Most employers have an agreement with their carrier or Third Party Administrator (TPA) if your company is self-insured. Drive-by medical treatment originates with the employer or claims staff just using whomever they find convenient for post-accident treatment.

The discounts used provided by the medical networks never see the light of day. By luck, the injured employee treats with a provider that is in- network. The savings can be significant with Workers’ Compensation Medical Networks. The usual PPO discount pegs at 15% or higher.

Many networks exist in the marketplace. Some are whitelisted by a carrier, TPA, or other networks as their own group of providers. The white-listing should not be a cause for concern. Use the network you have in front of you regardless of the source of the providers.

Emergency Services vs. Workers’ Compensation Medical Networks

Please note one exception to the networks. If an injured employee needs emergency medical care or incurs a serious injury, make sure the injured employee receives immediate medical care. Do not worry about medical networks on this type of claim.

Attempting to have an employee with severe injuries stay in-network ends up costing insureds more than any network savings. I designed a walk-in clinic medical network for a very large (now defunct) home builder. The injured employee had a thumb amputation. He showed up with his supervisor at a walk-in medical clinic.

The supervisor said he stayed in-network. I was horrified and told them to go to the nearest hospital emergency room. The walk-in physician had already made the referral. The hospital reattached the thumb – Duke University Medical Center – whew!

Adjuster and Claims Department Concerns

Rightfully so, the claims adjuster and departments raise concerns about staying in the Workers’ Compensation medical network while assuring that the injured employee receives treatment from industrial-minded physicians.

Adjusters like to use certain physicians in certain areas for certain types of injuries. When I adjusted claims and now consult on them, I always carry a list of medical facilities in my head for a certain state or area. I think the main attribute was a “successful return to work” with the employee’s capabilities returned to enable them to do their jobs in full. The other attribute by physicians and medical providers was the bedside manner.

WCRI performed a host of studies on the main attribute that employees possessed with a successful return to work. The word TRUST of the employer before the injury and the medical care resulted in better returns-to-work.

The Second Key

The second key of my Six Keys To Workers Comp savings was written in the order of the claim. If I had to rank the Six Keys on savings potential, medical networks would rank the highest. Creating a network for injured employees seems complicated. Being prepared ahead of time make the task much easier.

At the time this article was published, approximately 41 states allow the employer to choose the medical network or to provide the injured employee with a panel or list of providers. Even if the employee retains the right to choose the treating physician (nine states?), the injured employee will treat with a suggested physician.

Preparation and Teamwork for the Workers Comp Medical Network

The upfront preparation pays off with the proper medical treatment at the lowest cost. The team members should be:

Claims adjuster or staff
Providers in the area
Medical network access for all involved – should be online with the carrier or TPA
Employer representative
Rehabilitation nurse – can be the hub to set up the network
Original treating physician – in-network referrals for more complicated cases.
Trust – see WCRI study referenced in a previous section

The employer representative kicks the medical network into gear by checking with all the above mentioned other parties. When looking for providers in your area, make sure they know that you use a certain network. Many medical providers signed up with medical networks once they learned local employers use a certain workers compensation medical network.

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Workers Comp Medical Cost Terms – Back To Basics

November 29, 2018 By JL Risk Management Consultants

Workers Comp Medical Cost Terms – A Few That Have Caused Confusion

Most Workers Comp medical cost terms are very easy to understand. However, there are a few that, in my recent conversations, have caused confusion and concern.

picture billboard workers comp medical cost term

Wikimedia Commons Tony Berkshire

Workers Comp Medical Cost Terms

These terms are a little more specific than the general terms that you will see in a Workers Comp claim or medical network. Some of these workers comp medical cost terms are easily recognizable. Others may look new.

PPO

The health insurance industry first coined this term in the 1980s. A medical provider in a PPO or preferred provider organization will discount their services in some way to patients. These patients, their insurance company, and the medical provider have all operated under some discount agreement. The agreement stems from the medical provider receiving higher volumes of patients for a discount.

Workers Comp PPO networks flourished in the 1990s until today. However, many Work Comp insurance carriers and their insureds may only receive a PPO network discount as part of a drive-by arrangement where the employee just happens to use one of the PPO network providers.

The drive-by situation, of course, is not a good use of the PPO network. After all, most workers compensation adjusters have their set of physicians that they like to deal with in claims. If the adjusters’ preferred medical providers are on the PPO list, then the optimal situation has occurred for the injured employee’s treatment.

One of the large conundrums is matching up the claim department’s favorite industrial-minded medical providers with the PPO providers.

PPO Penetration Rate

If the situation in the previous passage caused the injured employee to treat at a non-PPO medical provider, the penetration rate to be much lower than what is optimal. Then again, if the employee is receiving adequate care outside of the PPO network, should her/his treatment be moved to a medical provider just to save 15% on some of the medical costs?

This workers comp medical term is another conundrum for claims departments and PPO’s.

Durable Medical Equipment – One of the most important workers comp medical cost terms

Durable medical equipment remains a highly concerning workers comp medical term – why? Most states do not fee schedule DME’s. DME’s costs can be extremely high in WC.

The PPO network mentioned previously should have access to DME providers. If a state does not have a fee schedule for DME’s then the cost savings would generate from the adjuster’s direct negotiation with a DME provider. The PPO penetration rate goal for DME’s should be set at 100%. That is if the PPO network used has a viable DME component.

Usual and Customary Rate

If no fee schedule exists in a state, then a Usual and Customary or U&C rate becomes the claims payor rates in a certain state. U&C rates are considered another frustrating workers comp medical term. U&C can be calculated by Zip Code, phone number, or a certain part of a city. The variation in these rates is extreme in a certain state.

When I was assisting in closing out a claims load for a defunct captive, the providers (often hospitals) would have attorneys sue the captive very quickly if the carrier questioned or tried to negotiate the U&C rate.

The PPO penetration rate becomes even more critical in a U&C state. How does an adjuster set medical reserves when they have no fixed rates to estimate what the medical cost of a claim will be over the life of a claim?

These are only a few of the workers comp medical cost terms that have caused confusion over the years.

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Medical Treatment Networks Save Money – Win Win Win On Claim

August 23, 2018 By JL Risk Management Consultants

Medical Treatment Networks – A Little Work Saves Big Claim Dollars

Works For All Types of Employers And Provides Injured Workers With Top-Notch Treatment

Workers Compensation Medical treatment networks remain the mother of all workers comp savings plans. If an injury occurs, knowing the local industrial minded physicians and other medical providers can save a ton of premiums (voluntary market) and budgetary dollars (self-insureds, large deductibles, etc.)

graphic of Workers Comp Medical Treatment Networks

Licensed – Wikimedia Creative Commons

We received such a large readership rate and buzz on the article from last week on injured employee trust. This led me to extract a piece of my cornerstone manual.

Our article readers will receive a great freebie today – this advice used to cost money – you had to buy the manual on medical treatment networks from me a few years ago. From my 1996 Workers Compensation manual – Keys To Cutting Your Workers Comp Costs – From The End To The Beginning – the verbatim excerpt follows on medical treatment networks: (One Of the Six Keys) –

Doctor and Patient medical treatment networks shaking Hands

by StockUnlimited

Network Importance for Industrial Accidents

THIS is the most critical part of any WC claim without question. One very important point to remember is the Industrial Boards and Commissions in each state that oversee Workers Compensation claims consider the medical providers, especially the treating physician, as the only impartial parties/witnesses in the WC claim.

Some states require that a medical panel be available to all employees so that all employees have immediate and proper medical care. All employers in all states should have a panel of physicians.

Some states allow the employer to have the choice of medical providers for the employees, while others allow the employee to choose their own physician. However, studies have shown that employees in states that allow the employee to choose the physician will usually attend the paneled physician appointment.

The treating physician makes the determination of what medical costs will be incurred, the length of time the employee is out of work, and if the employee has any permanent disability. A good industrial-minded physician in the local area is very important to your Workers Compensation program.

I recommend a walk in clinic or an urgent care clinic to initially treat all injuries. A large number of WC urgent care centers are cropping up around the US.

The most important physicians for the more serious injury are the level two physicians. These physicians are usually surgeons (Orthopedic, Neurosurgeon, etc). The level-one physicians should know who your preferred level two physicians are before a referral is made.

If an injury is very serious, the employee should be taken to the emergency room at the nearest hospital. It behooves the employer to know the nearest industrial-minded orthopedists, neurologists, orthopedic surgeons, and neurologists in their general area (within 150 miles). The physician network often has to be expanded beyond the local area due to availability of specialty medical providers.

Win Win Win for Employer Physician and Injured Employees

Nurse medical treatment networks preparing syringe injection

by StockUnlimited

Earlier I mentioned the win-win-win situation when medical treatment networks are used by employers. The win-win-win results are:

First and foremost – the injured employee receives timely and proper care. No treatment delays exist in the medical section of the file. An employee that receives timely and proper treatment usually returns to work more quickly than an employee who is unhappy with their treatment. WCRI (research) performed a very large injured employee study that proves this point.
Medical control – the employer knows the employee is receiving the best care in the medical network or panel provided to the employee at the time of accident.
Insurance carrier or TPA – with a medical treatment network, the workers compensation adjuster does not receive the twilight zone phone call,. If the injured employee treats within a familiar network, the adjuster usually calculates that familiarity into the reserves on the file. <<very important. This importance also applies to self insured reserves.
Return to Work – with the adjuster, employer, and employee all on the same medical treatment network page, the return to work will likely be very smooth. BTW, return to work is another of the Six Keys.
Cost Savings – Using the TPA or insurance carrier networks usually result in a 15% reduction in medical fees. However, the medical providers in the network need to be researched heavily before coming up with a panel.

Setting up a medical treatment network requires a little work. Speaking with your carrier or TPA about their recommended industrial-minded physicians may be a good place to begin building the panel.

A local rehabilitation nurse (a recommended risk management strategy) may also be able to assist in forming industrial-minded medical treatment networks.

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Injured Workers Trust Four Professionals The Most During Their Claim

August 14, 2018 By JL Risk Management Consultants

Who Do Injured Workers Trust During Medical Treatment?

Most injured workers resemble their counterparts in the general public. I came across this article on the most trusted professions. At least five articles on these professionals have appeared earlier.

sketch of medical practitioner after treating injured worker

I decided to covert the general public view as the view of injured workers. I had already written articles on the most trusted professional as a great risk management technique. The other profession held in very high regard were pharmacists.

According to the article by Espresso – Nurses were held in the highest regard by the public. That makes sense and further shows why rehabilitation nurses properly hired and place on workers compensation claims can be a win-win-win-win-win (injured worker-employer-doctor-claims adjuster-overall claim) situation.

The article refers to in-hospital nurses. Rehabilitation nurses should still apply as being a trusted professional. In fact, in 30 years of being involved with insurance claims, I have only had one complaint from an injured worker about their rehabilitation nurse.

I could have possibly been lucky. Even employees represented by an attorney have had very few problems other than the attorney wanting to be kept up to date.

The new addition to the list is physicians. However, Workers Compensation has the aspect of employer medical control to it that may make the medical treatment seem forced – the company doctor, etc.

Most injured workers do not have a problem with the care being controlled by a doctor appointed or paneled by their employer. Even if the injured worker has the right of medical control, they will usually see whomever their employer recommends as the initial treating physician.

One professional that “flies under the radar” is the professional that an injured worker sees the most except for minor claims. The Physical Therapist will usually see the employee for a few times a week for a few weeks.

No other professional will see the employee that often. Other than the rehabilitation nurse, the employee will have very limited time exposures to doctors and pharmacists.

Employers can control the doctor and rehabilitation nurse that sees the employee. Few medical networks address the treating pharmacist and physical therapist. The physical therapist should be considered part of the network of choice.

Many physical therapy networks (MedRisk, etc.) do exist even today. The best that can be done is to use a good network.

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Workers Compensation Medical Networks Save Bundle – Used Properly

February 22, 2018 By JL Risk Management Consultants

Proper Use Of Workers Compensation Medical Networks Key To Employee Health And Savings

Workers Compensation Medical Networks have always provided a large return on investment. Injured employees receive the best medical treatment and the employer cuts their workers comp costs. The insurance carrier or TPA claims staff being able to work with the treating physicians to obtain work statuses and medical information will always lower your workers comp reserves.

Picture Anesthesiologist Draws Workers Compensation Medical Networks Fluid

US Navy Public License

This is the first area in Workers Comp that I realized benefits all parties. In fact, in the old days, as an adjuster, I had built informal medical treatment networks for:

The largest homebuilder in the nation
Two different huge fast food restaurant chains on the east coast
Many manufacturing plants

There were many other companies that benefited from my informal workers compensation medical networks. I did this while adjusting claims, not as a special project.

I began the Six Keys List soon after that.

doctors doing workers compensation medical networks Treatment

Wikimedia Commons By Gracefairchildsfisher

This Key comes with a caveat. The medical networks built by me were not necessarily from a TPA or insurance carrier provider list. The providers on those lists usually provide a 15% reduction in services – but are they the proper industrial-minded physicians that you wish to treat your injured employees? We have to remember that one of the goals is to keep the injured employees as healthy as possible while they recover and return to work.

The win-win-win of great informal workers comp medical networks come from four different aspects:

The information flow between provider, an injured employee, and the carrier has no logjams.
The provider is listed on the carrier/TPA’s medical provider list – usually resulting in a 15% discount.
Managing one of my other Six Keys – Return to Work becomes much easier
The injured employee receives the best treatment possible in their area.

This key actually links to more of the other Six Keys than all the other keys combined. Having a great workers comp medical network aids another key Treatment of Employee (not medical). The great research organization, WCRI studied this area heavily. And yes, how an employee is treated by their employer has a large effect on the outcome of the file.

Employee workers compensation medical networks check up

Wikimedia Commons – Josie Kemp, U.S. Air Force

As a side note, I had a very severe case of the flu last week and this week. It was awful. I ambled to my GP (General Practitioner). As I take blood thinners, that complicated the issue. Having the Dr. run test and then tell me I was going to be 100% fine meant quite a bit to me. Bedside manner goes a long one when treating Workers Comp patients.

One question is often asked in this area – What if the state is employee-directed care? A study was conducted on this point which showed most employees will go to the physician recommended by their employer regardless of who directs the medical control in the state. Unfortunately, I cannot locate the source article as I write this passage.

This Key is one of the more difficult to immediately install in your Workers Comp program. However, once that you do, the benefits of a workers compensation medical network become quickly apparent.

Workers Comp Medical Networks Keeping Costs in Check NCCI

May 24, 2017 By JL Risk Management Consultants

Workers Comp Medical Networks = Cost Saving According to NCCI’s Barry Lipton

Workers Comp medical networks reduce costs in most instances. At NCCI’s 2017 Annual Issues Symposium, Barry Lipton, Senior Actuary covered a very interesting topic – Medical Costs Then and Now <<slides available at this link.

brain activity workers comp medical networks scan

Provided by US Government

I do recommend looking at the slides for a few minutes as they are beyond informative.

One of the more important aspects of his presentation was that medical costs were decreasing due to the increase (almost 2/3) of physicians’ charges were network-based. See slide 14 of the presentation.

Slide 13 of Mr. Lipton’s presentation shows that states without medical fee schedules dwindled down to just a very few (6 states).

Two of his conclusions stated

Most physician fee schedules have been in place since 2000
Higher provider network penetration reaps benefits of system efficiencies

StockUnlimited

The second bullet point used to be quite a concern with the employer clients that I consulted with to reduce WC costs. The network penetration rates were never that high in many of the employer’s medical treatment networks.

Slide 8 of his presentation points out the main reason for the reduction in costs. Surprisingly, it is physician utilization per claim. While the reduction only totaled 3%, one would have to say this is significant in a time of upward spiraling medical costs.

As stated in my last article, workers comp medical networks or medical control is the most significant way to reduce costs out of the Six Keys To Reducing Workers Comp Costs.

Slide 2 shows that Workers Comp medical increases on Lost Time claims grew much more slowly over the last five years. In fact, the costs decreased in 2015. However, costs increased quite a bit in 2016 compared to the last few years.

The NCCI analysis agreed with most of my findings on the importance of using workers comp medical networks.

Workers Comp Medical Networks Reduce Costs – Or Do They Actually?

May 24, 2017 By JL Risk Management Consultants

Workers Comp Medical Networks – Three Conflicting Studies

Most Workers Comp networks generate large claim payment reductions according to two studies. Another study indicates no savings from these same Workers Comp medical networks.

One of my Six Keys To Saving On Workers Comp Costs involves medical control. Since the late 1980’s I have tracked three variables which save on WC payouts. One of the Six Keys is medical control or the use of medical networks created by the employer.

The others are ASAP First Reports and Return to Work programs.

diagram workers comp medical networks decision

jean paul alonso – Wikimedia Commons

In the 1990’s, I decided to see if my three financial keys affected the files as I had anticipated from the beginning. I performed two studies on two very different groups of governmental WC claim files. My theory on the financial keys sustained my theory all throughout the two sets of files.

Medical control by the employer reduced costs by 75%. Each employer we have assisted in cutting workers comp costs saved premium or budget dollars when using medical control to direct their employees to certain physicians. We stress to each client to have a medical network in place and not just have the company Doctor in place.

Study after study has shown that employees use the physicians that the employer recommends for initial and subsequent treatment for their work related injuries regardless of whether the employee or the employer has the medical treatment control.

Therefore my studies and experience say that medical control and medical networks save big workers comp money. Additionally, the network or medical control provides good conservative care for injured employees. The win-win-win situation creates a great bond between employer and employee.

NCCI Recent Press Release

Business People Workers Comp Medical Networks At Conference Room

StockUnlimited

NCCI, the largest rating bureau for Workers Comp released a study at their Annual State of The Line conference last week. Their study on Workers Comp medical networks indicated much premiums are saved by using medical networks.

WCRI Recent Study Release

WCRI (Workers Comp Research Institute) recently released a study that seems to contradict my findings along with NCCI. WCRI and my findings have always agreed right down the line. In fact most of the time, NCCI, WCRI, and I agreed on almost any aspect of Workers Comp.

For further reading, the links below will take you to each study’s summary. Unfortunately, my study was informal. I do not keep all the data nor did I publish the study as it was a very ad-hoc analysis.

WCRI graciously supplied me with a copy of their study. The summary/abstract is here.

The recent NCCI study has not been released yet. It should be out shortly. I will link to it when it appears on the NCCI website.

I try to write short articles so I will not comment on the NCCI or WCRI Studies yet. I will comment on workers comp medical networks this week.

Communication With Your Company’s Workers Comp Medical Providers

June 23, 2009 By JL Risk Management Consultants

Communication With Workers Comp Medical Providers Save Premiums

Workers Comp medical providers are one of the very critical areas in your Workers Compensation program. Communication with the medical providers in your network is one of the most effective ways to control your Workers Comp costs.

Graphic Of workers comp Medical Providers Icon

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The most important medical providers in your network are not the first-level physicians such as general practitioners. The first-level physicians are still important to treat minor injuries.

The second level which includes surgeons is the best area to save on Workers Compensation costs. The second level physicians will usually be in charge of the more serious claims and will make decisions on the disability of a more seriously injured worker. The treating second level physician will also help in controlling the medical costs.

How can your company control the second level physicians that your employees are referred to for treatment? A working relationship with your first level physicians so they realize who you wish your employees referred to in case there is a referral to a second level physician.

How can a surgeon or specialist know what the job tasks are for an employee? I will cover that in one of the next few posts.

Workers Compensation Program – Medical Network Critical To Not Harm

June 20, 2009 By JL Risk Management Consultants

Workers Compensation Program Medical Networks Critical

Does your company have a solid Workers Compensation program? This would apply to all employers regardless of size, type of insurance program, or state. California has shown that MPN’s (Medical Provider Networks) are a way to reduce premiums very quickly. Designing your own provider network is a task that will pay your company back with a large amount of savings.

Vector Graphic Of Physicians Workers Compensation Program And Hospital

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Does your company’s Workers Compensation program have a medical network in place? If not, you are very likely spending out 400% more on your premiums. I performed a study ten and again two years ago on a set of public entity files that indicated that very fact. The 400% is a conservative figure. How do you set up a network of doctors and other medical providers for your company? The first step is to take some type of action.

The first step is always the most difficult. Your medical bill processing company – which is sometimes your insurance carrier – has a list of doctors in their network. You can usually save about 15% on your medical bills just by using these medical providers. Find the ones in your area and direct your employees to use them.
Find the doctors that are industrial-minded inside of the network. This is a double savings as your company gets the network discount from your carrier/TPA. Your company will also save as industrial-minded doctors and providers tend to return the injured employees to work earlier.
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If you do not like the providers that are in your carrier’s/TPA’s medical network, then explore your local area for industrial clinics. We have seen great results from Concentra Medical Centers. Certain state laws may prevent you from going outside of your medical network such as the MPN’s in California. We have found that medical walk-in clinics are great for minor injuries.
Once your network is in place, communicate with the medical providers. I will cover the communication to the medical providers in the next one or two posts. This relates into my last post on return to work.
Monitor the network for changes in medical providers. Quite a few of the pharmaceutical networks have changed over the last few years. The network that you originally built may not be the same even after one year.
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Communicate the network to your employees. We have advised companies to place the medical provider list with the employees’ paychecks once per year, or sending out a memo to all employees yearly on who is the required or recommend physicians and other medical providers in the network. The procedures for reporting workers comp claims that I covered in the last few posts is very important. That is where the employer has the initial control of their claims.

One of the other areas that I recommend to cut workers comp costs is how the employee is treated after the accident. The employees see the medical providers as impartial and so do the Workers Compensation Industrial Boards and Courts. Medical treatment is the make or break area for your workers compensation program other than safety.