WCRI 2017 Conference – Blogging Live – Afternoon Sessions p2

COULD VALUE-BASED HEALTH CARE WORK FOR INJURED WORKERS? WORKERS COMPENSATION CONSULTANTS

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 | Workers Comp Consultants

• 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 | Workers Comp Consultants

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. Read more in J&L Risk Management Consultants

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
• Read more in J&L Risk Management Consultants

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? 
• Read more in J&L Risk Management Consultants

Level and Quality of Medical Care in WC| Workers Comp Consultants

• 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
• Read more in J&L Risk Management Consultants

Unsafe Employers | Workers Comp Consultants

• 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
• Read more in J&L Risk Management Consultants

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 
• Learn More About experienced Workers Compensation Consultants

How does one have the Workers Comp community accept the psychological treatment part of an injury as the attempt is to avoid this type of treatment  – screening at 6- 10 weeks of care for high risk to send to collaborative care. Learn More About experienced Workers Compensation Consultants

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WCRI 2017 Conference – Blogging Live – Afternoon Sessions p1

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