By STEVE YAHN, who has written for and edited national publications for more than 30 years
Before Pat Venditti and his team took control of physician selection in the workers' comp program at St. Louis-based BJC Healthcare, some employees were seeing as many as six doctors.
Now, thanks to a physician selection system put in place by Venditti and his team, there has not been a single "out-of-control" case since the process was initiated in 2005--unlike in the past when a third-party administrator was in charge of the program.
"In out-of-control cases, the employer pays for it, but that's just money," said Venditti, a 20-plus veteran of the worker's compensation and disability field and director of corporate health services at BJC, winner of the 2009 Theodore Roosevelt Workers' Compensation and Disability Management Award in the nonprofit sector.
"The employee pays for it with damage to his lifestyle. I don't want to see that anymore, and we haven't," Venditti added.
"When our people came to face this challenge, one of our goals was that an injured employee would get two doctors--an initial primary surgeon and one specialist," said Venditti. "The only time they saw a third doctor was when they needed a second opinion or an IME (independent medical exam). We are not seeing four, five or six doctors in any cases anymore."
One of the failures of the old system was that the TPA was not capturing any data.
When the new system was initiated, Venditti hired someone to review all medical bills.
Now, Venditti's team compares the data in a number of ways.
"One, we look at disability claims through several programs that compare our doctors' practices to some various benchmarks. The healthcare network utilizes national disability and best practice guidelines such as the Official Disability Guidelines (ODG) and the American College of Occupational and Environmental Medicine (ACOEM) for comparison purposes."
Another highlight of the physician selection program is that Venditti and his team meet in person with any physician they use.
"We have made presentations to more than 100 specialists in the demographic areas of the companies HSOs (Healthy Service Organizations) and employees. The presentations are accompanied by a list of our expectations, our selection methodology and an offer to develop working partnerships," said Venditti. "Often, we invite providers to speak to our team of nurses, ergonomics specialists, safety and workers' compensation coordinators."
Venditti emphasized that BJC takes a common-sense approach to physician selection. For example, surgeries are done only when supported by medical evidence. As a result, lost production hours are minimized and overall program costs are reduced.
"It gives us great satisfaction to tell an employee that we would not send them to a physician that we would not go to ourselves," concluded Venditti. "Our reputation is such that we often get calls from employees asking us for referral for group health issues for themselves, friends or family."
November 1, 2009
Copyright 2009© LRP Publications