Maddy Bowling, principal, Maddy Bowling & Associates Consulting Inc.
Acquisitions, the economy and unemployment, and legislation are the biggest news stories in the workers' comp system today, she said. The fact that the system has been unable to control workers' comp medical costs are prompting several states to consider reforming their programs.
"There is always workers' comp talk in California and Texas, and there are changes already afoot in New York, Washington, and Illinois," she said. "Workers' comp reform in Illinois has been a long time coming."
She also believes the recent elections and changing of the guards in many states could impact workers' comp systems. "These states represent almost 50 percent of the total workers' comp benefits paid," she said. "So changes there could have a substantial impact."
Then there is the business aspect of workers' comp. "Acquisition fever appears to be encompassing our industry," she says. "I think that's a more dangerous trend. The bigger companies get, the more difficult it is for them to deliver quality service in all of their product lines and the less competition we have in the industry. . . .Of course it is also possible -- and I am hoping -- that this consolidation will lead to the development of new innovative players in our industry which would be a very good thing."
One of the toughest challenges facing the industry is the high unemployment rate and the ability to get injured workers back to work. Bowling says the resulting extensions of disability durations will require the industry to become more innovative about safety, prevention, and return-to-work initiatives.
Looking toward the future, Bowling believes the focus will shift in terms of how medical providers are selected for injured workers. "I believe that the day of the large, broad-based PPO as a tool for cost containment is ebbing," she says. "I think the industry payers and the medical providers are starting to realize that this model is probably not the way to reduce medical or indemnity costs."
Christopher Brigham, M.D., chairman, Impairment Resources LLC, San Diego.
Changes in the medical approach to injured workers have and will likely continue, Brigham says. There's an increasing recognition, albeit slowly, that some of the methods that have been near and dear to the hearts of workers' comp practitioners are not in the best interests of payers or patients.
"There are studies which are changing our understanding of the causality of conditions we often encounter, such as degenerative disk and carpal tunnel," he says. "It also relates to issues of treatment."
An example, he says is interventions with certain surgical procedures which have been shown to be problematic, such as lumbar fusions for low back pain and areas of abuse such as prescription drug repackaging.
"We're also starting to see a change in awareness that the local treating physician may not always be in the best position to address issues associated with the case, such as causation, apportionment, and impairment, that historically we've deferred to the person who saw the patient," he says. "It's not part of their training. It's not a skill set because very few are done on a regular basis."
At the same time, Brigham says there's been a resistance to change, driven largely by the interests of certain stakeholders.
"In the past year, I've seen continued resistance in the area of impairment assessment and using the most current methodology because the priorities of stakeholders are threatened," he says.
Brigham concurs with several other commenters on the issue of discount-driven medical provider networks. He sees a definite change.
"There's a recognition that cost savings is more effective by having a small network of quality providers rather than a large network based on discounting," he says. "There will be much more emphasis on outcomes and monitoring outcomes on the part of total quality improvement."
Brigham also sees a recognition of the importance of psychosocial factors and the need to manage them. For the immediate future, he believes there will be increased awareness of the need for quality, rather than discounted medical treatment for injured workers.
Read more at the WorkersComp Forum homepage.
March 3, 2011
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