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His session, The Future of Workers' Comp -- The World According to Paduda, will open the 20th National Workers' Compensation and Disability ConferenceŽ & Expo.

With the explosion of social media, Paduda developed Managed Care Matters. Now one of the most widely read blogs in the managed care and workers' comp space, it offers Paduda's insights on the pressing issues of the day.

The specific topics Paduda will address will be determined closer to the conference dates based on input from participants in the conference LinkedIn group. In the meantime, Paduda shared his thoughts on some of the pressing issues at this point in time.

Illinois workers' comp reform. In the waning hours of the legislative session, Illinois lawmakers passed legislation aimed at reducing costs in the system. At press time, it seemed likely Gov. Pat Quinn would sign H.B. 1698 -- at least, some form of it.

As Paduda pointed out, it's unclear what the regulations implementing the legislation would say and how the courts might interpret its provisions. With that caveat, "outside of the fee schedule and some of the items like carpal tunnel changes, I don't see any real material impact, with the possible impact of strengthening the utilization review process. Clearly, causation is a huge issue in Illinois and the reform did not address that.

The other issue in Illinois is the fee schedule, which would be reduced by 30 percent under the legislation. "Depending on how you look at it, it still remains one of the highest in the country," Paduda said. While Paduda said the cut is "certainly dramatic," he also said it only addresses the price paid for services, not how many services.

"Couple that with what is essentially a network in name only, an employer direction in name only, you've got limited ability for payers to lower reimbursement with providers."

The legislation would allow employers to use medical networks approved by the state Department of Insurance if they notify injured employees in writing. Employees, in turn, could opt out of the network, in writing, and select one treating physician, or opt in and choose two physicians within it.

"Because of the employee opt-out provision, there is essentially no employer direction. So all they did was fix the price per service, which was consequential, but there's a lot more," he said.

What could possibly have a significant impact on the system, Paduda says, is the change in utilization review. "Essentially, it changes the responsibility for determining whether something is medically necessary or not from the employer to the employee," he said. "So, depending on how the courts interpret that and the regulations, that could be a pretty significant measure."

Paduda believes more changes are needed and will likely happen since advocacy organizations, such as the state Chamber of Commerce, are concerned the reforms don't go far enough.

Illegal aliens. "As it deals with workers' comp, this is an employer issue not an employee or political issue," Paduda said. Several states have recently considered proposals to limit or completely ban undocumented injured workers from the workers' comp system.

"What appears to be happening is some employers hire undocumented workers, and if and when they get hurt, they report them to the Immigration and Naturalization Services and they get them deported. That appears to be worker abuse, and it's a way for unscrupulous employers to compete unfairly with businesses that do things the right way," Paduda said.

"There's been at least one bill where some knucklehead legislator introduced a bill to deny workers' comp benefits, which would exacerbate the problem. That sort of nativist, jingoist approach to what is an employer problem is completely inappropriate."

Schedule II narcotics. There's no question opioids and all the issues surrounding them are a major issue in workers' comp right now. "The biggest [concern] is dependency and addiction."Paduda said recent efforts in Washington state to curb the use of unnecessary opioids in the workers' comp system has "crystallized the problem. They've come up with what appears to be positive solutions. Unfortunately, few other states seem to be paying attention to this issue. Given what appears to be rampant overuse in workers' comp, that's puzzling."

Paduda has several thoughts on what could be done. "First off, implementing Washington state legislation regarding opioid prescribing would be a great first step for any and all jurisdictions to take. Requiring physicians who are prescribing Schedule II drugs to require random drug screens is entirely appropriate and requiring physicians to support their use of opioids for musculoskeletal conditions would be entirely appropriate."

"I think, also getting workers who are prescribed opioids to sign a pain or opioid contract is something that should always be done. This is not to say some patients don't benefit from taking Schedule II drugs because it's clear a significant percentage does. However, it seems that while they may not be the initial drug of choice they are used far too frequently in comp."

The 20th annual National Workers' Compensation and Disability ConferenceŽ & Expo takes place at the Las Vegas Convention Center, Nov. 9-11. The conference, produced by LRP Publications, includes three keynote presentations and more than 25 breakout sessions.

For complete information and to register, visit www.wcconference.com.

Read more at the WorkersComp Forum homepage.

July 18, 2011

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