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By Nancy Grover

Kathryn Caverly. As senior director of product planning for legal publisher LexisNexis, Ms. Caverly manages the performance of legal practice areas inclusive of workers' comp, as well as labor and employment, Social Security, and pension/benefits.

Caverly joined LexisNexis in 2007 after spending nearly two decades in HR. At this point in time, she says she's curious about how economic factors impact the ways workers' comp practitioners and state regulators view workers' comp.

"Take fraud, as an example," she says. "We know there are significant costs associated with employers who underreport head count as a means of defrauding state systems.In this era of belt-tightening and heavy scrutiny of expenditures, I am curious to see what, if anything, states do in the regulatory and compliance arena to control costs."

Joseph Paduda. The principal of Health Strategy Associates, Mr. Paduda has been involved in managed care in workers' comp and group health for nearly three decades. He's a familiar face to many in the industry as the author of ManagedCareMatters, a blog that attracts more than 1,500 unique visitors a day.

The biggest challenges he sees facing the system are largely outside the control of workers' comp practitioners -- namely the economy, and the phasing from a manufacturing/industrial society to a more services-oriented one, and what he says is a very dysfunctional medical system.

"The reason that is so important is the U.S. is the only industrialized country without universal health care, and providers treating those without insurance or with inadequate insurance have to make up their lost revenue somewhere. Increasingly, that is workers' comp."

The workers' comp system, he says, is being forced by societal drivers to be a provider income subsidy system. "If we don't get a handle on our medical care delivery system, I think that's going to become the dominant fact affecting workers' comp going forward."

Among the most immediate dilemmas facing workers' comp practitioners is the increased use of opioids by injured workers. Paduda believes the workers' comp system does not yet see the full impact of that.

"I think that is going to lead to significantly extended disability durations and higher medical costs for that subset of claims that are long-term opioid users," he says. "I am hearing from a few larger payers that they are only starting to understand the dramatic impact that is going to have."

James E. Pocius. As the chairman of the Medicare set-aside practice group for the law firm Marshall, Dennehey, Warner, Coleman & Goggin, Mr. Pocius is focused primarily on Medicare issues in workers' comp and liability. He negotiated the Medicare set-aside guidelines with the Centers for Medicare and Medicaid Services and maintains a national Medicare practice.

Keeping the workers' comp system solvent is the number one challenge he sees, especially with the upward pressure in many states from the average weekly wage and the increases in medical costs.

Pocius believes the answer may lie in looking at the cost-of-living adjustments that drive up rates each year in many states. "In wage loss states we may wish to take a look at the annual COLA and perhaps put a break on that, maybe look at the underpinnings of that COLA to see when or if rates should increase without legislative action," he says.

"Every worker should get the best medical treatment possible if they are injured. It's an employer's responsibility to make that employee whole, if at all possible," he says. "On the flip side, we have to get a better delivery system where costs won't spiral out of control, especially with regard to the spiraling and escalating -- almost without stop -- cost of prescription medication."

Milt Wright. "We have to think differently," is a theme voiced by Milt Wright. The creator and founder of Milt Wright & Associates has spent more than three decades designing programs to help employers reduce absence costs and increase productivity. Lately, he sees a lack of innovation among workers' comp and disability professionals.

"People are so concerned about costs going out of control that they are not thinking out of the box to come up with solutions," he says. "Claims people see the claimant as the enemy."

Instead, he says claims professionals need to focus on solutions to get people healthy and back to work. As he puts it, "we have to step outside of our own ways of doing things and think differently."

An example of thinking differently is the model of return to work as treatment instead of something punitive. Bringing people back to work in transitional duty can cut costs for employers and help injured workers recover sooner.

Among the biggest challenges Wright sees in the workers' comp and disability systems are attitudes. Despite inroads made by the Americans with Disabilities Act, discrimination against disabled workers persists.

"Unemployment of people with disabilities is higher than it was when the ADA was implemented," he says. "[Employers] are not looking at individuals; they are looking at the disability. That's true whether the person is injured, blind, etc. That is still there."

Read more at the WorkersComp Forum homepage.

April 2, 2012

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