Some look to medical costs as a source of needed change with treatment guidelines sweeping many states. Others look to their elected officials to bring about reforms to their workers' comp systems. Both are among the topics to be addressed by experts.
MTGs. Medical treatment guidelines are being adopted in many jurisdictions as a way to improve outcomes for injured workers and contain medical costs. But there are almost as many variations of MTGs as there are states implementing them.
The differences among the MTGs and the decisions leading jurisdictions to adopt them are among the issues the panel will address during the session, Emerging Trends in the Adoption of Medical Treatment Guidelines.
The speakers will first outline the general categories of MTGs. As Ken Eichler, head of government and insurance services in the guidelines division of The Reed Group explained, there are three basic types:
- Commercial, including the Official Disability Guidelines and the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines.
- State-specific such as those in Colorado and Washington.
- Blends, which may include parts of the commercially available MTGs and aspects of other state-specific guidelines or variations on either.
The panelists will provide the latest information about the types of MTGs in jurisdictions that have adopted them and states that are considering them. They will also discuss the ways guidelines are used in various states even when "adopted" to determine medical benefits. "For example, California is a very tight utilization review state using the guidelines adopted while New Mexico has adopted ODG but is not a UR state," explained Dr. Doug Benner, the chief medical officer for EK Health.
While some MTGs are evidence-based, others are consensus-based. Benner will also discuss the differences and explain what is meant by evidence-based medicine. He will also offer his unique perspective in working within several MTGs.
Among the issues for jurisdictions considering MTGs is the influence of the various stakeholders. "In some cases, the fox has been left to guard the henhouse, and the concept is getting flipped on its head by powerful interests, including device manufacturers," said Phil LeFevre, director of strategy at the Work Loss Data Institute. Having advance knowledge of that particular lobbying element was instrumental in the ultimate adoption of MTGs in New Mexico, according to Denise Gillen-Algire, principal of Risk Navigation Group and the moderator for the session.
The panelists will discuss:
- What is the purpose of MTGs?
- Do they lead to better quality care and/or lower medical costs?
- Why do states adopt a particular type of MTGs over another?
- What is the future of MTGs?
Reform legislation. California's latest effort to reform its workers' comp system was signed into law nearly one year ago. With many of the provisions yet to be implemented or even developed, it is too early to identify the overall effectiveness of the legislation.
What are the early successes or unintended consequences of the California experience and what can other jurisdictions learn from the process? Those are among the questions an expert panel will address during the session, California's Legislative Reform: Lessons Learned.
According to the California Department of Industrial Relations, those negotiating the legislation followed two guiding principles; first, that permanent disability benefits should be increased. "The second principle was that the costs associated with providing medical treatment and benefits to injured workers and administering workers' compensation claims had begun to rise significantly," according to the department's website.
While benefit increases have been implemented as a result of the legislation, costs for employers are expected to rise. At press time, the California Workers' Compensation Insurance Rating Bureau was expected to file with the Department of Insurance advisory premium rates that are 3.4 percent above the industry average filed pure premium rate as of July 1.
Representatives of the medical, employer, and insurer community will discuss the legislation and the work that went into its development that could help other states looking at potential reforms. For example, Mark Webb, vice president and general counsel of Pacific Compensation Insurance Company, says you should "say what you mean and mean what you say. If you aren't clear about what you are trying to deal with, it could be a missed opportunity."
Joining Webb on the panel will be Steve Cattolica, director of government relations for the California Society of Industrial Medicine and Surgery (representing the medical community), and Carolyn Horton, regional workers' compensation manager for Costco Wholesale (representing the employer community). Moderating the session will be Mark Walls, senior vice president of workers' compensation market research leader for Marsh.
The panel will address:
- What, if anything, has changed as a result of the legislation?
- Is the implementation process unexpectedly slow or on schedule?
- Where are the soft spots in the legislation, and why are they there?
- When might employers see lower costs?
- In hindsight, what might have been done differently?
- What strategies could other jurisdictions use to develop and implement reforms?
The session takes place Nov. 21 from 8:45-10 a.m.
By Nancy Grover
The 22nd annual National Workers' Compensation and Disability ConferenceŽ
& Expo takes place Nov. 20-22 at the Mandalay Bay Resort and Casino in Las Vegas. The conference is produced by LRP Publications. For more information, visit the conference website at www.wcconference.com.
Read more at the WorkersComp Forum homepage.
October 7, 2013
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