Likewise I find it illogical when regulators continue to utilize the same tools (i.e. inputs) and expect to obtain different outputs.
Two examples appeared today in the WorkCompCentral News reports.
First is a story about the ongoing, never ending, debate about what to do with "lien claims" in the California system.
Lien claims have been a "problem" in California as long as I have been in workers' compensation - 27 years now (yeah I'm bald and what few hairs are left are turning gray). The "problem" is that these pesky little legal units of reimbursement entitlement claims pop up and interfere with the claim adjuster's main job of dealing with the case in chief. This can be either the case in chief is still pending or after the main issues have been resolved.
The traditional legislative and regulatory reaction to complaints about liens (whether it is from the claimants about not getting paid or the employer/carriers about how much time they consume) is to tighten judicial procedures. Such is the case with the current administration's proposed regulations, the topic of which was in public debate yesterday in San Francisco.
The Workers' Compensation Appeals Board (WCAB) on Aug. 4 proposed regulations that, among other procedural changes, would create a mechanism to dismiss a lien when a claimant does not file a declaration of readiness (DOR) to proceed within one year of becoming party to the case, or within one year of an order taking a lien conference or trial off calendar, whichever is later. The proposed regulations would also require a lien claimant or party to a lien to request a lien conference when filing a declaration of readiness and would require the lien claimant and defendant to prepare a pretrial conference statement that frames the argument and lists evidence and witnesses for a lien trial if the dispute can't be resolved at the conference.
The proposed regulations remind me of the old doctor joke: "Doc, when I do this it hurts." Doc - "Don't do that."
Ergo lien regulations - treat the symptoms and the cause will remain. The WCAB has the authority to treat the cause and they should exercise that authority.
The cause is that no one is responsible for liens. Lien claimants may have their independent rights by law and regulation, but who is responsible for incurring the obligation of the vendor claiming payment entitlement? THAT is the party who should be responsible for ensuring reimbursement of the vendor.
Ditto in Tennessee. Like most states in the workers' compensation industry medical costs are out of control and the reaction is to control the cost of each procedure in the course of treating a workers' compensation injury or illness.
A proposed rate filing in the state that would increase rates by 6.3% is causing regulators to take a look at the medical reimbursement schedule and proposing a reduction in the fee schedule. The same old arguments are at hand in both (or more?) sides of the debate - fees need to be cut because they are too expensive vs. access to care if physicians aren't adequately compensated.
Stop the madness!! This is the same set of arguments that go nowhere each and every time the issue is raised. And each and every time the issue comes up, adjustments are made to a fee schedule, then everyone goes back to business as usual with cost shifting, procedure manipulation, bill review and utilization review shenanigans and in a few years we again have another crisis.
I've been on a roll lately about examining the value of medical care delivery and how to control costs by paying based on value returned for the course of treatment rather than on a procedure cost basis and I remain convinced that this is the only way that medical costs ultimately can be brought under some sort of logical control.
Mark Walls, assistant vice president of claims for Safety National, recently opined in Risk & Insurance Magazine that the "fee for service" model in workers' compensation doesn't work and that regulators need to look at how medical services can be paid for on a value scale.
Models are out there for how to measure outcomes, how to measure costs on a value basis and those models can be adopted into regulations that will result in medical fee stability - after all the issue is not how much the medical component takes up in the total benefit equation, but the rapid pace of medical inflation in relation to the balance of other benefits.
In both situations, regulators have the authority and power to change the mindset, ergo culture, of the systems but they need to go out of the box to do so. Expecting different results by pushing the same buttons a little harder is illogical.
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