Monday, May 16, 2016

It's Getting Transparent

Transparency is an issue in workers' compensation, probably more so than other industries, because the complex nature involving the intersection of medical, indemnity and liability creates too many potential shadows.

Opaqueness breeds mistrust.

This is particularly true when a state legislature creates an anonymous sub-system, like California's Independent Medical Review process.

The thought behind anonymity in IMR was to alleviate excess litigation by reducing the probability of medical disputes - if a party does not know who is making the IMR decision then there is very little likelihood that the party can subpoena that individual for interrogation.

But the statute doesn't say that the entire process has to be anonymous - just the name or identity of the person making the IMR decision.

So the State of California's Division of Workers' Compensation has rolled out a huge new feature in the IMR website that hosts decisions that allows users to search independent medical review decisions by the specialty of the reviewer and whether the underlying utilization review decision was upheld, overturned or partially overturned.

DWC’s new web page allows users to sift through IMR decisions by treatment request categories such as pharmaceuticals, surgery and diagnostic testing. For some categories including pharmaceuticals, it includes sub-categories including benzodiazepines, opioids and topical compounds.

The page also allows sorting individual treatment decisions by outcome.

This is huge.

While agency officials have not yet elaborated on DWC's expectations for this new tool, I for one think it is a tremendous vote of confidence in the process, and should lead to much better oversight and administration of the IMR process, in addition to providing parties with much needed confidence that the system is, or isn't as the case may be, working properly.

California Applicant Attorneys Association president, Bert Arnold, told WorkCompCentral that he was concerned about the ratio of cases being decided by different specialties which are not indicative of the proportion of medical specialities being submitted for review.

That's a valid critique, and one that should be noted by officials as they seek to improve the system.

In the past such criticism would not be afforded simply because nobody knew, other than Maximus, who was doing what with the disputes.

At least now we have some idea as to qualifications for opinions.

It's not perfect, but it is a giant step in the right direction.

Kudos to DWC for the foresight in providing this information, and its confidence that providing more transparency is good for the system. Perhaps in small chunks some trust can be restored.


  1. Half measures avail those harmed by this system, nothing. The only way to restore TRUST, is to stop doing what created the mistrust to start with. When folks have to hide behind "anonymous" sub-systems, to carry out their misdeeds, then there can never be any "trust" to start with. It's just another failed attempt, at trying to look transparent, while still doing business behind closed doors as usual.

    This does very little to help those harmed, while protecting those who carry out the harm on behalf of the insurance industry's bottom lines, over the health and well being of the injured workers. Just more pretense, and smoke an mirrors, under the disguise of so called "transparency".

    Anytime someone has to hide what their doing to and from others, by remaining "anonymous"? It will always create mistrust.

    Like Johnny Cash used to sing to us all, "what was once done in the dark, will be brought out into the light". And only then will we have TRUE, "Transparency"

    Is this baby step really progress? Or just more pretense and half measures towards keeping up the appearance of "transparency", in a profiteering industry that has ran amok? As always, just asking.

  2. This is definitely a step in the right direction. I appeal UR denials and this tool will be helpful.