IMR Bid Process and Credibility

The California Independent Medical Review process, introduced by SB 863 in 2012, was intended to be anonymous.

But it wasn't intended to be cloudy and opaque.

That's, however, how the Department of Industrial Relations and the Division of Workers' Compensation seem to want to keep it.

The news that was supposed to be announced yesterday was that the IMR contract for the next contracting period was to go to the existing contractor, Maximus Federal Services, Inc. There was no indication that there had been protests, or that any bidder might able to compete on the government's IMR selection scoring process.

But WorkCompCentral News discovered that in fact the process is not transparent and that CID Management, Inc. out of Westlake Village, CA, was competitive and should have been considered for the second round of the selection process.

CID has filed a protest to the award contract so the announcement that Maximus was the successful bidder has been delayed while the California Department of General Services reviews the protest to see if it has merit.

If the CID protest is found to be meritorious then the second round of the review process will be reinstated and it's quite possible that CID may take the contract away from Maximus because based on WorkCompCentral's analysis of the bid data and award criteria, had CID made it past the first round of elimination, it outscores Maximus on second round criteria.

It was not apparent from WCC's review of the process that CID was properly eliminated in the first round, so it is very possible that the contract process will be reinstated by DGS.

Trust is relative, particularly when it comes to money.

The race is a tight one, but it is market driven and could reduce fees to employer/payers regardless because of the competitive bid submitted by CID.

When WorkCompCentral evaluated the bids using DWC's rating methodology the conclusion was that IMR fees could be reduced by about a third had CID won the contract.

This is a good thing and is what a competitive marketplace should deliver.

What's not a good thing is that the bid and award process was kept as secretive as possible by the administration.

It seems that initially the administration was loathe to even talk to WCC reporter Greg Jones or supply documents requested.

DIR is reviewing Jones' request for documents to determine whether under the state Public Records Act it is required to release the proposals it received and the scores it assigned.

But the agency’s request for proposals states all documents submitted will become the property of the state and “will be regarded as public records under the California Public Records Act and subject to review by the public.”

It does not mention whether the scores would be considered public documents.

But they should.

How can government be held accountable to ensure that the competitive marketplace contemplated by the qualified bidding process actually works? How can the people paying for the system know that the administration in fact is looking out for the best interests of the system, rather than the best interests of a vendor or even itself?

And the unfortunate part of public information games is that the credibility of the DWC, DIR, and the government as a whole is hugely challenged - undermining confidence that the system is running as well as it can under the laws and regulations that govern it.

I've never really understood government's penchant for secrecy unless it is a matter of security - even then, as history has shown, security interests either may be trumped up or inflated, or worse, non-existent at all.

Whether it is embarrassment, something is being hidden, someone made a mistake, or no one wants to deal with tough questions or a review process, that a governmental agency deems information about a public bidding process and the outcome of that process proprietary information causes public mistrust.

Workers' compensation is all about mistrust. Lack of trust is what drives the system and creates frictional costs.

When the government itself is a source of mistrust, though, we have a much bigger problem than an employee not trusting the employer, or insurance company.

If workers' compensation is to ever accomplish its ultimate goal of providing protection to injured workers at a reasonable cost to employers then trust must be reestablished as the cornerstone to those promises, and it's up to the government to foster that trust.

Not stonewall when a process is questioned.