The conversation is changing about SB 863, California Department of Industrial Relations chief Christine Baker advised yesterday at the California Workers' Compensation and Risk Conference in Dana Point, CA.
Baker immediately followed former basketball star, James Worthy, who delivered the motivational keynote speech about teamwork.
Both were serendipitously thematic.
I expected Baker to be sanguine about the state of work comp in the post SB 863 world, and largely she was. But the tone was different 18 months after that landmark reform bill became law.
As one person in the audience pointed out in a question to her, she said that 16% of Independent Medical Review requests reversed the utilization review denials, rather that stating that IMR upheld 84% of UR decisions.
"That's a lot of care that should have been approved," she said.
When SB 863 came out the conversation was about fraud and abuse - those were the driving issues that fostered the law.
Now, Baker said, the issue is delivering appropriate medical care timely and efficiently.
"How do we bring back the humanity in the system," she counseled the audience.
And though I doubt it was intended, Baker's comments seemed perfectly orchestrated to follow Worthy's speech, as she said it will take dedicated teamwork among all system participants to make that happen.
COMMITMENT to the PHILOSOPHY that has been given to you even though you don't understand it, was the first element to successful teamwork, Worthy said.
Next, you must be a really good LISTENER to understand what is really going on and what is really necessary to be a part of success.
TRUST the team, said Worthy - you may be a star, but without the team you can't succeed.
A platform is given to you, and it is YOUR OBLIGATION to give back to that platform, he said, and understand what YOUR ROLE is on the team.
The Circle of Communication is what Worthy and his teammates on the Lakers used when egos and money got in the way of a followup championship after the first National Basketball Association title. Only the players were allowed into the Circle, but EVERY player was expected to be there, and EVERY player was required to speak up and use the 2 minutes allotted.
Uninterrupted.
What happened in the Circle was that the players with the least star power, the ones that basically warmed the bench, and who hardly ever saw any game time, had the most poignant comments and observations - not out of bitterness or disappointment, but because they had the time to observe, listen and understand what was going on without the cloud of stardom obfuscating the picture.
In California work comp we don't commit, we don't listen, we don't trust. People in the various service segments don't understand their roles and fail to give back to the platform.
Most of all, there is no single Circle of Communication. Each of the segments has their conferences, has their LinkedIn pages, has their podium. None of them, however, talk to the other players, at least not without interruption.
So I asked Baker, since she is the team leader, what is the philosophy that we need to commit to, and she replied without any hesitation that it is to deliver quality medical treatment to the injured worker and provide resources as quickly as possible to allow that person, that HUMAN, to return to as normal a life, and work, as possible.
Here's the deal, as Worthy pointed out: WE have to protect the brand because the brand is bigger than any one of us.
That brand is workers' compensation. It is the reason we are here, have jobs, have security.
The brand of workers' compensation is to deliver quality medical treatment to the injured worker and provide resources as quickly as possible to allow that person to return to as normal a life, and work, as possible.
I've written in the past that we have an identity crisis. Workers' compensation has a negative image, even though it is our job to DO GOOD. Why? Because we, collectively, don't commit to the philosophy.
It certainly is a challenge.
In the past I have questioned the relevancy of workers' compensation in the modern economy and society.
It is.
We just need to understand our roles, how we fit into the picture and give back to the platform.
In Oder To Protect The Brand, You First Have To Honor The Bargain.
ReplyDeleteThis blog is a really nice ‘back massage’ for Christine. And, I’m sure she appreciates it – I know I would. But it misses the point. She isn’t leading, she is administering. Her speeches are so much ‘hot air’. She gets credit for being responsible and caring without having to actually do anything. Not necessarily her fault. After all, who should be leading – the Governor, the Insurance Commissioner, the WCIRB, or Who?
ReplyDeleteWork comp is like every other ‘system’ or organization. Or, a better analogy would be kids on a playground at recess. They all want to have their way. They are all going to act out in their own best interest. What they need, and what work comp needs, is a ‘Recess Monitor’. One person (organization) that can arbitrate the situation. In recess, it is important all the kids get to play (the goal of recess) – and they are safe.
The goal in work comp is the same. Take care of injured workers in the most cost efficient way possible. Everything else is secondary and inconsequential. All the players in work comp are never going to ‘play nice’.
One point I disagree with Watkins is, ‘employers/carriers need to “listen” to applicant attorneys’. They can’t listen to AA’s because the AA’s don’t say anything – neither do they do anything. Their modus operands is to get the client (injured worker) then do nothing or absolutely as little as they can.
They know that, eventually, the claim will close. The longer it stays open, the more treatment and surgeries the injured worker gets, the higher the AA’s fee on the claim settlement will be. I’ve been representing employers and injured workers for eleven years. Most of the time, when I do call an AA, they can’t even find the file – much less tell me what is going on. And don’t even get me started on the fact that the kickbacks the AA’s get for medical referrals probably exceed their fee income.
I’m not picking on the AA’s. The Defense Attorneys are just as bad – only at the other end of the compass. The DA’s have no financial incentive to get the claim closed. They bill by the hour. The longer the claim stays open, the more they make. They whine about having to take lower fees from the carriers – sometimes less than $200 per hour. But, when you’re paying a paralegal $15 an hour and billing it out at $200, life doesn’t suck.
There will be no ‘self-regulation’ from the players in the system – nor should we expect it. Not everyone would participate. Once one player cheats, everyone has to cheat in order to stay in the game.
When we ( here, the Collective We) designed the work comp system we also created the agencies that were responsible for oversight to make sure it met its mandate. For the last 100 years (or since I first got involved in 1989) that has never happened.
Your other point leads to the heart of the issue. Self-insureds have the resources to manage their work comp. They have slightly fewer claims. More importantly, their average indemnity claim (the ones that take the most money) are about a third of the average for non-self insured employers. The difference is the self insureds have the ability to call everyone to task for their actions.
If we (again, the Collective We) want to change work comp – if we want it to heal itself – we need to extend that capability and capacity to the smaller employers that can’t afford to be self insured. How? Through education. Believe me, when an employer calls the carrier, the adjuster, the medical provider to task, they fold like a cheap origami in a steam room.
Talking to the people that benefit (read, make money) from the system is a waste of breath. Talk to the people that matter – talk to the employers.