Tuesday, September 22, 2015

Reality and Perception

There was a debate in one of the LinkedIn forums the other day, which I can't seem to find anymore, about "reality." A big part of the argument going around was about the difference between reality, and perception.

I differentiate the two only on the basis of perspective.

Perspective is everything.
Horace Mann

Reality is an objective observation. Reality can be measured. It is either on or off. It's nemesis is fantasy.

Perception may encompass reality, just as much as it may encompass fantasy. Perception is a subjective observation. The experience is personal, and filtered through one's experiences, which may generate bias and opinion.

The subject of lien filings in California was, and continues to be, a sore one to vendors, payers, and the government.

SB 863 introduced radically different qualifications for making claims of lien against compensation cases, introducing filing and activation fees, along with alternative medical bill resolution processes.

The reason for these changes was the perception that liens were clogging the system, denying injured workers of dispute resolution services as a result, and costing the payer community untold millions of excess and unnecessary dollars.

The reality is that no one actually knew, or knows now, exactly how many liens there were, or are, how many actually end up before a workers' compensation judge in place of an injured worker's dispute, how many get settled, how much the value is in both gross and net numbers, and whether or not in fact (not perception) these liens clog the system.

We do know the quantity of liens actually filed and/or activated.

But everything else is anyone's guess.

Division of Workers' Compensation spokesman Peter Melton said in an email to WorkCompCentral on Friday the division doesn't know how many viable liens are in the system, because many have been negotiated out or sold to third parties.

And unless a lien claimant notifies the Workers' Compensation Appeals Board that a lien has been resolved, it will show up in the system even though the provider is no longer pursuing the claim.

The 2011 Lien Report by the Commission on Health and Safety and Workers' Compensation provides some information on the average amount claimed per lien. According to the report, the average amount claimed per medical lien was $7,774 based on a 2010 survey of claims adjusters.

The WCIRB in its November 2014 SB 863 Cost Monitoring Report said the average amount demanded for all liens in 2012 was $6,009. For 2013 and 2014, the average was $6,662. The WCIRB report did not break down average cost by lien claimant type.

These are all very nice numbers, and demonstrate the amorphous nature of the problem - in workers' compensation we tend to solve problems that we don't understand because our perceptions govern our actions, not reality.

The California lien issue hit a lot of emotional nerves.

Payers objected to "phantom liens" - claims that arise years after a case is closed because some entrepreneur purchased a book of receivables that may or may not have been previously resolved. Payers ultimately decide it's cheaper to throw money at the paper than to litigate and risk being ultimately liable anyhow. This engenders more of the same...

Vendors argued that payers don't take bill resolution seriously and lien claims are necessary to ensure payment at some point in time in the litigation.

Neither position is supported by fact, even though the state has had a computing system for 25 years that was originally designed to manage lien claims (the Electronic Data Exchange or "EDEX"). EDEX is still operational even though much of its function has been merged with the Electronic Adjudication Management System ("EAMS").

But for whatever reason, these systems cannot provide the division with precise numbers. We're left to conjecture based on some reasonable assumptions and assessments ... i.e, perception.

I'm not sure much of this matters in the end anyhow.

We're all in The System. The bottom line of our jobs, whether you're a vendor, a payer or the government, is to serve the two (and only two) intended beneficiaries - injured workers and employers.

We can't prevent accidents (they are called accidents for a reason, 'An unexpected event usually with negative and harmful consequences.'). We can't make everything (anything) perfect.

Our job is to make it better than it might have been had we not worked on it.

It's pretty simple. Accidents hurt people and they cost money. Our jobs are to minimize that impact.

Horace Mann, in 1859, said, "Be ashamed to die until you've scored a victory for Humanity."

I think he meant, "Leave the world a better place."

In other words, "Clean up your mess for the next person that occupies this space and leave a mint on the pillow."

That should be the only reality that matters.

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