Stop The Fantasy

It was really difficult to keep me away from posting over the holidays - all sorts of interesting things happened in the workers' compensation world: scandal, new rules and laws, studies, court rulings, controversy... some things never change.

And ProPublica published yet another story about workers' compensation, this time taking to task all of the intermediaries that have evolved in the past couple decades under the rubric of "cost containment."

Author Michael Grabell points to the lavish parties and other extravagances at industry conferences as examples that "cost containment" services have run amok. This drew fire, understandably, since most industries have wild parties and indulgent conferences - so why should workers' compensation be different?

Yet, if you see Vons/Safeway/Albertson's VP of Risk, Bill Zachry at any of these conferences, he is always carrying a camera and taking pictures of all of the vendor booths.

I asked him about this one day. He explained that when he gets back to the office he reviews all of the photos and counts up the number of vendors in any particular special service sector - that tells him where all the money is going and where he could potentially see some cost savings.

A brilliant strategy, I think.

Zachry has the luxury of working for, and with, a self insured, self administered (in most jurisdictions) business with the resources to conduct such investigation and implement mitigation strategies to drive the claim dollar where it has the most effect - providing medical care and indemnity to injured workers according to legal obligation.

Most employers don't have that luxury because they delegate the claims decision process to their insurance company.

So an outside observer notes that some of the marketing is over the top, perhaps creating in the least, as we were taught in law school ethics, an appearance of impropriety - not that there actually is any.

There's nothing wrong with promoting your business, even a "cost containment" business. Marketing is a necessary element of business. Without marketing people don't know you exist, much less know of the awesome service and/or products you provide.

And I like parties and shows, even though I won't stay up past 9 p.m. for any due to my unfortunate internal alarm clock that forces me awake at 3:30 a.m. every single morning (even on vacation ... ugh).

Why do we care if Grabell points out that there is lavish spending by vendors at big conferences? What's the big deal?

Some injured worker advocates have latched onto the story to express their opinion that all this money is better sent to injured workers and/or pay for their medical care. Maybe they are right, but maybe those are opinions that aren't well founded either - arguments go both ways.

And maybe stories like the latest in ProPublica need greater publicity and distribution, and provide more people with greater insight into workers' compensation - in my mind whether the portrayal is positive or negative is irrelevant; any time workers' compensation is before the public is good for the institution.

Workers' compensation should not be mysterious, should not be hiding, and should be exposed to the public good or bad, because it is for the public - each and every person that works in this country should be afforded reasonable work injury protection. It's good social policy. It's good economic policy.

Each time The Media comes out with a story, an expose, a critique, of workers' compensation is an excellent opportunity for the industry to reflect and look at ourselves: are we really doing as good of a job as we can with the resources we're given?

Every day I'm the recipient of numerous communications from someone that has seen, felt, heard or otherwise experienced something negative with workers' compensation. It could be from an authorized provider still not getting paid on time, or at fee schedule. It could be from an injured worker or his/her attorney describing some of the ludicrous machinations required to access benefits. It could be from an employer disgusted with the misdirection of its premium dollars. It could be from a claims specialist frustrated with relentless collection attempts by a vendor that should have been satisfied. It could be from a medical professional tired of the authorization gauntlet.

Overwhelmingly, though, such communications come from someone who is just doing their job, or in the least, performing the functions described in the "job description," be it attorney, doctor, claims specialist, broker, and yes, even injured worker.

Everyone has their job to do. In workers' compensation, everyone's job description is created in part by law, by regulation, by a company document and also by culture.

Getting upset about some negative portrayal in The Media is natural - after all, someone is taking to task something very close to us: our professional livelihoods in which a huge part of our egos are wrapped. It is absolutely natural to be defensive.

But it's not productive.

Here's the issue with ProPublica's latest story: "cost containment," despite what Robert Hartwig told ProPublica, ARE dirty words. That phrase sends entirely the wrong message. Yes, the category was started to stop the outflow of irresponsible money and, coincidentally, promote smart medicine. Whether it is used to in fact accomplish those goals is debated by physicians, injured workers and their attorneys (and some employers too).

As in any endeavor, particularly where social benefits are at stake, there are those who play well in the sand box, and others who don't.

Cost containment is an apt term if we, as an industry, are willing to accept its definitional reality - that the intent of cost containment is to save money for those who are paying it out.

Let's stop with the fantasy that cost containment is for the benefit of injured workers. It's not. Otherwise it would be called something else. That cost containment paradoxically results in medical treatment that should result in better outcomes is not the paramount reason for these businesses.

We all know that - so let's stop trying to pretend that it is something which it is not.

If the services are intended to benefit injured workers then there should be a better term for those services that should reflect that beneficial treatment,

Maybe we're misunderstood. Maybe our good intentions aren't appreciated.

But maybe cost containment really is an accurate term - and at whose expense?

Hate to say it folks, but we're getting the attention we all deserve.

The old Pogo comic strip is oft quoted because it is all too true, "we have met the enemy, and he is us." (Walt Kelly, 1953)