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Anyone familiar with the Workers Compensation Research Institute’s 32-year history of providing the data and analysis that industry mavericks rely upon to understand, manage and effect real change have come to expect WCRI conferences to provide the discussion and debate of cutting edge issues and the kind of keen insight, new lessons, and key strategies that you can’t get anywhere else. This year’s theme is Understanding Today to Understand Tomorrow.
We’ve asked some of the speakers for the conference, to be held March 10-11, 2016, at the Westin Copley Place in Boston, MA, to tell us what we can expect to hear during their presentations.
LexisNexis: Some opt out proposals call for somewhat parallel state "systems" with limits on medical payments, with benefits tied to a claimant's continued employment status, and the like. Do we have any indication how much in the way of long-term medical costs would be shifted to Medicare?
Trey Gillespie, PCIAA: Through “free market” coverage together with employer control over benefit eligibility and dispute resolution, Texas “nonsubscribers” annually shift an estimated $400 million or more in medical costs to the injured worker, taxpayers, and other payers. (To find out more about this shifting of medical costs, attend the Opt-Out Panel 1 seminar at the WCRI Conference, Day One, March 10, 2016, where Mr. Gillespie will be speaking.)
LexisNexis: Recent WCRI reports highlight the fact that the frequency of surgery among workers with back injuries varies widely from state to state. What factors seem to explain this interesting and important phenomenon?
WCRI: In the study “Why Surgery Rates Vary,” we looked at injured workers with low back pain and found that the variation in back surgery rates was huge. In California, only 7 percent of workers with back injuries had back surgery. However, in Oklahoma, 19 percent of workers with back injuries had back surgery, almost 3 times the surgery rate of California. Our analysis indicated that some of the variation, indeed, was explained by differences in case mix and severity of injuries. But these differences could not explain all the variation. We found a number of other, equally important, factors that influenced surgery rates, such as the number of surgeons who practiced in the local area. To learn about them all, you will have to attend the session.
LexisNexis: Over the past decade or so, California has evidence-based medicine, medical treatment utilization schedule, and the addition of independent medical review (IMR) to resolve medical necessity disputes. What lessons have been learned in California about these contentious issues?
Alex Swedlow (CWCI): California has moved from an essentially subjective, anything-goes method of delivering medical care to a more objective and transparent path of scientific guidelines and peer review. Such a transition was bound to create disputes and disruption. I’ll provide the social and political context behind the research trends to position the essential question: has medical care delivery for injured workers improved? (To learn more about medical review and medical dispute resolution, attend WCRI’s conference’s where Mr. Swedlow will be speaking on the first day.)
LexisNexis: A number of experts say that various provisions within the Affordable Care Act tend to push more and more patients toward so-called "capitated" health insurance plans. What effect, if any, will this likely have on the mix of, the numbers and the amounts of workers' compensation medical claims?
WCRI: In a recently published study, we examined the extent of case-shifting from group health to workers’ compensation in response to the move towards capitated health arrangements promoted under the Affordable Care Act tend. We found that case-shifting was more likely in states where a higher percentage of workers were covered by capitated group health plans. In such states, a soft-tissue injury (i.e., back injury) was as much as 30 percent more likely to be called “work-related” (and paid by workers’ compensation) if the patient’s group health insurance was capitated rather than fee for service. For patients with conditions for which causation is more certain (e.g., fractures, lacerations, contusions), there was no evidence of case-shifting. At our conference, we will be sharing findings from a study that analyzes whether workers covered by group health fee‐for‐service plans are more likely to have care paid for by workers’ compensation in states with higher fee schedules.