In what will undoubtedly become a permanent part of its yearly offerings, the National Workers' Compensation and Disability Conference, at its 19th annual event held November 10-12, 2010 in Las Vegas, sponsored a spirited Executive Roundtable discussion.
Mark Walls, Assistant Vice President-Claims, Safety National, served as the Roundtable's moderator. In addition to his professional duties at Safety National, Walls is administrator of the Work Comp Analysis Group, a "community" within the popular LinkedIn® professional network online site. The group, which now has almost 7,000 members, is primarily composed of workers compensation attorneys, risk managers, adjusters, medical management teams, MSA specialists, structured settlement companies, healthcare network providers and other ancillary workers compensation industry people.
In many ways, the Roundtable was a "physical" extension of the "virtual" LinkedIn group since the important questions addressed at the Las Vegas gathering were chosen beforehand by the LinkedIn group through online voting. Topics included the selection of medical providers, the difficulty in measuring outcomes on workers compensation claims, the complicated dexterity required in balancing quality and cost, and the future of workers’ compensation claims handling.
Virtually all the important constituencies within workers compensation were represented on the dais: employers, insurers, TPAs, brokers and attorneys. The panel of experts consisted of:
Joseph Paduda, Principal, Health Strategy Associates
Evan Falchuk, President, Best Doctors, Inc.
Dee Dee Bloom, SVP & Chief Marketing Officer, SFA of Nevada, LLC
Pam Ferrandino, EVP, National Practice Leader Casualty, Willis North America
Mark Wilhelm, Chief Executive Officer, Safety National
Davidson Pattis, Executive Vice President, Zenith Insurance Company
Bryan Thomas, President & CEO, CCMSI
Jody Gray, President, York Public Entity, York Risk Services Group, Inc.
Joseph Boures, CEO, Specialty Risk Services
Patrick Venditt, Director – Corporate Health Services, BJC HealthCare
Bruce Wollschlager, President & CEO, Connecticut Interlocal Risk Management Agency
Robert Rassp, Attorney, Law Offices of Robert G. Rassp
Stuart Colburn, Shareholder, Downs Stanford P.C.
Moderator: Mark Walls, Assistant Vice President-Claims, Safety National
The underlying theme for the Roundtable could best be described as "best practices." Among the issues discussed during the first half of the session was the challenge in measuring outcomes on claims and the difficulty in selecting and compensating the best medical providers to get the best outcome on those claims. For example, a member of the audience observed axiomatically that an important factor in successful workers' compensation outcomes is the quality of medical care. Might the quality of care provided be reflected somehow in the compensation a physician or other medical care provider received?
Several panel members pointed out that on that any other questions the devil was in the details. Quality depends, at least in part, upon one's perspective. Was it being measured from the claimant's standpoint? From the employer's? From the carrier's? As one attendee mentioned to me during a break, "You say 'tomayto,' I say 'tomahto,' let's call the whole thing off."
Difficulty in Moving from the "Micro" to the "Macro"
There was lively discussion about the mix of science and art within medical care and how that mix made the assembly of empirical data accurately assessing outcomes difficult. Indeed, panel member Stuart Colburn observed that within the workers' compensation context, moving from the "micro" of the individual to the "macro" of the national work force was always problematic. Assessing one injured worker, her specific treatment regime, her long-term disability issues and her ability to return to work with a particular employer was difficult enough. Aggregating those factors from tens of thousands of claims was fraught with error.
The lack of credible data in judging workers' compensation outcomes was echoed around the room as well. One attendee repeated the oft told quip that "there are liars, damned liars, and statisticians." Another asked how one claimant's resolve to work through the pain and return to work could be measured against another's reluctance to do so. Still another offered a somewhat whimsical—but accurate—observation: the fact that the exhibit hall outside the meeting room was packed with so many companies whose purpose it was to clear away the complexities showed that there was little agreement within the workers' compensation world in measuring anything.
Emphasis on Transparency
And yet, measurement is at the heart of workers' compensation and always has been. Average weekly wages, levels of temporary and permanent disability, apportionment of claims for prior disabilities, the rating of the dangers of underground mining versus office work, the setting of insurance rates—they have historically been measured. They've been measured, of course, with varying degrees of accuracy.
Panelist Pam Ferrandino offered an important point: in all these issues related to worker safety, to management of claims, to medical care, return to work, the cost of insurance, etc., it was important for individuals and firms to emphasize transparency.
Future of Workers' Compensation Claims Handling
Following a break, the Roundtable gathered anew and took on additional issues. A number of attendees commented upon the changing role of claims adjusters. Several suggested that young adjusters seemed to have less training. Another pointed out the trend toward specialization within the claims administration process. At least one attendee lamented the fact that there seemed to be fewer and fewer adjusters who were comfortable dealing with the whole gamut of medical, legal, and claims issues in a complex claim. In a conversation I had with one attendee, who asked that I not reveal her name, I learned that many adjusters feel that in recent years, particularly in recent times when premium revenue has softened, case loads have been increased too drastically. She observed anecdotally that the quality of claims handling—particularly the handling of difficult cases—has fallen in recent years.
Impact of Health Care Reform
There was less discussion of the impact of federal Health Care legislation that I had anticipated. Responding to one query, panelist Joe Paduda indicated that so far there had been little direct impact, but that the indirect impact might be broad and diverse, affecting everything from pharmacy costs to medical treatment expense, to physician fee schedules and information flows. That might be a good topic for next year.
A great deal of credit should be given Mark Walls for his yeoman's effort in putting the Roundtable together, in orchestrating the online voting for topics, and in his general shepherding of the Roundtable event itself. While the benefits of attending an outlined, carefully planned and PowerPoint-illustrated lecture are obvious, the unrehearsed freshness of the Executive Roundtable was certainly an excellent change of pace. I know many attendees join me in saying that it should become a permanent part of the annual conference.
This article was written by Thomas A. Robinson.
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