Christee Yee from WCRI presented the finding on their study regarding variation from surgical rates in various states. In many states, the back surgery rates in workers’ compensation are following the rates also seen in group health. However, there are states with significant gaps between the back surgery utilization and reimbursement rates comparing workers’ compensation and group health. In Oklahoma and Illinois for example, reimbursement rates for back surgeries were over four times higher than group health. In addition, utilization rates for these services were much higher than group health. Overall, the study showed much higher back surgery utilization in
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At the WCRI Annual Conference Rebecca Yang (WCRI) and Barry Lipton (NCCI) led a discussion around workers’ compensation fee schedules. Mr. Lipton presented results from an NCCI study on the impact of fee schedules. The question on the effectiveness of fee schedules focuses on how workers’ compensation reimbursement rates compare to that of group health. The study showed that in many states the workers’ compensation reimbursement rates are significantly higher than under group health. Thus, even if a payer has a discount arrangement with a workers’ compensation physician network to get pricing below the fee schedule they are still paying
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At WCRI 2015, the panel of Vennela Thumula (WCRI), Dongchun Wang (WCRI) Alex Swedlow (CWCI) and Artemis Emsilie (myMatrixx) tackled this topic.   Eighteen states have made changes to their rules regarding physician-dispensed physicians with a focus on pricing. Four states (PA, NC, TN, FL) also put limits on the timeframe that physicians could dispense. According to WCRI studies, the prices paid for physician dispensed medications decreased significantly after the regulations on this were reformed. However, the prices paid under physician dispensing post reforms were still significantly higher than the same drug from a retail pharmacy. The exception was Ilinois
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The opening sesson at the 2015 WCRI conference focused on whether the ACA was leading to case shifting in workers’ compensation.  The speaker was Richard Victor, President & CEO of WCRI. One of the biggest concerns with regard to ACA’s impact on workers’ compensation is the risk of increase case shifting from group health to workers. compensation.  A recent WCRI study focused on this issue. A central part of ACA is creation of Accountable Care Organizations (ACOs). ACOs are a network of doctors and hospitals that share financial and medical responsibility for providing care for patients. These ACOs have financial
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This week we journey to Boston for the annual WCRI Conference.  Check back here later this week for postings on the great sessions we will be attending.  

At the New York Self-Insurers Association Annual Meeting, Christopher Whyland, Esq. presented on the 2014 workers’ compensation decisions of the Appellate Division, Third Department, heard in Albany, New York. In 2014, the Third Department issued decisions in 85 workers’ compensation cases. In 2014, the Board was reversed in only nine of the 85 decisions issued by the Third Department and another five appeals were dismissed as interlocutory. In addition, the Court of Appeals affirmed two decisions that involved workers’ compensation decisions. Some of the case updates included: Cook v. East Greenbush Police Department (February 13, 2014) The Case: The claimant
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At this year’s New York Self-Insurers Association Annual Meeting, Steven M. Scotti, Esq. provided an update on various aspects of recent workers’ compensation legislation impacting New York. In 2014, there were over 100 workers’ compensation bills pending, 65% of which were pro-labor. Workers’ Compensation Legislation Enacted in 2014 1. New York State Commercial Goods Industry Fair Play Act: Creates a new standard to prevent misclassification of truckers as independent contractors. Presumes that such workers are employees unless payments for their services are reported on a federal income tax form 1099 (if required by law). To be considered a separate business
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This session at the National Workers’ Compensation & Disability Conference in Las Vegas focused on the increasing diversity in today’s workforce and how that is impacting workers’ compensation. Jennifer De La Torre, Executive Director of Workforce Diversity at AT&T, and Elizabeth Demaret, Executive Vice President, Chief Customer Relationship Officer at Sedgwick, explained how the aging, multi-generational and multi-cultural workforce is demanding workers’ compensation programs to evolve. Aging & Retirement The issues: It’s estimated that Baby Boomers will make up one-fifth of the workforce by 2015. They are likely to have more disabilities than their younger counterparts. Injury duration tends to
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This rapid-fire panel on the final day of the National Workers’ Compensation & Disability Conference offered 60 usable tips to help improve workers’ compensation claims handling. Panelists included: Stuart D. Colburn, Esq. Downs Standford P.C. Todd DeStefano, President, Risk Managment Practices,York Risk Services Group Jodie Massingill, Senior Manager, Casualty Claims, Sysco Corp. Robert G. Rassp, Esq., Law Office of Robert G. Rassp Ann Schnure, VP, Risk Management, Macy’s Inc. Patrick J. Walsh, VP and Chief Claims Officer, Accident Fund Holdings Inc. Moderator: Matthew B. Schiff, Partner, Sugar Felsenthal Grais & Hammer LLP 60 Tips for Superior Claims Handling: 1. High
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In her session at the National Workers’ Compensation and Disability Conference in Las Vegas, Patricia Hostine, U.S. Director of Disability Management, Flex-N-Gate Corp, stressed that worker communications have a direct impact on losses and, if you can tailor your message properly, your communications can make the claim go as smoothly as possible. It’s important to understand that claims are all about perspective and all parties involved have a unique way of looking at them. For the employee, though, we must remember that this injury and the items related to it is the single most important factor in their life at
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