A Message from the President
Protecting Free Market Quality and
Access in Workers Compensation System
By Jonathan E. Isaacs, MD
President, Virginia Orthopaedic Society
Dear Virginia Orthopaedic Society Members,
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Jonathan E. Isaacs, MD VOS President |
In my last newsletter report, I discussed the importance of getting involved and, to say it bluntly, to be part of the political process. Laws that affect our practices, our patients, and our futures will be made whether we like it or not. Obviously, we want to have as much influence and control over those decisions and our own destinies as possible. Sometimes, we can assert some influence by voicing our opinion. Sometimes, we need to make compromises. And sometimes, we have to fight to protect our interests.
We are currently at a critical point on an important issue affecting many of our patients. Over the last several months there has been an increasing push by the workers' compensation insurance industry to “control medical costs.” Historically, if an insurer did not have an agreement with a specific provider, they were by law expected to pay that provider “prevailing community rates.” As you might expect, there is some disagreement between the compensation carriers and physicians regarding what those “prevailing rates” should be. The compensation carriers have used databases to “reprice” claims they pay physicians. We are not privy to the database, don’t know how they developed it, and don’t know if we agree with the data used. Several years ago, some providers identified, and began to successfully pursue, improper under-payments. The insurers did not like being forced to re-open and fully reimburse those claims. The insurance lobby attempted to change the law in their favor, but changes were shelved until “more data” could be collected. This data has now been collected in the form of a report by the Workers’ Compensation Research Institute (an “independent” group supported mostly by worker’s compensation groups)…it’s quite thorough and, from what we can tell, seems credible albeit favorable to industry.
Physicians and hospitals, in good faith efforts to respond to industry concerns about the medical cost component of workers' compensation, have explored concepts that could improve workers compensation for businesses and payors. These include reasonable limitations on assistants-at-surgery, addressing multiple procedures, and statute of limitations on claims. We studied these areas with hopes of providing relief to the businesses that provide workers compensation coverage to injured workers, our patients. Providers have our own desired reforms for many of the common practices of carriers. Issues include slow payment and absence of “fair business practice” requirements, burdensome casework and administrative hassles, re-coded claims to lower levels of reimbursement, unclear lawyer fees (if involved), and retroactive denials.
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| From left to right: Jonathan E. Isaacs, MD; President of VOS, Christine Isaacs, MD; Senator Steve Martin and Aimee Perron Seibert. |
One area, however, where we find consensus (including with the business community) is that injured workers in Virginia get great care. Our return-to-work rates are among the best of any nearby states and Virginia’s businesses pay the third lowest premiums in the nation. The report from the Workers Compensation Research Institute supported and endorsed this point as well.
With quality of care being the most important aspect to this workers' compensation debate, we felt confident that we could find some middle ground – reasonable reforms that did not threaten access to quality care. Unfortunately, despite months of meetings and constructive offers looking for compromise, the workers' compensation insurance industry seems committed to a Medicare-based fee schedule placed into law. In other words, a government-run fee schedule on all services equal to Medicare rates plus some percentage.
The leadership of the VOS and the Medical Society of Virginia will not agree to a “Medicare-based fee schedule” that replaces our current free market environment that results in quality care and affordable coverage for patients. This patient population is complex, the paperwork is cumbersome, and the non-monetary reward too little for most of us to make drastic changes to the status quo. Our plan is to work with our allies (hospitals, physician specialties, therapists, employee groups, etc.) to offer thoughtful, measured reforms as alternatives to government price fixing models. This could be a difficult and expensive fight but, in my opinion, is exactly why the Virginia Orthopaedic Society exists and why you are (or should be) a member – to protect our practice and our patients
What can you do to help? When we email you to contact your representative in the legislature, do so. If you are not a member of VOS, become one. If you have a colleague who is not a member, convince him to become one. If you’ve already contributed to the Virginia ORTHO-PAC, thank you. If you have not, this is the time. An investment in this fight now, may save you a lot of money later. VOS will host our “White Coats on Call” General Assembly visits on January 31 – take a day off to join your colleagues in Richmond. It matters. CLICK HERE to contribute to ORTHO-PAC.
The Virginia Orthopaedic Society will keep you posted as the fight progresses, but feel free to contact me or the VOS with your thoughts or suggestions.
