The reports from ProPublica are the result of employers not managing workers compensation. Here are 6 things employers can do to take control and avoid being included in the next report.
- Contact employees within a week or two after the injury to do a SURVEY of their medical and claims adjuster experience. Speak to them via phone. Just like one would ask a good customer about their experience, Jennifer Christian, MD’s, Webility Corp Staff, contacts employees to find out if each injured worker felt their care was poor, fair, good, excellent. Often poor treatment by medical providers and callous indifference by adjusters causes employees to become angry, seek counsel or even delay recovery due to lack of expertise during the initial treatment experience.
- Have claims reviewed periodically by an independent auditor with a MEDICAL PROVIDER on the team. Only an MD is qualified to read the medical reports to determine whether treatment was appropriate and sufficient, whether alternate causation has been considered, and whether aggressive and excellent (yes, perhaps MORE expensive) treatment has been provided. Make sure adjusters are not using UR to deny care. Audit, audit, audit. Care, care, care.
Do WEEKLY Roundtables with your TPA. E.G. Every Friday discuss 10 claims, etc. Don’t wait until claims reach $25,000. Discuss them when they are small, BEFORE they get astronomical.
- Retain an MD to be part of your claims team.This can be an onsite MD part-time or full-time who also speaks with treating physicians and injured employees. Adjusters and nurses do not know “medicalese”. Applause to those insurers who have MD’s on staff BUT employers still need to have their own medical advisors on the team. Employers often forget we are talking about MEDICAL INJURIES, not simply “claims”.
- Assess the key cost drivers of your workers compensation costs. 9 out of 10 times employers misdiagnose the cause of their high workers compensation costs. In one case, the employer was ready to fire the insurance company because “they thought” there was too much nurse case management. Upon more detailed analysis, including an independent review by claims experts and an MD, we found the claims were handled well 98% of the time. The cause of the problem was mis-identified. The REAL problem was a lack of a post injury response at the time of injury — employees and supervisors did not have steps to follow within the first 24 hours after the injury. We then held 19 training sessions over 3 weeks in this mega-entertainment theme park.
- There are no tools to guide employees and supervisors. In the above case, we provided: employee brochure, physician brochure, wallet cards in English/Spanish for supervisors and employees, and other tools.
- And, MOST importantly, PROVIDE the BEST QUALITY MEDICAL CARE available. Yes, even if it’s more expensive.Pennywise is pound foolish. Get the best, not the cheapest. Pay the doctor to spend MORE time with your injured employees, not less time.
- Establish bundled pre-approval of care in Account Instructions so UR (utilization review) is not necessary. E.G. “All PTP (primary treating physician) treatments and up to 5 visits to specialists is pre-authorized by insured. All testing requisitioned by PTP and specialists including PT and MRIs is to be approved; do NOT submit to UR. If you strongly believe treatment or testing is unwarranted, contact the insured’s Medical Director before denying request.”
If you don’t manage and monitor it, the process (any process, not only workers’ compensation) will not work well.
It’s time for employers to become involved in their own business! The first step is assessing the problem at YOUR company, not the industry in general or another company, but get that mirror out and have a look. You are most likely looking at the problem.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the co-author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool. He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com. Contact: email@example.com.
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