Three workers comp physicians and one medical practice were recognized as the best comp providers in Florida at the fourth annual Florida Choice Awards for Workers Compensation banquet last night in Otlando. Sponsored by Choice Medical Management (a consulting client), the awards are one of the few, if not the only, attempt to recognize the second-most important player in workers compensation, the physician.
These are the folks who diagnose the injury, assess causality and relatedness (is the injury work-related and to what extent is work responsible) write the scripts, encourage the patient, talk with the employer about alternate duty, fill out the innnumberable forms, develop treatment plans, and deliver the care.
The Choice awards represent the right way to work with comp docs – respect them, recognize them, reward them.
They are also in marked contrast to the way other networks, payers, and insurers think about and act towards physicians. For example, the head of claims for a large work comp insurer, speaking at the Florida Work Comp Institute conference (host of the Choice Awards) noted in his speech that driving greater network penetration and “savings” was key to reducing work comp expense. That mis-prioritization is largely responsible for the explosion in medical expense in work comp.
And physicians are beginning to reject the discount-oriented “managed care” approach employed by many work comp payers. Sources indicate that the Florida chapter of the American College of Occupational and Environmental Medicine (the professional association of occupational medicine physicians) will be forming a committee to develop a position statement related to managed care networks.
Here’s hoping it is direct, definitive, and blunt.

According to several providers in Florida, Aetna is recruiting physicians for its workers comp network while requesting discounts that are quite aggressive.
I’m attending the Florida Workers Compensation Institute annual conference in Orlando, and spent much of Sunday moderating a session for physicians. I caught up with several providers after the meeting, and the conversation turned to work comp networks (in my opening comments at the physician seminar, I posed the question “why are you, the acknowledged experts in treating WC patients, providing care at a discount?).
Several of the providers had been recruited by Aetna for participation in their AWCA workers comp network; all were already participating in Aetna’s group health and other arrangements. According to these providers, Aetna’s letter, which was sent regular mail and was thus no different from the dozens of letters they get each week from managed care firms, stated that unless the provider informed Aetna that they did NOT want to be part of their WC network, they were going to be listed as a participating provider.
That runs counter to what I have been hearing from Aetna, so perhaps there is some confusion on the part of these providers. Or perhaps Aetna is assuming that because the providers are already in their group network, this is all they have to do to enroll them in the WC version. If that is the assumption, Aetna may want to rethink their strategy.
(virtual Sidebar – I’m not an Aetna basher, and believe that on balance Aetna is one of the better mega-healthplans. My sense is their people really try to do the right thing, their leadership is smart and thoughtful, and their “brand” of health care is much preferred over that of their major competitors.
But no one is perfect.
(Back to the main post)
There was no confusion regarding the reimbursement offered by Aetna, which ranged from 30% off the work comp fee schedule to 20% off to 20% below Medicare. These were seasoned, intelligent veterans of the managed care world, well-versed in contract negotiations and reimbursement, and all agreed that the proffered rates were, to say the least, inadequate.
Perhaps that is why Aetna is having a bit of trouble launching a FL workers comp network.
I’d also note that the providers were quite clear in describing the contents of the letter, and the requirement that they inform Aetna if they declined to participate.
Discounting key providers is not the way to reduce workers comp costs. And if Aetna is requiring its group health docs to inform them if they do not want to participate in the group health network, it is setting itself up for major confusion on the part of the physicians, anger on the part of injured workers, and frustration on the part of WC claims adjusters.
For the reality is most practices will either not read the letters, understand the contents, and respond in a timely fashion.
What does this mean for you?
A likely delay in implementing in FL, and potential problems when you do.

Physicians choose surgical implants and devices, hospitals order and pay for them, patients get whatever the docs choose, device manufacturers make lots of profits, and payers foot the bill. A process that is seemingly designed to completely avoid any price sensitivity, and the results to date have shown that there is remarkably little concern about cost on the part of the doc or patient, and at least to date, little ability to reduce costs on the part of the hospital, or payer.
A column in today’s New York Times describes the results of an analysis performed by investment firm Sanford Bernstein (registration required) which compared the costs of surgical implants (artificial hips, knees, etc) at 100 hospitals. Many of these institutions thought they were getting preferential pricing, but the results of the study show that their costs may have been substantially higher than other hospitals’.
The net of the article is that the days of price opacity in surgical implants is likely coming to an end; the research, combined with inquiries by regulators and the US Justice Dept. will shine a blinding light on the arcane world of implant pricing, likely bringing to an end the annual 8% price increases.
There is a subtlety missed in the article, which pertains to the small but important role of the workers comp payer. Sources indicate that a substantial portion of surgical implants are covered by workers comp, a portion much greater than the miniscule overall market share of comp (about 2% of all medical dollars are spent on comp, but figures indicate over a third of surgical implants are paid for under workers comp).
In comp, specifically in DRG states like New York, the cost of the implant is added to the DRG cost, which can increase the cost of the care by 50-70%. Therefore, the wounded parties in comp are not the hospitals (who typically price these procedures on a bundled basis in the group health and Medicare worlds and thereby absorb the cost) but the WC insurers.
What does this mean for you?
More light shining on the murky world of medical costs and procedures is always welcome; be sure to make sure you understand how the bundling and unbundling applies to your contracts and reimbursement.