Good friend and colleague Bob Laszewski once used an analogy that has stuck with me -“It’s like the dog chasing the school bus; what’s it going to do if it catches it?
I’m often reminded of Bob’s aphorism when state reporting of workers comp medical information is the subject.
Several states (Texas, California, Florida, Oregon among them) require workers comp payers to send electronic files with extensive detail on all medical bills received, processed, and paid. This has created an entire industry – or more accurately, a sub-industry – of vendors specializing in providing this service for bill review companies, PBMs, and other payers who don’t want to – or can’t – do the filing themselves.
I’ll make a wild guess and estimate workers comp state reporting adds $5 – 10 million in ongoing additional admin cost to the system; much more if one adds start up costs.
What does the system – employers, injured workers, providers, payers – get for their millions? To answer that, one has to know what the various states do with the information. Texas has used the data for various studies, some of which have been useful and others less so.
I’ll have to admit I’m not entirely clear on what each and every state does, but I do wonder if all the effort is worthwhile – if the benefit to society and the stakeholders is commensurate with the cost.
I’m interested in hearing what value readers see from the work – how is state reporting benefiting the industry, premium payers, and injured workers?
Responses are welcome at infoAThealthstrategyassocDOTcom.
Feb
18
We are a smallish case management firm. Although Florida rules require the E/C payer to electronically file our invoices, the payers essentially told us we had to do it if we wanted to get paid.
Compliance with the state submission was relatively painless and cheap and is now in place.
My bigger concern is that it’s not just the regulatory agencies that want information electronically. Payers, auditors, etc. also want information transmitted electronically – each in a different transmission format for essentially the same basic information. This will ultimately be much more costly to the vendors than complying with one state agency’s rules.
It would be really helpful if we could agree on common data file layouts and essential information and go from there.
As to your question regarding value, I’d really like to see data collectors answer that one. I remember a number of years ago when the Florida agency regulating case management decided one night to change all the service codes. This put them in the awkward position of not having compatible year to year information to respond to the Legislature’s request for costs per service. The analysis of what they did have was completely useless and resulted in Florida going from a state very friendly to case management to absolutely opposed. Turns out the state agency didn’t know how to compile and report the information they had which made it look like case management was a completely useless expenditure.
Thank goodness my terrific customers had sense enough to look at real numbers and savings rather than seriously flawed statistics.
I think the late Ms. Nevans et. al. in CA used to shoot this over to UCLA/RAND to develop reports that insightfully indicate that patients and docotors are not happy but haven’t seen anything quantitative in terms of outcomes.
Texas publishes annual comparative evaluations comparing provider networks which may be marginally helpful to employers. Not to sure what the Oregonians and Floridians do with the data; probably cryogenically incubate it in datawherehouses until an innovative civil servant has the funding to actually do something with it. My2cents
Joe, new Med Data Call criteria implemented through NCCI and other worker’s compensation bureaus appears to be driven by state requests for support of loss costs and fee schedule review. Ultimately data users should be better able to drill down to cost drivers and possibly impact fee schedules. The start-up costs can be significant but I’ll be optimistic and say ultimately it will benefit all players in the work comp system.
Bruce,
I’m sorry but your assumption that data retrieved by NCCI and the like is being used for “Fee Schedule Review” doesn’t seem logical. I say this based on the fact that a growing number of states are turning to Medicare to establish their fee schedules. As such, the data submitted has no bearing on what Medicare will or will not allow from year to year.
I believe, in many cases, State Reporting has simply become another revenue stream for the States to tap into. Lord knows anyone submitting data to Texas or Florida better get it absolutely right. If not, the sizable fines that are levied against those that are not in accordance is MORE than significant.