Yesterday afternoon the medical directors from two of the three largest workers comp
Insurers told listeners at WCI precisely what providers needed to do to get paid.
And you were…where?
Providers’ and vendors’ complaints about getting paid are constant and loud. Waaaah waaah waaah is what payers hear from providers far too focused on billing and not near enough focused on delivering services intended to speed healing and return to work.
So Dr Rob Bonner’s brief talk detailing exactly what the Hartford would and would not pay for was exactly what providers needed to hear. There were very few providers in attendance, far fewer than have booths on the trade show floors, advertisements hanging from the rafters, events in their suites.
I guess it’s far more important to pass out trinkets to every Tom Dick and Mary walking y your booth than actually listen to the medical director of a top-four insurer tell you what he wants to buy. Or break away from that lunch date to hear David Deitz of Liberty Mutual tell you how he defines quality in medicine.
Why are you even IN Orlando?
Aug
22
Joe, FL Workers Comp has always been a ‘party conference’ and not a ‘learning conference’. I have not been for years. I really considered going as I noted you were a keynote speaker.
They say 7000 attendees but most of those are actually vendors who never set foot in a session.
Not having been at the conference I cannot comment on what was said. However, just based on this entry – Patient care should not be driven by what the payor wants to pay for but rather what the physician feels is warranted for the individual patient’s care.
Paduda’s response – Not if those physicians and other providers are treating outside evidence based medical guidelines and fail to justify that deviation. Why doctors ‘feel’ is warranted should NEVER be the sole standard; the well documented variations in practice patterns provide ample evidence of the poor consistency across providers.
Having worked with both industries for many years, I can 100% guarantee that quality physicians who are focused on caring for their patients are not concerned with David Deitz definition of quality in medicine.
Paduda response – since you did not hear Dr Deitz’ talk you cannot make that claim moreover your anecdotal experience does not stand any superficial much less rigorous test of validity.
The medical directors I think we can all agree have a vested interest in providing the opinions on quality and care that best represent their organizations needs. From a patients perspective (even in WC) I would tend to agree).
Paduda response – we agree. They promote the best possible care focused on return to functionality. That is their ‘vested interest’.
Conversely, being in the WC / Managed Care industry I would be remiss not to acknowledge that there are providers who abuse the system and bill in excess, hence the existence of medical bill review firms, UR and other “vendors”. However, the grouping of vendors and physicians into a consortium is inaccurate and incorrect.
Paduda response – two points. 1. I did not “group vendors and physicians into a consortium.”. Both should have been there. 2. There are a plethora of both who. Ot only bill but treat inappropriately.
There are three classifications for physicians in my experience which I will classify in the simplest way possible: 1)Old School – the near retirement generation of physicians who care only about the care of their patients they submit charges for the services they rendered in the best interest of their patient regardless of what the payors say.
Paduda response- and occasionally regardless of what EBM indicates is appropriate and without justifying the deviation from ebm.
2) Next Generation – these are the younger more savvy providers who have taken the time to educate themselves on the regulations and treatment protocols. They know what they will be paid for and they will not be and this group is divided into those that treat or make recommendation to their patients regardless in the best interest of their patients and those that will not provide the treatment even if they feel it is necessary because they won’t get paid and seek an alternate method instead.
3)Mill / Revenue driven – these are the providers to which I believe you refer. They are focused on billing out the most they can get away with, inappropriate billing, unbundling services, excessive treatments, etc.
Paduda response – you are mistaken; I refer to ALL providers.
A long opinion longer – quality care should not be governed by what the payor deems appropriate. That said the medical providers should be prepared to and required to substantiate their treatments.
Paduda – on the last point we agree
For those that have not been to this conference in a while, the educational content is by far some of the best you will find in WC circles. While most attendees are either adjusters, nurses or vendors, anyone who chooses to attend this conference will not be disappointed by the opportunity to pick sessions from the many experts speaking on current topics of interest. There has also been a significant uptick in the presence of senior managers from all stakeholders in WC. I would not underestimate this conference.
Joe, Why wouldn’t these powerful medical directors make this specific information widely available to their contracted networks prospectively rather than expecting people to pay hundreds of dollars to hear them speak? Seem important enough that their companies would want everyone connected with their health care delivery systems to be aware from the very beginning rather than relegating the task to bill reviewers’ cryptic EORs.
Paduda’s response
Well Steve their message is pretty simple and doesn’t require anyone spend anything. I am quite sure your physician clients have repeatedly heard that complying with EBM and clearly and completely describing any deviations from ebm are all that is required. Yet many choose to practice outside guidelines and complain when they don’t get paid for those practices.
Moreover you completely miss my point.
Joe, Your point is well taken by many, if not lost on a few as evidenced by prior comments. I don’t believe anyone questions the quality of information AVAILABLE at this particular event; rather the issue lies in peoples interest or willingness to crawl out of a hospitality suite to actually HEAR what is being said. I attended several excellent sessions that had relatively few (or almost no) people in attendance – including your keynote. Hate to say it, but the chairs didn’t fill until the comedian took your place.
Granted, you weren’t as funny, but people should have heard what you had to say.
If you can stand another comment defending the conference – here’s this: It is only a party conference if you attend the party events. I am an employer and attend sessions for attorneys, adjusters, and medical professionals to keep tabs on the trends to help manage and control my WC costs.
If you can stand another comment defending the conferece, here’s this: It is only a party conference if you attend the party events. I’m an employer and attend sessions for attorneys, adjusters, and medical professionals to keep tabs on the trends and help control/manage my costs.
Joe your comments are spot on. The amount of information available at this conference was staggering, as was the number of distractions,Hospitality Suites, Madigan and Lynard Skynard included. I too found many of the sessions I sat in on poorly attended although the material presented was valuable. Possibly there could have been too many competing sessions of interest but I suspect otherwise.