After the original post (below) I had a chance to review more carefully the recent releases from Texas re the adoption of medical treatment and guidelines and to gain more insight into the guideline selection process.
First, a clarification. ODG guidelines WILL be used for management of physical medicine, including physical therapy.
That said, if physicians or other stakeholders want to provide any type of treatment that differs from that recommended by ODG (surgery, therapy, etc), they can provide information to the payer/state justifying their position. And if their treatment plan is supported by other evidence-based medical guidelines, my sense is it will be approved.
Sources also indicate that MDA’s disability duration guidelines were selected primarily due to their accessibility; they are easier to comprehend and more “usable” for laypeople, while still backed by solid research and data. This accessibility may well make conversations among the stakeholders more productive and reduce confusion and mis-interpretation.
That’s good, as it allows providers and payers to have a discussion about treatment options with science-based guidelines as the ultimate test of appropriateness.
The latest state to adopt clinical guidelines for the treatment of workers comp injuries is Texas. While the adoption of guidelines is a good thing, Texas is clearly marching to its own mariachi band.

Continue reading UPDATE – Texas is getting there

13,000 American civilians have suffered compensable injuries in Iraq and Afghanistan. These are handled through the Federal system, with the Department of Labor having jurisdiction. The volume of cases has grown steadily since 2002, with the DoL now seeing about a thousand cases a month from employers such as Halliburton, Dyncorp, Bechtel and others.
And many of these are not your typical lower back strains. Post-traumatic stress disorder, closed head injuries from IEDs, and shrapnel and concussion injuries, all injuries once limited to soldiers are now suffered by civilians. These injuries are not commonly handled by civilian providers or hospitals, and many claimants are finding it difficult to obtain adequate care for their condition.
Outside of the human cost, the financial implications are staggering. Truck drivers are making upwards of $100k a year, and their workers comp premiums can be as high as $25 – $40 per $100 of payroll. While there is no accurate count of the total number of contractors, at the low end it is 50,000.
Workers comp costs for contractors in Iraq and Afghanistan are over a billion dollars.
Way over.
thanks to the Workers Comp Executive News Digest for the original idea.

California is much better, Florida is doing great, heck, even Texas is really trying to fix its workers comp system. Among the larger states, that leaves NY as the leader in the “state that needs workers comp reform the most” contest.
And boy does it.

Continue reading Could NY finally fix work comp?

This is a pretty esoteric workers comp post, so if you aren’t so inclined, click on something else now before your eyes glaze over and it’s too late.
In workers comp, employers have the ability to make claimants go to specific physicians or lists of physicians in some states and don’t in other states. The former are “employer direction” states, the latter are “employee choice” states.
Except that’s not really true.

Continue reading Directing care

A couple of sources informed me that the company CorVel bought in California is actually a Work Comp claims company – a third party administrator or TPA.
This is really confusing. Not only does CorVel sell their services to TPAs, but the TPA business in California is in the tank these days. While this may have helped CorVel get a good price, it also means opportunities are limited.
Not only does the stock price bewilder me, so does the strategy.

OK, this is just a little outside the usual focus here.
I’ve been fascinated by CorVel’s stock price lately. For a company that does not appear to have much in the way of growth prospects, with a record of declining revenues over the last three years, in an industry whose lifeblood (lost time claims) is dropping, it is awfully pricey.

Continue reading Mystified

Coventry is going to get into the work comp case management business. Public and private sources indicate that an acquisition is in the offing, and while it may not be CorVel, it will likely include an asset with case management capabilities.

Continue reading Coventry’s work comp strategy

CorVel continues to intrigue. After my last post/prognostication about the potential for CorVel to be on Coventry’s acquisitions-we’re-thinking-about list, trading volume jumped by 40%. I’m not claiming a causal relationship, just a statistical one.
Since then, the average volume has been six times what it was earlier in the year. The stock price itself has seen a similar trajectory, with CorVel now trading close to $60 a share, almost four times its 52 week low.

Continue reading Who’s buying CorVel?