Health Strategy Associates’ First Annual Survey of Workers Comp Claims IT Systems is well underway, and we’re well on our way to reaching our goal. Respondents will be receiving a detailed copy of the Survey Report.
We’re using SurveyMonkey to collect and tabulate responses; the survey takes about 15 minutes to complete. Click here for the Survey.
We’ll have a couple preliminary revelations posted here shortly; early indications are there’s lots of ‘opportunity’ for improvements among vendors…
Here’s one not-surprising-and-quite-revealing item:
88% of the front-line representatives and managers said their current system is NOT fully integrated with their bill review and utilization review system (75% wish that it was); conversely, 68% of the executive leadership responses state that their system IS fully integrated with their bill review and utilization review system.
Disconnect, indeed.
The Survey seeks input from front-line folks and execs in claims and IT, and we’ll be comparing and contrasting responses to see if – or perhaps more accurately where – there’s a disconnect or differences in opinions between the two groups.
A brief summary version will also be available to the general public. Customized analyses of and presentations on Survey findings will be offered as well. Of course, no respondent-specific information will be provided in any version of the Survey report.

Good friends and colleagues Frank Pennachio and Susan Toussaint’s WorkComp Advisory Group is conducting their annual get together at the Blackstone Hotel in Chicago (scene for much of the movie ‘The Untouchables’. (Remember the scene with the baseball bat in the dining room after the big dinner?)
The keynote this morning was provided by Peter Rousmaniere, who spoke on, among other issues, what appears to be a significant problem with under-reporting of injuries to OSHA, and a more significant problem with low reporting rates for illnesses (which evidently OSHA does not require to be reported).
Peter described a couple of instances wherein employers asked clinicians to use Steri-strips to close a wound instead of stitches in the hope that this would reduce the need to report the injury as work-related. Evidently this may be more of an issue in food preparation, construction, and seasonal work.
A major airline reported no injuries at one airport, and four airports with no lost time injuries. Meanwhile, the national average injury rate was 11.9% – almost one in six employees were injured during the year, and the lost time injury rate was about one in thirty employees per year. It could be that the five facilities were particularly safety conscious, or perhaps claims were not reported due to other motivations.
Peter supported these – and other anecdotes, with citations from work done by Dr Glenn Pransky that also described some significant concerns with under-reporting of OSHA claims. I’d note this is separate from workers comp – OSHA claims don’t always have to be reported as work comp claims.
There’s the segue into comp.
That also spurred a lively conversation with several of the agents and brokers in attendance discussing the pros and cons of self-management of occ injuries.
Peter’s discussion reminded me of research I’d come across some months ago that provided more depth to the issue.
And here’s one item that should get anyone thinking.
More than 75,000 work comp injuries were not reported in just three cities last year [2008]. Close to a million may have gone unreported nationally.

Earlier this week I attended the Maine Workers Comp Summit; spoke on the impact of health reform on workers’ comp. One of the sessions pertained to coding medical bills, and some of the intricacies thereof.
For one (me) who spends the majority of their time dealing with higher level, strategic and tactical issues and concerns, this deep dive into medical coding brought me back to my days as an HMO data analyst – and reminded me that there’s more than one devil in the details…
These days, its more important than ever to avoid paying for diagnoses that are not directly related to the work comp injury or illness, as those payments may well trigger higher MSA allocations. Reportedly, CMS’ Boston office has stated their position on a payer’s responsibility is rather definitive; if more than $300 is reimbursed for a condition, the payer ‘owns’ that condition.
An interesting issue – well, kind of interesting to those of us who find this stuff interesting – regards the lack of coding for left or right. several in the audience noted they’d had problems in the past when they paid bills for procedures/therapy on one arm or leg when it was the other appendage that was injured at work. Evidently, the provider had not, and does not have to, send medical records or notes for the non-comp condition, therefore the payer wasn’t aware of the other injury. So when the bill for the right knee/shoulder/hand came in, the bill reviewer/adjuster saw it was the correct body part and authorized payment.
This is most definitely not new news to anyone who’s spent a big portion of their waking hours immersed in the intricacies of coding, but served as a welcome reminder to the rest of us of the challenges inherent in what looks to be a very straightforward, if not simple, methodology.
What does this mean for you?
It’s far too easy to measure bill processing by throughput, but neglecting the quality and accuracy of the coding may well be missing the forest for the trees.

Under the radar, there’s increasing evidence that employment is up, hiring is up, and the economy is recovering – and with it, the workers comp industry.
I had several conversations today that validated what I’ve been hearing for several weeks – there’s a good bit more new activity in manufacturing, construction, and logistics/transportation than there was a few months ago – activity that requires new hiring.
Evidence of this not-yet-in-the-official-reports trend comes from several sources, most importantly activity at occ health clinics. There’s been a lot of pre-employment screenings and physicals, drug testing for truck drivers and equipment operators, and a significant uptick in new workers comp injuries of late. The screenings and testings are obvious indicators of hiring, while the new injuries likely result from a faster pace of work, more overtime, and more temp workers doing jobs they are less than familiar with. (The data do indicate significant additional hiring of temp workers, with 17,000 new hires last month)
Last week’s employment report provides additional color – emplloyment was up for temporary workers and in construction. And, revisions for the two previous months indicated employment was actually higher than the original estimates.
Several work comp specialty managed care vendors are also seeing an influx of new claims, particularly among vendors that provide services common in the initial stages of a claim.
Anecdotally, (I know, a lot of this is anecdotal), I was speaking with the hiring manager for a Maine manufacturer; they have a bunch of open jobs that they can’t find ‘just the right person’ to fill. The manager was frustrated by the ops head’s inability to understand that the applicant pool wasn’t as deep or wide as he wanted. The net? There were several – actually, more than ‘several’, jobs that were going to be filled with people that may not have fit the ops boss’ specific criteria.
I bring this to your attention, dear reader, to suggest there are lots of employers looking for lots of workers, (three million workers, to be precise) but many of these employers are waiting to find just the right worker. It may well be they’ll soon give up their persnicketiness and start hiring who’s available. If – and when – that occurs, things will get better in a hurry.
What does this mean for you?
Very, very welcome news that the worst is almost behind us.

Health Strategy Associates’ First Annual Survey of Work Comp Claims IT Systems is underway. The Survey seeks input from front-line folks and execs in claims and IT, and we’ll be comparing and contrasting responses to see if – or perhaps more accurately where – there’s a disconnect or differences in opinions between the two groups.
Sandy Blunt is the brains behind the Survey; he’s been responsible for several systems selection processes and as a former CEO and COO of large comp payers, he brings a depth of experience that we’re very fortunate to have.
We’re using SurveyMonkey to collect and tabulate responses; the survey takes about 15 minutes to complete. If you are interested in participating shoot Sandy an email – his address is SBluntAThealthstrategyassocDOTcom (substitute symbols for AT and DOT).
Respondents receive a detailed copy of the Survey Report.
A brief summary version will also be available to the general public. Customized analyses of and presentations on Survey findings will be offered as well. Of course, no respondent-specific information will be provided in any version of the Survey report.
Sandy will be providing a snapshot of findings here a couple times over the next few weeks.