Market Factors Drive Workers' Compensation Reimbursement

Changes in a state workers’ compensation fee schedule for a specific service do not necessarily stabilize the percentage of change in provider reimbursement, according to a new study from the National Council on Compensation Insurance (NCCI).

The Impact on Physician Reimbursement of Changes to Workers’ Compensation Medical Fee Schedules compares distributions of group health payments to workers’ compensation reimbursement in 2002 and 2006. The six CPT codes featured in the study illustrate the effect of certain special circumstances and outside influences on workers’ compensation medical reimbursement.

Among the findings:

• The change in average workers’ compensation reimbursement resulting from a change in a state physician fee schedule for a given service depends heavily on the relationship between the fee schedule and actual market prices.
• Workers’ compensation fee schedules are more effective at controlling the cost of high-volume, low-priced procedures than low-volume, high-priced procedures.
• The impact of increasing a workers’ compensation fee schedule maximum reimbursement is not simply the reverse of decreasing the scheduled amount.
• The lag time for providers to respond may depend on the relationship between the current fee and prices paid by group health and the timing of provider network contract renewal.
• Who performs the procedure and who bills for it—whether a single physician, multiple providers, or a hospital or other facility—can influence the reimbursement pattern and whether a fee schedule applies.
• Some medical treatments are performed several times, and some are reimbursed on a time basis rather than on a per-service basis.

For those of you who wish to delve deeper, group health is compared to workers’ compensation experience in the following state studies:

• Alabama—Emergency Department visits (CPT Code 99283)
• Florida—Carpal tunnel surgery (CPT Code 64721)
• Georgia—Burn treatment (CPT Code 16020)
• Kentucky—Established office visit (CPT Code 99213)
• Maryland—Therapeutic exercise (CPT Code 97110)
• Oregon—Shoulder X-ray (CPT Code 73030)

The NCCI notes that with the advent of more complex billing methods, such as Medicare’s Ambulatory Payment Classifications and Diagnosis-Related Groups, the task of building and maintaining workers’ compensation medical fee schedules is becoming more challenging. “These billing schemes and other reforms, such as treatment protocols, are meant to address utilization of services as well as prices. To meet the challenges these pose to monitoring, estimating and ultimately controlling workers’ compensation medical costs, it is important to make optimal use of information that reflects the entire medical marketplace," NCCI researchers conclude.

Many American Workers Are Discontented

The Gallup-Healthways Well-Being Index® is the first-ever daily assessment of U.S. residents' health and well-being. By interviewing at least 1,000 U.S. adults every day, the Well-Being Index provides real-time measurement and insights needed to improve health, increase productivity and lower health care costs, according to the sponsors.

Now the collective 2010 data is in, and it doesn’t bode well for the workforce. 

Newly released city, state and congressional district rankings show the

the Work Environment Index, as a subset of the Well-Being Index, fell to a low of 48.2 out of a possible 100 last year. This continues an annual downward trend that indicates increasing discontent with the U.S. work environment, declining job satisfaction and a lack of trust in employee/supervisor relations, researchers said.

The Work Environment Index measures Americans' perceptions in four categories:

• Job satisfaction 
• Ability to use one's strengths at work
• Supervisor's treatment (a boss or a partner?) 
• Supervisor creates an open and trusting work environment

Among the findings, unionized federal, state and local government workers, as well as unionized private-sector workers, have a lower Work Environment Index score than their counterparts who are not in a union. Workers who are unionized are more likely to consider their supervisor to be a boss rather than a partner, and less likely to say their supervisor creates a trusting and open work environment.

In addition, Gallup-Healthways reports that American workers who are emotionally disconnected from their work and workplace (known as "actively disengaged" workers) rate their lives more poorly than do those who are unemployed: 42% of actively disengaged workers are thriving in their lives, compared to 48% of the unemployed. At the other end of the spectrum are "engaged" employees who are involved in and enthusiastic about their work, 71% of whom are thriving.

Incidentally, other widely publicized studies have shown that one of the leading causes of absence and disability following a work-related injury is the lack of a supportive supervisor.