|
Employers must stay up-to-date on new regulations and integrate changes into existing policies and procedures. Forward-thinking organizations will use the recent reforms as a chance not only to identify new opportunities for cost savings, but also to reinvigorate existing workers' compensation programs.
Yet given the newness of the reforms, understandably many employers are still left with questions, including:
- What changes can or should we implement immediately?
- How do we prepare for new processes and procedures, such as medical provider networks?
- When will the complete reform package take effect?
While guidelines still need to be established by the Administrative Director, some reforms take effect immediately, and employers can begin making cost-saving changes today. The following charts detail possible immediate actions, as well as long-term goals, for businesses.
Medical Provider Networks
Effective January 1, 2005, all work-related injuries must be treated in employer-designated medical provider networks. Employees have the option to seek second and third opinions; out-of-network care is available only if the request falls within the guidelines of the American College of Occupational and Environmental Medicine. With this change, employers have the opportunity to create networks of qualified providers that specialize in occupational medicine.
While regulations are being defined, this is an excellent time for employers to evaluate their current medical provider networks and establish specific criteria for continued relationships or future selection. In doing so, employers will be well postured to quickly and informatively select the network that best meets their needs and to identify the most appropriate providers within those networks. Through the end of this year, California employers should continue to direct employees with work-related injuries to existing network providers and to exercise medical control for the first 30 days.
Establishing Medical Networks
|
Immediate Actions
|
Long-Term Goals
|
|
- Analyze loss history to identify injury patterns to determine scope and requirements for medical provider networks
- Develop network selection criteria
- Evaluate and select the best fit, highest performance providers
- Establish rigorous medical case management protocols
- Direct employees to existing network (30-day medical control)
|
- Negotiate medical provider network contracts with performance metrics based on selection criteria once guidelines are established by the Administrative Director
- Establish rigorous medical case management protocols
- Direct employees to medical provider networks as defined by final rulemaking
- Develop a scorecard based on selection criteria and monitor medical network performance
|
Disability Awards and Return to Work
Implementation timelines in this area differ. Effective immediately, temporary disability was reduced to a maximum of 104 weeks over two years with specific exceptions, and now physicians can apportion a share of permanent disability to non-industrial factors.
Other changes must wait until the Administrative Director establishes new guidelines, such as the creation of the Diminished Future Earnings Schedule. Other reforms, including the ability to decrease or increase permanent disability payments based on the offer of a work assignment, will not be effective until next year.
Managing Claims, Returning to Work
|
Immediate Actions
|
Long-Term Goals
|
|
- Incorporate post-offer employment testing to determine fitness to perform job duties and establish a baseline to support apportionment
- Establish investigation protocols and processes for employers and claims administrators that include an index or ISO search for similar claims
- Invigorate return-to-work programs, including protocols for modified duty programs
- Evaluate allocation models and the merits of incorporating incentives and penalties for timely reporting of claims, robust accident investigation, early return to work, etc.
|
- To be determined when further guidelines are established by the Administrative Director
|
Immediate Access to Medical Care
Effective immediately, injured employees now have prompt access to medical care, even before the condition is determined to be work-related. Employers are liable for up to $10,000 in treatment until a decision is made on compensability. Now more than ever, organizations need to focus on immediate claims reporting and timely incident investigations, as prompt determinations of compensability will be important to controlling costs.
Case Management & Compensability Decisions
|
Immediate Actions
|
Long-Term Goals
|
|
- Design and implement procedures for quickly reporting incident facts to the evaluating physician
- Maximize best practices in determining compensability, i.e., incorporate procedures to limit reporting lag time and assure rigorous accident investigation procedures
- Evaluate allocation models, incentives, and penalties for timely reporting of claims, accident investigation, early return to work, etc.
|
- Create a baseline, set benchmark targets for program performance, measure and report consistently and often
- Negotiate vendor service agreements to incorporate performance standards related to compensability decisions and case management
- Monitor vendor performance against established goals
- Measure cost of treatment of non-compensable claims
|
|
