STICKS AND STONES AND BROKEN BONES [Risk Management]
By Allen, Brian | |
Proquest LLC |
The Legislative Debates Over Workers Compensation Reform
It is no secret that the workers compensation industry must continually adapt to legislative and regulatory changes. So far in 2012, significant action has occurred in the areas of physician dispensing, prescription medication abuse and policy reform. Further activity is underway in a number of legislative chambers, and a handful of states have advanced reforms that impact workers compensation payors and injured workers.
These changes are altering operations, premiums, compliance, access to quality care, patient recovery, claim duration and the ability to manage outcomes. In fact, no single area of the system has been immune from scrutiny, with state legislators taking a hard look at everything from disability benefits to the cost and delivery of pharmacy and ancillary services. Some issues have resulted in harsh divisions with even harsher words, and in some higher-profile state issues, the debates have became fierce enough to make national news.
The Road Paved in 2012
One of the year's biggest developments was the escalation of physician dispensing and its cost on the system. Physician dispensing significandy raised costs; repackaged medications that were processed out-of-network at non-contracted rates and without utilization review were three times more expensive than retail pharmacy costs. The result was an extra
States reacted differently, with some restricting the practice, while others either limited reimbursement costs or engaged in rigorous policy debates. In
Both sides claimed influence was "purchased," with presented data immediately being refuted by the opposition. As a result of this passionate political volley, other important bills became political casualties as retribution for a particular stand on the bill. In the end, the senators, besieged by wildly conflicting data, were caught in the middle of a firestorm of words. So they did the only safe thing and stuck with the status quo.
Perhaps the largest challenge faced by workers compensation payors is the management of prescription drug misuse and abuse. Narcotics account for 25%40% of retail medication costs and total about
In 2012,
Throughout the country, workers compensation reform efforts were rampant in 2012.
Both sides traded volleys during a high-profile media campaign to sway the vote. Proponents touted patient safety and convenience while opponents pointed out that pharmacy was the one area where costs have actually been contained since the reform measures were adopted. Lawmakers, sobered by the announcement that
Groups in
And then there was
The legislation has many moving parts, but the highlights are that it increased disability benefits for injured workers and offset the cost of those benefits by reducing some provider fees, eliminating some add-on benefits for sleep disorders and sexual dysfunction, streamlining the lien process while shortening time frames to file liens, and limiting the services of some types of providers. Analysts indicate the overall savings to the
State Legislative Forecast for 2013
With the plethora of activity in 2012, what lies ahead for legislative agendas in 2013? Don't anticipate a quiet year.
Other states will also likely explore reform measures as they battle rising workers compensation expenses and persistent social issues contributing to these costs, such as physician dispensing, prescription drug abuse, compounded medications and drug repackaging. It will be interesting to see how
States are also likely to continue to observe the outcome of the
Additionally, we can expect continued debate and pending policy surrounding physician dispensing in
Just beyond the horizon, we will be following the potential for average wholesale price to be replaced by a different pricing model. If it is replaced, the new model will require significant reprogramming and re-contracting efforts by payors, at a significant cost.
But before we turn to the new year, let's not forget the elections, the outcome of which will greatly influence workers compensation policy. State elections will result in a large incoming class of freshman legislators with new ideas and potentially new solutions for the issues facing the workers compensation industry.
At the federal level, regardless of who wins, it is expected that they will take a closer look at mitigating the risks associated with narcotic use through expansion of education initiatives such as the
WHILE THE ACTUAL IMPLEMENTATION OF "I-STOP" IN
LOOK FOR THE CHAMBERS OF COMMERCE IN
Copyright: | (c) 2012 Risk and Insurance Management Society, Inc. |
Wordcount: | 1987 |
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