Worker's Compensation Advisory Council
    Council on Worker’s Compensation
    Meeting Minutes
    Madison, Wisconsin
    June 25, 2007

     

    Members present:  Mr. Beiriger, Mr. Brand, Mr. Buchen, Mr. Furley, Ms. Huntley-Cooper, Mr. Kent, Mr. Newby, Mr. Olson, Mr. Redman, Mr. Scott, Mr. Shaver

    Excused: Ms. Bean, Mr. Schimke, Ms. Vetter

    Staff present:   Mr. Conway, Mr. O’Malley, Ms. Knutson, Mr. Krueger and Mr. Topp

    1. Call to Order/Introductions: Ms. Huntley-Cooper convened the Worker’s Compensation Advisory Council (WCAC) meeting at 10:00 a.m. in accordance with Wisconsin’s open meetings law. WCAC members, staff and members of the audience introduced themselves.
       
    2. Minutes: The minutes of the June 07, 2007 meeting were approved without corrections.
       
    3. Presentation: Mr. Mark Grapentine, Wisconsin Medical Society, presented information concerning the requirements of providing medical care to worker’s compensation patients. He emphasized that patients with worker’s compensation injuries required a higher level of clinical and case management commitment and significantly higher administrative requirements than compared to other patients. The additional administrative requirements include completing more documentation and interaction with employers, insurance adjusters and attorneys. The time spent on clinic bills for worker’s compensation is 25% of staff time for 1% of total claim billings. There is also a longer delay in payment when worker’s compensation is involved. Providers are opposed to Management’s medical fee schedule proposal. They are willing to work on streamlining the administrative processes in worker’s compensation that currently result in inefficiencies and higher costs. Dr. Jurisic commented that in worker’s compensation cases, the treating doctor’s judgment is constantly questioned by other doctors, adjusters and nurse managers resulting in a larger time commitment and frustration level for the treating doctor.

      Mr. Greg Krohm, Executive Director of the International Association of Industrial Accident Boards and Commissions (IAIABC), presented information on Medicare-based Relative Value System fee schedules (RBRVS), developed by the Harvard School of Public Health in the 1990’s with the assistance of the American Medical Association. The CPT and DRG billing codes are a major component of this system. The values are based on survey data to include provider time, office expense, malpractice insurance and regional adjustments. RBRVS sets the relative compensation of treatment based on cost. Generally, primary health providers are compensated better than specialty providers. RBRVS is familiar to all medical billing departments as it is used by Medicare, Medicaid, federal worker’s compensation and Champus. Included in RBRVS is a prospective payment system for hospital length of stay based on DRG code. For hospital payments there are adjustments for class of hospital, acceptance of Medicaid/Medicare patients and teaching hospitals. The pros of RBRVS include: it is a transparent system; it is based on provider input; it cannot be “gamed”; there is widespread familiarity with it. The cons of RBRVS include: it is fairly complex with many rules; there are frequent updates; it may be slow to update data relative to new and complex treatments. Regarding usual and customary databases, there is not enough data collection involved in developing the databases to make them statistically credible. In addition, they are market-driven, not cost-based. Mr. Krohm indicated the Medicare geographic payment adjustment for Wisconsin providers is slightly higher than the national average.
       
    4. Reports: Ms. Knutson reported on the litigated caseload. Currently there are 3279 cases in ready status waiting for a hearing to be scheduled and 195 cases waiting for a prehearing conference to be scheduled. The median wait time continues to drop with the median wait time for a hearing at approximately 7 months for most cases. Hearing notices continue to be mailed out 12 weeks in advance of the scheduled date for most cases.

      Mr. Conway reported that a group consisting of WCD staff, ALJs and attorneys met on June 21st and discussed the certification of readiness process. There were good suggestions made by the attorneys and ALJs on changing the forms and the required documentation. The attorneys presented a negative view of the process, indicating it was not necessary. They suggested that the process should be voluntary only – not mandatory. Their comments and concerns are being considered by the WCD. Mr. Dale Cattanach reviewed the certification of readiness process in his study of the hearing process. Mr. Cattanach talked with attorneys and although the attorneys expressed concerns about the certification of readiness process, he indicated it was a good idea and the department should implement the process. This process has been discussed with the Secretary’s Office for over two years. The number of times staff review and handle files is inefficient. The report should be available by the end of June. Mr. John Neal commented that the WC Process Improvement Team (WCPIT) met for over two years and did not suggest this process. Ms. Knutson clarified that the WCPIT could not arrive at an agreement on when a case was “ready” to be scheduled for hearing. Ms. Huntley-Cooper commented that one of the department’s goals was to reduce the caseload, and for cases to be heard in a timely manner. The majority of cases are not ready to move forward to hearing when the hearing application is filed. The certificate of readiness process would allow for cases to be scheduled upon receipt and a hearing would be held within a 7 month period. We are asking for parties to try this on a pilot basis. Mr. Neal replied that it would be a good idea to implement it on a pilot basis but that it should be voluntary. He stated that most cases are not ready for hearing six months after the hearing application is filed. Mr. Conway commented that the department’s goal is to provide employees with a hearing within a relatively short time once we are advised the case is ready to be scheduled. The WCAC is pleased with the WCD’s progress in scheduling hearings and reducing the pending caseload. The Labor and Management members have concerns with the certification of readiness process as initially proposed by the department.
      Recess for lunch followed by Labor-Management caucus.

      Ms. Huntley-Cooper re-convened the meeting at 5:15 p.m. With the following members present: Mr. Newby, Mr. Kent, Mr. Beiriger, Mr. Brand, Mr. Shaver, Mr. Scott and Mr. Olson. It was moved by Mr. Newby and seconded by Mr. Beiriger to “defer implementation of the certification of readiness process for 90 days (from August 1, 2007) to allow time to review Dale Cattenaugh’s (sic) report when it becomes available”, and “to allow time to see if the current/present effect of the department’s staffing improvements continue to reduce the backlog.” The motion carried with one abstention.
       
    5. Labor/Management Proposals: Mr. Beiriger indicated Management was refining the medical fee schedule proposal and progress was being made by both sides in negotiating an agreed bill. He was optimistic an agreement could be reached. Management is committed to working on increasing permanent total disability benefit payments. The discussions involved a slow, thoughtful and careful process. Mr. Beiriger commented that Management was trying to ensure that employees continue to receive quality medical care while being responsive to employers.

      Mr. Newby responded that he was more optimistic before today that an agreement could be reached. The medical provider liaisons developed a proposal that could work with some modifications. Labor is disappointed in Management’s proposal to use a Medicare-based fee schedule system. Labor agreed to changes in the last two agreed bills that included reduction of the standard deviation and the introduction of medical treatment guidelines. There is no indication of a serious problem with medical costs for worker’s compensation claims based on the most recent Worker’s Compensation Research Institute (WCRI) data. Labor will agree to cooperate in controlling medical costs going forward and will participate in good faith discussions using the medical provider liaisons’ proposal as a discussion point.
       
    6. Correspondence:  Mr. Conway reviewed the correspondence the department sent to Sen. Robson and Rep. Sheridan in response to their request that the WCAC include in the agreed bill a statutory amendment to eliminate the interest credit on advance payments.
       
    7. Unfinished Business: None discussed.
       
    8. Adjournment:  Discussion on all agenda items concluded and the meeting was adjourned at approximately 3:35 p.m.
       
    9.  

    Future meeting dates are as follows:

    Wednesday, July 11, 2007
    Wednesday, August 1, 2007
    Thursday, September 6, 2007