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SUMMARY OF REFORM ACTIVITIES
CONCERNING WORKERS’ COMPENSATION
A.
The Three Member Panel, consisting of the Insurance commissioner, and two
members appointed by the Governor, is tasked to annually adopt schedules of
maximum workers’ compensation reimbursement allowances for physicians,
hospital inpatient care, hospital outpatient care, ambulatory surgical
centers, work-hardening programs, and pain programs. The legislature in
2002 also tasked the Panel to take testimony, records, and data to evaluate
the adequacy of the workers’ compensation fee schedule. They were tasked to
survey health care providers to determine availability and accessibility,
and survey carriers to determine impacts on changes to reimbursement
methods. They are to evaluate the information and submit recommendations to
the President of the Senate and Speaker of the House on or before January 1,
2003, on methods to improve Florida’s workers’ compensation system. The
Panel, through the Department of Insurance, hired Jerry Fogel, President of
Imagine Clinical, with assistance from Claude Revels of JM Family
Enterprises, to conduct the surveys and study. The Revels/Fogel plan was
presented to and approved by the Three Member Panel on October 28, 2002.
This plan is a complete “overhaul” of the current system.
Highpoints of the "Revels/Fogel" Plan relating directly to Physicians:
1. Fee Schedule based on costs (i.e., RB/RVS -Medicare) -150% of Medicare
with provisions for prompt payment.
2.Fee Schedule will not decrease; provisions for automatic annual upward
adjustment based upon CPI; Reimbursement Review Panel (with physician
representation) to decide on issues relating to adding new codes, periodic
Medicare changes so that fee schedule is Florida-specific.
3. Requirement that authorization guarantees payment.
4.Reduction of "hassle factors" with streamlining of paperwork and the use
of limited, universal reporting forms.
5.Return of medical decision-making to the physician and expectations based
upon community standards; no use of fixed practice parameters.
6.Principle of care based upon confirmed, abnormal, relevant physiology.
This
will empower physicians to release the patient or reasonably limit continued
evaluation and treatment to conditions that are related to the injury, based
upon medical evidence; reduces the frequency of "system-induced invalidism";
reduces the potential for the claim of "over-utilization"; reduces
unwarranted practices by physicians who do not practice quality medicine.
7. Removal of demands related to employer decisions: assignment of ability
levels and physical restrictions and limitations; elimination of "Temporary
Total Disability" or "No work" decisions by the physician.
B.
In May 2002, following passage of SB108, the Governor signed an Executive
Order creating the Governor’s Commission on Workers’ Compensation Reform.
The Commission consists of 13 members, each appointed by the Governor. The
Commission is to hold hearings to collect testimony and information in order
to study and make written policy recommendations to the Governor, President
of the Senate, and Speaker of the House by January 31, 2002. The Commission
has held four hearings (the last being October 22) to date, with the next
scheduled November 12, at FIU’s North Miami campus. The Revels/Fogel Plan
is scheduled to be presented at that meeting. At this time the plan is
conceptual, no draft legislative language is available. A coalition, headed
by Associated Industries, presented their reform package, except the medical
portion, to the Commission on October 22, 2002. It is my understanding that
they will present the medical portion of their plan at the December
Commission meeting. The coalition plan will propose modifications to,
rather than replace, the current workers’ comp system. It is similar to HB
1927 which did not pass last session.
As
you can see, a lot of activity is on-going in reference to the workers’
compensation system. It behooves the FMA and all current and potential
workers’ comp providers to monitor recommended changes to the system. It
will be easier to question and modify plans and proposals before the
concepts are in statutory language.
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