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Workers’ comp is still in the dark ages.

With extremely rare exceptions, workers’ comp payers – and PPO networks – are doing next to nothing about “quality”.  An illustration.

Let’s compare two hospitals near Jacksonville Florida.

Using publicly available, free data (thanks to RAND), Baptist Medical  is pretty good; it has 4 out of 5 stars on the CMS Hospital Star Compare rating system – the most widely accepted quality rating metric.

Over the bridge is an HCA facility – Orange Park Medical Center – with 2 stars, below average on CMS’ scale.

Both facilities are in multiple workers’ comp PPOs…none of which indicate the large gap in quality between the two. Or any other quality measures for any other facilities.

You’ll note there’s a cost difference as well. And no, you don’t get what you pay for.

The higher-rated facility costs less –  Baptist gets paid about 2.6 times Medicare’s rate for care delivered by private insurers, Orange Park is 4x Medicare.

What does this mean for you?

Want to show you care about the quality of care delivered to injured workers? Send them to good facilities.



2 thoughts on “Workers’ comp is still in the dark ages.”

  1. Thanks Joe,
    This is another reason for having a knowledgeable NCM with boots on the ground who knows the local providers.
    You can bet that any good NCM in the area knows the difference between Baptist Medical and Orange Park in terms of quality of care.

    1. Hello Fred – CMs can certainly help, although it is far better to ensure the patient is directed to a better quality facility at time of injury, and not try to re-direct from a low quality place.

      cheers Joe

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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