Mar

Work comp – 2012 regulatory changes

Posted by Joe Paduda on Monday, March 5th, 2012 | Comments

Every year any number of states change their workers comp regulations, sometimes a lot, sometimes just a minor tweak. This year there’s some of both.
Illinois has to be on the top of anyone’s list – the changes passed last summer are going to be working their way thru the regulatory – and judicial – systems for some time to come (more on Illinois workers comp reforms here).
This year, the Workers’Compensation Research Institute and IAIABC have collaborated on the annual compendium of state workers comp regs. I asked IAIABC Executive Director Jennifer Wolf Horejsh about the major changes over 2011: she reported “a few states experienced significant reforms in 2011 (KS, IL, MT, MI) that impacted the laws as of 2012.”
Montana’s had high costs for some time, and there were some relatively minor changes in the Big Sky state. Costs appear to be the factor in changes this year; again, Wolf Horejsh
“I would surmise that the major driver of change was system cost of one kind or another. High premiums in Montana and Illinois had been a source of frustration for several years. Of course, medical cost containment is an area that is still discussed frequently among the workers’ compensation regulatory community. The issue of physician-dispensing…is on the radar in some states and I anticipate it will still be an area of continuing reform in the next few years.”
Several states did take action to limit costs on physician-dispensed drugs; Alabama, Georgia, and Mississippi are all among those addressing the problem via regulation. (note the report doesn’t include details on reimbursement)

Mar

What health research articles can you believe?

Posted by Joe Paduda on Saturday, March 3rd, 2012 | Comments

There’s a lot of mindless blather in the media about scientific studies on health that purport to say this or that about something or other – much of it confusing, contradictory, and/or outright wrong.
While a lot is just sloppy journalism, there’s quite a bit that can be attributed to bias; physicians and/or researchers on the payroll of a specific company or industry conduct and/or report on research that is favorable to their financial supporter. Roy Poses and Gary Schwitzer have been two of the most prominent voices focused on this issue, and both have done exemplary work not only identifying individual examples of biased “research” but in calling for a higher standard of reporting by all members of the media.
Roy’s work exposing the influence of big money on academic medicine is exemplary.
That’s not to say that some of these advocates aren’t honorable and well-intentioned folks, and some of the research reports and/or advocacy positions are well-developed, legitimate and quite useful.
The tough work is identifying which ones are reliable and which may be less so. One resource is Gary’s list of experts with no links to purveyors of medical devices, medications, and/or treatment. Journalists seeking an unbiased, critical opinion can likely find someone on his list who can provide the straight scoop on the latest claim about peach pits, botox, or mercury toxicity.
A better bet may be to understand what makes for good research, and what’s not – and why, and how reporters can (unintentionally, one hopes) mischaracterize health research in such a way as to mislead the reader.
Here’s one example; a NYT article on treating baldness reported on “treating” mail hair loss by transplanting hair from the patients’ legs to their head. Schwitzer critiqued the piece as “observational with a sample of two patients, it misses nearly all of our measures and allows the author of the study to provide readers with a 777 word advertisement.” [emphasis added]
Ouch.
To answer my headline question, I’d say “yes, but check to see who the”experts” cited by the articles are and where they make their money.”

Mar

Streaming Health Wonk Review

Posted by Joe Paduda on Thursday, March 1st, 2012 | Comments

Trying something new in this fortnight’s edition of Health Wonk Review – instead of grouping contributions by topic, we’ll take them as they come – just like we encounter them on the web – and at the end, I’ll try to summarize and find common themes and make sense out of the chaos.
note the use of the word “try”…
Our revered colleague Hank Stern is pushing hard for full insurance coverage of men’s facial grooming products. Hank, you kill me!
David Williams takes issue with Mitt Romney’s call to increase the Medicare eligibility age, asking why we can’t start raising it now, and faster than Romney suggests. Good policy isn’t good politics, and to me this looks more like another Romney effort to address a perceived problem without angering a voting block… (I do agree with David’s note that a better faster way to reduce the long term deficit would be repeal of Medicare Part D…)
From new mandates we jump to the latest from Health IT, with dedicated reporter Neil Versel bringing us the news from the HIMSS 2012 conference. Neil walked the aisles, listed to talks, and chatted up insiders, all so we don’t have to suffer the sore feet and info overload. Think “meaningful use” and ICD-10…
Just in time, our colleagues at Health Affairs contributed their observations on the proposed rules for Meaningful Use of EHR , diving deeper into the issue with another post from an EHR stakeholder, noting the list of quality measures is likely to be significantly trimmed in the final rule.
Louise Norris – a retail health insurance broker in Colorado – combines a deep understanding of the implications of health policy on a national scale with her hands-on, daily working knowledge of how health insurance markets actually work, and that rare combination makes her observation “if all continues as currently planned but with the individual mandate eliminated, I would expect premiums – in the long run – to be significantly higher than they would be with the individual mandate in place…” one we would be well-advised to carefully consider…
Changing gears, At Workers’ Comp Insider, Julie Ferguson has been following the ingoing criminal probe and charges related to the 2010 Upper Big Branch Mine disaster. Many insiders believe that criminal charges will climb higher up the criminal ladder. How high? Stay tuned. (Ed. note – the Big Branch mine safety boss just got a three year prison term…)
HWR veteran Jason Shafrin PhD provides a critical review of a paper exploring factors affecting patients’ access to care. The always-insightful Shafrin’s summary is tight.
A different take on access comes from Anthony Wright who reports county-based Low-Income Health Programs (LIHPs) in California have already increased access to coverage for a quarter-million folks under the poverty level thanks to an early expansion of the Affordable Care Act.
Transparency in health care decisions is great – as long as consumers understand what the “price” buys, and the relative value and effectiveness and issues of different treatment options. That’s the point Joe Colucci makes while noting we’re a loooooong way from having access to enough usable information.
Another view comes from Greg Scandlen, who wants Medicare to incorporate spending accounts so individuals can set aside funds to cover their deductibles and copays. As a side note, Scandlen claims that his recent 19% premium increase is due to “ObamaCare”, a meme that has been debunked here and here – see page 19. In fact, PPACA’s impact on health insurance premiums accounts for about 1.5% of trend on average, and at most less than 5% when direct and indirect impacts are counted. In return, there’s coverage for dependents to 26 (adds <0.2%), elimination of lifetime dollar limits, coverage of pre-existing conditions, and free preventive care. There's rarely a point in time where it is suddenly and clearly obvious that no more medical care should be provided to a deathly ill patient, rather, it is a long and gradual decline, and suddenly we find ourselves with a very old, very infirm person with multiple problems all seemingly insoluble requiring Herculean efforts incurring massive cost. That’s Brad Flansbaum’s conclusion in his post on the timing of death.
Gary Schwitzer’s Health News Watchdog is fast becoming the go-to site for intelligent analysis of the mass media’s handling of health topics. Gary takes on the media’s handling of new research on colon cancer screening, noting “One study [in the New England Journal of Medicine focused] on colonoscopy, one on a form of blood stool testing, plus an editorial that addressed both. Some benefits for each approach were found in each study. Some stories only reported on the colonoscopy study, ignoring the blood stool test study. Others ignored the editorial – which provided easy access to an independent perspective.” Gary’s point? The blood stool study shows significant promise, and not discussing it in context diminishes the reader’s ability to understand that.
Perhaps the most diligent watchdog in the industry is Roy Poses, MD. Roy’s tireless efforts to uncover self-dealing and unethical behavior in the health care industry is notable not only for its thoroughness but, sadly, for the wealth of material. Roy takes on lazy reporters’ patent inability to see through conflicts of interest in health care research, and the logical fallacies that make a mockery of their “reporting.”
A new contributor is Wing of Zock (no, that’s not a typo), and from Michael Weitekamp MD comes a solid post leading with HL Mencken’s oft-used quote “For every complex problem, there is a solution that is simple, neat, and wrong.” Dr Weitekamp notes “The free market cannot fix this. We spent $2.6 trillion on health care in 2010 and the vested interest in the status quo is formidable.” Weitekamp goes on to note a government mandate won’t address duplication of low value services either. A very good overview; here’s hoping he continues with a series on solutions.
Good to hear from Maggie Mahar, who sends us her piece on obesity – I learned that it’s not the weight that kills, it’s the lack of activity. Obesity – in and of itself – isn’t near as damaging as inert behavior.
At Corporate Wellness Insights, Fiona Gathright has a different lament – many health care providers aren’t exactly pictures of health themselves, noting ” health care workers (nurses, aides, hospital administrators, etc) have some of the highest rates of obesity, hypertension, and diabetes in the country!”
Jared Rhoads discusses an effort to better understand public survey non-respondents views on health care reform, and laments the inadequacy of the “don’t know” answer.
A big component of some health plans’ efforts to improve patient care is the “medical home”. Jaan Sidorov MD isn’t sure medical homes are “all that”, and some research supporting medical homes is rather limited in scope.
A different perspective comes from Kerry Willis MD, who has a practitioner’s view of the issues with the health care system.
Finally, Avik Roy takes big pharma to task for working to delay approval of drugs, thereby forcing biotech firms to partner with big pharma companies if they’re going to survive long enough to get their molecules to market.
So, what does this all mean?
Technology adoption isn’t a panacea, and mixed and changed messages from CMS are causing mega-heartburn in the tech and health systems sectors. Most payers are pushing hard to prepare for reform, understanding that the world is changing with or without an individual mandate.
Big money has big influence and as long as it does, we’re likely not going to see significant reform – there’s just too many billions at stake.
And big media doesn’t help, with their superficial and under-researched take on news, studies, and assessments thereof.

Feb

North Dakota’s chickens are coming home to roost

Posted by Joe Paduda on Tuesday, February 28th, 2012 | Comments

Well, when you falsely accuse a (very) competent public servant of malfeasance and get rid of him, you get what you deserve.
That’s exactly what’s happening in North Dakota. The state workers comp fund (WSI) is dealing with two separate scandals, one involving alleged illegal removal of a nurse’s entry from a claim file, and the other alleged efforts by management to manipulate WSI’s Medical Director to change his medical opinions.
You would think that the current CEO, Bryan Klipfel, would be on this like white on rice. Alas, Klipfel stumbled into this job, with a grand total of zero prior experience in workers comp, insurance, medical care, rehab, finance, or customer service. But he was a “good listener…”
According to press reports, WSI’s “chief doctor who reviews injured North Dakota workers’ compensation claims said he twice resisted efforts by agency managers to alter his medical opinion.
Dr. Luis Vilella, the medical director for Workforce Safety and Insurance, said he refused to change his medical opinions when asked to do so on two occasions in February or March of 2010.”
I don’t know if the recent effort by WSI management to establish more control over their medical directors is related to those two earlier attempts to get Viella to alter his opinion, but the coincidence is certainly worthy of investigation.
Reading Klipfel’s comments on these issues, it is easy to see just how big a screw up the powers that be made in ousting Sandy Blunt and putting Klipfel, a complete newcomer to business, let alone insurance, never mind workers comp, in charge. Evidently WSI was working on this “policy”, but only submitted it to the state board of medical examiners after Viella asked for the Board’s help. According to press reports, Kilpfel said: “This is a draft policy…We were going to have some work done on it. We want to make sure the policy we have reflects the longstanding policy that legal never drives medical in handling our claims.”
As anyone who knows anything about comp learns on day one, you do NOT mess with medical opinions, and you most certainly do NOT try to get your medical director to alter his or hers’. Yet WSI was in the process of reviewing a policy that would “dictate how medical opinions are to be transcribed, documented, or recorded.”
That’s not all. A WSI nurse case manager found that her entry in a claim file was deleted by a claims manager who didn’t like that the case manager’s statement strengthened the claimant’s case.
Well, folks, you get what you deserve. The real reason Sandy Blunt was prosecuted was because he was working his butt off to reform a dysfunctional state agency that had long been subject to political manipulation; Blunt didn’t stand for that. Now he’s out, a complete incompetent is running the place, and the citizens of North Dakota are paying the price.
The chickens are coming home to roost. Someone is going to have a big job shoveling out the coop after Klipfel et al move out.
Or, as Bob Wilson notes, the dodos are the ones doing the roosting..

Feb

What is your hand worth?

Posted by Joe Paduda on Monday, February 27th, 2012 | Comments

Three numbskulls in South Carolina decided one hand was worth $671,000, the amount they collected from various insurance policies after sawing off one of their six hands.
Yep, one idiot agreed to have his hand cut off so he and his fellows could split the take from three AD&D policies; no word on how they picked which one would give it up for his buddies, nor if he got more of the take as compensation.
Evidently the FBI found out about the three stooges some time after the amputation and subsequent remuneration, Christina Bramlet of PropertyCasualty360 reported (in a pun-filled piece) on the event.
The surgical instrument of choice was – brace yourself – a pole saw. One of those long poles with a combination saw and lopper at the end for trimming branches in trees. No word if it was powered or manual…

So, walk me through this.
You’re sitting around with your buddies, likely a few beers into the evening, and you confess your deep sense of shame over your life-long-hand-to-mouth existence. Someone says he heard of someone else who collected big bucks from an accident where he lost his arm.

The lightbulb goes off...among this triumvirate, a rare event to be sure.
Then, the debate starts – no, it’s not “if”; it’s “who”.
How do you pick the unlucky co-conspirator? draw straws? rock-paper-scissors? flip coins? odds and evens, with odd man out losing his left?
Do you follow thru then, or give the unlucky guy a couple days with his soon-to-be-departed appendage, a sort of farewell tour. Maybe play a little baseball, tickle the ivories, tie a couple knots, drive a manual transmission car a few miles, button a few shirts, go a couple rounds with the ol’ pinball machine?
Or just grab the nearest sharp object and start whacking away?
And who has to do the surgery? Do both of the lucky ones agree they’ll do it together, to spread the guilt around, or maybe just see what it feels like to cripple a good friend?
Too bad there’s not a category for on-purpose maiming in the annual Darwin Awards...

Feb

Health reform, jobs lost and jobs gained

Posted by Joe Paduda on Friday, February 24th, 2012 | Comments

My post yesterday about the impact of health reform on employment generated an email from NFIB’s Bob Graboyes correcting an error in attribution (thanks Bob). It also got me to dig deeper into the issue of employment and reform – specifically, what’s the net effect – what jobs and how many will be lost to to PPACA, and what jobs and how many will be gained as a result of health reform.
Let’s leave aside the fact that with reform it will be a lot easier for workers to move from a big company and their health plan to individually-insured plan, enabling more would-be entrepreneurs to start their own firms.
According to Monster, there will be a plethora of new jobs for technicians, clinicians, and support workers.
And NFIB’s own analysis estimates the employer mandate [opens pdf, see p 20] – the old one, not the one that exempted employers with fewer than 50 workers – would have created 890,000 jobs. (NFIB hasn’t updated their numbers to reflect the lack of mandate for small employers.)
That said, NFIB indicated the mandate would create a lot of jobs – and good paying ones at that:
“The employer mandate would boost demand for healthcare goods and services, thereby increasing employment in healthcare-related sectors. The number of ambulatory healthcare professionals (physicians, dentists, and other healthcare practitioners) needed will increase by 330,000. An additional 327,000 staff will be required to work in hospitals. Some 157,000 more nurses (net of retirements) will be needed to staff doctors’ offices, outpatient clinics, and other provider locations. And payrolls at insurance companies will expand by 76,000 workers.”
Okay, so we have 330,000 more jobs for docs and dentists, and 157,000 net new openings for nurses. That’s almost half a million new high-paying jobs; these aren’t retail clerks, burger flippers or car wash attendees, these are folks making from $50,000 to $400,000.
True, some jobs will be lost, but we don’t know if there will be a net loss or gain. But lets say there’s a net loss. According to NFIB, the vast majority of the jobs we’ll lose are in retail and food service.
Marketwatch notes that the Sunshine State may well see more jobs added as a result of reform. The article goes on to note some experts’ opinions that while there will be more jobs open, many will go unfilled due to a lack of trained clinicians.
One hopes that the invisible hand will remedy this situation.
Of course, we’d be much better off if we could look into the future. Fortunately, we can. Recall Massachusetts enacted legislation very similar to PPACA back in 2009.
Overall, employment gains in healthcare Massachusetts have outstripped the rest of the country by four points; Mass added 9.5% more health care jobs since passage of reform while the rest of the nation averaged 5.5%.
But the impact wasn’t just on health care job counts. While the rest of the country saw a 2.9% drop in employment since Massachusetts passed reform, Mass’ employment dropped by a mere 0.2%.
What does this mean?
Well, there will likely be fewer overall jobs, but there will be a lot of new, high-paying jobs that may balance out the loss of what look to be lower paying jobs.

Feb

Physician dispensing and auto insurance

Posted by Joe Paduda on Thursday, February 23rd, 2012 | Comments

Over the last couple weeks I’ve fielded several calls from automobile insurance companies seeking information about the big drug bills they’ve been getting for physician dispensed drugs.
This is more of an issue in states with high dollar coverage for medical costs, but there’s increasing evidence that physician dispensing is hitting more and more auto claimants in many different jurisdictions.
There’s several reasons these bad actors are pushing into auto.
1. some states are controlling the pricing of repackaged/physician dispensed medications for workers comp, so docs – and their suppliers – are looking for greener pastures.
2. many auto insurers aren’t yet aware of the practice, so they’re just paying the bills without much scrutiny
3. it’s profitable – really, really profitable.
There’s a downside for consumers as well as their insurers. In addition to the added health risks inherent in physician-dispensed medications, these inflated charges also cause insureds to reach their policy limits much faster, thereby running out of insurance coverage for their medical costs.
This is happening in Hawai’i, Michigan, Georgia, Florida, and likely many other states.
So, what’s an auto insurer to do?
I suggest you start by figuring out the size of the problem. Find out the TINs these entities are billing under, total up their charges, scripts, and your payments, and see how bad it is.
If it’s not much, that’s great – for now. That won’t last.

Feb

Obamacare and jobs

Posted by Joe Paduda on Wednesday, February 22nd, 2012 | Comments

Will the health reform bill kill jobs? Devastate small businesses? Push us back into recession?
According to several organizations and and anti=reform politicians, it’s the worst thing to hit the economy since the Depression.
But it turns out those doomsayers are mostly wrong.
Here’s what FactCheck.com says about these claims:
“this is health-care hooey, aimed at exploiting public concern over continuing high unemployment, with little basis in fact.
As we’ve said before (a few times), experts project that the law will cause a small loss of low-wage jobs — and also some gains in better-paid jobs in the health care and insurance industries. [emphasis added]
It’s also expected that more workers will decide to retire earlier, or work fewer hours, when they no longer need employer-sponsored insurance and can obtain it on their own with help from federal subsidies. But that just means fewer people willing to work — and it will free up jobs for those who want them. If anything, that could reduce the jobless rate.” [emphasis added]
Here are a few factoids about the PPACA (aka Accountable Care Act) that seem to have escaped the attention of those concerned about health reform and jobs.
– some employers with fewer than 25 FTEs are already receiving government aid to help defray the cost of insurance
– employers with fewer than 50 FTEs are exempt from the requirement to provide coverage
– the original CBO analysis of reform’s impact on employment [opens pdf] indicated job losses from the employer mandate “would probably be small.”
In fact, the jobs picture, according to the CBO, is mixed.
“According to CBO’s August 2010 analysis, the legislation, on net, will reduce the amount of labor used in the economy by a small amount–roughly half a percent–primarily by reducing the amount of labor that workers choose to supply.30 That net effect reflects changes in incentives in the labor market that operate in both directions: Some provisions of the legislation will discourage people from working more hours or entering the workforce, and other provisions will encourage them to work more.”
The well-regarded Lewin Group concurs:
“Lewin’s analysis showed 150,000 to 300,000 jobs lost, all minimum wage or near minimum wage positions that would be lost permanently. That doesn’t account for increases in jobs in other sectors, mainly health care, that Sheils also expects but hasn’t quantified.”
There are entities with different opinions, but they are not neutral parties. Again, here’s FactCheck:
“a study by the National Federation of Independent Business…projecting a 1.6 million job loss…was issued Jan. 26, 2009 — well over a year before the new law was actually enacted. NFIB has not issued any study of what actually became law, and one of this study’s authors, Michael Chow, told us by e-mail that it has no present plans to do so…
NFIB did not study the new law. Its report was based on a hypothetical employer mandate that bears little resemblance to what was actually passed — and it also projects a gain of hundreds of thousands of health care and insurance industry jobs.”
I’d note that this hasn’t stopped the GOP from using the 1.6 million lost job figure when referring to jobs lost due to PPACA…
(note – an earlier version credited the NFIB with continued usage of the 1.6 million statistic; I should have said the GOP. I regret the error)
What does this mean for you?
While there are problems with PPACA, while it is far from perfect, and while it could stand improvement in many areas, no matter what NFIB et al claim, it is not a “job-killer.”

Feb

The Hawaiian political charade

Posted by Joe Paduda on Tuesday, February 21st, 2012 | Comments

I received an email from an individual who attended a “hearing” on a workers comp bill in Hawai’i. It’s compelling for two reasons – it clearly illustrates the comp system’s vulnerability to manipulation by those seeking ever-greater profits and ever-lesser oversight, and the weakness and inadequacy of employers’ and insurers’ efforts to prevent that manipulation.
Here’s the perspective of Charlie Donovan – and no, Mr Donovan is not an insurance guy; in fact he works for a group of physicians that serve workers comp claimants.
“I was bothered by the fact that one of the biggest supporters of the [IME] bill, and from my understanding one of the most active participants in fundraising for Senator [Josh] Green [orthopedic surgeon and drug dispensing physician], was not only given the chance to testify, but was called upon again to answer questions in front of the committee.
I was incensed that there were 2 orthopedic surgeons with over 50 years of combined experience treating patients, performing surgery, and conducting IMEs sitting 10 feet in front of Sen. Green who were not given the time of day.
And it seemed so blatantly unfair that an injured worker who had driven in “all the way from Waianae” was given a chance to testify, but that a neurologist with over 30 years of experience who flew in from Maui to give testimony was not afforded the chance to speak.
But when testimony was closed, I looked at my watch and saw that barely 40 minutes had expired since the hearing was gaveled to order. With easily 2 dozen more people anxiously waiting to have their opinions heard, it was over.
Epiphany!!! The entire hearing had been a charade. The members of the committees who graced us with their presence (all 6 of them) were not interested at all in being educated, or in hearing what the “public” had to say. Passage of that bill was a “done deal” before anyone walked into the room, and the hearing was nothing more than an inconvenience for the committee members.
I suppose that I was naïve for thinking that “public testimony” really mattered, that years of experience, statistical data, and the opinions of other professionals would trump fundraising donations. I suppose that somewhere down deep I knew that politics was a dirty business, and that “public service” was a catch-phrase of absolutely no significance. But part of me didn’t want to admit it, until it was rammed down my throat in the most transparent piece of kabuki I have ever seen.
So while facts comes before fundraising in the dictionary, I must now begrudgingly admit something that I probably already knew – that the order is obviously quite different in the world of politics.
Like wandering behind a horse and getting kicked, this is a lesson that will not have to be taught twice.”
What does this mean for you?
Insurers and employers better get real, and fast. You are going to get your heads handed to you if you don’t stop dissembling and focus on these issues.
Workers comp is a very, very soft target for profiteering physicians and the various businesses that have sprung up to suck money out of employers’ premium checks. They are organized, very well-funded, and aggressive.
Meanwhile, insurers and employers are sitting idly by while these bad actors use your dollars to buy political influence.

Feb

Hawaii’s (likely) evisceration of the workers’ comp system

Posted by Joe Paduda on Monday, February 20th, 2012 | Comments

After posting last week on the politicization of the physician dispensing issue in Hawai’i, I heard from a number of stakeholders alarmed by that – and other issues.
Chris Brigham, MD, has been following what can only be described as an effort to eviscerate Hawaii’s workers comp system. He contributes these observations to MCM.
The Aloha State has been friendly to physician dispensing and to certain legislative officials, including Senator Clayton Hee, Chairman of the Senate Judiciary and Labor Committee, receiving funding from individuals and entities associated with physician dispensing companies [Hee’s contributors were identified in MCM last week; last week I referenced a physician dispensing cost control bill that would take steps to deal with this issue, however the bill is likely to end up in the Committee and die.]
Physician practices involved in physician dispensing lobbied very actively for another bill, a bill that would effectively thwart the independent medical evaluation process in Hawaii.
HB 466 was passed this week by the State’s Joint Committee on Judiciary and Labor and the Committee on Health (chaired by Senator Josh Green, MD, who has also been the recipient of fund raising by interests aligned with physician dispensing companies.) This bill would require independent medical evaluations (IMEs) to be performed upon mutual agreement of the injured employee and the employer. The attitude and behavior of the treating physician heavily influences the patient; if the treating physician feels threatened by the IME physician, it’s likely the treating doc will advise the patient to reject the evaluation. Thus, what this bill really means is the treating doctor and employer have to agree on an IME. If there is no agreement, the evaluation is assigned by the director to a doctor from a list of qualified physicians maintained by the state.
At the hearing, a physician who heads up a large practice involved in physician dispensing stated he would be pleased to provide names of physicians qualified to be on the “list”. Interestingly, documents reveal that certain physicians charge a fee of $3500 for an IME for one of their own patients and the resulting five page report. Curious how a doctor could perform an “independent” evaluation on his own patient…
This bill also limits IMEs to one per case, unless valid reasons exist with regard to treatment. How does this deal with various issues that occur during a life of a claim and to multiple problems? What is the rationale or need for this legislation? No studies have been performed to demonstrate a problem. Hawaii has been known for high quality IME reports and, according to data published in the AMA Guides Newsletter March / April 2010; Hawaii has the highest degree of accuracy in impairment ratings in the country.
How is this state going to deal with changes that are likely to dramatically increase costs and result in delayed case closure? This is particularly problematic given Hawaii’s state budget shortfall. This legislation appears to be responding to a non-existent problem, rather than addressing any issue of questionable care. If decision makers are rational, recognize the true issues, understand there is no money to pay for the proposed needless changes, and do not make decisions influenced by who sponsors their campaigns, there is still a slim opportunity for defeat. I’m not optimistic.
In terms of thwarting bad care, could it get worst for Hawaii? Yes.
The same parties are advocating passage of a bill to allow the Director to approve treatment plans without a hearing if they are disputed by the employer, a bill to permit the Director or claimant to reopen cases even years after they are resolved by settlement if a question arises concerning undue influence or the injured worker’s mental competence, and a bill to allow attorney’s fees to be awarded if a claim is prosecuted or defended without good cause. Attempts to bring evidence-based medicine to Hawaii have been thwarted.
What does this mean for you?
Beware of strategies by certain stakeholders who are attempting to alter the workers’ compensation system through legislation to be more “friendly” to them – even if it results in increased costs (human and financial).
Recognize that some of these stakeholders may well be seeking influence through contributions to key legislative decision makers; Money talks. Recognize despite its beauty, not all is perfect in Hawaii – it is a wonderful place to visit, however you probably would not want to have a business or be injured there.

Year: 2012