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Compensation Advisory Council
Council on Worker’s Compensation
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.
Excused: Ms. Bean, Mr. Schimke, Ms. Vetter
Mr. Conway, Mr.
O’Malley, Ms. Knutson, Mr. Krueger and Mr. Topp
- 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.
- Minutes: The minutes of the June 07, 2007 meeting were approved
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
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.
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.
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.
Unfinished Business: None discussed.
- Adjournment: Discussion on all agenda items concluded and the
meeting was adjourned at approximately 3:35 p.m.
Future meeting dates are as follows:
Wednesday, July 11, 2007
Wednesday, August 1, 2007
Thursday, September 6, 2007