Posts Tagged ‘Texas workers compensation’

Drastic workers compensation changes called for in Texas

Thursday, September 16th, 2004

In response to what has been called a developing crisis by Texas Governor Dewhurst, the Sunset Advisory Commission, a body charged with reviewing state agency performance, has just issued recommendations that include abolishing the Texas Workers’ Compensation Commission (TWCC) and migrating many of the TWCC responsibilities to a newly created Office of Employee Assistance in the state’s Department of Insurance. An article in the Houston Chronicle states:
“The proposal comes as state legislators try to address a 14-year-old workers’ compensation system criticized by workers, doctors and business owners as ineffective.
“Nobody likes it,” said Rep. Burt Solomons, R-Carrollton, chairman of the Sunset Advisory Commission, which is charged with reviewing state agency performance. “We’re proposing drastic changes.”
Members of the Sunset panel said the main goal is to get injured workers treated and back on the job.”

Past studies have shown that costs for medical treatment under workers comp can be as much as six times higher than under group health. Chiropractic care and overutilization are often pointed to as cost drivers, and Texas lacks a fee schedule. Employers are also seeking a change that would allow them to direct employees to networks. The Chronicle reports that only 23% of surveyed physicians were willing to take workers compensation cases under the current system. Recommendations include creating a workers’ comp-specific medical network that might attract more physician participation. Texas is also unique in that employers can opt in or out of the system, and it is thought that reforms that result in a physician network might provide more incentive for employers to opt in.
The Sunset panel’s recommendations for TX workers comp reform are also discussed in the Dallas Business Journal, which reports:
“Many of the issues that kept physicians from participating in the workers’ comp program are the same insurance-related issues that were appropriately addressed by lawmakers during the past two legislative sessions and assigned to TDI for enforcement,” the TMA said in a statement. “It only makes sense to transfer TWCC responsibilities to TDI where the mechanism and agency culture already exist for a more successful workers’ compensation system.”
Existing TDI regulations include the right for patients amd their physicians to request an independent review of an insurance company’s denial of medical care, as well as prompt-pay laws to penalize insurance carriers who duck contractual requirements to pay claims in a timely manner.
Recommendations also include creating appropriate fee guidelines and adequate physician networks that are large enough to provide quality care.”

These recommendations will be under consideration in the 2005 legislative session, which begins in January. The Senate has appointed a select committee to study the issue. The Chronicle reports that the Sunset panel’s findings will likely get heavy consideration since the panel is made up of 10 state lawmakers and two members from the public.

Research: outcomes for injured workers

Wednesday, July 7th, 2004

This year’s NCCI Issues Report contains a report by Richard Victor of the Workers Compensation Research Institute (WCRI) of Cambridge, MA on WCRI’s ongoing study of injured worker outcomes in California, Massachusetts, Pennsylvania, and Texas. The objective of the research is to measure key outcomes that are frequently at the heart of public policy decision making:

  • recovery of health
  • successful return to work
  • injured worker access to healthcare
  • injured worker satisfaction with healthcare

Most interestingly, the highest per-claim medical expenditures and the highest frequency of visits do not necessarily yield the highest satisfaction by workers or the best outcomes.
“For example, workers in Massachusetts and Pennsylvania report better outcomes after their injuries, on average, than do workers in California and Texas. This includes better perceived recovery of physical health and functioning; more frequent, faster, and more sustainable returns to work; greater access to desired providers and services; and higher levels of satisfaction with their healthcare.
Better outcomes occur in Massachusetts and Pennsylvania even though workers in California and Texas receive more medical services, on average, that generate more medical expenses for employers compared with workers in the other states. Further, this occurs despite the fact that workers from each of the four states report, on average, similar perceived severity of injuries.”

One of the specific examples that the report cites is that Massachusetts, a state with some of the best outcomes, also has the lowest medical prices of the four states at $4,937; in contrast, Texas has one of the poorest worker outcomes, yet it has one of the highest medical prices of the four states at $11,617.
It’s a report worth your time to read. This is one of the first major studies to measure injured worker satisfaction and outcomes, and to measure them against a multi-state backdrop so that system variables can be compared and contrasted.
The annual Issues Report available at NCCI is always worth checking out. Also, we keep a link to WCRI in the sidebar – it’s a good practice to periodically visit the WCRI – What’s New page to keep abreast of their current research and reports.