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.