Austin, TX – The Division of Workers’ Compensation (DWC) recently released the results of the 2013 Health Care Provider Performance Based Oversight (PBO) assessment. For 2013, heath care providers were assessed on their performance in one of four categories:
- timely filing the DWC Form-069, Report of Medical Evaluation;
- completeness of the DWC Form-073, Work Status Report;
- documentation supporting why the injured employee was prevented from returning to work as reported on the DWC Form-073; or
- usage of magnetic resonance imaging.
The DWC is statutorily required to monitor system participants’ compliance with the Texas Workers’ Compensation Act and DWC rules and to take actions to correct noncompliant behavior. The DWC assesses the performance of insurance carriers and health care providers as a part of a biannual PBO assessment.
Of the 68 health care providers reviewed for the timeliness of filing the Report of Medical Evaluation, 41 had scores placing them in the high performer tier, 19 were in the average performer tier, and eight had scores placing them in the poor performer tier.
Of the 57 health care providers reviewed for the completeness of the DWC Form-073, 34 had scores placing them in the high performer tier, 14 were in the average performer tier, and nine had scores placing them in the poor performer tier.
Of the 57 health care providers reviewed for documentation supporting why the injured employee was prevented from returning to work as reported on the DWC Form-073, 38 had scores placing them in the high performer tier, 11 were in the average performer tier, and eight had scores placing them in the poor performer tier.
Of the 46 health care providers reviewed for the usage of magnetic resonance imaging, 21 had scores placing them in the high performer tier, 16 were in the average performer tier, and nine had scores placing them in the poor performer tier.
The DWC uses PBO, data monitoring, complaint handling, education letters, warning letters, audits, and enforcement actions, when appropriate, to achieve its compliance objectives. The DWC will focus its regulatory oversight on the poor performers while offering incentives for high performers in order to promote improved performance and greater overall compliance with the Workers’ Compensation Act and DWC rules.
The results of the 2013 PBO assessment and a list of the health care providers assessed are posted on the Texas Department of Insurance (TDI) website. Health care providers not listed were not assessed, but this does not imply that any health care provider participating in the Texas workers’ compensation system is exempt from the requirement to comply with the Workers’ Compensation Act and DWC rules.
Insurance carriers will be assessed separately in 2014.
Further information regarding PBO and the 2013 assessments may be found on the TDI website at http://www.tdi.texas.gov/wc/pbo/hcppbo.html.
Source: TDI-DWC