Austin, TX – The Division of Workers’ Compensation (DWC) released the results of the 2015 Health Care Provider Performance Based Oversight (PBO) assessment. For 2015, 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, Work Status Report; or
- usage of magnetic resonance imaging.
Of the 83 health care providers reviewed for the timeliness of filing the DWC Form-069, Report of Medical Evaluation: 61 had scores placing them in the high performer tier, 18 were in the average performer tier, and 4 had scores placing them in the poor performer tier.
Of the 124 health care providers reviewed for the completeness of the DWC Form-073, Work Status Report: 55 had scores placing them in the high performer tier, 38 were in the average performer tier, and 31 had scores placing them in the poor performer tier.
Of the 124 health care providers reviewed for documentation supporting why the injured employee was prevented from returning to work, as reported on the DWC Form-073, Work Status Report: 62 had scores placing them in the high performer tier, 41 were in the average performer tier, and 21 had scores placing them in the poor performer tier.
Of the 33 health care providers reviewed for the usage of magnetic resonance imaging: 21 had scores placing them in the high performer tier, 8 were in the average performer tier, and 4 had scores placing them in the poor performer tier.
DWC uses PBO, data monitoring, complaint handling, education letters, warning letters, audits, and enforcement actions, when appropriate, to achieve its compliance objectives. DWC focuses its regulatory oversight on poor performers, and offers incentives to high performers to promote improved performance and greater overall compliance with the Workers’ Compensation Act and DWC rules.
The results and a list of the health care providers included in the 2015 PBO assessment are posted on the Texas Department of Insurance (TDI) website. If a health care provider is not listed they were not assessed in 2015; however, this does not imply that any health care provider in the Texas workers’ compensation system is exempt from the requirement to comply with the Workers’ Compensation Act and DWC rules.
DWC assesses the performance of insurance carriers and health care providers as a part of a biannual PBO assessment. Insurance carriers will be assessed separately in 2016.
More information on PBO and the 2015 assessment is available on the TDI website.
Source: TDI-DWC