By: Shelley Boyce, CEO, MedRisk Workers’ Compensation managed care has come a long way since its emergence in the mid-1990’s. When it first arrived on the scene, managed workers’ comp looked a lot like group health – big generalist discounted networks – with discounts below state fee schedules instead of discounts below billed charges. As… [Read more]
Leaders Speak
Shelley Boyce: Guidelines Are Not All Created Equal
By: Shelley Boyce, CEO, MedRisk Evidence-based medicine is now widely accepted in workers’ compensation and guidelines are proliferating. New York State recently implemented guidelines addressing lower back, neck, shoulder, and knee conditions and is working on a fifth guideline on carpal tunnel. I applaud this and other states’ efforts to go far beyond simply authorizing… [Read more]
Joe Paduda: The RFP Process – A Better Way
By Joe Paduda, Author, Managed Care Matters Last week’s piece detailed the problems inherent in the RFP process; lots of vendors doing lots of work answering lots of questions in an attempt to win business where only one will succeed. Decisions delayed, decisions deferred, decisions never made. Potential vendors answering formulaic questions with pat answers,… [Read more]
Joe Paduda: Do Unto Others – Reflections on the RFP Process
By Joe Paduda, Author, Managed Care Matters Workers comp payers – TPAs, employers and insurance companies – buy lots of services from many different vendors. Some are ‘purchased’ by adjusters and case managers on a claim-by-claim basis, but most payers use the formal ‘request for proposal’ process when big dollars are at stake. Vendors of… [Read more]
Dr. William Hopper: Utilization Review—Focus on Cost Effectiveness and Patient Safety in the Management of Pain
By Dr. William Hopper, CMO, MediCall There is growing concern about the increasing cost of unnecessary health care services.1 The rate of cost increases is being driven by acuity and severity of service categories2, and one of the most accelerated areas is pharmacy services. In addition to cost, the impact on patient morbidity and mortality… [Read more]
Dr. William Hopper: Thoughts on Utilization Management
By Dr. William Hopper, CMO, MediCall With the recent passage of legislation in both Workers Compensation, Federal and private health plan arenas, more attention is being paid to the rising cost of increasingly expensive and often times unnecessary healthcare services. Utilization Management is one of the mainstays of resources to deal with combating unnecessary utilization.… [Read more]
Jim Greenwood: The Value of Physical Therapy
By: Jim Greenwood, CEO, Concentra The use of Physical Therapy for musculoskeletal injuries in workers’ compensation has been and continues to be a controversial topic. Is there value when a patient receives physical therapy? The answer to this question is, it depends. The range of when therapy is received (acute early intervention or delayed chronic… [Read more]
Jim Greenwood: Trends in Workers’ Compensation Fee Schedules
By: Jim Greenwood, CEO, Concentra While many may debate the benefits of a medical fee schedule, most feel they play a part, some believe a large one, in controlling medical costs. Most will also agree that a fee schedule in isolation, without appropriate utilization controls, really does very little in limiting medical costs. The rub… [Read more]