Tuesday, March 27, 2007, 10:48 PM - Political developmentsOn Wednesday, March 28 at 9 AM, the California Assembly's Insurance Committee (chaired by San Jose Democrat Joe Coto) will hold a public information hearing on the effect of recent revisions to the workers' comp permanent disability rating schedule.
The Schwarzenegger administration (through the staff of the Division of Workers' Compensation) has been conducting a study of return to work rates and earnings losses of California injured workers. Portions of the study have been released (see below to download those studies), but the study is not complete.
Meanwhile, Cheese Whiz (the California Commission on Health, Safety and Workers' Comp, CHWSC) has continued to study the issue, and recently issued a report. The CHWSC report released on February 23, 2007 verified that the impact of the 2003 and 2004 workers' comp reforms (and the new rating schedule that was adopted) has been to drastically reduce permanent disability awards.
The March 28 hearing may provide insight into how the various system stakeholders will "spin" this information and information as to where the administration is headed in its DWC study. I will be covering the results of the hearing over the next several days.
To see the DWC study released last week, click here:
http://www.dir.ca.gov/dwc/WageLossForIn ... withTD.htm
And to see a PDF version of the CHWSC study of ratings through January 2007 (prepared by Berkeley's Frank Neuhaeuser), you can click here:
http://www.dir.ca.gov/CHSWC/Reports/Mem ... an2007.pdf
Friday, March 23, 2007, 08:31 AM - Medical treatment under WCFew people in California haven't heard Mick Jagger of The Rolling Stones squawking "I Can't Get No Satisfaction." He was wailing with existential angst about finding meaning in a world bombarding him with useless information about how white his shirts could be (as well as his search for "girl reaction").
Would most California injured workers echo his unsatisfied refrain? Are California's injured workers satisfied or unsatisfied with their medical treatment? Anecdotal horror stories have indicated that they are not. The 2003 and 2004 reforms affected medical treatment in several key areas:
-medical treatment standards (the "ACOEM guidelines") were adopted as the presumptive standard of medical care allowed
-provisions were added allowing utilization review ("UR") of medical treatment requests by insurer-hired outside doctors
-employers were authorized to setup Medical Provider Networks ("MPNs") of employer selected physicians
-workers subject to an MPN lost the right to "free choice" of a doctor unless they predesignated a doctor before they were injured
-the MPN provisions were declared retroactive, allowing insurers to force many workers to terminate treatment with doctors they had seen for years
-strict limits on chiropractic treatment and physical therapy were instituted on post 1.1.04 injuries
These reforms have squeezed billions of treatment dollars out of the California comp system. But there are lots of unhappy campers. Just how many?
The UCLA Center for Health Policy Research study of worker satisfaction with treatment was published in February 2007. You can find the Los Angeles Times account of the study by clicking here:
http://www.latimes.com/business/la-fi-c ... s-business
And you can download the actual study at this site:
http://www.healthpolicy.ucla.edu/pubs/p ... ?pubID=216
Getting satisfaction. Or not. In future posts, I will discuss the results of this study as well as problems with the study. And I'll be looking at an effort being made to roll back these changes through the California initiative process.
Thursday, March 22, 2007, 11:27 PM - Political developmentsThe California Division of Workers' Compensation (DWC) has really been struggling to "get it right" in formulating regulations concerning utilization review.
The FOURTH set of revised proposed regulations has just been unveiled. These are available at the following site:
http://www.dir.ca.gov/dwc/DWCPropRegs/U ... h15day.pdf
These revisions yet again weaken the proposed regulations on utilization review enforcement. In essence, the proposed regs weaken the requirement that reviews of utilization review determinations examine a certain proportion of utilization review denials.
This is all in the context of massive criticism of the utilization review process by doctors and injured workers. As billions of dollars in treatment costs have been squeezed out of the system, some doctors and workers have experienced outrageous treatment delays or denials by non-qualified UR doctors acting on limited information.
But is it possible that the DWC regulators are missing the forest for the trees? Shouldn't utilization doctors be required to get all of the treatment records rather than a slim version of the records, or a computer summary of treatment? Shouldn't there be better procedures for treating doctors to appeal denials? Shouldn't patient (i.e. worker) input be permitted in the process? Shouldn't there be more transparent disclosure regarding the financial arrangements between insurance carriers and utilization review companies? Shouldn't the UR regs require that the UR doctor be the exact same medical specialty as the doctor requesting the treatment? Would standardized treatment request forms help resolve the problem that some physicians fail to include sufficient data on diagnosis and clinical findings and/or justification for the requested treatment?
None of these concepts are rocket science. But the DWC regs do not adopt these simple requirements, many of which would make the utilization review process clearer and fairer.
Monday, March 19, 2007, 08:18 AM - Political developmentsIn a post a few days ago, I discussed Senator Perata's lockout of the so-called Senate Mod Squad. Three state senators were briefly locked out of their offices to show Perata's disapproval of their attempt to set up a legislative bloc within the state senate's Democratic caucus.
What does this portend for legislation this year? Perhaps it is a tempest in a teapot. Or will so-called business Democrats be able to block health care reform and workers' comp reform (not to mention environmentally friendly bills)? In an era of term limits, how much power does the Senate Pro Tem have? Keep in mind that Senator Perata has pledged to move legislation addressing some of the inequities in the 2004 workers' comp reform. He was able to shepherd a bill raising permanent disability payments through the legislature in 2006, only to see it vetoed by Governor Schwarzenegger.
But there are some clouds on the horizon. Apparently an investigation of Perata's past fundraising has been revived. It's not clear where that is headed. And there has been some speculation as to whether there could be a leadership challenge. The most likely candidates would be first-term State Senator Alex Padilla (from Los Angeles) or Sacramento area State Senator Darrell Steinberg. There has been precedent for this sort of intraparty struggle in Sacramento before, if you look back to the victory of Willie Brown over Howard Berman and Leo McCarthy in the 1980s. Let's hope it does not happen now.
For an analysis of some of this, check out the Oakland Tribune piece:
Friday, March 16, 2007, 10:16 PM - Political developmentsI rarely read the California Bar Journal, the State Bar's official publication. But the March 2007 edition featured a graphic that caught my eye. The article focused on California's "justice gap."
Did you know that there is one private lawyer for every 250 Californians? We are a well-lawyered populace. But the article, by staff writer Nancy McCarthy, notes that there is only one legal aid lawyer for every 8,361 low-income Californians.
The California Commission on Access to Justice has found that a majority of the legal needs of California poor go unmet and that those who do get some assistance often receive only minimal services. You can find their reports at the following site:
http://www.calbar.ca.gov/state/calbar/c ... %20Justice
I recently consulted with Worksafe! on workers' comp representation issues. Worksafe! (www.worksafe.org) is a non-profit devoted to helping California workers. Apparently, many legal services lawyers are starting to see more workers who are having trouble finding adequate workers' comp representation. Further, the reduced workers' comp benefits under the Schwarzenegger reforms have led to increased demands for legal services in other areas... housing issues... credit issues... bankruptcy issues... and so on.
The 1990s were a time of excess in California workers' comp. There were reports (true or unsubstantiated?) of doctors and attorneys gaming the system by signing up individuals... even homeless and people in unemployment lines, particularly in Southern California. Looking backwards, perhaps the system stakeholders did a poor job of supporting structural changes in the system to prevent these types of abuses.
The post-2004 landscape is very different. Workers are now finding it hard to find adequate representation. In many rural areas of the state, it may be almost impossible, particularly for farmworkers and residents of smaller places in California's Central Valley.
According to California Supreme Court Chief Justice Ronald George, "A chasm still separates the need for representation of low-income litigants and the supply of services available".