May 18, Wisconsin Health News
The management side of a council charged with developing changes to the state's workers' compensation system has proposed creating a fee schedule for healthcare services.
The Worker's Compensation Advisory Council, which consists of representatives from management and labor, crafts a bill that updates state law around workers' compensation every two years. Management and labor introduced their proposals at a meeting last week.
Management is calling for setting initial rates at 150 percent of Medicare rates starting in 2017. The schedule would adjust each year with the medical consumer price index.
The proposal differs from a measure that was pursued by the council four years ago but failed to make it into law, which was based on rates for surgeries and procedures negotiated by group health plans.
"The goal is the same, which is to bring cost containment to the state," said Chris Reader, an advisory council member and director of health and human resources policy at Wisconsin Manufacturers and Commerce.
He said it's easier to construct the fee schedule using Medicare as it's difficult for the state to obtain average group health plan rates. More than 40 other states have fee schedules, he said.
Mark Grapentine, Wisconsin Medical Society senior vice president of government relations and liaison to the council, questioned why Wisconsin would want to mimic other states when it already has a successful system.
"The value of the current workers' comp system as it exists is by just about every measure fantastic," he said. "For whatever reason, the management side tends to have this fascination with sticker prices of individual procedures and not the overall cost of care."
Reader pointed to other proposals from management they believe could help with costs. That includes allowing employers to direct workers to healthcare providers and requiring providers to follow treatment guidelines.
If a provider decides to deviate from the guidelines, they would have to get prior approval. That ensures providers get employees back to work as soon as possible, he said.
"Let me be clear - most do an excellent job of getting workers back to work," he said. "But having strong treatment guidelines will ensure that everybody has to do that unless there's a good reason not to."
Grapentine said they're concerned about both proposals. Treatment guidelines could make it inefficient and frustrating for physicians to provide care to injured workers, he said.
The proposal relating to guidelines, he said, is coupled with the fee schedule approach. States with fee schedules aren't as efficient in providing care, and treatment guidelines can cut utilization. He compared it to pushing on both sides of a balloon at the same time.
"If you push on both sides of the balloon really hard, you know what happens," he said. "Why on earth would you do that to a system that people across the board think is a national model?"
Management and labor are set to negotiate over the coming months to craft an agreed-upon bill for introduction to the Legislature.
Stephanie Bloomingdale, secretary-treasurer of the AFL-CIO and an advisory council member, declined to comment through a spokeswoman.