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Integrated Risk Hosts Seminar “Controlling Work Comp Medical Costs Without a Fee Schedule”

Four expert perspectives on managing the costs of worker’s compensation claims in the current Wisconsin environment were presented on May 10th as part of an on-going series of educational opportunities for Integrated Risk clients and partners.

Medical costs for workers compensation claims can be controlled through innovative treatment arrangements, careful case management and utilization of cutting-edge billing procedures, according to expert presenters at “Controlling Work Comp Medical Costs Without a Fee Schedule,” a free seminar hosted by Integrated Risk Solutions on May 10.

Dr. Michael Ritter, an occupational health physician with Sensia Occupational Health and Wellness, discussed the current business model for most clinics: more treatment equals more revenue.

“If employers are celebrating success in their safety and OSHA recordable numbers, occupational health providers are likely anxious,” Ritter said. “If the providers are celebrating success, employers are likely anxious. There’s a significant disconnect.”

Ritter encourages employers to establish a relationship with an occupational health physician who focuses on outcomes rather than trying to meet a performance metric aimed at improving the provider’s bottom line. He suggests partnering with a clinic that does not have financial incentives to overtreat, such as coding quotas or dashboards, and avoiding patient satisfaction surveys that encourage doctors to do more for patients to placate them emotionally rather than objectively treating the injury.

He also advises employers to integrate their occupational health provider into their culture by developing programs that promote onsite care. This can eliminate the need for community based care, and align provider goals with employer goals.

Tess Maier, MS, RN, BSN, president of Aurum Medical Management, discussed the role of Nurse Case Managers in worker’s compensation cases, and how employers can utilize this resource to achieve better outcomes.

“A nurse case manager is an advocate for the employer, and the injured worker,” Maier said.

At times, the employer needs expert help negotiating return to work, minimizing unnecessary treatment and obtaining end of healing. Other times, employees need expert help understanding and managing medical care that is not effective, or worse, potentially harmful.

Effective nurse case management can significantly reduce worker’s compensation costs by minimizing medications, physical therapy and un-needed medical equipment, while encouraging faster return to work with fewer permanent limitations.

Bill Felsing, President and CEO of Trilogy Health Solutions, discussed his firm’s innovative approach to medical billing – WC Bundled Payments.

The system works by arranging pre-negotiated rates for surgeries and other procedures with high-quality providers. These “bundles” include all of the services on the day of the procedure, including facility fees, physician fees, anesthesiology fees, medications and equipment. Savings for some procedures can be more than 70 percent off the rate paid under Wisconsin’s usual and customary fee databases.

“Employers achieve superior financial outcomes,” Felsing said. “Insurance carriers see reserving predictability because the price is agreed to before the procedure.”

img_6732 img_6731Felsing said WC Bundled Payments also result in positive selection of top providers. All providers in the system are credentialed through the most recognized associations in healthcare, including the Joint Commission on Accreditation of Healthcare Organizations.