Workers Comp Zone


The California Commission of Health, Safety and Workers’ Compensation held its first 2013 meeting this past Thursday. Here’s a thumbnail sketch of some of the more interesting tidbits discussed:

Christine Baker, Director of the California Department of Industrial Relations, stated that the DIR is thriving despite resource limitations.

She noted that the DWC is examining ways to reduce the backlog in assigning QMEs. Baker noted that using “overtime” to reduce the backlog is a short term fix and that there needs to be regulatory and technological fixes, though she also referenced redirecting staff resources. Baker noted they are reviewing methods of assigning QMEs. Reference was made to possible development of an online QME request portal.

Baker did not mention it, but the DWC has issued a June 11, 2013 newline on the details for seeking QME panels: … f#zoom=100

Baker also spoke about the $120 million fund created under the SB 863 .
Labor Code 139.48 was amended to create the fund “for the purpose of making supplemental payments to workers whose permanent disability benefits are disproportionately low in comparison to their earnings loss”.

That section specifies that “Eligibility for payments and the amount of payments shall be determined by regulations adopted by the director, based on findings from studies conducted by the director in consultation with the Commission on Health and Safety and Workers’ Compensation”.

Baker, who is fond of using the term “data driven”, noted that RAND has been doing a study on wage losses of approximately 19,000 workers. The study is said to be almost ready and is currently in RAND’s internal quality control review process. Baker promised that the study would be posted on the DWC website soon and that there would be ample opportunity for comment by the public and CHSWC.

That’s good, because there are many questions and concerns about how the annual $120 million fund should be distributed.

As former executive officer of CHSWC, Baker relied heavily on RAND studies.
So it’s likely that whatever methodology RAND has developed will be key in the development of the criteria for the $120 fund.

It was not clear from Baker’s presentation whether CHSWC staff has been heavily involved in designing whatever methodology RAND plans to propose, or to what extent various stakeholder groups have already been involved in that planning process.

On the topic of liens she noted that the DWC had collected some $11 million in lien filing and activation fees. A year end lien filing rush may occur in late 2013, but she noted that lien filings are down from 45,000 a month to around 2,000 per month.

Baker noted that reform of the physician payment schedule is coming, based on RBRVS codes. The fee schedule has not been updated in years.

DWC Acting Administrative Director Destie Overpeck noted that regulatory reforms already are projected to save $62 million (ambulatory surgery center regs) and $64 million (spinal hardware payment changes) respectively.

Overpeck noted that a number of final regulations are near adoption, including regs on supplemental displacement job benefits (vouchers), QMEs and interpreters.The DWC has asked for readoption of emergency IMR (Independent Medical Review) and IBR (Independent Bill Review) regs, so those final regs will come later. She noted that MPN and RBRVS and predesignation regs are being worked on. For home health care and interpreter fees, the DWC has commissioned studies which are under way.
Audit regs will be updated.

In sum, Overpeck noted that the DWC is “really busy”.

Dr. Rupali Das, executive medical director of the DWC, spoke about IMR. Das noted that there have been 637 IMR requests to date. Not all of those have yet come to decision, but Das noted that of the decisions to date, 34% overturned the utilization review denial of treatment and 66% upheld the denial of care.

Das noted that is a lower rate of treatment approval than for IMR in California group health, where figures over a decade have shown that treatment denials were overturned 54% of the time.

Das noted that some treatment denials are being posted online (after being redacted). According to Das, this is “for transparency” and “as a learning experience”. A link to that section of the DIR website can be found here:

Opioid medical guidelines may be addressed, according to Das.

CHSWC acting executive officer Lachlan Taylor noted that the RAND study on wage loss is expected in July. A study on copy service costs is expected soon. Interpreter fee study and home healthcare studies are also being performed.

Taylor noted that he would like to begin the process of evaluating the effects of medical reforms. His suggestion that the CHSWC members approve an RFP for a study on that passed by unanimous voice vote.

Also, Taylor suggested that he would like to evaluate the mixture of liens in the system. He noted that CHSWC staff would explore whether this could be evaluated in house or whether an outside contractor would be needed, so a formal RFP was not requested.

In my next post I’ll cover some of the others who provided comments at the CHSWC meeting.

Stay tuned.

Julius Young

Category: Understanding the CA WC system