By Sandy Shtab, VP of Industry and State Affairs, Healthesystems
The phrase “Think Globally, Act Locally,” often credited to social scientist Patrick Geddes, became the original mantra for urban planning and environmental management causes. However, the phrase also works in context of private businesses, state funds and workers’ compensation. It can apply to how we each establish connection to and interact with our state regulatory systems to impart needed improvements in our heavily regulated state-based systems. Collaboration between national and regionally based stakeholders is a terrific way to work towards improving the workers’ compensation system. While there are shared challenges, solving them requires understanding and engaging at the local, state-based level.
Each person working in this industry brings a perspective and expertise based on their role and time in the field. One of my favorite things about my role is the many opportunities to engage in meaningful discussions about how things can be better all around. Better for the injured worker, better for their employer, and a whole lot easier for the claim and medical professionals working with the injured worker.
One of the ways we can go about this is to focus on administrative simplification; a buzzword that gets used a lot in the healthcare space, and for good reason. This term encompasses various aspects aimed at reducing the complexity and administrative burden of government systems, such as workers’ compensation.
The Burden of Heavy Regulation
The workers’ compensation system can be overwhelming for injured workers, frustrating for physicians, and a juggling act for claims professionals. The added complexity of managing a multi-jurisdictional claim inventory requires frequent context changing and more attention to detail. Failure to do so can add risk or result in non-compliance with rules. It creates a recipe for delayed recovery, disputes, and higher claim costs.
Reducing the administrative burden on all parties would allow adjusters and physicians to focus on achieving the best medical outcomes. This can be achieved through more productive and timely communication between the injured worker, employer, adjuster, and physician.
Using evidence-based treatment guidelines and utilization review to inform medical decision-making is widely accepted in most healthcare settings, yet in workers’ compensation claims, some critics argue treatment guidelines are a cookie-cutter approach and therefore unacceptable for injured workers, even within the same region. For example, it is puzzling to see the same patient in Alabama could be treated differently in Tennessee, or an injured worker in Texas placed on a different treatment protocol than if they were to reside in Louisiana.
Another example of local differences is measuring functional impairment via disability guides. A patient who has improved might be evaluated using different editions of the AMA Guides® to the Evaluation of Impairment, resulting in higher impairment ratings in one state as compared to another. Understanding these differences requires local expertise, regulatory engagement and advocacy for more uniformity between states.
Being Proactive, Not Reactive, with Regulators
Administrative simplification is not always top of mind for regulators, as they are busy running their agencies, managing dispute processes, and contending with other challenges. But regulators need to hear more from our industry about the importance of simplifying administrative processes so we can spend more time on helping the injured worker through the claim process.
Advocacy begins, and can be most impactful, at the local/state level. Interacting with each other through disputes and problems is necessary to resolving claims, but it is much more important that we find ways to collaborate and communicate proactively, ideally in settings like workers’ comp advisory council meetings, through local events like state workers’ comp conferences, and even via networking and industry trade associations.
Regulators are open to productive input and welcome proposed solutions. Far too often, regulatory changes are a reactive process, brought on by a long-standing problem which has finally come to a head. As one of my earliest mentors once said to me, “Don’t bring me a problem without bringing me a potential solution.” This is true for regulatory agencies as well. They often hear from stakeholders when problems occur, yet they are less likely to hear from employers, injured workers or providers with constructive ideas of how they can simplify the system. Bringing these types of issues to the table prospectively is a terrific way for our industry to build connections and prevent problems in the future.
Understanding local and regional politics and economic differences is crucial before engaging in policy discussions, as these factors can hinder the adoption of new regulations. For example, physician dispensing in the southeast region remains a systemic problem due to politics and economics. Persistence and local engagement are key to progress.
Local Advocacy Can Create Global Change
So how can we all do better? One way to increase your engagement is to join a trade association that brings together others who have the same interests. Many regulators like to hear from those working day to day in the workers’ comp system. Getting involved with organizations like the International Association of Accident Boards and Commissions (IAIABC), the Southern Association of Workers’ Compensation Administrators (SAWCA), or the National Association of Insurance Commissioners. In organizations such as these, regulators and industry experts sit side by side, working on projects and committees to address issues in the system. We actively participate in these organizations and engage regulators at both the local and national levels to improve the system for all participants.
This article originally appeared on WorkCompWire.
