Wednesday, July 16, 2014

The Value of Regulator Interaction

This week, I find myself at the Southern Association of Workers' Compensation Administrators' (SAWCA) annual conference in Sarasota. Florida has been the fortunate host to this convention the last two summers. And, while SAWCA will take a hiatus from the Sunshine State in 2015, hosting in Williamsburg, Virginia next year, it returns in 2016 to the idyllic beaches of Destin, Florida (shameless plug for Florida and specifically the panhandle).

The SAWCA is a group of those who work to administer this thing we call comp. There are 19 jurisdictions that form SAWCA, and it has been hosting these gatherings for 66 years. 

At a dinner Monday night, it occurred to me that we who do comp for a living are a bit nerdy in that context. I felt sorry for the spouses who sat with us around the table as we droned on with each other about treatment guidelines, medication formularies, MSAs and the like. We are a bit academic in our own rights, but get us together talking comp and we really shine, to the chagrin of the "non-compers" who surround and somehow tolerate us.

On Tuesday afternoon, we had a regulator's round-table. This was an open forum of at least 15 states' leaders gathered in a room to openly discuss the challenges and successes of comp over the last year. The subjects were interesting in themselves, but hearing various perspectives on them was a bonus. Unlike an educational seminar with a panel espousing pre-prepared materials, this was a free-flowing conversation. Fifty people sat around the table and another 45 around the periphery of the room. 

Topics of discussion included workers' compensation fraud, challenges of uninsured employers, states with uninsured employer funds or other "safety nets," opiods and the treatment of pain, compounding pharmacies and physicians, physician dispensing of medication, adjudication of medical issues, weight loss claims and particularly the weight loss surgery, the role of medical directors in various state systems, and challenges that technology may bring to the administration of workers' compensation. Certainly not the topics most people would choose to spend their afternoon on, but for us workers' compensation nerds, fascinating stuff!

Fraud examples were shared from a variety of standpoints. There are injured workers who receive benefits to which they are not entitled. There are employers who under-report their payroll to save costs, or who elect not to have workers' compensation coverage at all. There are bad brokers who collect premiums from employers, but who do not procure the policy promised, and the list goes on. From the various examples, it is clear that states are working hard to identify and deal with those who are not following the law. There were also examples of efforts underway to educate people as to what is and is not fraud under various laws. 

Significant time was spent discussing challenges that come from medications. Compounding pharmacies are a growing trend in some jurisdictions, and remain virtually unheard of in others. These companies take ingredients and combine them for a specific patient. This allows a very specific combination of agents into one dose for the patient. It also allows for alternative use of the medication, such as through a topical cream instead of ingestion. The novelty of the practice has led to issues on reimbursement amounts and to new regulations in some states. 

Obesity is an issue that we all face, either personally or professionally or both. As I age, I know I struggle with keeping my weight in check and we hear that this is a struggle across the country. The body weight issue can have a bearing on workers' compensation injuries and treatment. There can be issues with whether anesthesia is safe for someone because of their size, or whether a knee, hip, or back surgery would have better success expectations if excess weight were shed before hand. How can weight be dealt with appropriately, and when is stomach surgery an appropriate alternative to diet and exercise?

States struggle with medical claim determinations. California's recent implementation of an Independent Medical Review (IMR) process was discussed. A good article by David DePaolo describing IMR is here. Some states employ medical directors or consultants in their divisions of workers' compensation. Some states' adjudicators order independent medical examinations to resolve disputes, and Florida is alone in the expert medical adviser process. There seems to be a shared anxiety about whether processes can be better. Is there a more efficient method to resolve treatment and care disputes? As with all dispute resolution debates, can such efficiency come without compromise of the due process guarantees that are fundamental to America?

A fascinating discussion ensued about some technology issues. We learned that there are "apps" out there that allow you to "share" a ride. As I understand it Uber, Lyft, and Sidecar (there are likely others) allow people to connect with one another and "share" a ride. The technology company that markets the app processes a payment by the person not doing the driving, takes a commission from this and passes the rest along to the driver. As it has become more common, it seems there may be some who drive for a living and market themselves through these apps. 

Some states apparently think this sounds a lot like a taxi service, without the regulation, licensing, and yes revenue to the state. In the micro chasm that is workers' compensation, the issues surround whether these drivers are employees of the technology company, and thus whether they must have workers' compensation coverage. This is an interesting debate, and various states are apparently engaged in discussing the ramifications. This is an example of how technology will continue to change our world. How we react to those changes will be up to us. 

The round-table yesterday was a fascinating afternoon of what is hot in workers' compensation. Leaders like Karl Aumann (MD), Melodie Belcher (GA), Rod Bordelon (TX), Darrin Childers (NM), Elizabeth Gobeil (GA), Abigail Hudgens (TN), Greg Jenkins (FL), Deneise Lott (MS), Dwight Lovan (KY)(who according to SEAK is one of the 50 most influential people in workers' compensation in America), Frank McKay (GA), Kathryn Mueller, M.D. (CO) J. Landon Overfield (KY), and Jim Szablewicz (VA), Paul Tauriello (CO) Roger Williams (VA) and Lawrence White (LA) were among those who shared insight and perspectives. 

There are so many things I find make our states unique, and yet so many common issues we face in workers' compensation. there is a huge value in hearing what issues are arising in other jurisdictions and how they are being studied, considered and approached. I find the depth of knowledge that these luminaries bring to the table stimulating. The round-table is consistently a source of great insight.

In August at the WCI, SAWCA will have another regulator roundtable on Monday, August 18, 2014, 2:00 to 5:00, Crystal Ballroom J1. This annual event brings even more jurisdictions to the discussion. This year there will be regulators from Alabama, Arkansas, Colorado, Florida, Georgia, Idaho, Kansas, Kentucky (Dwight Lovan, one of the 50 most influential Americans on worker's compensation), Louisiana, Maine, Maryland, Mississippi, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Twenty-one jurisdictions and counting! 

If you made the round-table yesterday, I hope you got as much out of it as I did. If you did not make it, perhaps you can make the round-table in August. With the line-up of administrators and experts, it will doubtlessly enhance your perspectives on what is going on in the world of workers' compensation.

The goings-on with SAWCA are mostly the doing of Secretary Treasurer Gary Davis. The accommodations and planning are largely the work of Malcolm Jennings. Without these two, there would not be opportunities like the round-table yesterday.  

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