Friday, December 30, 2016

A Thanks for All our Team Does!

We pause this holiday season to express appreciation and admiration for the outstanding job done by the OJCC team across Florida each year. Thanks team, for an outstanding 2016! We are counting on each of you for more of the same in 2017! It is astounding that these 165 people manage all of the disputes for Florida's workers' compensation system!

Belkis Alvarez Deputy Clerk Miami
Wilbur Anderson Judge Daytona Beach
Susan J Arrick Mediator Miami
Robert A Arthur Mediator Lakeland
Catherine E Bailes Administrative Secretary Lakeland
Diane B Beck Judge Sarasota
Susan Berman Commission Deputy Clerk II Orlando
Patrick S Bickford Commission Deputy Clerk II Tallahassee Clerks
Susan G Bisbee Mediator Tallahassee
Shirley J Blank Deputy Clerk Ft. Myers
Yolanda P Bradshaw Commission Deputy Clerk II West Palm Beach
Eric R Bredemeyer Mediator Ft. Myers
Jeffrey S Breslow Mediator Ft. Lauderdale
John P Brooks Mediator Daytona Beach
Shanetta Brown Commission Deputy Clerk II Ft. Lauderdale
Julie K Brown Deputy Clerk Orlando
Susan J. Burton Commission Deputy Clerk II Sarasota
Pamela S Cain Deputy Clerk Jacksonville
Alejandra Campuzano Commission Deputy Clerk II Miami
Kimberley M Cardone Commission Deputy Clerk II West Palm Beach
Laure M Carnes Deputy Clerk Sarasota
Gerardo Castiello Judge Miami
Frank J Clark Judge Ft. Myers
Anne W Claussen Mediator Sarasota
Tara C Cole Administrative Secretary Tallahassee
Ruby M Coleman-Brown Deputy Clerk Lakeland
Willie J. Condry, Ii Judge Orlando
Merle B Cortez Commission Deputy Clerk II Ft. Myers
Kelly A Cronan Commission Deputy Clerk II Daytona Beach
Mary A D'ambrosio Judge West Palm Beach
Kahlil A Day Mediator Jacksonville
Luis E De Fana Deputy Clerk Miami
Lidia Delgado Secretary Specialist Miami
Jacquelyn S Denton Administrative Secretary Orlando
Robert L Dietz Judge Melbourne
Romeika L Dixon Administrative Secretary Miami
Nerida C Dominguez Administrative Secretary Miami
Marquita M Dukes Commission Deputy Clerk II West Palm Beach
Joseph A Edwards Commission Deputy Clerk I Tallahassee Clerks
Elina Escarda Deputy Clerk Miami
Leticia Espina Commission Deputy Clerk II Miami
Ana R Ferlita Deputy Clerk Tampa
Iliana Forte Judge Ft. Lauderdale
Tammy L Galey Commission Deputy Clerk I Tallahassee Clerks
Louise V Gaskin Dministrative Secretary St. Petersurg
Deborah L Geer Commission Deputy Clerk II Ft. Myers
Randee J Gildea Administrative Secretary Melbourne
Deborah M. Golden Deputy Clerk Tallahassee Clerks
Malena B Gonzalez Deputy Clerk Miami
Alan M Gordon Mediator Jacksonville
Narita B Green Commission Deputy Clerk II Tampa
Adrianne M Guy Deputy Clerk West Palm Beach
Christina L Hamons Court Reporter/Transcriptionist Tallahassee Clerks
Kevin G Harris Commission Deputy Clerk II Gainesville
Deirdre J Harrison Commission Deputy Clerk II Tampa
Deborah D Hart Mediator Ft. Myers
Paul L Harwood Mediator Port St. Lucie
Mark C Hauber Mediator Melbourne
Walter J Havers Mediator Miami
Stephanie R Hayes Staff Counsel Tallahassee
Sophia D Heath Commission Deputy Clerk II Ft. Lauderdale
Thomas A Hedler Judge West Palm Beach
Joshua Henderson Commission Deputy Clerk I Tallahassee Clerks
Lyna S Hickman Commission Deputy Clerk II Panama City
Marjorie R Hill Judge Gainesville
Charles M Hill Iii Judge Miami
Sherry D. Hires Mediator Orlando
Sherri Coleman Hobbs Administrative Secretary Daytona Beach
Silvia M Hoeg Mediator Orlando
Geraldine Hogan Judge Ft. Lauderdale
Anastasia Jean Hollaway Deputy Clerk Panama City
William R Holley Judge Jacksonville
April M Holsman Commission Deputy Clerk II Ft. Lauderdale
Wendy M Hope Deputy Clerk Jacksonville
Ralph J Humphries Judge Jacksonville
Julie Hunsaker Office Operations Manager I Tallahassee Clerks
Michael H Imber Mediator West Palm Beach
Antoine P Jacques Administrative Secretary Ft. Lauderdale
Shahida A James Administrative Secretary West Palm Beach
Gregory J Johnsen Judge West Palm Beach
Mark B Johnson Commission Deputy Clerk II Tallahassee Clerks
Pamela J Johnson Deputy Clerk Tampa
Wanda L Keenan Commission Deputy Clerk II Tampa
Chymbee A Keith Administrative Secretary Port St. Lucie
Margret G Kerr Judge Miami
Regina A Key Deputy Clerk West Palm Beach
Paula C Kiedeisch Administrative Secretary Gainesville
Daniel R Kilroy Deputy Clerk Orlando
Anna Marie M Kim Mediator Orlando
Jaquandra E King Administrative Secretary West Palm Beach
Rhonda G Lapin Mediator Miami
John Lazzara Judge Tallahassee 
Laurie R Leon Mediator Tampa
Linda S Leonard Administrative Secretary Sarasota
Daniel A Lewis Judge Ft. Lauderdale
Pamela L London Deputy Clerk West Palm Beach
Ellen H Lorenzen Judge Tampa
Noreen A Lusco Commission Deputy Clerk II Jacksonville
Mark A Massey Judge Tampa
Sylvia Medina-Shore Judge Miami
Ilene V Mele Commission Deputy Clerk II Orlando
Jessica Melendez Deputy Clerk Ft. Myers
Beverly J Melton Commission Deputy Clerk I Tallahassee Clerks
Gary A Miller Mediator Miami
Marla R Miller Deputy Clerk Orlando
Sarah T Minker Deputy Clerk Gainesville
Melissa R Moody Deputy Clerk Tallahassee Clerks
Amanda L Morales Deputy Clerk Tallahassee
Paula Nickel Deputy Clerk Tallahassee Clerks
Nelio E Oramas Mediator Panama City
Keef F Owens Judge Pt. St. Lucie
Carmen L Padilla Deputy Clerk Ft. Lauderdale
Neal P Pitts Judge Orlando
Ronda T Pope Deputy Clerk Ft. Lauderdale
Irish L Porter Commission Deputy Clerk II Tallahassee Clerks
Sylvia Ramkishun Administrative Secretary Ft. Lauderdale
Eduardo Ramos-Almeyda Judge Miami
Jeanette M. Randall Commission Deputy Clerk II Pensacola
Brittany L Reid Deputy Clerk Pensacola
Ellen F Riley Administrative Secretary Ft. Myers
Teresa D Robinson Administrative Secretary Orlando
Rosanna Robles Administrative Secretary Miami
Barbara Glenn Rook Commission Deputy Clerk II Lakeland
Liliana J Roque Administrative Assistant Ii Miami
Stephen L Rosen Judge St. Petersburg
Adam I Ross Mediator Ft. Lauderdale
Carol Ruffin Deputy Clerk St. Petersurg
Sheila A Ryder Deputy Clerk Melbourne
Doris Salgado-Sama Administrative Secretary Miami
Isabel M Schuchman Commission Deputy Clerk II Miami
Thomas W Sculco Judge Orlando
Carolyn C Slowikowski Mediator Pensacola
Suelean J Smith Deputy Clerk Ft. Lauderdale
Margaret E Sojourner Judge Lakeland
E Douglas Spangler Jr Judge Tampa
Callie M Stamper Administrative Secretary Jacksonville
Timothy S Stanton Mediator Tampa
Angelique I Steele Commission Deputy Clerk II Port St. Lucie
Cory Strickland Administrative Secretary Tallahassee Clerks
Yadira Suarez Commission Deputy Clerk II Orlando
Sharleen J Sudbury Commission Deputy Clerk II Melbourne
Michele Suero Commission Deputy Clerk II Miami
Christine A Sullivan Administrative Secretary Ft. Lauderdale
Theresa Sullivan-Hadden Administrative Secretary West Palm Beach
Stuart F Suskin Mediator Gainesville
Kelly Tiska Deputy Clerk Port St. Lucie
Karla A Trumbull Commission Deputy Clerk II St. Petersurg
Kathy M Valdez Administrative Secretary Panama City
Bethany L Valliere Mediator West Palm Beach
Keren Vega Deputy Clerk Miami
Joan H Venable Comission Deputy Clerk II Jacksonville
Jonathan E Walker Judge Panama City
Priscilla A Walker Commission Deputy Clerk II Tallahassee
Angelique S Washington Deputy Clerk Tampa
Jack A Weiss Judge Ft. Myers
Alena H Wilson Deputy Clerk Daytona Beach
Nolan S Winn Judge Pensacola
Joann Winters Commission Deputy Clerk II Miami
Ronnie K. Witlin Mediator Miami
Rita L Young Mediator St. Petersurg

Thursday, December 29, 2016

Important Points from 2017 Three Member Panel Draft Report

The Florida Three Member Panel will meet in January in Tallahassee. The Three Member Panel is a statutory body created and created/enabled by Section 440.13(12), Fla. Stat. It deals with reimbursement rates and schedules. And, it is charged with submitting biennial recommendations "on methods to improve the workers’ compensation health care delivery system." Section 440.13(12)(e)4, Fla. Stat. The 2017 meeting has received some publicity because the agenda and Draft Report make mention of a pharmacy formulary. That is worthy of attention and discussion. However, there is much more in the draft report of the Panel.

The Panel notes that the workers' compensation system here is significant. It says "Florida has a $3.64 billion workers’ compensation marketplace." This industry and system, the Panel says, impacts "hundreds of thousands of employers, thousands of health care providers, and hundreds of insurance companies." It does not mention workers' specifically. but clearly the Florida workers' compensation system impacts literally millions of Florida employees (injured or not, the system is here for all employees). I have said it before, this system is literally "Huge" (See, Where did it Come From, Where is it Going, and How “Huge” is it Anyway?, Lex and Verum, June 2014, http://www.nawcj.org/docs/newsletters/newsletter_2014-06.pdf). 

The Panel has previously noted its support for Florida workers' compensation being exempt from certain requirements of Chapter 120, Fla. Stat. Since 2010, all State agencies have been required to assess the financial impact of rules and regulations. The concept is simple, government should be conscious of the implications of its actions. So, when regulations are proposed by agencies, they are required to assess the financial impact of those regulations. 

If certain criteria are met, then the proposed regulation has to be approved (ratified) by the legislature (the body that is elected by the people of Florida to pass laws). The main criteria at issue here is when regulations will result in a $1 million impact or cost within 5 years of enactment. The Panel notes that workers' compensation is large, affects so many, and virtually any change in fee schedules for medical services will exceed that total. Therefore, the Panel advocates the Division should be exempt from this requirement to enhance its nimbleness and effectiveness. Legislative bills in 2015 sought this change, but did not pass. 

Following attention to repackaging of pharmaceuticals, there were recommendations from the Three Member Panel in 2013. Legislative changes were made regarding reimbursement for pharmaceuticals. The 2017 Biennial Report Draft says that the reimbursement for medication in Florida has changed markedly in the period 2011-2015. Highlights include (all italics direct quote):

The total payments for physician-dispensed repackaged drugs decreased 73%
The total payments for pharmacy-dispensed repackaged drugs decreased 65% 
The total payments for all repackaged drugs decreased 73%

The total number of repackaged drug prescriptions dispensed by pharmacies decreased 28% . . . (and for physicians) a 78% decrease. 

The total for physician-dispensed non-repackaged drugs increased 626% 
Pharmacy-dispensed nonrepackaged drugs total payments increased.
The total payments for all non-repackaged drugs increased 33% 

The total payments for all drugs dispensed by physicians and pharmacies increased 2% 

The 2017 Draft report also discusses electronic medical billing. It documents that the Division of Workers' Compensation held a meeting in 2014 and solicited input from stakeholders regarding electronic billing. From this meeting, the Division concluded (all italics direct quotes):

E-billing continues to grow in Florida. 

There was general agreement that E-billing may lead to quicker payments to providers and reduce administrative costs compared to issuing and processing paper bills

Pursuing a mandate and implementing a “one-size fits all” approach may prove to be the least effective method to expand the use of Ebilling. 

The Division of Workers’ Compensation should continue to promote mutually-agreeable E-billing practices between the provider and the insurer.  

The Draft Report concludes that the Division should "continue its current practice of permitting health care providers to electronically submit medical bills to insurers," essentially continue to allow but not mandate electronic billing. This allows flexibility, but little consistency for the "hundreds of thousands of employers, thousands of health care providers, and hundreds of insurance companies." Essentially, Florida today may have hundreds of available e-billing platforms available to its "thousands of health care providers." Whether any make use of these hundreds of various programs is up to each provider. Would consistency or standards help the market move in the direction of e-billing?

There appears to be no appetite in Florida for mandatory e-billing. If either the medical providers or insurance carriers were clamoring for such a process, it seems likely that there would be more discussion and perhaps movement toward mandatory standards or participation. The Three Member Panel's recommendation for continuing the current course is predicated on the absence of such clamoring ("unless providers and insurers specifically request the Division to mandate a standardized E-billing requirement . . .").

The debate of electronic medical billing came up in a recent conversation at the National Disability and Workers' Compensation Conference in New Orleans. The mandate of several states was mentioned, generally as outlined in When Will Electronic Billing Come to Florida. That post noted that only four states mandate e-billing, New Jersey, Minnesota, North Carolina and Texas. Six other states "have adopted an electronic medical billing framework for their workers' compensation systems:" California, Georgia, Illinois, Louisiana, Oregon and Washington. While these are not mandating use, they are seeking some uniformity among likely "hundreds of insurance companies" in those states. 

The benefits of e-billing are obvious. The process will reduce cost, decrease duplication of effort regarding data entry, and lead to greater access to treatment and cost data. When these benefits were discussed in New Orleans, several experts corrected the "misconception" of "mandatory e-billing." They assured me that although some states "say" that e-billing is "mandatory," no state enforces the use of e-billing. One suggested to me that actual compliance with the requirement in some "mandatory" states may be as low "as the teens." One attendee confided in me that states lack the will to enforce regulations on physicians. 

That conversation reminded me of the first meeting of the National Summit in Dallas last summer. As we discussed health care in the broadest workers' compensation context there, the impact of the "affordable care act" was raised. Some expressed that it might impact workers' compensation positively, because now "everyone has health insurance." That drew laughter and derision. Other participants assured us that "millions" remain uninsured after full implementation of this federal law. Despite health insurance being "mandatory" for all Americans, it appears that coverage may remain optional for a great many. 

These two definitional misinterpretations of the word "mandatory" reminded me of Captain Jack Sparrow (Pirates of the Caribbean, The Curse of the Black Pearl, 2003). In it, various characters periodically attempt to rely upon the "Code of the Brethren," or the "Pirate's Code." Seen by some as a binding governing document, it is humorously discounted and derided throughout the movie. Captain Barbossa notes at one point "the code is more what you'd call 'guidelines' than actual rules." And, perhaps that is true of the "mandatory" that is applied to e-billing and health insurance? Perhaps the benefit of "mandatory" e-billing is limited to a good feeling about "progress" without any commensurate actual requirement of actually using the system?

Perhaps there are those out there who have different perspectives on how "mandatory e-billing" works? Are there other "mandatory" elements of workers' compensation that are in fact voluntary due to enforcement issues? Are jurisdictions better served by "mandatory" systems that are not, or voluntary systems? Are voluntary systems with standardization better than those without? Many questions remain about electronic billing.