Referencing a new draft bill in Wisconsin seeking to
establish a medical fee schedule for workers’ compensation, Mark M. Grapentine,
a senior vice president of government relations for the Wisconsin Medical
Society, is on the record as saying, “This
will cause a holy war at the capital.”
Might have phrased it differently, but I get his point. He might not even be far off the mark. There are some big stakeholders involved and
one of them (the physicians) wasn’t invited to the table.
A fee schedule seems like a straightforward way to combat
medical inflation and workers’ compensation reimbursement severity, but a
glance at price and utilization numbers out of Wisconsin wouldn’t suggest such
a legislative move is necessary. The
linked article points out, courtesy of the National Council on Compensation
Insurance, Wisconsin ranks in the top third of all states considered with one
of the lowest average costs per medical claim filed between 2010 and 2012. Similarly Wisconsin can boast the fewest work
days lost to disability by total disability claim of any state.
To some extent, we know
what to expect with the implementation of a fee schedule: a negligible
impact on utilization and an inelastic price response. The recent WCRI study on the impact of a fee
schedule adjustment in Illinois serves as an excellent case study. While there was a 30 percent reduction in the
Illinois medical fee schedule enacted in 2011, medical prices on average fell
24 percent. This was accompanied,
however, by more frequent billing of costlier and more complex offices visits.
My guess? This is a
result of income targeting.
An implementation of a fee schedule in Wisconsin might
similarly leave providers to pursue income targeting – increasing the amount of
services provided to maintain the previous income level. Or it might cause providers to exit the business. As always time will tell and hopefully
someone’s keeping track.
The economic recovery, while slow, is still ongoing. As employment numbers rise, so do workers’
compensation claims and expenditures. A
fee schedule is a means of controlling costs, but it may do so at the cost of
quality services and overburdened physicians. And lest we forget, the full impact of the
Affordable Care Act has yet to play itself out as well.
I’d be surprised if Wisconsin legislators were eager to move
on a new fee schedule.
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