Wednesday, September 26, 2012

Louisiana: Will the Fix... Work?

I presented at the Louisiana Claims Association earlier this year to a room full of work comp adjusters, nurses, and executives.  We talked about the problem of opioid dependence and addiction and WCRI's analysis of Louisiana (not particularly good news for those assembled in that room). 
We talked about the new Medical Treatment Guidelines as well.  After sharing some uncomfortable laughs about the nature of Louisiana politics and how the development and adoption of the guidelines wasn't the most transparent of processes (I wrote about that here), we got into the specific area of the guidelines focused on prescription medications. 

In reality, the portion of the treatment guidelines dealing with drugs isn't bad.  Without going into the details, there's enough in the guidelines to, in theory, give Louisiana payers a way out of paying for medically unnecessary medication therapy. 

In theory.

I asked for a show of hands: How many payer organizations represented in the room were actively using utilization review, based on the treatment guidelines, to challenge inappropriate care?  A single hand went up.  And even that hand went up tentatively. 

What's the problem?  We all know.  Louisiana is like most state work comp systems.  Change isn't really change until the lawyers fight it out and the court says it's so.  And too often, the battle has been waged and lost by the payer community.  Thus, most payers take a "wait and see" approach to any level of reform that doesn't compel their action, but might cost them time and money. 

This week brings news that Louisiana is trying to clarify the appeals process for disputed medical treatment.  The goal is to edit form 1009 to make clear that the path to dispute resolution doesn't run immediately to the courts, but rather through the Office of Workers' Compensation Medical Director. 
A public hearing on the rule change is scheduled for tomorrow in Baton Rouge.

Louisiana readers: Will this make a difference?  Or is Louisiana creating a distinction in process without a difference in outcome?

On Twitter @PRIUM1

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