Yesterday, the Louisiana Association of Self-Insured Employers (LASIE) hosted its annual Open Forum and Legislative Recap in Baton Rouge. The event included a variety of speakers addressing everything from the recent 19th JDC decision declaring parts of the MTG process unconstitutional to the organization’s first self-insured health presentation since LASIE decided to open the Association to all lines of self-insurance. However, the highlights were two issues at the forefront of comp community concerns: the upcoming gubernatorial election and the update to the medical fee schedule from the Office of Workers’ Compensation (OWC). Scott Angelle opened the forum with a rousing speech in support of self-insurance and the workers’ comp industry.
Angelle, who currently serves as Public Service Commissioner, spoke extensively about business competition, the health of Louisiana’s economy and the budget crisis, introducing the audience to his small town, middle class background and the importance of job training for Louisiana’s youth. Angelle also touted his background as Security of Natural Resources for two consecutive governors, a first in the history of the state.
“When you take a look at where we’ve come from, from the days of the assigned risk pool, where we are today is a dramatic improvement, but there’s still work to do,” Angelle said. “A lot of people don’t know how many employees are covered under a self-funded workers’ comp program.”
Like all of the other candidates currently in the race for Governor, Angelle stated that his first order of business upon taking office would be to call for a Special Session to address the structural problems in the state budget. “I certainly bring a bipartisan, collaboration style to government,” he said. “We have clearly got to find a way to have a budget system that resembles our economy. Our gross domestic product is the highest it ever was [last year] and there’s a disconnect and a broken model between how our economy is doing and how our government is organized.”
Following Angelle later in the morning, Patrick Robinson, Director of the OWCA, discussed the proposed changes to the medical fee schedule, which is in the midst of a much-called for update from its current 1990s-level reimbursements.
In particular, Robinson focused on eliminating the “by report” codes for some services in the schedule and the percentage of billed charges for outpatient services. “Why this [‘by report’ specification for some codes] was done still baffles me, although I am quickly learning the intricacies of politics. It is a bad system,” Robinson said.
“We’ve got to create a fair fee, that everyone will know about, so that providers know what they’re going to be paid for a service and payers know how they can reserve their cases. It’s the same thing for percentage of billed charges for outpatient services. Both of those have gone up because these other fees [on inpatient per diem] have stayed fixed for so long.”
Robinson went on to state emphatically that the OWCA is striving for fairness in reimbursements to avoid driving providers out of the system, which would limit access to care for injured workers. “We don’t want to be number one in the country in terms of lowest costs. That is not a good place to be,” he said. “That is a place where doctors don’t want to treat workers’ comp patients. Patients can’t get treatment, and then what happens? Injured workers can’t get back to work.”
Robinson confirmed that a draft of the proposed medical fee schedule has been distributed around the agency and also to a select few outside of the agency, with predictable criticism from all sides. “This is only a draft,” he said. “We needed something to work from so that people can make specific edits as it goes through the process. We will not publish this until we have a modicum of agreement that this is a reasonable proposal to support all of the stakeholders within the system.” Robinson also offered examples of specific numbers, including the current proposal’s “178 percent of Medicare” reimbursement for E/M visits and physical therapy visits.
At this time, the OWC will not be posting the proposed medical fee schedule changes to the website, however, he urged stakeholders to remain patient as the changes move through the process. Robinson, and the Administration’s medical coding consultant from Bossier City Community College Sherie Phillips, said that they expect the final version to be prepared by the end of the year, with enactment later in 2016.