Last week in Champaign, IL, several hundred industry movers and shakers jammed the I-Hotel on the campus of the University of Illinois for the 19th annual work injury conference produced by Dr. David Fletcher of SafeWorks Illinois. This year’s theme REFORM 2011:Challenges*Debates*Solutions centered on the changes to the Illinois workers’ compensation system following the May 2011 reform.

Jay Tebbe, President & Publisher of the Belleville News-Democrat riveted the audience with his review of the BN-D’s investigation of the Menard prison scandal, which gained the attention of the State House and paved the way for WC reform. Tebbe stated the BN-D has a pending law suit against CMS to turn over nerve conduction velocity test results of a sample of 50 prison guard cases awarded carpal tunnel syndrome claims that resulted from infrequent turning of locks of old manual prison doors, even though Attorney General Lisa Madigan’s office has recommended turning over the results to the BN-D while CMS is being defended by private outside counsel.

The morning sessions focused on challenges and debates following the passage of HB1698. Petitioners’ attorney Kim Presbrey gave an insider look at how the new law came about following the State of Oregon WC study that alleged Illinois was number 3 in the country for WC costs. Presbrey said “Illinois is a market-driven insurance market and the failure for new reform to set up a mandated state-run insurance option to compete against the private sector to offer employers a lower cost alternative was wrong, especially in light of NCCI asking for a 3.5% increase in workers compensation rates for Illinois next year.” Presbrey noted the recent 3.1% increase came after the NCCI sought an 8.8% decrease in advisory rates in Illinois after state lawmakers adopted workers comp reform legislation last May based largely on a 30% reduction of Illinois' medical fee schedule under the new law.

A panel of industry leaders from all stakeholder point of views including medical providers, petitioners’ attorneys, respondents’ attorneys, employer/business representatives, insurance managers and labor delegates gave perspectives on what HB1698 will bring. The consensus of the panel is doctors, hospitals and other medical care-givers got the worst of the reforms. While it is well known that the IL WC medical fee schedule got reduced 30% the actual effect of the fee schedule reduction was even more drastic with the collapse of 29 geo-zips into 4 regions for the new fee schedule—up to 45% reduction in some areas, such as Champaign.

Illinois State Medical Society (ISMS) policy analyst Patrick Gallagher provided an analysis of the fee schedule cut:

Code

Desc

2011 WC Champaign

After 30% cut WC Champaign

Medicare

% Below Medicare

99203

off visit new pt

$157.26

$110.08

$110.68

-0.54%

99204

off visit new pt

$225.41

$157.79

$170.93

-7.69%

99212

off visit

$72.33

$50.63

$44.16

14.65%

99213

off visit

$97.50

$68.25

$73.90

-7.65%

99214

off visit

$146.79

$102.75

$109.66

-6.30%

Studies show once physician reimbursement is less than 160% of Medicare that access to medical care is a real issue.

The mismanagement of workers’ compensation for employees of the State of Illinois was a major recurring topic. “Just change the locks…” was the mantra of several audience members when the discussion of the Menard prison scandal was brought up repeatedly as symbolic of the public sectors’ failure to be pro-active.

Unfortunately, about 10 days before the conference, Governor Quinn’s office pulled a speaker from IDOT who was supposed to discuss highlighting model programs IDOT had implemented to promote worker safety and save money for the Illinois taxpayers. In response to this censorship by Governor Quinn’s office, Illinois Chamber President Doug Whitley said: ”It is of course disappointing, but not surprising that the Governor’s office did that. The State is missing the boat and failing the taxpayers by not devoting the resources and efforts that a private employer would pursue. The pursuit of seeing the State’s WC program privatized will be a part of the Illinois Chamber’s next campaign to build support for another round of WC changes in 2013.”

The afternoon’s session featured solutions being touted to further help with WC cost control. Dr. Charles Bush-Joseph managing partner for Midwest Orthopaedics at Rush (MOR) spoke about the formation of Preferred Provider Program (PPP) networks Illinois employers can offer injured workers as their first option of care before choosing to opt out of the PPP system and then utilize their final choice of treating provider. Dr. Bush-Joseph touted a smaller elite PPP network that would be based employee assurance of quality. He believed it was important to have independent or community-branded providers in the network and providers needed the skill-set in dealing with injured workers by understanding the nature of the work environment. He also felt effective providers must engage in efficient communication with all stakeholders.

We did receive a draft copy of the PPP “opt-out” form and we would be happy to email it to anyone who wants it. We were told it may make the IWCC website today or later this week. If you want a copy, send a reply.

Dr. Fletcher gave an overview of the AMA Guides and the physicians new Permanent Partial Impairment (PPI) ratings that arbitrators now have to consider when arriving at PPD awards, along with other enumerated factors.

Dr. Fletcher wrote this article and it was briefly edited for space and content. A DVD of the conference is being produced and our readers may contact Dr. Fletcher for more details at their website: www.safeworksillinois.com or via email to dfletcher@safeworksillinois.com.

KCBA Blog

10-25-11; Safeworks Illinois’ 19th annual Work Injury Conference tackles ChallengesDebatesSolutions of REFORM 2011.