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In Search of Better Outcomes for Florida's Injured Workers

By Fraser Cobbe

Orange and Seminole County Medical Societies

There is a looming showdown in Tallahassee over Workers Compensation insurance after the Office of Insurance Regulation announced a 14.5% increase in premiums last week. The increase is the result of recent rulings from the Florida Supreme Court that reverse some of the reforms enacted in 2003.

As the major stakeholders prepare to put forward their recommendations for fixing the system our organization hopes that policy makers take a patient-centered approach to addressing the situation.

The Supreme Court overturned several areas in which they believe the 2003 reforms went too far as to jeopardize the "Grand Bargain" offered to our workers.

In the reforms, the Legislature approved capping attorney fees in an attempt to remove perceived incentives to drag out litigation which increases costs to the system. The Court has overturned these caps expressing concern that workers may not be able to find representation due to the limitations.

Interestingly, according to the National Council on Compensation Insurance (NCCI), attorney involvement in workers compensation before and after the 2003 reforms has held consistent at 25%. Meaning before and after reform, one quarter of all injured workers still had to seek representation to secure the care and benefits they feel they deserved.

The Workers Compensation Research Institute (WCRI) recently released their research entitled Comparing Outcomes for Injured Workers in Florida. In their study Florida finished last of all 15 states studied in access to health care and patient satisfaction. The study reveals significant issues that injured workers have in accessing timely and quality medical care in Florida. According to their study:

  • 20% of injured workers in Florida were "very dissatisfied" with the overall health care they received.
  • 21% reported "big problems" getting services they or their primary provider wanted.

If the Legislature and business interests still believe that reduced attorney involvement will lower costs, we believe we can reduce the need for injured workers to seek representation in the first place by providing timely access to medical services.

There can be no denying the fact that Florida has historically devalued physician professional services compared to other states.

According to WCRI, Florida's physician fee schedule was the worst in the nation prior to the 2003 reforms. The 2003 reforms did increase physician reimbursement slightly, but still far below most other states.

In their 2013 study, Medical Price Index for Workers Compensation, Sixth Edition, WCRI noted that reimbursement for physician services had again fallen to the lowest in the nation. Based on an average index of 100 for all states across the country, the price paid for Professional Services by Workers Compensation in Florida was 69.

In 2016 the Florida Legislature did approve a new physician fee schedule. However it did not change the statutory reimbursement formula and maintains a bottom 5 ranking for physician reimbursement in the US.

So does the suppression of professional services in Florida lead to overall lower premiums? The answer to that question is apparently no.

The State of Oregon publishes data on average workers compensation premiums paid by businesses across the country. The 2014 Oregon Workers Compensation Premium Rate Ranking shows that Florida ranks 28th in the nation in premiums paid. Last week's announcement of a 14.5% increase will push Florida further up the ranks in premium paid.

As the Legislature prepares for this looming debate we believe the more appropriate pathway to promote a self-executing system and lower costs is to provide timely access to quality medical care by providing incentives for physicians to prioritize care for injured workers.

Let's follow the formula that works for most other states. Rapid access to quality medical care expedites return to work, reduces litigation, improves outcomes, and lowers costs.

Florida invests a significant amount of resources training and recruiting the very best work force possible. It makes no sense to deny them access to the very best medical care. It is time for Florida to focus on quality outcomes for our injured workers.

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