Do you remember the scene in the movie Bull Durham® where Kevin Costner, as the catcher, tries to call a pitch and the pitcher keeps calling him off? Costner then calls time to talk to the pitcher and after returning from the mound he whispers to the batter to get ready for a fastball over the plate. The slugger, having been duly advised, smokes the ball over the fence. All the batter needed was a little bit of a warning on what was coming and when prepared, he clearly took advantage.
With that in mind, the current situation on Illinois workers’ compensation reform has us scratching our heads. While the Governor hasn’t signed it yet, our legislature has provided one of the biggest cost-savings in the century-old workers’ compensation system. Assuming the Governor signs it soon, and every indication is he will—is Illinois business ready to take advantage of your newly found advantage? Are you folks listening to what just happened and ready for it?
The biggest cost saver is the shift in medical coverage in the Illinois WC system. From an historical perspective, the supposed “limits” on choice of doctor by an employee in this state have actually been “unlimited.” By that we mean, for several decades, an Illinois employer was responsible to pay for the first choice of physician by an injured worker. Thereafter, the employer was also responsible to pay for any healthcare provider to which the initial choice of doctor referred the patient in a “chain of referrals”, allowing all healthcare providers to refer injured workers to new doctors, clinics and hospitals.
Does that sound pretty generous? Well, there is more. On top of the initial doctor and the chain of referral from that doctor, an injured worker could change their mind and then start all over again with another doctor and a new chain of referral flowing from that doctor!!! In our view, it was legalized doctor-shopping and lots of abuses flowed from the effectively unlimited Illinois double-chain-of-referral system.
Has this changed? Well, only if you are ready to step up to the plate and take advantage of the new 2011 Amendments to the Illinois Workers’ Compensation Act. If you don’t take affirmative action right now to change what you are offering your workers, you are going to remain in the “two-choice” medical choice program outlined above.
Moving your IL WC program so your employees will have one choice of doctor/chain of referral
Our vote is to cut one of the “chains” for your workers right now. If you want to cut out one choice of doctor, you have to offer a PPO for your workers. If you do this, you immediately supplant one of their choices with a WC medical care system of your own selection. Please don’t be confused, even with a PPO, injured Illinois workers still have one post-emergency choice and the chain of referral stemming from their initial choice.
However, if you provide a PPO for workers’ comp injuries after the Governor signs this new bill, you limit workers to only a single choice—the only other choice is your PPO. In our view, if you work hard right now to put a WC PPO in place, you not only limit your workers’ post-injury medical choices, with a little tweaking, you may also provide a much better WC medical system for your Illinois operations.
In our view, it is easy but you need to get on it right now. This bill could be signed any day and it will go into effect of its own accord if the Governor takes no action by August 1, 2011. Please note there is no way to find out when Governor Quinn will sign the new bill—he is busy with other major government issues at present.
Either way, dig in and expect that very-hittable belt-high fastball. Illinois risk managers should get on the phone to their brokers right now and let them know you need to offer all of your workers what is called a Preferred Provider Network in the new Amendments. If you don’t have a broker who understands what you are asking, have them contact us. We have been advised these programs are also called Preferred Provider Program, Preferred Provider Association and Preferred Provider Option. We are not aware of any difference regardless of the name chosen. All of them involve a ready-made system for healthcare that should be identified, explained and presented to every Illinois employee at the time of their hire.
Then, if an unfortunate event occurs and they become injured at work, you are ready. We recommend you already have your selected emergency care treatment facility identified. For non-emergent OccHealth care, have your OccHealth facility selected and ready to rock. As it is now completely legal to direct workers to such institutions to initiate early care, make the absolute most of it. This is something you need to emphasize at job orientations, at any manager’s meeting and consider putting up signs identifying these facilities as your place of choice. If you have a workers’ comp website for your workers—add the PPO to it. If you want a sample or suggested WC website for your workers and managers, send a reply.
If/when your troops go into the PPO for work-related care, you may expect solid medical care with lots of options; the PPO should work for you. Most PPO’s also provide tremendous cost-savings for employers with reimbursements lower than our newly reduced WC Medical Fee Schedule. A truly solid WC PPO should also have primary care physicians who have a focus on targeting MMI and return to work at light and full duty. There is nothing wrong with telling your OccHealth providers of your light work program and ask them to keep it on file at their facilities.
We consider this an amazing new change to our WC system and we are certain it will provide savings in both medical and indemnity reserves at every level and with all Illinois employers smart enough to move to it. Please don’t be the last one on your block to sign up—all of your competitors are going to be doing so.
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