7-27-15; Thoughts From Dr. Fletcher on Illinois' Unbalanced WC Medical Fee Schedule; Former Arbs Dibble and Akemann Lose Federal Appeals; Shawn Biery's Updated IL WC Rate Sheet Now Available and more
/Synopsis: Thoughts From Dr. David Fletcher on Important WCRI Research Report on IL WC Medical Costs..
Editor’s comment: The Workers Compensation Research Institute or WCRI is an independent, not-for-profit research organization providing high-quality, objective information about public policy issues involving workers' compensation systems. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures.
You can analyze and review the recent IL-focused WCRI statistical study by using this link: Illinois Chamber Presentation 2015
This is a current and up-to-date WCRI analysis of IL WC Medical Costs prepared for the IL WC State Chamber Working Group. This group is composed of a number of influential Illinois leaders from business, industry and our IWCC Administration. Dr. Fletcher is the CEO of SafeWorks Illinois and a leading source of workers’ comp information and guidance to other medical and industry leaders. As we have advised our readers over the years, the IL State Chamber is on the point as the lead organization looking out for the interests of Illinois business in the WC arena. We urge all our business readers to consider joining the IL State Chamber to learn more about the strengths and weaknesses of the IL work comp system and possible legislative and other changes.
Dr. Fletcher advised:
Illinois has a very unbalanced fee schedule that incentivizes surgical procedures over conservative management for injured workers.
Until July 2014, the reimbursement for evaluation and management (E&M) codes was below Medicare and this low reimbursement caused access to care issues as documented by WCRI research and Dr. Fletcher’s experience trying to refer injured workers to non-surgical specialists for care.
Currently, the Illinois Workers’ Comp Medical Fee Schedule posted rates for typical office visits as documented by WCRI in their findings are 20% below the national median average and ranks Illinois as the 6th lowest fee schedule state in the entire country. In contrast, surgery reimbursement remains high and averages around 400% above Medicare (see slide 9 of the link above). WCRI documents Illinois WC surgical fees rank 3rd highest in the nation.
Injured worker primary gatekeepers, such as occupational medicine specialists, that control return to work decisions and referrals to other specialists for care, have the most effect on controlling costs in work injury care. Due to the current IL WC Medical Fee Schedule the private practice of occupational medicine in Illinois is dying because $80 reimbursement for an office visit that may require 30 minutes of direct patient interaction, but requires an hour of additional unreimbursed professional time (most WC carriers refuse to pay for CPT code 99358 for prolonged non-face time even though Medicare recognizes this case management service as vital in controlling costs) to update the employer, interact with an external case manager, review diagnostic studies, consult with the physical therapist, issue a return-to-work slip, and prepare a detailed narrative report that a practitioner may have to defend line-by-line in a future deposition.
Thirty-one (31) states of the 43 states that have a WC medical fee schedule construct a fee schedule that is based on relative value (Medicare RVU-relative value units is the most common system) in contrast to Illinois’ unbalanced WC medical fee schedule.
Neighboring states, Iowa, Indiana, Wisconsin, often cited as models for the Illinois WC system, pay substantially higher E&M codes than Illinois and have much lower costs.
Bottom-line, Illinois needs a balanced RVS-based fee schedule that would encourage and reward effective office management of complex work injuries as opposed to rushing off to surgery when such indications are not clear-cut. Higher reimbursement for office visits would bring back many Illinois primary care practitioners, who will no longer see injured workers, because the reimbursement is not worth the time and effort required to manage such patients.
Dr. Fletcher is personally advocating for an IL WC fee schedule that is 200% above Medicare across the board that recognizes taking care of injured worker takes more physician or healthcare resources and time than a typical Medicare patient, where decision-making on return to work and communication with multiple parties are not necessary.
For the last five years, Dr. Fletcher has been one of the two WCRI advisory committee physician members. We salute him for letting you, as our readers, know what is happening right now for this crucial IL WC working group.
From your editor—we want our readers to understand the number one cost in workers’ comp across the United States and the world is medical care. The recent statistical study documents current measurements on the cost of some aspects of IL WC care aren’t nearly as bad as the popular business or government perception.
We also note the IL WC Commission has a Workers' Compensation Medical Fee Advisory Board which includes among its members leading WC medical and legal gurus like Dr. Michael I. Vender, Dr. Avi Bernstein and David Menchetti, J.D. along with others from both sides of the WC matrix. We hope the Medical Fee Advisory Board members are closely watching what is happening in Springfield and working hard to save money for Illinois businesses and local governments while also insuring injured workers get solid medical care.
We appreciate your thoughts and comments. Please post them on our award-winning blog.
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Synopsis: Former Arbitrators John Dibble and Peter Akemann Lose Their Federal Appeals Over Getting Canned. Sadly, You Are Still Paying Them.
Editor’s comment: Former Arbitrators John Dibble and Peter Akemann were hearing officers for the Illinois Workers’ Compensation Commission. At the time of their appointments, the IL Workers’ Compensation Act, 820 ILCS 305/14, provided each arbitrator would be appointed for a term of six years, with the possibility of reappointment.
The Illinois General Assembly passed Public Act 97–18, which was signed on June 28, 2011 and took effect three days later, ending the terms of all incumbent IL WC arbitrators effective July 1, 2011 and providing Governor Quinn could make new appointments, basically at his whim. The new law allowed incumbent arbitrators to serve as holdovers until the Governor made new appointments.
In the interim, Governor Quinn was booed off the stage at the Illinois State Fair by a group of union members who were unhappy about proposed legislation that would have limited their fake pensions and lifetime-taxpayer-paid health care benefits. Shortly thereafter former Arbitrators Jackie Kinnaman, Peter Akemann and John Dibble were summarily terminated. As these hearing officers came from opposite sides of the political fence, it is hard to understand why they were summarily canned. We assure our readers former Arbitrator Kinnaman was always considered liberal and pro-union—she was also married to an important union official. Former Arbitrator Akemann was the son of a west suburban judge and considered to be a middle-ground hearing officer for representatives of business and labor. Former Arbitrator John Dibble surfed on the challenging waves in southern Illinois where some Petitioner attorneys used to have plenary power to get someone appointed or fired as an Arbitrator.
Former Arbitrator John Dibble was a middle-of-the-road hearing officer who generally got along with the rabidly pro-labor lawyers in southern Illinois. John Dibble had the stigma of receiving a favorable bilateral carpal tunnel WC settlement for $48,790.45 at a time when hundreds of prison guards and Central Management Services WC adjusters were also getting favorable WC settlements in a setting that made the settlements appear questionable. In 2010, Dibble, who was not an attorney, received a tax-free payment on his claim he incurred "delayed onset" carpal tunnel syndrome as the result of falling on steps at a workers' comp hearing site in Herrin, IL. The award was withheld from the public record until the Belleville News-Democrat reported it. One embarrassing aspect of the settlement is the claim was brought against the State, defended by the Attorney General’s office and then-Arbitrator, now current IWCC Commissioner Ruth White had to approve the deal.
We note former Arbitrator Peter Akemann had a work comp claim for an injury occurring in 2010 and, in 2014, got an award of 10% LOU BAW or $33,236.00 as the result of an arbitration decision by an independent IL WC Arbitrator named Alan Rosen.
Either way, by July 1, 2012, both John Dibble and Peter Akemann lost their IWCC positions. They alleged by shortening their six‐year terms as arbitrators under the prior law, Public Act 97–18 deprived them of a property interest without due process of law. The Seventh Circuit affirmed judgments for Defendants. Plaintiffs’ claims for injunctive relief were moot, and Defendants were entitled to qualified immunity on Plaintiffs’ claims for damages. Even if Plaintiffs plausibly alleged a constitutional violation, the applicable law was not clearly established under the circumstances of these cases, where a statutory amendment eliminated the property interest the statute previously conferred.
From our perspective, They were both solid hearing officers who did nothing wrong. They showed up and worked hard. These former Arbitrators who received either a settlement or decision got caught up in the moment in a fashion we consider wholly unfair—it shouldn’t be a stigma to suffer from a work injury in a system that provides benefits for injuries.
Don’t Cry Too Hard for Them
We want our readers to note, you never truly “fire” any IL state employee who is vested in their fake or comically defunded IL government pensions. By law, we as taxpayers have to keep paying them and they no longer have to work. To our knowledge, former Arbitrator Dibble should be getting a full fake pension and IL taxpayers continue to compensate him, despite his termination. He will also get compounded 3% annual increases so he is probably making more from taxpayers than he made while actually working. His fake government pension may double or triple, if he lives long enough. He also gets taxpayer-paid lifetime health care—not a bad deal either.
Our research indicates former Arbitrator Peter Akemann worked for the State starting in 1983 with IDOT and then as an Arbitrator—we are confident he remains on our dime and is getting lots of your tax dollars. He is a good man and among many other things, Peter is on the board of a kid’s theatre group http://www.cteelgin.com/about-us/board/
It is weird how things work out. We appreciate your thoughts and comments. Please post them on our award-winning blog.
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Synopsis: If You Handle IL WC Claims, the WC Rates are Updated again So Get the Updated Version of Shawn R. Biery’s IL WC Rate Sheet.
Editor’s comment: The new IL WC minimums and maximums have been posted and our updated KCB&A IL WC Rate Sheet is now available via email or snail mail if you prefer the fancy laminated version. We note IL WC rates continue to increase based upon the reported increase in the statewide average weekly wage or SAWW and the increase was more significant than the WC rate increase last July.
The reality on the streets still doesn’t seem to match the hefty increase however as noted in the past, since the 1980’s, the IL WC Act provides a formula which effectively insures no matter how poor the IL economy is doing, your WC minimum rates somehow keep climbing.
We caution our readers to pay attention to the fact the IL WC statutory maximum PPD rate is now updated too—the new MAX is $749.06!! The new PPD max rate becomes retroactively effective on July 1, 2015. You have to retroactively change reserves on all claims. If this isn’t clear, send a reply or email IL WC rate wiz, Shawn R. Biery at sbiery@keefe-law.com.
The current TTD weekly maximum is $1,379.73. A worker has to make over $2,069.60 per week or $107,619.20 per year to hit the new IL WC maximum TTD rate.
The new IL WC minimum death benefit is 25 years of compensation or $517.40 per week x 52 weeks in a year x 25 years or $672,620.00! The new maximum IL WC death benefit is $1,379.73 times 52 weeks times 25 years or a lofty $1,793,649.00 plus burial expense benefits of $8,000. These numbers make it very important to keep your workplace safe and free from hazards.
The best way to make sense of all of this is to get Shawn Biery’s awesome and easy-to-understand IL WC Rate Sheet. If you want one, they are free so simply reply or email Shawn at sbiery@keefe-law.com and we will send it along.
If you would like fancy/shiny laminated copies, copy Marissa at mpatel@keefe-law.com and let her know the number of copies and your MAILING ADDRESS!