July 10, 2015

BWC launches new pilot program to improve outcomes

The Ohio Bureau of Workers’ Compensation (BWC) has launched a new pilot program that is designed to address complicating factors that drive claim costs and lost time. The Enhanced Care Pilot (ECP) began on July 1, and it involves working with physicians to accelerate treatment for knee injuries and to capture information on a wider range of health issues that often contribute to extended periods of lost work days for injured employees.

The ECP was developed after a lengthy study of the most complex and costly workers’ compensation claims. Common themes that emerged were the non-injury related health conditions (or comorbidities such as diabetes and cardiovascular problems) and delays in administering necessary medical treatment for the work-related injury. For additional research information, see our previous Client Bulletin.

Physicians participating in the ECP must agree to the requirements, which include developing a care plan that coordinates treatment of the work-related injury and communicating with the employee’s primary care physician for any non-related health issues that may impact recovery. A Provider of Record (POR) who participates in the ECP (ECP-POR) is incentivized by a 15% increase in the reimbursement total for office visits.

Another key aspect of the pilot addresses the timeliness of medical treatment. If treatment is requested for specific conditions that are not yet allowed in a knee injury claim, the physician may proceed with treatment. The applicable medical treatment must still be requested and added to the claim through the normal process. If the additional conditions are eventually disallowed, the cost of the related medical treatment will be absorbed by BWC’s surplus fund and will not be charged to the employer’s risk. The goal is to allow necessary treatment to move forward effectively after an injury rather than await final approval by BWC, which may take several weeks.

A few parameters to be aware of:

• The risk charges to the employer associated with claims in the ECP will be discounted by 50%
• The pilot is limited to workplace knee injuries and the employee must reside in one of these 16 counties in northeast Ohio: Ashtabula, Carroll, Columbiana, Cuyahoga, Geauga, Holmes, Lake, Lorain, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas and Wayne
• A claim must be initially allowed by BWC to be included in the ECP
• The physician must be enrolled as an ECP-POR (physicians may enroll after the July 1 start date and after initiating treatment for a new claim); physician recruiting for the ECP is ongoing
• Treatment for conditions that are eventually disallowed by BWC will not be charged to the employer’s risk
• Treatment for non-related comorbidities will not be paid for through the workers’ compensation claim
• Claims can still be contested by employers for allowances, additional conditions and medical treatment; contesting a claim will result in the claim being removed from the ECP

In many respects, the ECP’s objective to accelerate treatment is nothing new to CompManagement Health Systems (CHS). We seek to approve reasonably appropriate medical treatment for work-related injuries as quickly as possible. Delays typically occur when physicians wait until all medical conditions are fully allowed by BWC and payment is guaranteed before providing treatment. Also, all parties involved in claims management will need to pay close attention to the manner in which comorbidities are addressed by the ECP-POR. It will be important to ensure that a balance is maintained between coordinating care on all issues impacting the employee’s recovery and monitoring claim costs associated with the work-related injury.

Employers in northeast Ohio should be aware of the ECP as they will be directly impacted if an employee sustains a knee injury. But employers state-wide should keep an eye on this pilot program as it signifies a change in BWC’s injury care model that may extend to other parts of the state in the near future.

For questions, please contact CHS at ClientServices@chsmco.com or call 888-247-7799 x 65606.

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