Medical Treatment Lien (California)

The filing and enforcement of liens (different states refer to these with different terms) to secure payment for services or goods against a workers' compensation award is complex and filled with special rules - this category is for questions and discussion of this special area of work comp law.

Re: Medical Treatment Lien (California)

Postby rider001 on Mon Apr 13, 2009 9:07 am

I am posting an article which gives the history of woprkers comp. Now i read this as workers comp being borrowed by Germany from Marxist and socialists. I also learned this in history class. Either way read for yourself:
http://www.mjsorority.com/MJI/MJSororit ... 20Comp.pdf
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Re: Medical Treatment Lien (California)

Postby kpusavat@bagbylaw.net on Tue Apr 14, 2009 6:15 pm

<<Last month, a state board that tracks workers' comp costs recommended a rate increase of more than 24%. The reason: higher medical expenses and the threat of increased payments to permanently disabled workers.>>

No mention of UR as the reason for the increase.

<<But in the last couple of years, the system's costs have started rising again, especially the medical costs. In fact, the board projected that medical costs for injuries last year will be higher than they were before the reforms were enacted.>>

All this tells me is that treaters have learned how to work the system over the past 5 years.

<<Among the factors driving up those costs, according to the board, are sharp increases in expenses related to "medical cost containment" and "medical legal costs.">>

Ahh, there's the weasel words: "among the factors." Not "the primary factor," or even "one major factor." And no actual numbers to give any perpective. Are UR costs higher now than 5 years ago, before there was UR? Obviously. But in the big picture, they're still a tiny fraction of the overall medical costs.

<<In other words, the mechanisms that insurers use to keep a lid on healthcare expenses are becoming increasingly expensive.>>

But how much more expensive? 24% of all claims costs? I'm calling BS on that.

<<And no wonder -- in the overhauled workers' comp system, more people are likely to review an injured worker's paperwork than his X-rays.>>

It's always been that way, even before the "overhaul."

<<Insurers can require doctors to submit treatment plans to one set of reviewers to make sure it complies with national standards for care, then have a second set scrutinize the bills once the treatment is performed -- even when the doctors were handpicked by the insurance company.>>

You mean that different people make determinations on medical necessity and the reasonableness of charges? If only we had a doctors who were also experts in medical billing. File this statement under "no sh*t Sherlock."

<<Critics say the review process not only can delay treatments but can pad costs.>>

More weasel words. Which critics? You mean the author of the article and his socialist buddies who would rather have a government-run doc-in-the-box program than private insurance?

<<For instance, an insurer might charge the system more for reviewing a treatment plan than it pays a contractor to do the work.>>

Yet more weasel words. "Might?" Call me when you have a real example.

<<The increased "cost containment" expenses account for only part of the swift rise in medical charges.>>

At last, a hint of perspective. What's missing is HOW BIG a part. 1 percent? 10 percent? 24 percent? Because CWIC puts containment costs at less than 10% of overall medical costs.

<<Analysts say treatment bills per injured worker are rising unusually fast, as are pharmaceutical costs.>>

Again, no analysis on HOW FAST or HOW MUCH.

<<Clearly, the system is still adjusting to the changes made in 2004. Nevertheless, policymakers should scrutinize why healthcare costs in the workers' comp system are outpacing the rate of healthcare inflation, and why the mechanisms that were intended to hold down costs are contributing to their rapid growth.>>

It wouldn't take much scrutiny, just a few hard facts and numbers - which are missing entirely from this article.

<<The "state board that tracks workers' comp costs" is likely the WCIRB, and it is the source of the data on the expense of cost containment. Argue with them about their data being inaccurate.>>

What data?
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Re: Medical Treatment Lien (California)

Postby jonbrissman on Wed Apr 15, 2009 3:30 pm

Keith, some of your criticisms of the editorial may be valid. But it seems to me that you are doing exactly what you accuse the LA Times editorial writer of doing -- making conclusions without citing supporting data.

Recognize that an editorial for LA Times readers is written differently than if it was intended for WC practitioners. The former audience would find any figures to be stultifyingly boring, while the latter group would insist on a proof source for each conclusion. Your critiques are on point for a law review article or trial brief, but maybe a bit harsh for an article aimed at general readership. We do not know if the writer viewed the data and gave us his impressions; we do know that you did not have the data when you voiced your criticisms.

If you are interested in an accurate analysis, why not go to the WCIRB and see if the raw data is available for inspection? Then tell us whether UR costs have added "1 percent? 10 percent? 24 percent?" I would be interested in whether the editorial's conclusions were largely correct or were blown out of proportion. (It would surprise no one if the LA Times was promoting an agenda.)

If you are willing to spend some time to delve into the issue, Keith, I respect your intellectual integrity enough to accept your analysis.

JCB

P.S. -- Post your photo, please. It would be nice to see everyone do it.
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Re: Medical Treatment Lien (California) (California)

Postby kpusavat@bagbylaw.net on Wed Apr 15, 2009 4:25 pm

Jon, I believe the relvant data can be found here:
https://wcirbonline.org/wcirb/resources/data_reports/pdf/2008_cost_monitoring_report.pdf

If you'll look at the executive summary and the conclusions buried way, way down at the bottom of the document, you'll see that although values for medical containment costs have sharply risen in terms of percentages of the overall claim, the actual dollar values we're talking about are in the range of hundreds of dollars, perhaps a few thousand over the life of the claim. In the meantime, payments to providers still account for 90% of the medical costs, and the report clearly states that overall medical costs have dropped significantly during the same period.

The LA Times article is a gross misrepresenatation of the data in the WCIRB report.

P.S. Why would you want to see my picture? Don't you see enough of me at the WCAB? Maybe you just need something to put on your dartboard?
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Re: Medical Treatment Lien (California)

Postby jonbrissman on Wed Apr 15, 2009 5:02 pm

Thanks, Keith.

You might want to do an in-depth analysis and submit it in article form to Lynn Peterson, editor of the California Workers' Compensation Quarterly, the State Bar publication for WC Section members. (The CWCQ has published several of my articles on lien-related matters.)

Also, if you are interested in making a MCLE presentation on this issue to the San Bernardino County Bar Association Workers' Compensation Section, let me know (I am the chairperson). We have speaker slots open for Fall, 2009.

JCB
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Re: Medical Treatment Lien (California)

Postby steve appell on Mon Jun 29, 2009 1:02 pm

FYI:
Today's WCC article titled "Cost Containment Fastest growing cost in Medical" confirms out of $4.1 billion total medical paid in 2008, $284 million was paid for medical cost containment. Although this is only 7% of all medical spent, it is over a 50% increase of what was spent in medical cost containment the prior year.
Steve

appellandassociates.com
6311 Van Nuys Bl #480
Van Nuys, Ca 91401
wcexaminer@aol.com


Check out 'WORK COMP MATTERS" Free PODCAST below
https://www.workcompcentral.com/educati ... ype=online
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Re: Medical Treatment Lien (California)

Postby steve appell on Mon Jun 29, 2009 1:02 pm

FYI:
Today's WCC article titled "Cost Containment Fastest growing cost in Medical" confirms out of $4.1 billion total medical paid in 2008, $284 million was paid for medical cost containment. Although this is only 7% of all medical spent, it is over a 50% increase of what was spent in medical cost containment the prior year.
Steve

appellandassociates.com
6311 Van Nuys Bl #480
Van Nuys, Ca 91401
wcexaminer@aol.com


Check out 'WORK COMP MATTERS" Free PODCAST below
https://www.workcompcentral.com/educati ... ype=online
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Re: Medical Treatment Lien (California)

Postby davidd on Mon Jun 29, 2009 1:41 pm

Shameless promotion (which I generally don't permit, but the topic is timely since the growth in cost containment, itself, needs containment):

Friday, July 17 from 9 a.m. to 4:30 p.m. Maureen Bennington, will present Cost Containment Isn't a Silver Bullet - How to Take Charge of Managed Care.

Students will:
- Understand the function and application of workers’ compensation managed care cost containment services.
- Learn to identify and address performance issues with managed care cost containment vendors.
- Learn to effectively manage cost containment vendors to maximize outcomes and bring claims to resolution.
- Improve claims audit results through appropriate application, management and documentation of managed care cost containment intervention and outcomes.

Bennington is an industry consultant on medical cost containment for carriers & TPAs across the spectrum. She has a master's degree in Rehabilitation Administration and is credentialed in Case Management, Disability Management, Utilization Review and Vocational Counseling.

CE CREDIT HOURS
6 Claims Professional
6 Legal Specialization
6 MCLE

For more information go to www.workcompschool.com
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