I suppose it's too much to ask for emergency (California)

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Re: I suppose it's too much to ask for emergency (California)

Postby jpod on Fri Mar 20, 2020 8:34 am

I can't speak for other self insured companies or insurance companies but our claims operation is still functioning. Most are working from home; a skeleton crew is onsite to receive mail, upload it into the claims system so the WC reps will get their mail; to mail benefit notices and respond to IMR and QME issues. Our bill review vendor is also able to continue to function via working remotely.

That doesn't mean things will run as they would without this pandemic, but we are committed to continue to provide benefits to our injured employees.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Fri Mar 20, 2020 12:46 pm

One area of the system that could actually operate MORE efficiently and be ANTIFRAGILE to this threat is telepsych. It will be BETTER than what we are doing now and also examinees as well as interpreters will like it. Hopefully when this is all over we will reconsider how silly the ten traveling offices nonsense is.

I read the sort of wishy washy response yesterday and that seemed to be a half-hearted yes, but without provisions to make it easy.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Fri Mar 27, 2020 6:44 am

Saw in the articles that a law firm is going to try to force the issue by judicial ruling next week.

Why does it have to come to this?

IWs are almost always in financial hardship after an injury, delaying case resolution could break them.

Taking positive regulatory action on this is such a no-brainer.

And the changes should be permanent. There's no reason to force IWs to leave home with injuries if the interviews can be done remotely. This is especially cruel in rural areas, where IWs have to drive hundreds of miles.

The only winner in the multiple office game is the Regus Corporation that rents space per diem.
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Re: I suppose it's too much to ask for emergency (California)

Postby jpod on Fri Mar 27, 2020 10:20 am

I don;t know the WCJ's/WCAB can issue such a rule since they are bound by statute. It would be nice if there were some sort of emergency powers available - the State's police power should cover this issue, for the health and safety of the public etc, etc, etc...

I know industry led groups have been asking the DIR to issue rules that allow it, but the statute problem might also apply.

The question I have is will QME/AMEs be prepared to set the injured worker up with the teleconferencing tool needed that complies with all the privacy and security issues telemedicine requires?
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Fri Mar 27, 2020 12:49 pm

There are at least four HIPAA compliant programs I know of. I've done it before for other medical-legal work and that included an interpreter at their own home. I've already gotten full authorization on one recent case and consent from IW and it went off with barely a hitch. The programs do not record the conversation on a hard disk. The applicant only needs a smartphone or a tablet and some of the programs don't require an app. It's not that hard and the applicants love not having to drive or use medical transport. After this is all over, it should become standard practice as it is much easier on all parties. Once you do a deposition this way you probably won't want to go back to the old way, especially when traffic picks up again.

The problem is the authorization process is clunky not the teleconferencing process. There are so many staff headaches than can be eliminated with proper directives.

Let's help injured workers, and our staffs to boot, not the Regis corporation who benefits from all the silly office locations. With virtual appointments we can also pretty much eliminate additional injuries going to and from psych appointments.

Care is a verb more than a noun. You care by making the process easier, not by virtue signaling how much you care.
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Re: I suppose it's too much to ask for emergency (California)

Postby jpod on Fri Mar 27, 2020 1:57 pm

Yes, I thought of HIPPA too. I don't think the exclusion in HIPPA for workers' comp insurers and administrators extends to physicians working in the WC system. But I can not claim to be an expert in that area.

There is a requirement (I think it is a Federal law) that a patient must "consent" to telehealth/telemedicine.

"...With virtual appointments we can also pretty much eliminate additional injuries going to and from psych appointments..."
I agree it lowers the risk; I don't agree it "virtually eliminates" the risk. I can see ergonomic related issues being raised by some applicants. Claimants can be, how should I put it, very "creative" with respect to filing claims.

I suspect you won't agree but some would argue eliminating the overhead costs for those "silly office locations" might affect M/L pricing considerations. After all eliminating that overhead cost should not be a windfall to the provider (setting aside the argument about fees not having been adjusted for inflation). Maybe a shared savings between payers and providers.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Fri Mar 27, 2020 3:07 pm

HIPPA is deliberate overkill for medical-legal. You don't need it, but why not have it?

There is a federal requirement but it has been waived. In any case consent is easy.

"Eliminating that overhead cost should not be a windfall to the provider"

Seriously, you have to be kidding. Before this multioffice nonsense, it wasn't an additional expense then it became one. And a hundred bucks is not a "windfall" especially since we haven't had a raise in 15 years. Have insurance and premium rates gone up in 15 years?

That "windfall" would probably cover inflation from 2005-2007, but not much else since 2005 was the last COLA. I can prove that a COLA of at least 50 percent is necessary to cover inflation and rising business expenses.

It's pretty callous to talk about windfalls for people whose purchasing power and enrollment numbers are in steep decline.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Sat Mar 28, 2020 4:25 pm

Looks like we got a solid green light today from the DWC for exams that do not require a physical.

This is good news. Congrats to them and credit for being responsive.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Sat Mar 28, 2020 4:25 pm

Looks like we got a solid green light today from the DWC for exams that do not require a physical.

This is good news. Congrats to them and credit for being responsive.
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Re: I suppose it's too much to ask for emergency (California)

Postby jpod on Mon Mar 30, 2020 10:21 am

I was referring to the rental costs of multiple locations if telemedince eventually becomes the norm. The system is required to be cost effective to prevent consumers from paying an unnecessary hidden tax built into the prices of every good and service. I was suggesting that eliminated costs should be recognized when calculating any COLA.

The problem is there isn't anything close to a free market when it comes to the medical industry, so how does one fairly set prices? It is nearly impossible to calculate the marginal cost wage which is how economists go about calculating wages and prices in normal markets.

The original M/L fee was set based on the population of court ordered IMEs (when the WCJ found the parties M/L evidence to be lacking) which was the only data available when the legislature was establishing the first M/L fee schedule. This point was specially called out in the White Paper the legislature used to set the initial M/L fees in the mid 1980s. The population of cases were a small sub set of the M/L universe and probably represented the more complicated cases. The expectation was after the DIA Forms 76 were compiled the fee would go down not up. So the base line you calculate the COLA from was already biased to the high side b/c it was based on cases that had high M/L costs that was not representative of the entire population of ML events.
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