PayersDirect response to COVID-19
During these difficult times dealing with the Coronavirus pandemic, I want you to know some good news.
Because of our digital organization, combined with the most sophisticated cloud-based referral and tracking solution in the country, we are functioning normally to service our payers, your employers and their employees. That means our phones, faxes, email and appointment monitoring is fully operational and responsive. Of course, the entire state of California has been mandated to “shelter in place” at home, which we are doing, but each of us is working together virtually, without a hiccup.
If your staff has any difficulties managing injured workers’ care through their connections into your internal systems or those of your partners, remind them that they have full access to our HIPAA-compliant web portal. From the safety of their homes, adjusters and nurses staff can quickly and easily refer all diagnostic and PT services through PayersDirect and can view the status of all patient appointments and view/print any medical report any time. For those of you who have opted to use us exclusively, this benefit is magnified as all your referrals are tracked in one place, on one screen.
In order to begin or continue PT rehabilitation care to those injured workers who need it, while maintaining social distancing guidelines and other disease mitigation strategies for the safety of both the patient and the provider, working closely with our California providers, PayersDirect is now offering the choice of ordering remote PT therapy directly in our system. Such interactive synchronous care started statewide on March 31st, utilizing various web-based video conferencing platforms, including Skype, FaceTime and others, so that PT services can be provided in the safety of the patient’s home.
Our telerehab solution is better because…
It is fully integrated with our current Referral and Tracking solution for diagnostics and therapy. Just click the option to request “remote” PT care whenever you send a referral. As simple as that! All remote care is ordered, tracked and billed using the same processes you currently use with PayersDirect.
Care will always be performed by the same PT providers that you, your employees, adjusters, nurses and referring physicians know and trust, rather than a third-party or out-of-state service.
In most areas, your injured workers have the option at anytime to switch back-and forth, between hands-on and remote care, within the same PT practice, based on their needs, desires or health situation.
And when this terrible Coronavirus situation is over, there is nothing you have to do - just continue as before.
Stay safe. Do your best to mitigate the spread of this disease to yourself, your family, friends, employees and our heroic healthcare workers.
Dick Turkanis, M.D.
Pennywise and Pound Foolish.
Why do most employers and TPAs focus on discounts they can obtain from their medical providers?
Because it’s an easy number to show in a monthly “cost-savings” report. “Wow, look at how much money we saved.” In states with fee schedules, you may see 2%, 5%, 10% or more in “medical cost-savings.”
But is this the amount that you have really “saved”? A closer look might surprise you.
First of all, you probably get charged for those “discounts,” often paying a 20-25% fee for your “savings.”
Second, your “cost-savings” amount is proportional to your utilization of services. The more services performed, the higher your savings ; so larger “cost-savings” due to higher utilization means higher total medical costs and delayed return-to-work.
Third, and most important, you aren’t shown the impact those savings programs might have on your indemnity costs. Focusing on directing care to “discount” providers often results in subpar care, delays in scheduling, wrong diagnoses, repeat exams, and over-utilization of physical therapy.
Is a $35 medical discount on a $350 MRI exam worth it if it results in slower return-to-work? Is a $15 discount on a Physical Therapy visit worth it if it leads to delayed scheduling or more PT visits? For an employee with a $40K salary, it costs you over $100 in TD for every extra day of delay. And for most government workers, TD costs can be 50% higher. You do the math.
Maybe these recent numbers will help frame the issue of what’s more important?
Average losses for accident year 2015, 2016 and 2017 claims showed increases in average paid losses within the first two years of injury, driven primarily by rising indemnity payments. Average medical costs at six months, one year and two years post-injury showed only modest increases in paid medical costs, or none at all.
Since accident year 2014, average indemnity paid on lost-time claims rose 12.9% at six months after injury, 10.5% at one year and 6.8% at two years. In contrast, average paid medical losses on those claims increased at 3.9% at six months, 0.6% at one year and showed no change at two years.
What can you do?
1. Stop obsessing on “discounts” without understanding their consequences and effect on your indemnity and total claims spend.
2. Use quality, experienced providers that deliver prompt, efficient care. Know which providers are best at which medical problems, and direct injured employees to them.
3. Insist on real-time communication between all stakeholders to further speed up claims closure and return-to-work.
“Why is my work comp medical care so bad?”
We hear this complaint all the time from employers and employees. Delays in scheduling, wrong diagnoses, repeat exams, never-ending physical therapy and of course, prolonged return-to-work.
Well, here’s one good reason that might help explain the situation… Much of what you pay in medical fees doesn't reach the local medical providers who care for your injured employees.
If you, or your TPA, are using third party scheduling networks to schedule your Radiology and Physical Therapy exams in states like California, as little as 40% of what you pay for medical services might actually get to your medical providers. The rest - up to 60% of what you pay – is kept by some of these networks. When this happens, those provider networks make more money just scheduling your referrals than the providers receive who deliver the medical care to your employees.
Why does it matter?
Because when medical providers are paid such low rates by some networks – often below their own medical practice costs – they need to cut corners when caring for your injured employees in order to stay in business. This could result in subpar diagnostic quality, delayed medical services, less one-on-one physical therapy care and slower recovery.
And when traditional scheduling networks offer providers very low reimbursement rates, many top quality providers opt out or are not selected by those networks. This limits your access to many of the high quality local physicians and therapists you would want to care for your employees.
What can you do?
Find out if this affects you. Demand full transparency. Ask your network vendor partners to show you exactly how much of each of your medical payments goes to the provider and how much the network keeps. Then, you can decide if that’s the best way to care for your injured employees.
Insist that your providers receive a larger portion of what you pay for medical services. A good number should be 80% to 100%. Anything below that level might affect care and raise your total claims costs. Pay your local providers fairly, demand better care and return your employees to work more rapidly. Isn’t that the goal of work comp?