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About Northwest labor press. (Portland , Ore.) 1987-current | View Entire Issue (Aug. 15, 2008)
LaborDay-08-(1-14):NWLP 8/12/08 10:03 AM Page 2 ...Comp fee changes worry labor officials (From Page 1) governor-appointed representatives from labor and five from management who advise WCD on issues involving workers’ compensation. “We have a no-fault insurance pro- gram that, for the most part, has been working pretty well,” Shiprack said. “I don’t see how this benefits anyone but insurance companies and national PPOs.” Shiprack has contacted Gov. Ted Kulongoski to protest the emergency rule. “One of the top three complaints I hear from injured workers is that doc- tors won’t take them if they are in the workers’ comp system,” said Ernie Delmazzo, co-founder of Injured Workers Alliance, a support group for people who have been hurt on the job. The problem is amplified east of the Cascade Mountains. “Sometimes injured workers have to drive to Port- land for treatment,” Delmazzo said. “It is absolutely a sweeping change to the system,” said State Rep. Brad Witt (D-Clatskanie). Witt and Shiprack were outraged that the emergency order came with little or no input from the two main b h m k players in the system — labor and management. “This entire system is based on a compromise agreement between labor and management to get an injured worker’s injury addressed as soon as possible and to get that person back to work as soon as possible,” said Witt, a union rep with United Food and Com- mercial Workers Local 555 and a for- mer MLAC member. “This ruling is not in anyone’s in- terest — not the state’s, not the em- ployer’s, and certainly not the injured worker’s,” he said. Witt is drafting legislation that would rescind the emergency order and return the system to the prior re- imbursement rate schedule. “(Medical provider) reimbursements should be regulated by the reimbursement fee schedule,” he said. Lon Holston, a union rep for Labor- ers Municipal Employees Local 483 and another MLAC member, said he wasn’t made aware of the need for an emergency ruling until about a week before it was issued. He believes the order came too quickly and without enough discussion. “Somewhere in corporate America Bennett Hartman Morris & Kaplan, llp Attorneys at Law Oregon’s Full Service Union Law Firm Representing Workers Since 1960 The Attorneys and Staff of Bennett Hartman Morris & Kaplan join you in celebrating victories for working families and the many accomplishments of the Labor movement in 2008 Have a HAPPY & SAFE LABOR DAY!! We Work Hard for Hard-Working People! 111 SW Fifth Avenue, Suite 1650 Portland, Oregon 97204 (503) 227-4600 www.bennetthartman.com Our Legal Staff are Proud Members of UFCW Local 555 PAGE 2 they came up with this plan and ran with it,” he said. Union officials argue that the PPO structure is designed for private-sector health care and that it doesn’t belong in the workers’ comp system. “We ask a lot more of our doctors who handle workers’ comp cases than we do those in general medicine,” Shiprack explained. “To combine the two — I believe a mistake has been made.” WCD Administrator Shilts told the NW Labor Press that medical providers should have the freedom to enter into a PPO contract if they so choose. He said providers have partici- pated in networks with discounted rates for years — for workers’ com- pensation as well as other types of health insurance. “The discounted fees have helped keep medical costs under control in workers’ compensation and through- out the health care industry,” he said. Shilts told the Labor Press the emergency order simply “clarifies” how providers are paid. “We wanted to respond quickly to the uncertainties about PPO contracts.” Those uncertainties surfaced after Godwin, the attorney representing physical therapists, began disputing the amounts some insurance compa- nies were reimbursing physical thera- pists for treating injured workers. Fee dispute resolution requests start at WCD, but can go all the way to the Oregon Supreme Court. Godwin said the explanation of benefits that routinely accompanies each insurance payment check would include a note “to the effect that a dis- count was being applied to the billing pursuant to a contract owned or ac- cessed by a named PPO.” In some instances, the discount was more than half the medical bill. Godwin prevailed on most of her appeals. In turn, WCD ordered the in- surers to pay the difference between the PPO discount and the state-man- dated fee schedule. In almost all cases, the insurers ap- pealed. Shortly after that, Shilts said he was contacted by insurer Liberty North- west informing him that Coventry Health Care was threatening to leave the Oregon market unless there was a resolution to all the fee disputes. Coventry is a Fortune 500 company based in Bethesda, Md. “They asked how we decided the disputes. We told them that rules are rules. We obey our own rules,” Shilts told the NW Labor Press. Following their conversation, Shilts said his department took a closer look at the statute. In light of the agency’s own rules, WCD determined that state law allowed for the PPO discounts. “The statute says the fee schedule is the ceiling; that a medical provider can’t be paid above that,” Shilts said, emphasizing that Oregon’s medical fee schedule overall is the highest in the country. Upon further review, the agency also realized there was no time limit on how far back a provider could chal- lenge a reimbursement. “It could be 4- 5-6 years or longer,” Shilts said. “Go- ing back that long, and ordering a resolution of the lower of the fee schedule or the providers normal rate (over the PPO discount) ... well, that could add up to a lot of money.” Godwin said she had 163 fee dis- putes pending and more to be filed when the emergency order was handed down. “It was in the hundreds of thou- sands, if not millions of dollars,” she said. That much potential cost added to the workers’ comp system likely would impact insurance premiums, Shilts said. “In my experience, if rates are pushed up, the typical response is that benefits (to injured workers) are reduced or taken away.” The emergency order was made retroactive, effectively wiping out all of the disputed fees that had not been resolved by a final order. Godwin has filed a legal challenge with the Oregon Court of Appeals and is advising her clients not to accept new injured workers if the insurer is applying a PPO discount. Shilts pointed out that the tempo- rary rule puts several protections in place for providers with PPO con- tracts. For instance, if a provider’s fee is covered by multiple PPO contracts, only one contract discount will apply. Additionally, the department must be given a copy of any PPO contract that is the basis for a fee reduction to deter- mine whether it actually covers work- •Oregon has about 1.72 million workers cov- ered under the state workers’ comp system. This does not include employees working for self-insured employers, the federal govern- ment, maritime, police and fire departments, and others. •Approximately 45 percent of workers in the comp system are covered by SAIF Corp., a quasi-public insurer. SAIF contracts with state- certified managed care organizations. •Nearly 104,000 workers’ comp claims were filed in 2006 (the most recent complete data available). Of those, 89,700 were accepted as compensable under Oregon’ s workers’ comp system. •Of those accepted claims, 23,000 were recorded as “disabling.” A disabling claim is an injury that results in time-loss from work, permanent disability, or death. A non-dis- abling claim is one that does not result in time-loss or permanent disability, but requires only medical treatment. •In 2006, workers’ compensation medical payments accounted for $313,742,500, or 54.5 percent of total workers’ compensation claim costs, an increase of 9.1 percent from 2005. •In 1990, massive reforms were made to Oregon’ s workers’ comp system, primarily because insurance premiums were some of the most expensive in the nation. Between 1990 and 2006, however, the pure premium employers pay for workers’ compensation coverage has dropped 57.4 percent, repre- senting an estimated $11.5 billion in savings to employers. ers’ compensation. Before an emergency rule can be made permanent, it must go through a public rulemaking process. WCD is putting together an advisory commit- tee of all interested parties to discuss the matter. Meetings are set for Friday, Aug. 22, from 9 a.m. to noon, and Wednesday, Aug. 27, from 5:30 p.m. to 8 p.m., both at the WCD office at 350 Winter St. NE, Salem. The meet- ings are open to the public. Shilts would like to have a perma- nent rule to present to MLAC when it meets Sept. 11. Labor Metal Trades Council Day of Portland & Vicinity Greetings from NORTHWEST LABOR PRESS 4545 NE 102nd Ave., Portland, Oregon 503-256-0462 AUGUST 15, 2008
