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Part One: Recapping the 2017 Workers' Compensation Medical Access Executive Summary

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The 2017 Worker' Compensation Medical Access Executive Summary was recently released, which collects data from injured workers, healthcare providers and insurance companies in the Commonwealth of Pennsylvania to consider the effects fee schedules and utilization of provider panels have on access to quality care and lost days from work.

The Pennsylvania Department of Labor & Industry (DLI) is required by the Workers' Compensation Act to retain the services of an independent consulting firm to perform an annual accessibility study of healthcare services for injured workers. Pennsylvania's workers' compensation law aims to ensure access to quality care as well as cost containment. The summary was derived from survey data collected through surveys with injured workers, healthcare providers and insurance companies.

The summary contained valuable, detailed information that will help inform you should you be facing a workers' compensation case for an injury suffered at work. In the first of our two-part series, we'll explain the findings of the summary from surveys with healthcare providers and insurance companies.

Overall Findings

The medical access summary highlighted a number of interesting statistics and facts pertaining to injured workers. All three groups in the survey (injured workers, providers and insurance companies) experienced a decline in response rates.

1. Injured workers: 10.7% response rate down from 11.4%
2. Providers: 24.3% of providers were represented (some responses represented multiple providers in a practice) a decrease of 3.2% in representation from 2016 

3. Insurance Companies: The 3% response rate was down from last year at 9.5%.

Healthcare Providers

The survey for providers was sent out in January 2018 to 1,380 providers, and the 87 responses represented 335 individual providers. The responses from providers showed:

1. 60% of providers who treated workers' compensation patients belonged to a provider panel, which reflected 2.6% increase. 

2. 87.8% of the providers who treated workers' compensation patients reported receiving payments at the Pennsylvania Workers' Compensation Fee Schedule rate either all or most of the time. 

3. The top number of provider specialties represented in the survey were family medicine, chiropractic, and orthopedic surgery. Chiropractic responses increased from last year, however - due to variations in the mailing lists - it cannot be determined if this correlates to an increase in the use of specific provider types.


Insurers

The survey was sent out in January 2018 to 480 insurance carriers, self-insured employers and group self-insured trusts that covered workers' compensation cases in 2017. There were 15 organizations that responded, resulting in a 3% response rate. Of note, several organizations decided to submit a single survey aimed at representing multiple subsidiary organizations, which suggests the low response rate may underestimate the scope of the stakeholders represented. All respondents completed the survey using the online option. The DLI investigated methods to potentially improve the response rate and tracking of the insurer aspect of the survey for 2018. Respondents were asked to identify the most important characteristics considered when requesting a provider to join a panel. The top three characteristics reported were:

1. Communication/Rapport 

2. Ease of Access/Proximity to the Employer Location 

3. Credentials/Knowledge

The respondents reported utilizing a combination of surveys and complaints to monitor the quality of care and patient satisfaction with providers on a panel.

 
Dugan & Associates is Here For You!

Our team at Dugan & Associates is ready to fight for your right to workers' compensation/personal injury benefits. If you're weathering a loss of income from a workplace injury, an increase in medical bills or distress due to an accident - don't worry! Led by Mitch, our group of devoted injury lawyers will make sure you receive the maximum monetary compensation available to you. Give us a call at 412-353-3572 or contact us online today!

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