Workers Compensation Cost Containment Plan Approved

MacIver News Service | December 11, 2013

[Madison, Wisc…] The Wisconsin Workers Compensation Advisory Council (WCAC) unanimously voted to back a plan that would tie healthcare rates in the workers compensation (WC) system to a fee schedule based on local market prices at its December meeting.

Currently, there are no limits on what Health Care providers can charge the WC system for treating injured workers. Not surprisingly, that is the fastest growing cost in an otherwise fiscally sound WC system. The MacIver News Service has closely followed this issue for months.

In 2012, the median amount paid by Workers Comp was nearly five times the Medicare reimbursement rate for the 25 most common procedures, according to a report by the Wisconsin Compensation Rating Bureau.

Another study, by the Wisconsin Insurance Alliance, found that the maximum allowance for medical costs in the Badger State were nearly double what they were in neighboring states. Many believe the reason for such high medical costs is that there is no limit to what medical providers can charge the Workers Comp system.

WCAC has been discussing cost containing ideas for months. Insurance companies on the council wanted compensation tied to Medicare rates, but medical providers did not want a fee schedule. The council decided on the market-based fee schedule, which is a middle ground approach.

The market-based fee schedule will take the average group-health rates in five regions of Wisconsin and add ten percent. The fee schedule will be adjusted for inflation, which will be based on the medical Consumer Price Index, and will be reviewed every two years by WCAC. The new fee schedule would be required to be up and running by June 30, 2015.

The legislature still needs to approve the recommendations from WCAC, but no timeline was announced.

“The Workers Compensation Advisory Council is statutorily charged with recommending changes to workers compensation law and administrative rules to the Legislature, which occurs through an agreed-upon bill,” John Dipko, Department of Workforce Development (DWD) Communications Director, told the MacIver News Service. “The most recent agreed-upon bill will now go to the Legislature for its consideration.”

Dipko said that the legislature does have the authority to make changes to the bill and DWD will ultimately carry out the legislature’s directive.

The full minutes from the meeting were released on Wednesday which include all statutory changes recommended by the council.