Fee Schedule Again Proposed for Worker’s Compensation

May 12, 2017

On May 9, the manager’s representatives to the Worker’s Compensation Advisory Committee again put the idea of a government-established fee schedule on the table for discussion, as they did in 2013 and in 2015. The previous proposals have been strongly opposed by WHA, the Wisconsin Medical Society, the Wisconsin Chiropractic Association, the Wisconsin Physical Therapy Association and others in the health care provider community, and will again see similar opposition. 

The Council is comprised of five representatives of labor and five representatives of management, and offers a chance for labor and management to come to agreement on policy changes they would like to see in the Worker’s Compensation program. Typically, labor and management come to agreement and the agreed-to proposal is often adopted by the Legislature. The notable exception was in 2013-14, when the proposal included government-established reimbursement rates for providers. At that time, the bill failed to make it out of committee in the Legislature. 

At the May 9 meeting, both management and labor representatives identified policies they would like to see in a bill that would eventually make its way to the Legislature. In addition to setting provider reimbursement at 150 percent of Medicare rates, management representatives also proposed allowing employers to direct care, meaning employers would be allowed to specify a list of health care providers who are authorized to provide care for injured workers. Currently, injured workers can choose their care provider. Manager’s representatives also propose establishing treatment guidelines for care that would have to be followed unless a pre-authorization from the insurer was obtained. 

Labor representatives also put forth their proposals, none of which included a fee schedule, directed care or treatment guidelines. Labor representatives are interested in helping to address the use of opioids and have asked the health care community for its assistance.

WHA and other health care groups are very concerned about the management proposals. Over the past several years, the health care community has worked to emphasize to the Council and legislators that a fee schedule puts at risk the excellent outcomes produced by one of the best worker’s compensation systems in the country. 

Joanne Alig, WHA senior vice president, policy and research and WHA liaison to the Council noted, “The data shows that injured workers in Wisconsin return to work faster than other states, have access to high-quality care, and are happy with that care. The data simply doesn’t support the case for these proposals,” she said. 

Alig pointed to information provided to the Council earlier this year. Staff from the Worker’s Compensation Research Institute presented data showing that Wisconsin has a relatively low percentage of workers who lose more than seven days of work after injury, has low litigation, steady utilization, the lowest number of injured workers reporting “big problems” getting medical services and the lowest percentage of injured workers who are “very dissatisfied” with overall care. With respect to medical prices, in 2014-2015, medical prices for non-hospital services grew just 1.8 percent.

In addition, the Council recently heard from Bernie Rosauer, president of the Wisconsin Compensation Rating Bureau (WCRB)—the independent agency that establishes rates charged by insurance companies for worker’s compensation insurance coverage in Wisconsin—who discussed the positive attributes of Wisconsin’s worker’s compensation system. In a presentation provided to the Council, Rosauer reminded the Council that worker’s compensation insurance rates decreased by -3.19 percent in 2016 for all job classifications in aggregate, but decreased even more for manufacturing at -5.00 percent. Rosauer noted Wisconsin has “got a good thing going” with its worker’s compensation system, and other states are aware of Wisconsin’s well-functioning system.

This story originally appeared in the May 12, 2017 edition of WHA Newsletter