WCAC Again Seeks Government Fee Schedule for Medical Services

“An outdated solution looking for a problem”

August 25, 2017

At the end of two days of meetings August 23, the Workers Compensation Advisory Council (WCAC), which includes five representatives of organized labor and five representatives of management, voted to support a fee schedule to reimburse hospitals, doctors and other practitioners who provide health care services to injured workers through the Worker’s Compensation program.

WHA President/CEO Eric Borgerding emphasized the Wisconsin system is considered one of the best in the nation. “We have the top ranked health care in the country (see news release). Workers injured on the job in Wisconsin get some of the best care, have some of the best outcomes, satisfaction and return to work rates, and lowest service utilization in the country. And Wisconsin workers comp premiums continue to plummet. Yet here we are, once again, talking about fee schedules and price setting; outdated solutions looking for a problem. It’s really time to move on.”

In 2014, health care provider groups defeated a proposal put forth by the WCAC that would have the government set provider fees in the worker’s compensation program. It was the first time in the history of the Council that its proposal was not adopted by the Legislature.

When reviewing what will be introduced in the Legislature this biennium as the Worker’s Compensation bill, the Council gave no fiscal impact of the proposal, but described it as “approximating the average price of group health in Wisconsin.” The details of how this will be determined are unclear, but the Department of Workforce Development (DWD) would be required to develop the fee schedule using available data and a survey of self-insured employers, all of which would be considered proprietary and none of which would be subject to open records requests. The fee schedule could be adjusted by medical inflation each year, but once set would only be reset every 10 years. The fee schedule, under their proposal, would be implemented in 2019.

Given the excellent system, Borgerding questioned the wisdom of the Council’s decision. “If the Council gets its way, a government agency will establish how much doctors, hospitals, and other practitioners who take care of injured workers are paid for their services. That’s government rate setting. When has government rate setting improved quality or efficiency? When has it reduced costs?”

Additional policies, including proposals to reduce the use of opioids are also part of the agreed to package, which can be found here: proposals.

The DWD is beginning the process of obtaining a legislative bill draft containing the proposals. The Legislature generally considers and votes on the WCAC’s bill during its spring floor session. WHA and the other provider organizations are calling on members of the Legislature and the Walker Administration to reject the Council’s plan and protect Wisconsin’s excellent worker’s compensation system.

This story originally appeared in the August 25, 2017 edition of WHA Newsletter