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Workers' Compensation Networks Informal Working Group (May 24, 2006)

May 24, 2006
1 p.m. to 4:30 p.m.
Hobby Building - Room 100

Goals of the workers' compensation system of Texas

  • Each employee shall be treated with dignity and respect when injured on the job;
  • Each injured employee shall have access to a fair and accessible dispute resolution process;
  • Each injured employee shall have access to prompt, high-quality medical care within the framework established by the Texas Workers' Compensation Act;
  • Each injured employee shall receive services to facilitate the employee's return to employment as soon as it is considered safe and appropriate by the employee's health care provider.

Agenda - May 24, 2006

Agenda Items Presenter
  • Antitrust statement
  • Review of ground rules

Albert Betts
Division of Workers' Compensation

Audrey Selden
Senior Associate Commissioner
Consumer Protection

  • Update on WC rules
    • Peer review rules data call

Allen McDonald
Acting Deputy Commissioner
Workplace & Medical Services

  • Discuss revised proposal of performance-based oversight system

Teresa Carney
Acting Deputy Commissioner
Compliance & Regulation

  • Discuss disability management proposal regarding treatment guidelines, treatment planning process, and return-to-work guidelines

Allen McDonald

  • Presentation on return-to-work

Virginia May
Return-to-Work Services

  • Update on networks
    • New improvements to the certification process
    • Applications
    • Complaints update
    • Outreach update
    • Silent PPOs

Jennifer Ahrens
Associate Commissioner
Life, Health & Licensing

Margaret Lazaretti
Deputy Commissioner, Health and Workers' Compensation Network Certification and Quality Assurance

  • Open discussion
  • Next meeting: June 14, 2006

Meeting Notes - May 24, 2006

Commissioner Albert Betts welcomed the group and thanked the members for their participation. Audrey Selden reminded the group of the antitrust statement.

Update on WC rules

Allen McDonald noted that TDI is moving forward on proposed rules for Treating Doctor Examination to Define Compensable Injury, Designated Doctor and Required Medical Examination Changes, and Peer Review Doctor Requirements. For more information, please click on http://www.tdi.texas.gov/wc/rules/planning/ruleschart.html. Also staff is starting on the hospital fee guidelines rule; currently there is no guideline for hospital outpatient fees. In addition, he would like feedback regarding a proposal for a data call to the carriers in order to gather factual data about who is doing peer reviews, when are they being done, and how many are being done; DWC does not collect this information now. Commissioner Betts added that facts are needed in order to set policy and propose rules about peer reviews. Members were sent a draft discussion paper about the Peer Review Monitoring data call ( see attached). They provided the following comments:

  • If DWC sent the data call to the top 25 WC writers, then 98 percent of the market would be included.
  • In general, data calls are burdensome to the carriers; is there another way to get this information? The cost of collecting the data should be weighed against the benefit of having the data.
  • DWC should meet with some carriers' technical staff to discuss the data elements being requested.
  • Sharing the results of data calls and explaining how the data was used, for example, by publishing data summaries or including the information in a rule preamble, would be appreciated by stakeholders.
  • There is not a standard format for peer review reports - some are six pages long. Suggest that it be standardized and shortened, and a copy sent by the peer review doctor to DWC. Include a definition of "peer review" on the form.

Commissioner Betts said staff would re-look at the proposed data call in light of the members' suggestions. Also DWC will invite small groups of carriers' business staff and technical staff in to review the proposal and provide additional input. Staff will come back with a revised proposal at the next WCWG meeting on June 14. He reiterated his commitment to use data calls that are tailored to meet specific needs, and to be mindful about collecting only data that is needed and communicating to stakeholders how the data was used. He added that he hoped the members would use the special e-mail box wcwg@tdi.texas.gov to provide their feedback, comments, and suggestions.

Update on Networks

Jennifer Ahrens provided a handout on the common deficiencies found in WC network applications ( see attached). She urged the members to share the list with interested persons. Networks that are preparing applications should use the list to review their applications before submitting them to TDI. She explained that TDI is not able to make "provisional" certifications and applicants are encouraged to think about how they can work with TDI to meet the statutory requirements. TDI has an open door policy, and applicants are welcome to call or visit Jennifer, Margaret Lazaretti, and the Health and Workers' Compensation Networks (HWCN) staff. Also a new weekly conference call is set for every Thursday in June from 2 p.m. to 3 p.m. (call toll-free 888-387-8235 and enter the passcode 5751967#). Applicants can ask questions about network certification and how certified networks will operate. Last, she provided a list of suggestions about how to improve the certification process, and encouraged the members to give TDI additional suggestions today or send them to wcnet@tdi.texas.gov or wcwg@tdi.texas.gov.

Lee Ann Alexander suggested TDI use the question resolution log. Creg Parks noted that improvements are evident, and network applicants are receiving clearer feedback from TDI. Regarding whether the network requirements will be changed, Jennifer explained that information was provided to legislators and TDI has no additional information regarding changes. She added that TDI is working with the two certified networks to make it easier to find specialists, for example, a specialist in a specific ZIP code, by using the networks' webpage lookup applications. She stressed that providing consistent answers to questions about certified networks has been emphasized to TDI staff. Regarding how providers can contact a network applicant or certified network that they may wish to become a part of, TDI makes a list available via an open records request. Requesters can send an e-mail note to wcnet@tdi.texas.gov and HWCN will reply with the list. Last, Jennifer noted that, as the members suggested at the last WCWG meeting, TDI will issue a bulletin about "tailored" networks.

Margaret Lazaretti said TDI has received 24 applications for WC networks, and two have been certified. The latest information will be posted at http://www.tdi.texas.gov/wc/wcnet/index.html. So far, TDI has received ten complaints regarding WC networks; two have been closed ( see report attached).

Regarding "silent" PPOs and WC networks, Jennifer Ahrens invited the members to help her better understand their concerns by meeting with her, calling her, or sending written comments regarding the potential problems they foresee.

Regarding WC network outreach activities, Audrey noted that a summary of completed and future events was included in the meeting packet ( see attached). Please continue to invite TDI to your events. Staff is working on a "virtual" workshop including a PowerPoint and audio recording for the website.

Discuss revised proposal of performance-based oversight system

Teresa Carney thanked the five members who sent comments on the previous draft; their comments have been added verbatim to the May 24 draft ( see attached). Regarding the key regulatory goals, the members agreed that they are "final." Comments included:

  • Understand that carriers have strong concerns about being evaluated regarding their role in promoting a safe workplace. Carriers can offer training and encourage safety programs, they cannot force employers to make their workplaces safe. They point out that many factors influencing workplace safety are beyond the carriers' control.
  • Consider the key regulatory goals as desirable paradigms, not necessarily goals to be used by the regulator to rank or fine carriers.
  • Think about measuring the ways in which carriers can contribute to a safe workplace, for example, by making programs and materials available to employers.
  • Consider adding a goal to measure stakeholders' satisfaction with the system and each other; for the system to be successful, injured workers, employers, and providers must all express satisfaction with the system.
  • Ask companies with good safety records what they do to keep workers safe, and base the measurement system on this information.
  • Enhance the PBO pilot program and use it to test some of these ideas.
  • Suggest the members rank order the goals, and have the department focus on the top priority goals first.

Bonnie Bruce noted that TDI has no option, these goals were set by HB 7. Some members volunteered to serve on a subgroup to work on the proposed PBO goals. Should other members or observers wish to submit comments or suggestions for ranking the goals, please send an e-mail to Teresa.Carney@tdi.texas.gov by June 5.

Discuss disability management proposal regarding treatment guidelines, treatment planning process, and return-to-work guidelines

Allen McDonald presented a draft discussion paper based on a meeting of some stakeholders to discuss rule development on this topic ( see attached). He asked the members to review the recommendations included in the paper, keeping in mind that no treatment guideline is perfect. Please provide feedback now, while staff is drafting the rule, to wcwg@tdi.texas.gov. To learn more about the California approach on treatment guidelines, please visit their website at http://www.dir.ca.gov/imc/guidelines.html.

TDI will monitor implementation of the guidelines via complaints and other data received. Bubba Klosterman suggested we include a definition of treatment planning. Brian White suggested the same quantum of evidence be used for overcoming the presumptive weight for both the treatment guidelines and return-to-work guidelines. Regarding a standard form for treatment plans, Allen said the rule would define the required elements only. Audrey emphasized that TDI has not made a decision regarding a treatment guideline for Texas and specific guidelines are mentioned only as examples.

Presentation on return-to-work

Virginia May provided a summary of marketing for the return-to-work (RTW) pilot project for small employers ( see attached). Staff have trained more than 3,100 people to date on RTW. In addition, 773 DARS counselors have been trained. OIEC Ombudsmen are participating in the training. No applications for the pilot project reimbursements of up to $2,500 for modifications to the workplace have been received. She asked the members to encourage participation in the pilot program and announce that RTW services that are available, and send her contact names and phone numbers. Allen added that in addition to RTW, staff can provide worker health and safety training also. Shelton Green offered to help identify potential employers for the pilot program, and help with outreach to NFIB also.

Regarding questions about DARS counselors, how much they are paid, and how to retain them, please contact DARS - the web address is http://www.dars.state.tx.us/. Dr. Norwood suggested tying the RTW and health and safety goals together - they are really partners. Jim Baker observed that such a holistic approach is great that includes all stakeholders is great; members agreed.

Next meeting: June 14, 1 p.m. to 4 p.m., Room 100, Hobby Building. Agenda will include revisiting the peer review data call.

For more information, contact:

Last updated: 10/16/2015