Helpful Links: Learn More | IC PBO |
PBO Assessment Results | PBO-Home Page
Health Care Provider Methodology
Downloads:
2021 Health Care Provider Methodology Paper (5/26/2020 - pdf)
Weighted Measures | Time Frames and Data Sources | Selection Criteria | Tier Structure and Placement Methodology | Overall Performance Standard
Weighted Measures
The health care providers selected will be assessed on the following measures:
DWC Form-073, Work Status Report Category
- Documentation supporting how the injured employee’s medical condition prevents them from returning to (any) work as reported on the DWC Form-073, Work Status Report measure - 70% weight.
- Completeness of the DWC Form-073, Work Status Report measures - 30% weight.
DWC Form-069, Report of Medical Evaluation Category
Time Frames and Data Sources Used for 2021 Assessment
The data used to assess performance of health care providers for the 2021 PBO assessment is based on the following parameters:
DWC Form-073, Work Status Report Category
Timeliness of filing the DWC Form-069, Report of Medical Evaluation Category
The designated doctor DWC Form-069s will be identified from the DWC database where the form is received on or before May 31, 2021. The review will include DWC Form-069s where examinations occurred between January 1, 2021, and April 30, 2021.
Selection Criteria
The following describes how the health care providers are selected for the 2021 PBO assessment:
DWC Form-073, Work Status Report Category
The health care providers selected for assessment on these measures are based on their volume of DWC Form-073, Work Status Reports identified in the data time frame. The minimum volume of forms will be determined based on the overall volume of the assessment data and DWC resources, but will not be less than 20 forms.
DWC Form-069, Report of Medical Evaluation Category
The health care providers selected for assessment on this measure is based on their volume of DWC Form-069, Report of Medical Evaluations identified in the assessment data timeframe. The minimum volume of forms will be determined based on the overall volume of the assessment data and DWC resources, but will not be less than 20 forms.
Tier Structure and Placement Methodology
Three regulatory tiers are used to make a distinction between poor, average, and high performers in the workers’ compensation system. The health care providers assessed are considered to have an impact on the workers’ compensation system due to their volume of filings. DWC is not asserting that a high volume has a negative impact on the system. Health care providers who are not assessed due to low volume are not absolved from regulatory duties or regulatory oversight.
DWC will conduct several steps to place each health care provider into an overall regulatory tier for each category. The first step is to calculate the performance score (percentage) for each measure. Next, the performance score for each measure will be multiplied by the assigned weight value (the value is rounded up). This calculation of two percentages will then be multiplied by 100 to obtain a weighted value (the value is rounded up). For measures where the weight is 100%, the weighted value becomes the overall score for the measure. For multiple measures, the weight value of each measure will be added together to calculate the overall score (no rounding). The overall score identifies the performance standard for the assessed entity.
Overall Performance Standard
The performance standard for health care providers are:
High Tier: 95 or greater
Average Tier: 80.00 through 94.99
Poor Tier: 79.99 or less