Is There a Better Way?

Monday, October 28, 2013 | 0

There are so many similarities around the country's workers' compensation systems. All jurisdictions do many things with at least commonalities. This becomes more apparent to me when I get the opportunity to sit around a table with officials from other states. The Southern Association of Worker's Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC) are exceptional venues for such interaction.

Great ideas have come from these groups, and the IAIABC notably has led the way for consistency among the states in the area of electronic-data interchange, or EDI. Computer programmers are creative people. Certainly, they live in a world that is dependent upon logic and they create programs that are themselves functional because they react and respond in a predictable manner to the input with which they are provided. However, if you sit 10 of them in a room and describe what you want a program to do, you will get 10 creative and distinct programs. There is a creativity and an art to programming.

Without the EDI leadership and planning, there would therefore be 50 or more EDI processes out there. In other words, the insurance companies that are able to collect the data regarding claims would be burdened with reporting that data to each of the various jurisdictions in a vast number of formats. I am sure that even with the EDI leadership, that there are still distinctions that complicate data reporting, but I am as sure that the situation is better than it otherwise would be without the leadership on consistency that grew out of a national or international approach.

This subject came back to mind as I was reading California's news last week. Their Commission on Health and Safety and Workers' Compensation, or CHSWC, has approved a proposal for reimbursement of copy services. This is not the first time that the subject has been in the news. WorkCompCentral Chief Executive Officer David DePaolo blogged about the process about two years ago. He acknowledged that those of us outside California likely did not understand the process, and he conceded that he, and therefore likely other Californians, has little information as to how other jurisdictions address the procurement of medical evidence.

DePaolo explains in his blog that there are two approaches for obtaining medical records in California, one for the defense and one for the injured worker (or her/his representatives). Whether because of laws, contracts or custom, he explains that injured workers' access to records is governed by a "more rigid" process, with record authentication being a significant focus. Rigidity, in my experience, often translates to expense.

The issue which California faces with a fee schedule is interesting. Not because I see any grand significance in their decision last week to reimburse $103.55 for up to 1,000 pages, if timely paid (60 days) or to reimburse $251.20 if that payment is not timely paid. They can argue all they want about whether such payments are appropriate and whether their system for payment is fair or just.

I find the issue interesting because it seems to me this ignores a debate that might be more appropriate. In today's world of the portable document format (PDF), the internet and the electronic transmission of documents, is there not a better way than having a "copy service" procure paper replications of injured worker medical records?

I have seen the vision that the Florida Bar Workers' Compensation Section has for some kind of "data warehouse" system for medical records. They want to build something similar to what the Social Security Administration uses. That vision accepts that the world around us is changing and that many or perhaps most medical practices have evolved from paper records to digital records. Doctor's offices and hospitals are either in that mode or moving in that direction, for the same reasons that compel the rest of us, digital filing and records save physical space, time and money.

The vision of the Section is to build a data warehouse in which injured workers and carriers could stock documents and data from various medical providers. They see it as a cooperative method by which everyone in our compensation disputes would have increased access to complete and inexpensive information and data. I can see the potentials for savings in both time and money. That does not mean the path to such a process is not complicated by obstacles; they abound.

I am not sure we will get such a warehouse built. I am convinced that it is a valid process for consideration. If the providers are keeping the records electronically, why should those be converted to paper replications for production to any party? Is it only so that a digital file which could be emailed becomes a revenue generator when it is printed at $1.00 per page or more?

Is there a way for the discovery processes to encourage electronic production? Are there pitfalls to such a process? Is the data warehouse methodology the answer or a path to more questions? Is there benefit in establishing a paradigm or model that more jurisdictions might be able to adopt, as the IAIABC EDI model suggests?

I see California expending significant effort in the past two years, trying to deal with the apparently difficult issue of what is the fair price for copy services. I wonder if that effort might be better channeled into a broader debate about process and how it might be modernized, simplified and expedited?

David Langham is deputy chief judge of the Florida Office of Judges of Workers' Compensation Claims. This column was reprinted with his permission from his Florida Workers' Comp Adjudication blog.