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Re-empowering physicians to take control of the treatment of injured workers is the critical component of a planned overhaul of the Miami-Dade County Public Schools' workers compensation program.
Although programs overseen by Risk and Benefits Officer Scott B. Clark have reduced the number of workplace injuries and related costs, his latest plan is to move the workers comp program away from the managed care format and place responsibility for treating injured employees with their doctors.
The school district has self-insured its workers comp exposures since 1974, with claim expenditures averaging about $30 million a year during the past three years.
Mr. Clark and his team have launched initiatives to manage workplace safety, including informing supervisors about the number of injuries occurring at their locations and helping them implement site-specific loss prevention strategies. Return-to-work initiativessuch as encouraging rehiring of previously injured employees to new positions they are capable of fillingalso have been implemented.
The efforts have helped the district reduce its injury numbers by 10%, existing claims spending by 15% and lost-time days by 33% in 2006 compared with 2005. "The trend is going in the right direction, even though our employee base continues to increase," Mr. Clark said.
A key part of his strategy was to create a loss prevention department within the risk management department, rather than the previous practice of contracting loss prevention to an outside vendor. Mr. Clark felt that setting up an in-house department responsible for the school district's loss prevention efforts would best serve the organization.
The loss prevention group works closely with various segments of the risk management department, particularly the workers comp group, so that when an injury occurs, the group can immediately analyze what happened and decide how to prevent further incidents, he said.
Mr. Clark, though, has even greater aspirations for the district's workers comp program.
He wants physicians to control the treatment of injured workers, rather than a nurse case manager directing the care and telling doctors what to do.
Under Mr. Clark's plan, one that has the backing of the school board, the physicians would be accountable for the quality of care they provide and be rewarded based on outcomes. The reward would come in the form of more autonomy and higher reimbursements for physicians recognized as facilitating favorable treatment outcomes. "If they're practicing efficient and quality medicine, than there should be no reason why you should micromanage that care," he said.
The planned reorganization calls for annual evaluations of doctors, placing them in three categoriessilver, gold and platinumbased on outcomes. As they go through each level, doctors are rewarded with higher reimbursements and less oversight of their care.
In addition, the claims adjuster would be responsible for all aspects of an injured worker's file, rather than the adjuster handling indemnity while a nurse handles the medical portion of the file. As a former claims adjuster, Mr. Clark said that model is flawed because injured employees have to deal with different people without having a strategic, integrated care system. "I've always said it doesn't make sense making the claimant deal with multiple factions," he said.
Even if the district increases physician compensation to get the best doctors into its workers comp provider group, Mr. Clark said he believes the district will ultimately see significant savings. "If we can cut by 10% the amount of dollars we spend on workers compensation, right there is $3 million," he said. "That's found money" that could be put toward direct education of students.
A few years ago, Mr. Clark spoke to his staff about reconfiguring the workers comp system. He said it was better to allow injured workers to get necessary nonemergency services from a doctor immediately rather than forcing doctors to get authorization before providing medical services, which could result in months of delays, said Carol Erbs, assistant risk and benefits officer for the school district. Mr. Clark felt that the system unnecessarily prevented injured employees from quickly returning to work, she said. "There are a lot of reasons for getting people back to work," Ms. Erbs said, "and this platform should help us do that."
Mr. Clark also expressed distaste for a system where doctors had to justify the care they were providing to a nurse case manager, she said. Doctors "just want to practice medicine," Ms. Erbs said. "We want to let them practice medicine and get rid of all the red tapeÖ."
His planned overhaul of the workers comp system speaks to Mr. Clark's status as a visionary in the industry, observers say.
"It makes sense, but it truly is an innovative way of looking at workers comp," Ms. Erbs said.
The workers comp revamp is "way beyond what most people are able to do," said David Marcus, vp, southeast regional manager at Arthur J. Gallagher & Co. (Florida) and a managing director of Gallagher Public Entity and Scholastic Division, based in Boca Raton. Mr. Marcus has been the district's broker for more than 20 years.
Being responsible for both risk management and benefits has been helpful in his workers comp endeavor, Mr. Clark said, because he can take an approach that's gained adoption in the benefits arena in the past 10 years and apply it to workers compeven though it goes against everything that is typically done in the workers comp arena.
Despite the unusual approach, the board has embraced his plan and Mr. Clark is working with the district's third-party administrator, Gallagher Bassett Services Inc., to set up infrastructure for the revamped program, which goes into effect July 1.
"I'm lucky enough to have the latitude to envision something that I want to do, that I think will be meaningful, and figure out how to make it happen," Mr. Clark said.