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Florida eyes California’s medical review process for comp savings

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California’s 6-year-old independent medical review program for workers compensation claims could be a solution to keeping Florida’s workers compensation costs low, according to a report released Tuesday by Florida TaxWatch.

The report examined how California implemented it “cost-effective, non-judicial process… in which disputes about the medical treatment of injured workers are resolved by physicians instead of by the courts,” according to a statement by the Tallahassee, Florida-based independent watchdog.

“This program enables more efficient resolution of claims while reducing the need for lengthy and costly judicial processes and provides states with the opportunity to re-invest these cost savings into further program improvements,” said Tom Naughton, President of Maximus Federal Citizen Services Inc., a Reston, Virginia-based firm that helps manage government programs and helped develop the California IMR process, authorized with S.B. 863 reforms in 2012.

That IMR process was approved “with the expectation that IMR would reduce workers compensation disputes once doctors, attorneys, and other participants came to understand which services could be approved because they meet evidence-based medicine standards,” the report states.

If a similar process were to be applied in Florida, it could result in a reduction in lien costs, expedited hearings, a reduction in temporary disability duration, a reduction in litigation costs, and the supply of opioids being limited, according to the report.

In 2016 in California, nearly 250,000 applications were processed under that system and of those, 69% were determined to be eligible for review, the report states. Concurrently, 176,002 cases were decided through the IMR process, involving 343,141 treatment request decisions. Overall, 8.4 % of these treatment request decisions were overturned, meaning the independent medical review organization decided that the disputed service was medically necessary and appropriate 91.6 % of the time, according to the report.

During 2017, 91.2% of utilization review decisions appealed to California’s IMR were affirmed; in the first half of 2018, 90.1% of UR decisions appealed to IMR were affirmed, according to the report that urged Florida lawmakers to take notice.

“Workers compensation is a critical safety net to protect Florida businesses and families,” said Florida TaxWatch President and CEO Dominic M. Calabro in a statement. “If the state policymakers want to continue to grow Florida’s economy, it is imperative that the legislature take the IMR process into consideration.”