On Friday, December 19th, 2014 I testified at a hearing before the New York State Assembly in connection with the 2015 Health Budget regulations proposed by the Workers Compensation Board.
The meeting was presided by Assemblyman Kevin Cahill (Chairman of the NYS Assembly Insurance Committee).
These regulations will result in a serious reduction of payments to certain medical practitioners, especially orthopedic surgeons, radiologists, chiropractors (and other providers of conservative care).
Here is what I learned:
1) The Fee Schedule is promulgated as a regulation (versus part of the Budget Bill) and thus neither the Assembly, not the Senate have any legislative power to address the proposal.
2) The Workers Compensation Board (herreinafter “WCB”) proffered testimony via Mary Beth Woods (Acting Executive Director of the WCB). Essentially, WCB is recommending the fee schedule changes to “simplify medical billing, insure prompt payment, and facilitate streamlined exchange of medical records.” She further testified that a “medical portal” will give medical providers easy access for billing disputes, medical documentation” by employing a software to achieve these goals.
Orthopedic,Neurosurgeons, chiropractors, and providers of conservative care will suffer drastic cuts in their fees. Providers of conservative care (the front line for acute injuries) will suffer 50% decreases in already low fees. Primary physicians will show a much higher increase.
Ms. Woods stated that the changes had a “zero economic effect” and the purpose of the changes was to facilitate a streamlined process (as stated above) and to update the fee schedule to reflect how the medical profession deals with work related accidents in the 21st century.
3) The Chairman seemed to be on the offensive with his questions, specifically how the WCB justified changes in the Fee Schedule when there is no economic upside. He was poignant in his attack on how the changes would have a negative effect on the quality of care that persons with work-related injures (and those injured in motor vehicle accidents). He focused on the WCB’s lack of studies to address the impact of these changes. Additionally, Mr Cahill discussed how Texas and Hawaii had implemented the same changes and how those states are proven failures on the issue of WC Fee Schedule reduction. The WCB Director claimed that the proposed system was successful in many other states, but she failed to identify those states (and how their so-called “successes” could be described).
4) It should be noted that the Fee Schedule (“FS”) rates would be equivalent to “Medicare rates Plus 20%.” An example provided was under current FS rates for an arthroscopy of the shoulder, an orthopedic surgeon is paid $1635. Under the proposed FS, the rate would sink to less than $950.
5) It was noted by Chairman Cahill that the NYS Department of Health had not been contacted by the WCB for discussion and this violates the Public Health Laws.
6) On behalf of the Staten Island Trial Lawyers Association, I testified as to the significant and negative impact the proposals would have on the injured worker and accident victim.
Injured persons would receive low quality health care due to the expected exodus of competent medical providers from No Fault and WC system.
If injured persons were not healing well or recovering quickly, the local economy would suffer. Workers would not return to work and families would be without a breadwinner.
No Fault and WC currently provides an even playing field for injured persons, regardless if they are a CEO or a day laborer. The proposals would put the working poor without a safety net.
Emergency rooms (already overburdened) would see an increase in patients seeking care for acute injuries.
Lastly, I testified that Staten Island is unfortunately the epicenter of the Oxycodone Epidemic. If injured persons are unable to find adequate conservative care,then they will be huddled into Pain Management (i.e., opiate drug therapy). This will place tremendous stress on our hospital, police, and families.
Conservative care (e.g., chiropractic, PT, acupunture) are cost effective and promote prompt healing. If they are cut out of the equation, we can expect negative long term health care effects.
The overall tone of the hearing was against the proposals. Our only hope is that with enough pressure exerted on the Governor, the WCB will cave in and not implement these regulations.