2010 has been a busy year for WOEMA’s legislative activity, with the California Division of Workers’Compensation formally launching its effort to revise Official Medical FeeSchedule at time when while pressure is growing to control medical costs andrevise the permanent disability schedule. Also this year, WOEMA has also offered to engage withCal/OSHA on revision of the lead standard and other regulatory activities. And while relatively little legislationpertaining to Occupational Medicine was advanced in the state legislatures,WOEMA did lobby Sacramento policymakers on several bills that would affect ourmembers’ practices and patients.
Representation: Dr. Schumann, Dr. Levy and Don Schinske, representingthe interests of WOEMA, participated in discussion at the CMA Council onLegislation, where the CMA begins to develop policy on proposed legislation.
As well, Dr. Schumann sits onthe CMA Workers’ Compensation Technical Advisory Committee, joining indiscussion and debate regarding the CMA’s position on legislative andregulatory issues. Don Schinske participated in parallel discourse with the CMAand legislative analysts also on legislative and regulatory matters.
Official Medical Fee Schedule: Over themonths of March through July, DWC issued three different proposals for a newRBRVS-based fee schedule, collecting input on each. WOEMA has:
- Commented on each proposal
- Issued an alert to our members, urging them to comment directly to DWC
- Testified in an August stakeholder meeting (Dr. Levy, Dr. Swann, and Don Schinske)
- Met with DWC staff several times as well as Dept. of Industrial Relations Director John Duncan (Dr. Schumann, Dr. Levy and Don Schinske)
WOEMA has worked closely with CMA and the other specialties on the DWC proposals. Understandably, physicians are a split on the latestproposals, largely depending on how their reimbursement would be affected. However, all specialties have been ableto advocate together for certain features, such as the inclusion of CPT codesfor consultation and a medical inflation index, and against others, such as thewholesale adoption of Medicare billing ground rules.
As of yet, DWC has yet toenter formal rulemaking on a revised OMFS. (And time grows short, with a new Administration taking overin January). Although the latestproposal is far short of ideal, WOEMA generally supports its use of threeconversion factors that boost payments for the Evaluation & Managementcodes while some surgery and radiology codes are potentially decreased by alittle.
Other Workers Compensationissues: Driven by industry proposals for double-digit premium increases, the California Insurance Commissioner and the Commission on Health, Safety and Workers Compensation (CHSWC) have been exploring the drivers ofsystem costs. Medical liens and compounded medications have received particular attention. Dr. Paul Papanek represented WOEMA and CMA at a meeting in Insurance Commissioner Steve Poizner’s office to discuss medicalliens. In addition, WOEMA engaged in some late-session maneuvering around AB 2779 (Solorio), a bill to requiringprior authorization for prescription of compounded medications. WOEMA representatives met with theauthor’s staff and CHSWC representatives to discuss amendments to thebill. Ultimately, the bill stalledin policy committee (WOEMA stayed neutral, while CMA and CSIMS opposed) butwill surely be resurface in some form next year. Likewise, we can expect to see bills next year that addressthe issue of medical liens, as CHSWC is considering data that suggests thatalmost a quarter of the medical dollars spent in the system are part of alien. Dr. Levy and Don Schinskeattend CHSWC meetings.
Cal/OSHA: Drs.Papanek, Levy, and Don Schinske met with Cal/OSHA Chief Welsh to exploreopportunities in which WOEMA could participate in the Division’sactivities. Several ideas werediscussed, including WOEMA participation in updating the state’s lead standards- a move we are pursuing currently with Cal/OSHA staff. In addition, the three WOEMArepresentatives attended an August workgroup of federal OSHA in Sacramento onthe subject of expanding California’s Injury and Illness Prevention Program nationwide.
Legislation: Inaddition to AB 2779 (above), WOEMA lobbied on the following bills:
AB 933 (Fong), a CSIMS-sponsored bill to require UR physicians to belicensed in state. Governorvetoed.
AB 1600 (Beall) – WOEMA urged Governor Schwarzenegger to sign thisbill, which requires coverage of mental health by all full-service Knox-Keenehealth plans. AB 1600 is still onthe Governor’s desk
AB 2253 (Coto), extends length of time that cancer in firefighters ispresumed to be work-related;
AB 2269 (Adams), extends the presumption to hospital securityofficers who get heart trouble;
AB 1994 (Skinner) extends the presumption to hospital workers who getMRSA, H1N1, or neck or back impairment.
WOEMA expressed concerns on all three bills, on narrow grounds that such extensionsare not supported by scientific evidence. Only AB 2253 has reached the Governor’s desk.
SB 1050 (Yee) – WOEMA-supported bill to remove two naturopathicdoctors from the Osteopathic Medical Board of California. Governor signed.
WOEMA’s Voice Heard at FedOSHA Conference
Federal OSHA is poised to enact new regulations on preventive planning for workplace health and safety that may be among the most significant steps OSHA has ever taken to protect American workers, as it considers a new Standard on Hazard Communication that would be modeled after California’s requirement for Injury and Illness Prevention Plans (IIPP’s). On Tuesday, August 4, 2010, Dr. Paul Papanek represented WOEMA at a stakeholder meeting held by Federal OSHA in Sacramento, aimed at gathering information about how best to craft such a Standard. WOEMA and ACOEM have championed such a step by Federal OSHA, arguing that a national requirement for Injury and Illness Prevention Programs would raise the bar on worker safety, and level the national playing field, since over 20 states in addition to California already require some version of IIPP’s.
Among the nearly 40 stakeholders at the meeting, most of whom spoke strongly about the likely benefits of such a new regulation, WOEMA argued for more involvement by Occupational Medicine physicians in preparing IIPP’s, particularly in workplaces where medical surveillance is required. WOEMA also urged Federal OSHA to explore mechanisms to incorporate health and wellness planning into IIPP’s, particularly since we know that reducing health risk factors correlates with decreased reported injury rates.
OSHA announced that it will probably require another 18 months before the promulgation of a final rule, and OSHA is expected to publish the proceedings of this and other stakeholder meetings on its website in the fall.
The California Division of Workers’ Compensation (DWC) issued a new draft revision of its fee schedule for physician services. WOEMA members were alerted and urged to send comments (by July 20) on the draft Official Medical Fee Schedule (OMFS) to the DWC’s online forum: DWCForums@dir.ca.gov.
DWC’s new proposal contained the following key features:
1) Implementation on Jan. 1, 2011 of an RBRVS-based schedule with three conversion factors: one for surgery, one for radiology, and one for all other codes.
2) Transition to current CMS (Medicare) ground rules for determining E&M codes.
3) No changes in reimbursement for completing PR-2 forms (the current rate is $11.69).
For Primary Treating Physicians who bill under the Evaluation & Management codes, the anticipated change in reimbursement under the proposed schedule would depend on a number of factors, including the specific code, changes in coding practice under the CMS ground rules, and the loss of any current adjustments based on geographic practice area (GPCI). Early calculations suggest modest increases for each E&M CPT code.
WOEMA made the following comments as an organization sending comment to the DWC Forum:
1) The minimum conversion factor for all codes should be set at 45. The proposed conversion factor of 42 for E&M codes is simply too low, given the historic underpayment for cognitive services. In its March 2010 updated report on the RBRVS conversion, the Lewin Group calculated a conversion factor of 45 based on adoption of a single conversion factor and dollar neutrality. Although it may be necessary to adopt more than one conversion factor, the minimum conversion factor for all codes should be set at 45 to adequately align incentives within the system.
2) The conversion factors must be indexed to medical inflation, preferably the Medicare Economic Index (MEI).
3) The new proposal should not adopt the CMS (Medicare) ground rules in total. Medicare patients and injured workers have different profiles and different treatment needs. Each specific ground rule should be considered for applicability to Workers Compensation and for the effect of any downcoding on payment and treatment.
4) Payment for completing PR-2 reports should equal that of the PR-4 and other reports.
5) The new schedule should set appropriate fees for the E&M consult codes, series 9924x.
6) The proposed fee schedule continues the practice of the multiple procedure payments or “cascading” of fees associated with Physical Therapy. This process of cascading is not followed by Medicare. The value of each procedure and the work required to provide those services are not reduced just because multiple services are delivered on the same date.
WOEMA’s advocacy requires the support and participation of all its members, and we very much appreciate your help. Questions? Contact WOEMA Lobbyist Don Schinske.
Cal/OSHA and WOEMA Explore Areas for OEM Physician Service
In a May 27 meeting initiated by WOEMA Chairman Steve Schumann, MD with WOEMA representatives, California Dept. of Industrial Relations Director John Duncan and Cal/OSHA Chief Len Welsh invited experts among the WOEMA membership to “roll up their sleeves” with Cal/OSHA officials to explore where WOEMA can assist the division in its regulatory efforts.
Chief Welsh proposed holding a working meeting in the next three weeks in which several WOEMA representatives could meet with him and his staff in Oakland to explore who has particular expertise and where it can be deployed. Welsh listed a range of areas in which WOEMA members might possibly be of service, including as advisors for development of Permissible Exposure Limit (PEL) standards, the division’s effort of gain permanent approval for its State Plan, or as expert witnesses.
WOEMA will recruit members with relevant expertise to participate in this effort. It represents a fantastic opportunity for public service and to build the profiles of both WOEMA and Occupational Medicine.
WOEMA Board Chairman Steve Schumann, MD