Managed Care caseloads thwart effective management
Joseph Paduda of Health Strategy Associates and a nationally-recognized expert on Workers’ Compensation, managed care and general health cost containment, points out that many Worker’s Comp claims adjusters carry a caseload of 160 lost time claims. “How do they have time to ‘manage’ any case?” His answer is clear: “There is no possible way an adjuster can dedicate the time and brain power necessary to effectively manage claims with a caseload that high.”
He points out, somewhat cynically, that with many of these cases “there’s little going on––except continued use of medications, in many cases physical therapy, and the odd surgery to repair an older fix or replace a surgical implant worn out by use or otherwise defective.”
Paduda indicates that newer claims require adjusters to “initiate the three point contact (actually four in most cases) within a predetermined time, set up the case, conduct an investigation into causality, establish liability, ensure reports are filed in a timely manner, determine the initial reserve and coordinate medical management.”
Then there are the established cases that require ongoing contact with case management, voc rehab, the injured worker, attorneys, if represented, employer, and likely the injured worker’s family. “Medical bills have to be approved, drugs authorized, surgeries and hospital cases ok’ed, voc rehab plans reviewed and then discussed with management,” he says, noting that “these just hit the highlights.”
According to Joe Paduda, “Employers who buy claims adjusting services on the cheap will get exactly what they bargain for––poor quality from overburdened, frustrated and ineffective adjusters.” Instead of saving money, the Workers’ Comp costs climb higher.