Pennsylvania’s Discussion to Adopt Nationally-Recognized EBM Treatment Guidelines

Regulators, stakeholders, and shareholders continued the discussion on evidence-based medicine (EBM) treatment guidelines by way of HB1800 in Harrisburg, Pennsylvania late last week. The discussion was comprehensive and, at times, passionate – as it should be when discussing the well-being of injured/ill workers.

The hearing agenda was structured allowing only invited panels to testify before the well-attended committee. Invited panels included Pennsylvania Department of Labor and Industry (DOL&I), Healthcare (addressed the committee as Medical Providers and Employers), Business, Legal (representing Claimant Attorneys and Defense Attorneys), and EBM Industry.

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The Pennsylvania House Labor and Industry Committee heard well-positioned and statistically-supported testimony for more than 2 hours. Please be advised that this entry is to provide a sampling of what was presented and is not intended to be a complete summary of the hearing.

As expected, the recurring theme from stakeholders and shareholders opposing HB1800 was the objection and concern of a “one-size-fits-all” and “cookie-cutter medicine” approach. Interestingly, the State’s DOL&I, along with several committee members, expressed the sense of a “stable” system (based on yearly decreases in associated costs to employers) and the perception that the process is “not broken“. Reports of favorable patient satisfaction scores further supported their position for not passing the bill.

Specifically, Michael Vovakes’, DOL&I Deputy Secretary for Compensation and Insurance, testimony stated “…such a change is nothing more than a solution in search of a problem.” Citing the Bureau of Workers’ Compensation’s annual medical access study, approximately 90% of all injured workers believed that they received timely, appropriate and satisfactory medical care for their work-related injuries. Scott Weiant, Director of Bureau of Workers’ Compensation, echoed Mr. Vovakes’ position to oppose HB1800 stating the associated costs paid to carriers decreased from $7.6M in 2014 to $5.4M in 2015.

Proponents of HB1800 addressed concerns with the State’s rampant over-prescription of Opioids, lack of URO certification requirements, and high litigation costs due to the subjectivity of treatment that is considered “reasonable and necessary” for work-related injuries. The urge to adopt nationally recognized evidence-based guidelines was further supported by the business panel’s report that Pennsylvania employers pay workers’ compensation premiums that, on average, are higher than the national mean.

The Pennsylvania Chamber of Business and Industry Director of Government Affairs, Alex Halper, testified that a significant cost driver in Workers’ Compensation is the over-prescription of Opioid pain-killers. Citing the Workers’ Compensation Research Institute’s (WCRI) “Interstate Variations in Use of Opioids” report, Pennsylvania ranked 3rd among 25 States analyzed. Pennsylvania’s “Average Morphine Equivalent Amount per Claim with Opioids” measured 78% higher than the median State.

The Chamber of Business and Industry further reported that premiums costs have increased for more than 1/3 of employers surveyed in August of 2015. Of 650 Pennsylvania employers (both Chamber members and non-members), nearly 40% of employers reported premium increases in recent years.

Of Pennsylvania’s “family-owned” businesses (59% of respondents) 47% reported increases in premiums. Mr. Harper further clarified that the state-wide cost decrease cited by DOL&I is due to a decline in frequency of workplace injuries; whereas the average cost per claim continues “to increase significantly“. Halper continued, “It is false to suggest that workers’ compensation costs on employers are generally going down.”

It was evident after the hearing that a second round of testimony may be needed to allow stakeholders/shareholders who were unable to participate due to time constraints to share their positions on the bill.

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As a sidebar comment from the writer of this post, it is interesting that patient satisfaction scores were referenced in opposition of HB1800. Patient-centric medicine is not always synonymous with high patient satisfaction scores. This is particularly true when a treating provider recommends against prescribing a pharmaceutical agent that the patient is requesting, such as pain-killers.

It is not surprising however, that 90% of patients in Pennsylvania are satisfied with the care they receive. A preliminary report from the WCRI on “Indemnity Benefits per Claim” compared 18 States’ payments per claim and disability duration per claim. Pennsylvania ranked 4th highest on payments per claim (~$20K) and 2nd longest in duration per claim (23 weeks). These findings may suggest the potential of patients driving the medical process causing longer than normal duration of disability and driving up indemnity benefits paid per claim.

There is more work to be done in Pennsylvania educating regulators, stakeholders, and shareholders. But in my humble opinion, Pennsylvania stands to gain and improve from the adoption of nationally recognized EBM treatment guidelines.

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