Amended SB 563 Would Require UR Contracts Disclosed to AD
So there I was, dear readers, just minding my own business, when a gentleman wearing a hat, trench-coat, and dark glasses sat next to me in the cafeteria of one of the WCAB boards. “Shhh… don’t look up, they’re watching us.”
“Us?” I thought to myself…
Captain crazy continued – “I’m on to it, maaaaan, I finally got a lead that’s going to bring the whole thing down. The insurance companies – they’re paying millions of dollars for every utilization review report to deny treatment.”
I had the same reaction as I expect you would, dear readers. Apparently, this… umm… “gentleman” was under the impression that there was some major conspiracy to pay UR vendors to recommend denial of treatment that would otherwise have been authorized. Research from the CWCI reflects that the vast majority of California workers’ compensation treatment gets authorized, but perhaps there is a conspiracy out there after all? Perhaps between discussions of concealing the existence of extra-terrestrials and slipping fluoride into our drinking water to pollute our precious bodily fluids, the smoky rooms are all a-chatter with rigging the UR system?
Before I could ask my new friend about what information he had acquired, I heard the rapid footsteps of men in white coats rushing down the hall. In a flash, before he could reveal the truth to me, this crusader for truth was gone…
Well, never fear, dear readers, as it appears word has gotten out. Senate Bill 563, as amended, would “prohibit the employer, or any entity conducting utilization review on behalf of the employer, from offering or providing any financial incentive or consideration to a physician based on the number of modifications, delays, or denials made by the physician.”
Labor Code section 4610(e) would be amended to not only prohibit these incentives, but to provide the Administrative Director with authority to review any payment arrangements between an employer and a UR vendor.
As this humble blogger’s not-so-humble readers will recall, this proposal was reviewed on this humble blog not too long ago, but the language was a lot more offending: the information, essentially, would have to be made available to any member of the public. Now, the power to demand inspection is limited to the Administrative Director. At the very least, we’re moving away from the initial craziness.
But, the bill still provides additional burdens of regulatory compliance to the employers and insurers. It still exposes the parties to having to reveal their bargaining power and position, which might make negotiation a bit more difficult (“You want to charge Courage Insurance Company $200 per report? But I know you’re only charging Bravery Insurance Company $150!”).
What do you think, dear readers, is this a big deal? Should UR vendors just start attaching the invoice for every UR report to the report itself? Is there anything worth hiding? Or perhaps your humble blogger is just getting paranoid (that’s what THEY want me to think!)
Have a good weekend, folks!