Ohio BWC: Workers’ Comp Reform Aims To Improve Injured Worker Care

Columbus, OH (WorkersCompensation.com) - Ohio Bureau of Workers' Compensation Administrator/CEO Steve Buehrer recently joined State Representatives Barbara Sears (R-Monclova Twp.), Craig Newbold (R-Columbiana), Al Landis (R-Dover), Mike Henne (R-Clayton), Jay Hottinger (R-Newark), Bob Hackett (R-London) and John Adams (R-Sidney) in announcing targeted reform aimed at helping injured workers achieve better outcomes by getting them healthy and back to work more quickly.

“Governor John Kasich has asked us to find ways to make the system work better, and these reforms are reasonable steps to help address the most immediate problem of getting injured workers healthy and back to leading productive lives sooner,” said Buehrer. “The longer an injured worker goes without treatment, and the longer they remain off work, the less likely it is they will ever achieve total recovery,”

According to Buehrer, employees of BWC have spent the past year identifying areas for improvement, primarily related to improving declining return-to-work rates. Over the last five years, the number of injured workers with lost-time claims who've returned to work has dropped from 75 percent to below 69 percent.

Prior to seeking legislative reform, BWC initiated a number of reforms that could be done within the authority of the Bureau and its Board of Directors. These administrative reforms included pilot programs to better manage the claims process and more quickly identify candidates for vocational rehabilitation. Also, the bureau has enacted numerous changes, including a drug formulary and pharmacy lock-in program to better manage prescriptions, and created Destination: Excellence a program that provides incentives to employer to focus on safety programs as well as transitional work and vocational rehabilitation programs for injured workers.

Specific elements of the three bills include:
Focusing on creating superior outcomes for injured workers (HB 517)
Too many injured workers are not achieving positive medical outcomes and are unable to return to work in a timely manner. The longer injured workers remain off the job, the less likely they are to have a positive health outcome and successful return to work. BWC, managed care organizations (MCOs), providers, the employer and the injured worker all have a role and each must be held more accountable for a quality outcome. Highlights of this bill include:

• Ensuring care sought in the first 45 days following an injury is paid for regardless of whether the claims is eventually allowed or denied. This will encourage injured workers to seek care-and doctors to provide it-without concern over the bill. If the claim is later denied, BWC will seek reimbursement from third-party payers such as the worker's insurance company;
• Requiring MCOs to create provider networks focused on quality care and return-to-work, and require injured workers to use a network provider after 45 days;
• Encouraging workers to follow treatment protocol and move through the treatment process in a timely manner by tying certain benefits to their compliance with the treatment plan;
• Reward high-performing providers by easing payment processes and offering bonuses.

Focusing primarily on under-performing providers (HB 518)
Providers are a critical part of creating positive outcomes for injured workers. Creating an environment that includes only the best providers will benefit all injured workers in Ohio. Highlights of this bill include:

• Protecting injured workers by codifying BWC's authority to immediately decertify providers who present a clear danger to public health and safety;
• Requiring all provider decertification appeals be made in the Franklin County Court of Common Pleas;
• Protecting the integrity of BWC fraud investigations by keeping investigation records confidential until the close of an investigation.

Focusing on streamlining BWC processes (HB 516)
Workers' compensation costs are a factor in business location and growth decisions. Reducing bureaucracy and providing incentives that contain costs by rewarding businesses for focusing on safety and a quick return to work for injured workers will allow the focus to remain on the recovery of the injured worker, while giving companies more money to invest in growing their business. Highlights of this bill include:

• Saving employers money by codifying their access to rating and discount programs that focus on safety and getting injured employees back to work sooner, including the Destination: Excellence risk management program and BWC's new Wellness Grant Program;
• Providing greater flexibility for state universities by allowing them to participate in self insurance;
• Saving money for schools and local governments with minimal claims by allowing them to participate in the One Claim Program;
• Eliminating the additional premium assessment for older claims where the worker is permanently and totally disabled;
• Reducing bureaucracy by removing some requirements related to printed materials and certified mail.

A pdf fact-sheet on the three bills is also available: Ohio BWC Legislative Reform

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