Before the weekend can start in earnest (I have made a commitment to clean out my car and wash the dog), I thought I should share some commentary about a process that has been underway in Tasmania over the last six months or so.
In my earlier post, Let Me Explain I mentioned my roles as the Convenor of the AMA Tasmania Workers Compensation Reform Committee and as convenor of meetings between the AMA and representatives of the insurance industry, known as the AMA Insurer Forum (AIF).
It is not possible to provide independent commentary about a process where you are directly involved, but the process is certainly worthy of mention. My involvement declares my personal support for such initiatives.
The impetus to the process was the growing frustration by doctors about poor outcomes for a relatively small proportion of workers injured (or claiming to be injured) at work. The AMA agreed to set up a committee of concerned members, and following liaison with representatives of the private insurers, and later the self-insurers, a process was set up to facilitate dialogue. It was an opportune time as the new Tasmanian Liberal government was due to review the workers compensation legislation and had also expressed an interest in ‘Red-Tape’ reduction.
It emerged that there was common ground between the insurers and doctors in some areas. The WorkCover Board in Tasmania which oversees the system has voting representation for workers and employers, but doctors and insurers as key ‘players’ have no voting representation, only practitioners nominated by the Minister with expertise in their respective fields, not true representation or voting rights.
There was also commonality of concern about lack of communication and understanding between doctors and insurers that was contributing to the poor outcomes for injured workers and the costs of the scheme. There was also agreement that impairment assessment methodology where spinal surgery had been undertaken required review, although the issues for doctors and insurers were somewhat different.
As a result of the process the AIF was able to produce a joint submission to Minister Peter Gutwein. The submission included recommendations for immediate priorities that fitted within the Government’s ‘Red-Tape’ reduction priority over the next six months and recommendations for more fundamental changes to be considered in the long-term.
The AMA, in particular, was keen to explore what has been called a ‘Complex Case Management Model’ where the doctor involved in the “early” stages of management of a work injury is empowered to consider prognostic factors and identify “complex” cases. The AMA recommended that cases flagged as “complex” could be streamed into an alternative management pathway managed by a medical practitioner with enhanced skilled in “complex case management”.
In addition, the AMA expressed concern that workers compensation processes had been dominated by a legal adversarial approach to the detriment of optimum health and rehabilitation management. Higher level input by the medical profession was seen as necessary to balance the system more in favour of health outcomes.
I previously expressed concern about lack of research data about compensation systems.
However more research is being done. Just yesterday the ISCRR’s Alex Collie has publicised relevant research on the importance of health professional interactions with insurers.
It seems clear that processes such as the dialogue between insurers and doctors occurring in Tasmania can be more productive with the increasing evidence base about factors that affect outcomes for those injured at work. Discussion no longer need to rely entirely on personal perspectives and opinions, but on some more solid, if incomplete, data.
The AIF Joint Submission has now been widely circulated to interested parties in Tasmania and is available for those interested to read the detail.
Here is a link: AMA Insurer Joint Submission
The preamble provides some perspective:
‘AIF’s key initiative is the need to achieve better health outcomes for workers in the Tasmanian Workers Compensation system through mechanisms such as balanced decision-making models incorporating medical and injury management input at a case and strategic level. This can be achieved by:
* initiating alternative injury management pathways,
* early identification of complex/long-term injury cases, and
* establishing mechanisms to monitor the quality of medical input
AIF also identified that communication between doctors and the insurance industry will need to be further enhanced to ensure more collaborative working relationships are established to achieve our key initiatives.
Enhancements in the way injuries are managed in accordance with these principles has potential to expedite recovery time, lower the risk of secondary conditions and improve return to work outcomes. These measures will ultimately reduce the direct and indirect cost of work related injuries, including employer premiums. The community as a whole will also benefit from a reduction in the impact of chronic ill-health and disability.
AIF agree that ‘simple’ injuries that account for up to 90% of all work related injuries are well catered for in the current system. The focus of attention of the AIF has been to consider measures to enhance the management of the more serious or ‘complex’ cases that the statistics indicate account for the majority of financial and human costs.
The challenge is to identify these cases as early as possible after injury/ disease onset so that medical and rehabilitation resources can be used more effectively to improve outcomes.’
Dialogue between key ‘players’ in workers compensation is key to mutual understanding and improvements in the system!