As the Division of Workers' Compensation heads into its public vetting at the Sunset Advisory Commission, the Texas Association of Business is opposing proposed recommendations to change the medical quality review process for investigating unscrupulous doctors, a process that is currently under controversy. The association historically has carried much influence in changes to workers' compensation, as insurance premiums have systemic effects on business in Texas.
"They have the tools, they just haven't been using them to the best of their ability," said Cathy DeWitt, TAB's lobbyist. "This is such an appropriate place for the Commission to go, what will work better? It's always tough when you're working within worker's comp. Bad actors reflect badly on the really good doctors."
For those of you who are just joining in, here's where we are in the Sunset vetting: Over the past several months, the Sunset Commission staff researched the division and wrote recommendations for streamlining its processes, based largely on questionnaires and interviews with division leadership. The 10 lawmakers and two public members of the commission then get to take a vote on those recommendations this week. Complicating matters, a medical staff exodus and former employees coming forward to call out what they say isl a "broken system" happened after the staff reviews were nearly complete. But it's not too late for amendments.
"Any member can modify the recommendations," said state Sen. Glenn Hegar, R-Katy, the commission's chair.
So the business association is adding its considerable voice to the small chorus of former employees who oppose sunset's recommended changes to the medical quality review process. The process at issue lays out how the state's workers comp doctors are selected and investigated for violations like overtreatment or overbilling.
DeWitt is planning to briefly testify at sunset on Tuesday. The full draft of association comments are available at the link, but below is the part regarding the medical review process. The current sunset recommendations are in bold, followed by the business group's positions and explanations for opposition.
2.1 Require Division staff, rather than the Medical Advisor, to manage and oversee the medical quality review process.
DISAGREE. TAB questions the use of Division staff that does not have the medical expertise and qualifications to manage and oversee the medical quality review process. TAB feels that this would dilute the ability of the Division to effectively evaluate the quality of care for injured workers if there is no Medical Advisor to lead this effort.
2.2 Require the Division to develop guidelines to strengthen the medical quality review process.
OPPOSE. Currently, guidelines are already in place, but there has been no follow through by the agency to impose sanctions on medical providers who are providing inappropriate care. Much focus has been placed on providers’ administrative violations with fines being frequently levied on providers for paperwork violations. While paperwork is important, patient care should be a priority and abusers should be penalized promptly after a proper investigation.
2.3 Establish a more streamlined medical review process by removing the Quality Assurance Panel's involvement.
OPPOSE. The Quality Assurance Panel provides great expertise to the medical review process by reviewing recommendations of the Medical Quality Review Panel.
2.5 Require the Division to work with health licensing boards to expand the pool of Medical Quality Review Panel members.
OPPOSE. This is unnecessary. The Division already receives input from health licensing boards.
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