Workers' Compensation

Medical Director, Northeast Corridor Metropolis

Challenge:

When a Northeastern state legislature required a large metropolitan city's workers' compensation system to reduce fraud and regain control of runaway costs, a third party administrator (TPA) was hired. We were asked to provide medical oversight for the program.

Solution:

The TPA negotiated contracts with city hospitals, clinics and providers delivering care to city workers. It chose to go outside the city to hire one of our physicians, an independent individual who had no ties to the community, as the acting medical director. We reviewed claims, care delivered and disability decisions and made recommendations to the Pension Board. Within one year, costs for medical/surgical care were brought under control and Workers' Compensation costs for disability and pension decisions were reduced.

Reflection:

Once the local medical community recognized that both quality and cost of care were under scrutiny, the era of the "open checkbook" ended. Moreover, with confirmatory evidence that disability and pension decisions were regularly being scrutinized and aggressively addressed within the Workers' Compensation system, loose awards practices gradually tightened.

Other Case Studies