With extremely rare exceptions, workers’ comp payers — and PPO networks — are doing next to nothing about quality.
Let’s compare two hospitals near Jacksonville, Florida. Using publicly available, free data (thanks to Rand), Baptist Medical is pretty good. It has four out of five stars on the CMS Hospital Star Compare rating system, the most widely accepted quality rating metric.
Over the bridge is an HCA facility, Orange Park Medical Center, with two stars, below average on CMS’ scale.
Both facilities are in multiple workers’ comp PPOs, none of which indicate the large gap in quality between the two. Or any other quality measures for any other facilities.
There’s a cost difference as well. And no, you don’t get what you pay for.
The higher-rated facility costs less: Baptist gets paid about 2.6 times Medicare’s rate for care delivered by private insurers; Orange Park is four times Medicare.
What does this mean for you?
Want to show you care about the quality of care delivered to injured workers? Send them to good facilities.
Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.
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