By Eugene F. Keefe
 

Synopsis: "Implants" in Illinois workers' compensation for more than $150,000. Is anyone at the IWCC listening?
 
Editor's comment: After an earlier article about what we thought were wildly high costs for artificial discs, we are now learning of a very strange new pricing practice hitting our defense clients. Turns out anything that is arguably "implanted" as part of a workers' compensation surgery is being wildly overpriced to the point of gouging. We cannot prove it but our sources tell us the hospitals aren't billing the same amounts for non-work-related surgeries of precisely the same nature.
 
We are told the "implant" community fought and lobbied and donated monies to Illinois politicians to keep their products out of the limitations imposed by the Illinois workers' compensation medical fee schedule. We know our readers are stunned to hear Illinois politicians from the prior administration might actually succumb to such things!! As the implants are not on the schedule, we are seeing bills where less than a pound of screws, cages or rods are now being billed at $100,000 to $200,000 in costs to Illinois business.
 
For example, we have a hospital bill for a cervical fusion that is $280,000. It is from a small hospital in southern Illinois. Please note that staggering amount for a surgery that takes about 45 minutes — if you are doing the math that is about $6,200 per minute for a clean, well-lit room and instruments. The surgeon and post-surgical care are all extra.
 
The bump in costs is the hospital is charging $10,000 to $20,000 for each "implant" like screws or cages. Please understand the actual cost of a titanium screw is fractionally lower. The only justification for the claimed cost is the absence of such products on the fee schedule and the hospital is willing to accept 76% of the billed cost under Illinois law.
 
We are battling this and hope we can get an arbitrator from that area to stop the gouging. We are told many Illinois arbitrators are hearing more and more complaints about the practice and they are using common sense to stop it. We applaud them for doing so.
 
But we truly hope the governor, Illinois Attorney General and the Workers' Compensation Medical Fee Schedule Advisory Board and that "Commission" itself start to investigate this practice. If the perpetrators are only pricing things in this fashion for workers' compensation claims, it clearly is gouging Illinois employers and must be administratively stopped. If that isn't enough to get it to end, we urge our administrators to make recommendations to the Legislature to make it end.

 
Synopsis: The battle between workers' compensation benefits and group health care/STD is going to continue.
 
Editor's comment: When you offer short-term disability (STD) and group health care, don't "deny" WC claims — just drive them into the lower-cost path. Our research indicates workers are continually analyzing and comparing disability benefit offerings against potential workers' compensation payments to learn which of the two systems provides easier and more lucrative benefits. Then they are steering disability and injury claims into respective the work comp system or disability benefits area, depending on which would provide the greatest or possibly longest-running payments.
 
Our sources and research indicate "benefit shopping" is driving some employer's severity and exposures higher and higher. The concept is being fueled by the biggest recession of our lives and workers who face layoffs and an uncertain future.
 
Our focus is to avoid fully and adequately investigating a claim and then "denying" it as workers' compensation. We feel this practice unnecessarily acts like a "slap in the face" to someone who truly has a problem. We feel you are much better served to try to keep the employee happy by letting them know you have a system that is a viable alternative to workers' compensation. The only significant difference between group health care and STD in relation to workers' compensation is permanency — in Illinois, avoiding PPD is a win-win for Illinois business. And most health care and STD systems already implement utilization review and loss time in a way our Illinois WC system has not yet caught up to.
 
So when you get a new claim of injury, have everyone fill out your accident form and HIPAA-compliant release. If you fully investigate and learn there are questions about the compensability of the claim under WC, don't "deny" it, just shift the employee's focus to your STD and group health care systems.
 
If you have thoughts and comments about this approach, please send a reply.
 
       
Synopsis: Midwest Orthopaedics at RUSH is moving!
 
Editor's comment: We know may veteran attorneys, IME providers, nurse case managers and claims handlers are used to the old River City digs for Midwest Orthopedics at Rush. If you are going to set an IME or schedule a deposition, please make sure to note Midwest Orthopaedics at RUSH will have a new home in Fall 2009. The new facility will be located in a new building at the Rush University Medical Center campus at 1611 W. Harrison, on the corner of Ashland Ave. and Harrison St.
 
The building will house the top-ranked physicians known for innovative, quality care in subspecialties including sports medicine, joint replacement, upper and lower extremity reconstruction, spine surgery, cartilage restoration, pediatric orthopaedics, limb preservation, trauma, and orthopaedic oncology. The new Orthopaedic Building at Rush University Medical Center is a single site, multidisciplinary center that contains all aspects of orthopaedic care including:
.         State-of-the-Art Digital X-ray
.         Physical and Occupational Therapy facilities
.         State-of-the-Art Advanced Imagine Center (CT and MRI), available to doctors to eliminate the need for additional appointments.
.         Rush's Motion Analysis and Gait Lab
.         Orthotics and Prosthetics Services
The new facility's efficient design will allow for an enhanced patient experience in diagnostic services and outpatient procedures as well as convenience for inpatient care with its proximity to the Rush University Medical Center.
 
For more information about their new facility and/or Midwest Orthopaedics at Rush or to schedule an appointment, visit www.rushortho.com or call 877-MD-BONES.
 
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Eugene F. Keefe is a partner in the Chicago law firm of Keefe, Campbell & Associates.
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