At a June 26 meeting of California’s Commission on Health and Safety and Workers’ Compensation, daisyBill co-founder and CEO Catherine Montgomery detailed some of the serious administrative obstacles providers face when treating injured workers.

Catherine Montgomery

DaisyBill’s testimony left commissioners with “their jaws open,” in the words of CHSWC chair Nicholas Roxborough.

CHSWC recommends improvements to the workers’ comp system, reporting directly to the Department of Insurance and the governor. With hard evidence and verifiable data, we offered CHSWC a glimpse of the severity of the burdens imposed by the chaotic medical provider network system, onerous treatment authorization requirements, and antiquated paperwork and reporting mandates from the California Division of Workers’ Compensation. 

The data we shared drew from millions of bills for injured worker treatment that California providers submitted through daisyBill. Those data represent the real-world experience of more than 4,100 California providers. In the absence of any functioning comprehensive statewide database, this is one of the most significant sample sizes available from which regulators can reasonably infer statewide trends.

With California employers’ premium rates set to increase for the second consecutive year (even as other states lower rates), reduced access to care due to flagging provider participation can worsen injury outcomes and compound employers’ costs, further eroding the return on investment in those premiums. 

We commend CHSWC for opening a forum to discuss the systemic issues currently deterring providers from taking on comp patients. We encourage stakeholders to watch the meeting recording and review the written comments daisyBill submitted to the commission. 

CHSWC’s good-faith efforts to encourage stakeholders to report the facts on the ground, and commissioners’ willingness to hear difficult truths, are the first necessary steps on the road to much-needed reform. 

CHSWC: Diagnosing the crisis, seeking real solutions

The centerpiece of the meeting was a panel and roundtable discussion examining workers’ comp medical care delivery, a notoriously inefficient process encumbered by administrative hurdles, with California claims costing twice as much and taking twice as long to resolve as the median state.

DaisyBill presented remarks following up on written comments we submitted in response to Dr. Basil R. Besh’s recent reform proposal, accurately titled "A Promise Unkept." Besh’s proposal spotlighted the shortcomings of the MPN system and the overall problem of paperwork as an obstacle to efficient care delivery, proposing an alternative to the MPN model and arguing for enhanced provider training and credentialing. 

DaisyBill took the commissioners on a deeper dive into three specific barriers to injured workers’ care:

• MPN verification. We unpacked the true severity of the MPN problem, showcasing the tangle of thousands of (mostly defunct) MPNs and providing examples of the Odyssean journey required to confirm whether a given provider is eligible to treat a given injured worker. 
• Treatment authorization. We shared the administrative slog that is obtaining authorization, including completing the mandatory request for authorization form for every single treatment and determining where and how to submit that form to the payer, which can vary from claim to claim.
• Crushing paperwork. We demonstrated step-by-step the labyrinth of forms and reporting requirements, largely uncompensated, that bog down providers and staff to the point of making workers’ comp financially unsustainable (particularly in light of low fee schedule rates and data demonstrating rampant reimbursement discounting). 

CHSWC’s call to hear from frontline professionals engaged in the struggle to facilitate injured workers’ care is a welcome opportunity to demonstrate, with objective evidence and hard data, what’s bedeviling this struggling system. 

As advocates for a better system with more than a dozen years of data on the subject, we see CHSWC bringing daisyBill to the table as an effort to confront difficult realities with the objectivity and honesty that California’s workers' comp crisis demands.  

We thank CHSWC for inviting experts into the very necessary conversation about what needs to change. DaisyBill will continue to contribute our considerable data and experience. We encourage stakeholders to watch the recording and peruse our written comments as CHSWC moves forward.

Catherine Montgomery is the co-founder and CEO of daisyBill, a provider of workers' comp end-to-end revenue cycle management software. This post appears with permission.