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04/14/2021 05:13 AM
Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20210&cosponId=33645
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House of Representatives
Session of 2021 - 2022 Regular Session

MEMORANDUM

Posted: December 18, 2020 02:15 PM
From: Representative David S. Hickernell
To: All House members
Subject: Workers’ Compensation Healthcare Network
 
I will be reintroducing HB 1784 from the prior session to improve the workers’ compensation (WC) system in Pennsylvania by providing an option for employers to utilize a healthcare network. Current law only allows employers to utilize a network approach for the first 90 days of treatment. This network option – known in WC as a “provider panel” – has benefited patients.

Working in Pennsylvania has never been safer as employers continue to emphasize and invest in workplace safety and employee health, and as we’ve transitioned to a more service-based economy. The result has been a gradual decline in the number of workplace accidents. At the same time, the average cost of individual claims continues to increase and can still spiral out of control – which can lead to significant insurance cost increases on employers and worse outcomes for the worker.

Rising healthcare costs is a challenge for all types of health insurance, which is why strategies have been broadly implemented to mitigate costs. Provider networks are one such strategy that is a standard practice in group health, commercial and public health insurance. Network care helps ensure acceptable standards of provider quality and integrity and allows for more effective coordination among health professionals, which helps eliminate unnecessary services, excessive or duplicative treatment and over-prescribing of medication. It also helps prevent abuse from some of the bad apples in the system who use injured workers to enrich themselves rather than focus on patient care. We have seen such examples recently in Pennsylvania and they are unacceptable.

According to the Workers’ Compensation Research Institute, most states provide employers a managed care option. Many states, like New Jersey for example, allow employers to choose the providers – no network or time limit. It would certainly appear that providing a network option for Pennsylvania employers is a reasonable compromise and aligned with national standards.

The time period in which employers can utilize network care has been increased over the years – from 14 days, to 30 days and eventually 90 days – as its benefits to the patient and system have become apparent. In recent years, patient satisfaction surveys conducted by the Department of Labor and industry have consistently shown that patients who received treatment though a network were more likely to be satisfied with their care, the timing of their return to work, and more likely to have their rights explained to them. This experiment has been a demonstrable success and it is time to allow for network care for the duration of the claim.

Providing for a network option will help control costs, prevent and combat fraud and abuse and make Pennsylvania more competitive; all while helping to ensure that quality care and employee health remain the top priority.

Thank you for your consideration in co-sponsoring this legislation.

Previous Cosponsors:  HICKERNELL, MILLARD, ROTHMAN, KAUFFMAN, BERNSTINE, FEE, DUNBAR, TOPPER, MENTZER, MALONEY, ZIMMERMAN, JAMES, EMRICK, GREINER, SAYLOR, HELM, KEEFER, DOWLING, IRVIN, HERSHEY, WHEELAND, LEWIS and GAYDOS
 



Introduced as HB421