Peter Rousmaniere made an excellent point last week with his column, The Stale State of Reform. In it he discussed our industry’s almost myopic focus on cost whenever legislative reform is discussed. He rightly pointed out that, not only is the focus of most reform centered on reducing costs through restricting or reducing benefits to injured workers, but that the core focus of much of our continuing analysis is centered on same. His column indicates that we, as an industry at least, do not generally consider quality of outcome when establishing new processes or reviewing their effectiveness. Employer cost is simply the comparison that rules our attention.
It stands to reason that both cost and quality of results should be considered in order for any “grand bargain” to remain as such. I would also assert that our failure to properly measure quality of outcome is actually increasing our costs; thereby making a sole focus on benefit reduction a fool’s errand.
While we didn’t address this topic directly, at a recent conference we touched on an issue that is a direct result of it.
I had the pleasure recently of moderating what I will call a “unique” panel at the 69th Annual Convention of the Southern Association of Workers’ Compensation Administrators (SAWCA) in Pinehurst, NC. SAWCA has been very kind to me, creating a session called “Things That Make Bob Go, hmmmm…”. This was the third time we have done this.
In this session, I sit with a panel of administrators and industry representatives, and ask frank questions about our industry. These are not necessarily discussions you will hear at a staid and rehearsed workers’ comp panel presentation. This may surprise you, but I can be frank when I want to be (the first time we did this I asked the administrators which stakeholders were “the biggest pain in the ass”). Panelists are assured that their quotes will never be reflected in my blog, and we get fairly blunt discussions as a result.
One of the questions I posed to the panel this year, which consisted of Maryland Comp Chairman Karl Aumann, Texas Commissioner Ryan Brannan, ODG VP Ken Eichler and Coventry’s Lisa Anne Bickford, was related to the rise of significant court challenges we have seen in numerous states this past year or two. I asked if these decisions, some that challenged the constitutionality of their states systems, were the result of poorly constructed legislation, increasingly activist courts, or some combination of the two. While their direct answers, in accordance with tradition, will not be reflected here, I believe Rousmaniere’s column provided the answer that we should have struck upon in the panel.
We do not think of workers’ compensation as a two-wheeled motorcycle when we discuss “fixing it”, or when analyzing the effectiveness of previous fixes. Instead we act as if only one wheel carries the load exclusively. This has led to the creation of a complex system that fosters confusion and encourages expensive litigation. Quite the opposite result envisioned by the creators of the Grand Bargain more than one hundred years ago.
To be fair, there is imbalance on both sides of our industry. The bargain for employers has been strained to the point of incredulity in some areas. Employers today are responsible for much more than they were when workers’ compensation was established, and in some cases are being required to pay for things never envisioned by the system’s founders. The people who endlessly advocate for the widening of presumptions and expanding the definition of causation are also helping to establish a less effective system overall.
Still, the onus for effective reforms and management rest largely with legislators and state administrators. Workers’ compensation was originally envisioned as a self-executing system. I think we can agree today that in many cases it is not. For us to be able to return to that concept, effective outcomes for injured workers’ must be considered as part of ongoing reform efforts. We must change the industry culture, and that includes the way we analyze results.
For years now I have been an advocate of changing the culture of workers’ compensation. People know I believe it should be renamed “Workers’ Recovery”, as that simple change would alter the focus of many involved in crafting its form as well as those working within the system. I stubbornly maintain the position that system costs, overall, will be lessened with a greater focus on outcome, and a culture geared to recovery and return to function.
Rousmaniere was correct. A motorcycle will not run efficiently if we only service one wheel on the machine. We must concentrate on both tires to be balanced and properly inflated if the vehicle is to roll with less friction and better mileage. We must consider the outcome of the system when we are designing the system itself.
Otherwise, we are just dragging our fannies on a unicycle built for two, and that’s not very Zennish at all.