Workers’ Compensation – Medical Fee Schedule
2016 Status Report
Through 2015 and into 2016, NVOS participated in a 16-month long regulatory process about the Medical Fee Schedule (MFS) for workers’ compensation and was able to significantly impact the outcome of the deliberations. Originally, the proposed changes in the reimbursement methodology and levels in the MFS would have been devastating to physicians. We were able to influence DIR to abandon assumptions recommended by their consultant and to preserve a reasonable level of physician payments. We were also able to significantly impact the level of payment for Independent Medical Examinations, which were not included previously in the MFS and were originally set at an extremely low level that would have negatively impacted patient access.
Background:
In December 2014, the State of Nevada Division of Industrial Relations issued a report from Milliman Consulting, a global insurance/healthcare/actuarial consulting firm, that reviewed and suggested modifications to the assumptions to be used in developing the Medical Fee Schedule for workers’ compensation in the State. It is a statutory requirement that DIR review the assumptions periodically (approximately once a decade) and Milliman had also conducted the last review.
The deliberations commenced in January 2015, when DIR scheduled a meeting to review the recommendations provided by Milliman. Of primary concern to NVOS was Milliman’s recommendation that the state move away from the RVP methodology to the RBRVS model used by Medicare to calculate reimbursement rates. NVOS strenuously objected to this shift, verbally at the meeting and in a written comment letter.
There was silence on the issue during the legislative session, which lasted from early February through the first week in June 2015. Immediately after the session, DIR held “listening sessions” with interested stakeholders and took more verbal input. Dr. Abdi Raissi and Dr. Colby Young presented testimony at those meetings.
In September, DIR issued its proposed Medical Fee Schedule and held a meeting in early October to review the proposed rates. The assumptions and language in the MFS indicated that the DIR staff was responsive to NVOS’ suggestion to retain the RVP model. In fact, analysis of the proposed rates by an NVOS member practice CFO led the board to conclude that the proposed MFS would be, overall, a net positive for members’ practices. The physician reimbursements would remain at 2015 levels (with a CPI adjustment) and ASC reimbursements would increase.
In late November 2015, the DIR issued a slightly revised version of the MFS. One lingering concern arose, namely, the low reimbursement for IMEs. Dr. Hugh Bassewitz took on the issue and testified at a January meeting that too-low rates would exacerbate already limited access to IMEs. NVOS’ comments – including recommended levels for IME reimbursement — are memorialized here.
The final MFS was issued on January 28. The final IME reimbursement rates closely align with NVOS recommendations. As is customary, the CPI was applied to existing fees. New fees (such as the IME and dental fees) and those fees that were already increased for 2016 were NOT increased again in 2016 final schedule.