worker injury (copy)

A contractor working on the Dane County courthouse in 2004 was injured on the job after falling 20 feet. Wisconsin's Worker's Compensation Council has proposed setting fees for medical costs, a move supported by employers but opposed by health care groups.

State Journal archives

Powerful employer and health care groups are clashing over a proposed workers’ compensation bill that would set fees for medical care in the state program.

The Worker’s Compensation Employers Coalition, including Wisconsin Manufacturers and Commerce and more than 40 other groups, says workers’ comp medical costs are going up, and care costs much more for work injury patients than people covered by regular health insurance.

Employers are “seeing that they’re paying more, and they just don’t quite understand why,” Chris Reader, Wisconsin Manufacturers and Commerce’s director of health and human resources policy, said Tuesday at a Wisconsin Health News panel debating the bill expected to be introduced in the Legislature soon.

Mark Grapentine, the Wisconsin Medical Society’s senior vice president of government relations, said overall workers’ comp claims in Wisconsin run about the same as the national average, in part because workers use fewer medical services and return to their jobs three weeks shorter than average.

Although the vast majority of states use fee schedules, the proposal in Wisconsin is “a solution in search of a problem,” Grapentine said.

The Wisconsin Hospital Association and groups representing chiropractors and physical therapists also oppose the bill, saying an 8.5 percent drop in workers’ comp premiums for the fiscal year starting Oct. 1 shows the system works well.

In a decades-old process, the Worker’s Compensation Advisory Council, which has members from labor and management, hash out proposed changes to the program in a bill each two-year legislative session.

The council’s 2013-15 bill including a fee schedule didn’t pass. Its 2015-17 measure containing other changes did.

The group incorporated the fee schedule again into its proposed 2017-19 bill, which also calls for curbing opioid use and other changes.

The fee schedule would set rates for medical care at 2.5 percent higher than the average negotiated prices for regular health insurance plans.

Joanne Alig, the hospital association’s senior vice president of policy and research, said those rates aren’t fair because health care providers get something in return for the discounts they give to other payers: prompt payments, along with large volumes. More than 70 percent of health insurance bills are paid within 30 days, but for workers’ comp it’s 8 percent, Alig said.

“There’s a time value to money,” she said. “No other business would wait to get paid 12, 18 months down the road.”

Charlie Burhan, assistant vice president and senior public affairs officer for Liberty Mutual Insurance, said, “the problem is most employers cannot negotiate on (workers’) comp. It is a small volume, high margin business.”

Wisconsin, the first state to pass an approved workers’ comp program, in 1911, had about 93,000 claims in 2015, for which about $691 million in benefits has been paid so far.

Under the program, companies agree to pay for the economic cost of work-related injuries, and workers give up the right to sue for negligence.

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David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.