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Worker’s comp: Quality, access and value

Those who know the history of Wisconsin’s Worker’s Compensation system often talk of the “Grand Bargain” reached in 1911, when the state created the country’s first constitutional worker’s comp system. Workers gave up the right to sue for negligence while employers agreed to pay for the costs related to injuries regardless of fault. It was revolutionary, and quickly became a national model.

Health care wasn’t officially part of that bargain, but has always played a vital role in the worker’s comp system. The state’s physicians, hospitals, physical therapists, chiropractors and others in the healing world were quickly aware of the value that high-quality health care would provide to both workers and employers. Seeing injured workers quickly means patients were happy that they were prioritized, and employers were happy to see injured workers return to the job site.

A little more than 20 years ago an important book posited that heath care suffers from an “Iron Triangle,” in which the three important aspects of quality, access and costs are in competition with one another. This makes it difficult for all three to fully evolve satisfactorily. What’s interesting – and most definitely ironic considering the rhetoric thrown around by some these days – is that Wisconsin’s worker’s comp system performs well in all three areas.


Just this August, the federal Agency for Healthcare Research and Quality ranked Wisconsin’s health care system as best in the nation. This is no fluke; last year Wisconsin ranked third overall. This quality shows up in the worker’s comp world as well: Wisconsin workers have the shortest duration of disability in the nation, return to work faster than workers in most other states and are very satisfied with their care. There’s less need for repeat care than in other states. And injured workers in Wisconsin require fewer visits per claim and receive fewer services per visit than we see in other states.


Wisconsin’s injured workers enjoy rapid access to that high-quality care. Again, patient-satisfaction scores bear that out. One think-tank study comparing a representative sample of 15 states shows that injured patients score Wisconsin best in both avoiding “big problems” in getting services and in finding their desired providers. Wisconsin health care officials know the importance of seeing injured workers quickly, often moving them to the front of the line for assessment and treatment. This despite the significant administrative hassles of handling all the paperwork and insurance inquiries, investigations, appeals and delays that are imposed on health-care providers as part of the worker’s comp system.


The state’s Department of Workforce Development recently announced that, in 2017, the state’s work comp program will have the largest drop in insurance premiums in nearly a quarter century. This drop, an 8.5 percent rate decrease, is expected to save employers $170 million in premium payments this year. The state reports that some of that savings is because health care costs haven’t risen as much as previously predicted.

And Wisconsin’s health-care costs per worker’s comp claim are lower than the national average. You read that right: Despite the propaganda that some are trying to sell – often in 140 characters or fewer, which is always an interesting tactic for engaging in complex issues – the facts and data are there for all to read. That is, of course, if that information is shared.

Wisconsin health care delivers higher quality care more efficiently than most others in the country. So even though prices for an individual worker’s comp service might be higher than prices in other states, that care is of such high quality and delivered so efficiently that the overall cost per claim is less than average – all while still enjoying rapid return to work and nation-leading employee satisfaction.

If you’re confused by these facts because you’ve been hearing otherwise, we don’t blame you – some choose to ignore data points that disagree with their premise. Unfortunately that’s happening now in the debate over whether to install the heavy hand of government price-fixing on the worker’s comp health care world. The current proposal would use rates that are negotiated in good faith between health care providers and non-work comp payors and slap them on all worker’s comp health care services, even though those negotiated rates are a trade-off – each side gives up something in order to receive something of value.

And here’s another fact the pro-government rate-setting crowd doesn’t talk about: there are already opportunities to negotiate worker’s comp rates. One major health care system in the state receives a substantial percentage of its worker’s comp reimbursement through rates that have been negotiated alongside group-health contracts. Another major self-funding insurance entity has penned a letter trumpeting its ability to negotiate worker’s comp rates that are often equal to those of group health.

When government sets prices for health care services, it often doesn’t go well. Look at Wisconsin’s low Medicaid reimbursement rates – just one example of the perils of arbitrary government price fixing. Medicaid often doesn’t pay enough for even the basic cost of providing patient care. That means those with insurance are paying a “hidden health care tax” of sorts, forced to subsidize a large, underfunded program.

Four years ago this fee schedule idea first made its way to the Legislature, but it failed to get out of committee. A fee schedule mandating bargain rates with no value received for those lower rates just didn’t make sense then, and it doesn’t make sense now. It’s like walking into a large hardware store for a power drill and demanding the same price as was negotiated by a major construction company. It’s likely that you’d find yourself briskly escorted to the parking lot by a smock-wearing employee.

But while that employee would have to deal with a troubled customer, at least that worker would know that the worker’s comp program in Wisconsin is still regarded as a national model – stable, effective, and providing the highest-quality health care in the nation. And if for some reason there’s an injury on the job, that health care is readily accessible and will treat the employee quickly and effectively.

It’s a role in the “Grand Bargain” that health care is proud to play.

Column submitted by the Wisconsin Medical Society, Wisconsin Hospital Association, Wisconsin Physical Therapy Association and Wisconsin Chiropractic Association

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