| Title | Extend the Use of Medical Provider Networks to the TxDOT Employees Workers' Compensation Program |
| ShortDescription | This article outlines the argument for the use of medical provider networks to treat state employees with on-the-job injuries. The article shows how this will help keep the total cost of workers' compensation low. |
| LongDescription | Texas provides state employees with comprehensive health care benefits. Health care networks contract with the state, giving employees access to high-quality health care while allowing the state to monitor and control usage and costs. As incentives to participants to control costs, these networks use primary care physicians, preferred providers, and a system of variable co-payments or deductibles. The use of medical provider networks generally is accepted as a reasonable arrangement that has not jeopardized the quality of state employees' health care. Medical provider networks are not used, however, to treat state employees with on-the-job injuries. Texas law does not permit employers or insurers to restrict an injured worker's choice of doctor or pharmacy. Under workers' compensation, an injured state employee in effect can direct his or her own medical care, leading to steady increases in Texas' workers' compensation costs. According to the Texas Research and Oversight Council on Workers' Compensation (ROC), Texas workers' compensation medical costs are 49 percent higher than the national average. [4] ROC also reports that the average medical cost of Texas' workers' compensation claims is rising faster than in other states. [5] Other states and jurisdictions have incorporated some features of medical networks into workers' compensation systems to limit the number of available care providers. In these programs, employees must obtain treatment from an employer-selected provider, or from a list of providers developed by the employer or a network provider organization. [7] To address concerns about such restrictions, some states allow the employee to change providers after the initial visit or after a specific period of time. [8] The State Office of Risk Management (SORM), which administers the state employee workers' compensation program, is already experimenting with medical provider networks and is reporting savings through use of an optional pharmaceutical preferred provider organization (PPO). [11] Opportunities to use medical provider networks extend beyond pharmacy services. Workers' compensation medical networks, similar to those networks already used to deliver medical services to state employees but focused on meeting the specific needs of injured workers, can reduce medical costs and could be used to provide medical and hospital services for injured state employees. NOTE: The numbers [numbers] point to reference documents linked off the website. |
| SourceAuthor | Susan Combs, Texas Comptroller of Public Accounts |
| Reference | Paving the Way: A review of the Texas Department of Transportation, January 2001, Chapter 5.10 |
| Organization | Texas DOT |
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http://www.window.state.tx.us/txdot/txdot510.html
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