August 29, 2003

VUMC gains workers comp market share

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Dr. Roy L. DeHart

VUMC gains workers comp market share

Reimbursement for care and treatment of patients under workers comp plans has increased three-fold at VUMC over the past four years, from $10 million in fiscal year 1999 to $30 million in fiscal year 2003. This recent level of success in the workers comp market is a business milestone, said Dr. Roy L. DeHart, professor of Medicine and medical director of Vanderbilt Corporate Health Services.

When treating work related illness and injury, doctors and hospitals are reimbursed at rates significantly higher than most other commercial contracts, making the workers comp market that much more important for helping to sustain the VUMC mission. DeHart estimates workers’ comp to be a $100 million market for Nashville health care providers.

Workers comp cases require a degree of added documentation by providers, and, for a variety of reasons, employers and insurance carriers have a pressing need to keep informed of the patient’s status (workers comp cases are in this respect excepted from federal patient privacy laws).

VUMC formerly lacked mechanisms to ensure that this need for information was satisfied, and DeHart said this caused some employers to steer workers comp patients away from Vanderbilt. Also, VUMC’s former business model for workers comp involved collecting fees in exchange for guaranteeing rapid access to specialty care, fees that weren’t charged by other providers.

Four years ago, Vanderbilt took a new approach to serving Middle Tennessee’s occupational health care needs. Vanderbilt Corporate Health Services established a new business plan to provide centralized administrative support for workers comp business, coordinating patient access and providing an information conduit between the health care team and the employer and insurance carrier.

The office handles about 2,500 calls per month for appointments and information, and it now directs approximately 2,000 referrals per year to VMG. DeHart said all specialties except obstetrics and pediatrics see workers comp patients.

“The response from employers and insurance carriers has been very positive,” DeHart said. “They find that the system they have here at Vanderbilt is really working…We’ve tried as much as we can to establish a firewall to protect the physician’s time and reduce the hassles that can come with workers comp.”

The other element in Vanderbilt’s new competitiveness is a strategic partnership with Concentra, a national occupational health primary care provider. The company’s two area clinics (there will soon be a third) provide a rich source of referrals for VMG specialty services. Concentra’s Nashville volume is currently around 34,000 visits per year.

Through the Vanderbilt Center for Occupational and Environmental Medicine, which was also established four years ago by DeHart, Assistant Professor of Medicine Dr. Jonas Kalnas sees patients and conducts work site evaluations; Kalnas consults nationally in the field of industrial toxicology. DeHart, a national authority in occupational medicine, also sees aviation medicine patients at the center.

For workers comp cases referred to VMG/VUH, Corporate Health Services is set to begin measuring patient access and return to work against national occupational health benchmarks.

DeHart said Vanderbilt could increase its workers comp volume if it could further improve patient access.

He said that he and the Corporate Health Services staff are engaged in a constant search for VMG physicians who are available to see workers comp patients on short notice to provide treatment, second opinions and independent exams.