From WisPolitics.com/WisBusiness.com …
— The new budget signed by Gov. Tony Evers includes a workers’ compensation fee schedule for hospital charges — a compromise on an issue that for years has pitted the state’s business lobby against the health care industry.
Scott Manley, executive vice president of government affairs for Wisconsin Manufacturers & Commerce, says the fee schedule doesn’t go as far as the group would have liked. But he called it a good first step to “rein in” costs for employers related to workplace injuries, as it would set new maximum fees for hospital care provided to injured workers under the workers’ compensation program.
In an interview last week, Manley noted Wisconsin has some of the highest costs in the country for common procedures in the workers’ compensation space, such as major surgeries and pain management. He argued that’s because the state is currently one of just five that don’t have a fee schedule for workers’ compensation medical costs.
“Although we recognize that the fee schedule that was passed in the budget is not as, you know, comprehensive as we’d like it to be, we think that it’s a very important and necessary first step, in terms of being able to get Wisconsin out of the position of being the most expensive state in the country for work comp medical procedures,” Manley said.
Ultimately, he expects “the rate that businesses pay for their workers’ compensation insurance will go down” to the extent that the fee schedule lowers medical costs in the program in the years to come. A recent study from the Workers Compensation Research Institute focused on the recent inflationary period found fee schedules “ensure similar or lower price growth rates” compared to the overall health care system.
But Kyle O’Brien, president and CEO of the Wisconsin Hospital Association, said “we disagree with some of those assessments of prices” made by WMC, arguing they focus only on one part of the health system rather than the overall cost and value provided.
He said the state has some of the best return-to-work rates and lowest litigation rates in the country thanks to the high-quality care that workers receive. And he added overall workers’ compensation rates have fallen in recent years, noting costs for Wisconsin employers in the system have declined by $1 billion since 2017.
O’Brien also said previous fee schedule proposals in the state would have taken “a sledgehammer” to a system he says is working well. This time around, he said WHA was able to support the overall budget including the fee schedule thanks to “reforms” to the system to prompt faster payments. He also said a separate provision directing more federal dollars to hospitals was key.
“This is different from previous cycles wherein the Workers’ Compensation Advisory Council has pushed the fee schedule onto providers without our input,” he said in an interview. “It’s something that has caused us to go to the Legislature and successfully defeat those proposals. This is different, because we actually were at the table negotiating reforms in the system, and that’s why we were okay with this being included in the budget.”
The debate over a fee schedule has percolated in the Capitol for years. The Worker’s Compensation Advisory Council — a body made up of labor and management — proposed legislation in 2014 that included a fee schedule. The legislation got public hearings in both houses, but never made it to the floor amid opposition from the Wisconsin Hospital Association and other providers.
That bill called for the Department of Workforce Development to break the state into five regions and determine the average payment for services included in the schedule. The agency would then have set a maximum fee that any health care provider could charge at 100% of the average cost for each procedure covered.
The provision in the budget signed last week requires the state Department of Workforce Development by mid-2027 to establish the framework for the maximum fees hospitals can charge under workers’ compensation. That means most employers in the state likely wouldn’t start to see the impact through lower workers’ compensation insurance rates until 2028, Manley said.
And unlike other states with such a system in place, Wisconsin’s fee schedule would only apply to hospital charges. Manley notes other states’ workers’ comp fee schedules apply to other eligible care, such as physical therapy and chiropractor services.
WMC would prefer a fee schedule to cover all medical services, he noted. But Manley also added the “biggest, most expensive” workers’ comp medical costs are linked to procedures taking place at hospitals such as a rotator cuff repair or knee replacement surgery.
See the full story here.
— Exact Sciences says getting Medicare coverage for its Oncodetect test marks a “significant milestone” for the Madison-based business.
The diagnostics company recently announced its Oncodetect molecular residual disease test has received Medicaire coverage through the Centers for Medicare & Medicaid Services’ Molecular Diagnostic Services Program. It’s been approved for use in patients with certain forms of colorectal cancer in specified settings, the announcement shows.
The test tracks up to 200 circulating tumor DNA variants to identify signs of cancer recurrence for patients with solid tumors. By assessing levels of tumor DNA that has entered the patient’s bloodstream, the test can flag signs of recurrence “up to two years earlier than imaging alone,” the company says.
By getting the test covered in certain situations under Medicare, Exact Sciences says it can help expand colorectal cancer screening for the more than 3 million Americans that are eligible for testing.
Brian Baranick, executive vice president and general manager of precision oncology for the company, touted the clinical value of the test in a statement on the Medicare coverage inclusion.
“Gaining Medicare coverage for the Oncodetect test is a meaningful step forward in expanding access to earlier, more personalized insights for patients with colorectal cancer,” he said.
See the release below.
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