Health care providers warn 'poison pill' in workers' comp bill could jeopardize needed PTSD coverage

MADISON – Health care providers are raising concerns about what they're calling a "poison pill" inside a set of bills that would make a number of widely supported changes to the state's workers' compensation program.

The legislation would, among other things, expand coverage for first responders who are diagnosed with post-traumatic stress disorder, index permanent total disability benefits for injured workers, increase compensation rates for permanent partial disability and raise the cap on how much the state covers for injured employees of uninsured companies.

The Senate's and Assembly's labor committees held a joint hearing last week on the two bills backed by the state's Worker's Compensation Advisory Council, which is composed of representatives of both the labor and management sides of employment interests.

The "poison pill"? Attached to the bill that would boost total disability benefits and expand PTSD coverage for first responders is a measure that's been rejected several times over the last decade that would set limits on how much health care providers can charge for services provided through the state's workers' compensation program.

Both proposals received overwhelming support during last week's hearing — save for the fee schedule component, which is opposed by health care organizations including the Wisconsin Medical Society, the Wisconsin Hospital Association, the Wisconsin Chiropractic Association and the Wisconsin chapter of the American Physical Therapy Association.

Wisconsin is one of five states without a medical fee schedule for workers' compensation claims. Fee schedules determine the maximum amount a provider can charge an employer for medical services.

Supporters of the change say it will keep costs down for employers, who are required to provide coverage. Opponents argue the system works well as it is and a fee schedule is unnecessary.

Both parties can point to numbers that bolster their case, largely sourced from the Workers Compensation Research Institute.

Fee schedule proponents note that Wisconsin's medical payments per claim are among the highest in the nation, outpacing Midwestern states including Michigan, Minnesota, Illinois, Iowa and Indiana. But health care providers point out that workers' compensation premiums in Wisconsin have dropped year after year for much of the last decade — most recently by 8.4%.

"The need for reform is long overdue. Employers cannot afford another session to go by without the Legislature addressing this growing problem," said Rachel Ver Velde, director of workforce, education and employment policy for Wisconsin Manufacturers & Commerce and member of the Worker’s Compensation Advisory Council.

Ver Velde noted that more than 100 employers have signed onto a letter asking lawmakers to approve the fee schedule proposal.

Mark Grapentine, chief policy and advocacy officer for the Wisconsin Medical Society, pointed to a Workers Compensation Research Institute study that found 82% of Wisconsin workers are satisfied with their medical care, along with one that measured the average time away from work following an injury as lower in Wisconsin than any other state studied.

"Wisconsin’s workers' compensation system allows health care to provide top-quality care soon after a worker is injured. Workers are very satisfied with the health care they receive," Grapentine said. "This prompt service helps get the worker back on the job much faster than in other states. They are less frustrated over their situation, and therefore less likely to enter into litigation."

The advisory council took a new approach that raised some eyebrows in last week's hearing, by proposing two bills rather than one. There was no opposition to the bill that doesn't contain the fee schedule proposal.

Both Sen. Patrick Testin, R-Stevens Point, and Sen. Tim Carpenter, D-Milwaukee, questioned that approach.

"Why combine the PTSD component and the fee schedule in one bill, knowing full well that the other bill, there's not a lot of concern or issue there?" Testin asked.

Ron Kent, who represents the AFSCME union on the Worker’s Compensation Advisory Council, said they separated issues that aren't as controversial as the fee schedule into another bill "that would be less divisive."

"The one provision on the bill that has the fee schedule, it looks like all the other provisions about expansion of PTSD and indexing the permanent total (disability) benefits could easily fit into the other bill. And so with it having two separate bills, it makes it a little more complex. And that's a little bit of a concern for me," Carpenter said.

Representatives of the medical groups testifying against the fee schedule provision stressed that they support the rest of the bill, emphasizing the importance of the expansion of PTSD coverage.

Police officers and full-time firefighters were granted PTSD coverage in a 2021 law. The latest bill would expand that to include volunteer first responders.

A 2022 study by the Ruderman Family Foundation found that police officers and firefighters are more likely to die by suicide than in the line of duty.

Despite suicide rates for the general population declining by 3%, or 1,656 people, from 2019 to 2020, according to CDC data, the rates among first responders showed moderate to no decrease from 2017 to 2020, the Ruderman study found.

Several firefighters shared traumatic experiences on the job with the committee, along with stories of co-workers who have died by suicide.

"We appreciate that the nature of our profession requires our responders to see things that people are just not designed to see," said Joe Pulvermacher, president of the Wisconsin State Fire Chiefs Association. "We also know that critical incidents and post-traumatic stress has a cumulative effect. So … things that you've been exposed to over the term of your career will come back, and you'll remember them. And there's got to be a way for us to be able to provide that support.

The Assembly labor committee voted unanimously Wednesday in favor of the bill without the fee schedule attached.

USA Today contributed.

Jessie Opoien can be reached at jessie.opoien@jrn.com.

This article originally appeared on Milwaukee Journal Sentinel: Health care providers warn about 'poison pill' in workers' comp bill