Orthopedic and Neurological Surgeon Quality Project

Self-Insured Employers Participating

L&I developed this project to help injured workers rehabilitate promptly by improving access to high quality surgical care. Because self-insured employers are responsible for the workers compensation benefits of one-third of Washington’s workforce, it’s important to have self-insurance participation. Participation in the project is voluntary. The project requirements and fee schedule are not in effect for self-insured injured workers unless the employer has registered to participate.

What are the benefits of participating?

  • Improved access to orthopedic and neurological surgeons for your employees.
  • More consistent information to manage claims (Activity Prescription Form).
  • Improved coordination of care.
  • Increased availability of work activity (restriction) information.

What are the costs?

  • L&I estimates an additional $300, on average, of payment per injured worker receiving care from a project surgeon (including payment for APF and incentive pay).
    • NOTE: This additional cost may be offset by a decrease in time loss payments. The University of Washington will evaluate the project to find out the effects of the project.
  • Participating providers may bill and be paid a quality indicator incentive payment each time they complete and bill for an APF:
    • Amount of incentive pay depends on the provider’s tier assignment.
    • Tier assignments are based on provider meeting thresholds for specific indicators of quality care.
  • There is no fee to register as a participant.

Which self-insured employers are currently participating in the project?

  • Clark County
  • Clark County PUD #1
  • RSG Forest Products
  • Peace Health
  • WinCo Holdings
  • Walmart
  • Vancouver Public School Dist. #37
  • Legacy Health
  • ESD 112
  • City of Vancouver
  • City of Longview
  • Safeway
last updated June 8, 2017

If you would like to contact one of the self-insured employers please visit: http://Lni.wa.gov/ClaimsIns/Insurance/SelfInsure/EmpList/FindEmps/Default.asp

 

How do I participate as a Self-Insured Employer for the project or obtain more information?

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