| Orthopedic and Neurological Surgeon Quality Pilot: Self Insured |  | |
Self Insured Employers Participating
L&I developed this pilot 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 pilot is voluntary. The pilot 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?
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L&I estimates an additional $300, on average, of payment per injured worker receiving care from a pilot 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 pilot in 2009 to find out the effects of the pilot.
- 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 pilot?
- City of Vancouver , WA
- Clark County
- ESD 112
- Fleetwood Homes of Washington
- Georgia Pacific Corp.
DOI on or after 12-19-05 is State Fund
DOI prior to 12-19-05 is self-insured
- Waste Connections, Inc.
- Southwest Washington Medical Center
- JH Kelly, LLC
- Legacy Health System
- Weyerhaeuser
- Great Western Malting Company
- WinCo Holdings, Inc.
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 pilot?
- Download and fill out the application (F245-381-000) and submit via:
For more information please contact the pilot project team at: ONSQualityPilot@lni.wa.gov
