George Parisotto, administrative director of the DWC, spoke about the state of the California Workers Compensation system with Insurance Journal. The system has undergone numerous changes since the implementation of the sweeping reforms that started in 2013 with Senate Bill 863.

In the last few years medical provider fraud has been addressed by subsequent new laws, a plague of liens that burdened the system are being addressed, and there’s even a new drug formulary. Mr. Parisotto provided his views on some of these changes.

He admits that not everyone likes the changes. One has no further to look that public comments on new rulemaking proposals by the the Division of Workers’ Compensation, which some providers have called unfair and overly burdensome. And there is a shortage of qualified medical examiners – who are an essential backbone of how workers’ comp medical reviews are dealt with in the system.

Mr. Parisotto equates what it takes to make changes as “almost like turning a cruise ship. It takes a lot of time, and it takes a lot of effort, and it takes a lot of understanding on the part of people.”

Among the many task on his plate, – he wants to make sure is that the new drug formulary is up to date and reflects the best evidence based medicine that is there. The legislation, which is in the labor code, also mandates implementation a pharmacy and therapeutics committee that will give advice as to what is going on of evidence-based medicine, new drugs, how they are used.

He is also proud of the rule-making at the end of last year which updated all of the treatment guidelines to the current chapters that are used by ACOEM.

SB 1160 added provisiona that provided a faster route to adopt newer guidelines so the DWC does not have to go through the regular rulemaking process. “What we have now is we have a process where, if there’s a new guideline – we send out a notice, we provide a 30-day period for written comments, we have a public hearing. We have to respond to those comments.”

“That’s important. One thing I wanted to say is that this expedited process that we’re using now, we certainly allow public input and public comment into it. Once we have our hearing, we respond to the comments, and we can adopt those chapters. Again, we want to have a process that makes our treatment guidelines more living documents, something that can be changed just to reflect what’s going on out there.”

With respect to the drop in the size of the QME list, he wants to “see how we can step up our recruitment efforts. Generally we just post a notice, as a matter of fact I think we did that today, about our new exam that’s coming up. We want to reach out to various associations to help, to see what they can do to recruit.”

He concluded by saying “I think it all kind of comes back into what we need to do, what can we consider to make our system better, to make it more efficient. I think once we move in that direction, I think we’ll see how our QME system is at that point. Whether it’s sustainable.”