A Thanks for All our Team Does!

We pause this holiday season to express appreciation and admiration for the outstanding job done by the OJCC team across Florida each year. Thanks team, for an outstanding 2016! We are counting on each of you for more of the same in 2017! It is astounding that these 165 people manage all of the disputes for Florida's workers' compensation system!

Belkis Alvarez	Deputy Clerk	Miami
Wilbur Anderson	Judge	Daytona Beach
Susan J Arrick	Mediator	Miami
Robert A Arthur	Mediator	Lakeland
Catherine E Bailes	Administrative Secretary	Lakeland
Diane B Beck	Judge	Sarasota
Susan Berman	Commission Deputy Clerk II	Orlando
Patrick S Bickford	Commission Deputy Clerk II	Tallahassee Clerks
Susan G Bisbee	Mediator	Tallahassee
Shirley J Blank	Deputy Clerk	Ft. Myers
Yolanda P Bradshaw	Commission Deputy Clerk II	West Palm Beach
Eric R Bredemeyer	Mediator	Ft. Myers
Jeffrey S Breslow	Mediator	Ft. Lauderdale
John P Brooks	Mediator	Daytona Beach
Shanetta Brown	Commission Deputy Clerk II	Ft. Lauderdale
Julie K Brown	Deputy Clerk	Orlando
Susan J. Burton	Commission Deputy Clerk II	Sarasota
Pamela S Cain	Deputy Clerk	Jacksonville
Alejandra Campuzano	Commission Deputy Clerk II	Miami
Kimberley M Cardone	Commission Deputy Clerk II	West Palm Beach
Laure M Carnes	Deputy Clerk	Sarasota
Gerardo Castiello	Judge	Miami
Frank J Clark	Judge	Ft. Myers
Anne W Claussen	Mediator	Sarasota
Tara C Cole	Administrative Secretary	Tallahassee
Ruby M Coleman-Brown	Deputy Clerk	Lakeland
Willie J. Condry, Ii	Judge	Orlando
Merle B Cortez	Commission Deputy Clerk II	Ft. Myers
Kelly A Cronan	Commission Deputy Clerk II	Daytona Beach
Mary A D'ambrosio	Judge	West Palm Beach
Kahlil A Day	Mediator	Jacksonville
Luis E De Fana	Deputy Clerk	Miami
Lidia Delgado	Secretary Specialist	Miami
Jacquelyn S Denton	Administrative Secretary	Orlando
Robert L Dietz	Judge	Melbourne
Romeika L Dixon	Administrative Secretary	Miami
Nerida C Dominguez	Administrative Secretary	Miami
Marquita M Dukes	Commission Deputy Clerk II	West Palm Beach
Joseph A Edwards	Commission Deputy Clerk I	Tallahassee Clerks
Elina Escarda	Deputy Clerk	Miami
Leticia Espina	Commission Deputy Clerk II	Miami
Ana R Ferlita	Deputy Clerk	Tampa
Iliana Forte	Judge	Ft. Lauderdale
Tammy L Galey	Commission Deputy Clerk I	Tallahassee Clerks
Louise V Gaskin	Dministrative Secretary	St. Petersurg
Deborah L Geer	Commission Deputy Clerk II	Ft. Myers
Randee J Gildea	Administrative Secretary	Melbourne
Deborah M. Golden	Deputy Clerk	Tallahassee Clerks
Malena B Gonzalez	Deputy Clerk	Miami
Alan M Gordon	Mediator	Jacksonville
Narita B Green	Commission Deputy Clerk II	Tampa
Adrianne M Guy	Deputy Clerk	West Palm Beach
Christina L Hamons	Court Reporter/Transcriptionist	Tallahassee Clerks
Kevin G Harris	Commission Deputy Clerk II	Gainesville
Deirdre J Harrison	Commission Deputy Clerk II	Tampa
Deborah D Hart	Mediator	Ft. Myers
Paul L Harwood	Mediator	Port St. Lucie
Mark C Hauber	Mediator	Melbourne
Walter J Havers	Mediator	Miami
Stephanie R Hayes	Staff Counsel	Tallahassee
Sophia D Heath	Commission Deputy Clerk II	Ft. Lauderdale
Thomas A Hedler	Judge	West Palm Beach
Joshua Henderson	Commission Deputy Clerk I	Tallahassee Clerks
Lyna S Hickman	Commission Deputy Clerk II	Panama City
Marjorie R Hill	Judge	Gainesville
Charles M Hill Iii	Judge	Miami
Sherry D. Hires	Mediator	Orlando
Sherri Coleman Hobbs	Administrative Secretary	Daytona Beach
Silvia M Hoeg	Mediator	Orlando
Geraldine Hogan	Judge	Ft. Lauderdale
Anastasia Jean Hollaway	Deputy Clerk	Panama City
William R Holley	Judge	Jacksonville
April M Holsman	Commission Deputy Clerk II	Ft. Lauderdale
Wendy M Hope	Deputy Clerk	Jacksonville
Ralph J Humphries	Judge	Jacksonville
Julie Hunsaker	Office Operations Manager I	Tallahassee Clerks
Michael H Imber	Mediator	West Palm Beach
Antoine P Jacques	Administrative Secretary	Ft. Lauderdale
Shahida A James	Administrative Secretary	West Palm Beach
Gregory J Johnsen	Judge	West Palm Beach
Mark B Johnson	Commission Deputy Clerk II	Tallahassee Clerks
Pamela J Johnson	Deputy Clerk	Tampa
Wanda L Keenan	Commission Deputy Clerk II	Tampa
Chymbee A Keith	Administrative Secretary	Port St. Lucie
Margret G Kerr	Judge	Miami
Regina A Key	Deputy Clerk	West Palm Beach
Paula C Kiedeisch	Administrative Secretary	Gainesville
Daniel R Kilroy	Deputy Clerk	Orlando
Anna Marie M Kim	Mediator	Orlando
Jaquandra E King	Administrative Secretary	West Palm Beach
Rhonda G Lapin	Mediator	Miami
John Lazzara	Judge	Tallahassee
Laurie R Leon	Mediator	Tampa
Linda S Leonard	Administrative Secretary	Sarasota
Daniel A Lewis	Judge	Ft. Lauderdale
Pamela L London	Deputy Clerk	West Palm Beach
Ellen H Lorenzen	Judge	Tampa
Noreen A Lusco	Commission Deputy Clerk II	Jacksonville
Mark A Massey	Judge	Tampa
Sylvia Medina-Shore	Judge	Miami
Ilene V Mele	Commission Deputy Clerk II	Orlando
Jessica Melendez	Deputy Clerk	Ft. Myers
Beverly J Melton	Commission Deputy Clerk I	Tallahassee Clerks
Gary A Miller	Mediator	Miami
Marla R Miller	Deputy Clerk	Orlando
Sarah T Minker	Deputy Clerk	Gainesville
Melissa R Moody	Deputy Clerk	Tallahassee Clerks
Amanda L Morales	Deputy Clerk	Tallahassee
Paula Nickel	Deputy Clerk	Tallahassee Clerks
Nelio E Oramas	Mediator	Panama City
Keef F Owens	Judge	Pt. St. Lucie
Carmen L Padilla	Deputy Clerk	Ft. Lauderdale
Neal P Pitts	Judge	Orlando
Ronda T Pope	Deputy Clerk	Ft. Lauderdale
Irish L Porter	Commission Deputy Clerk II	Tallahassee Clerks
Sylvia Ramkishun	Administrative Secretary	Ft. Lauderdale
Eduardo Ramos-Almeyda	Judge	Miami
Jeanette M. Randall	Commission Deputy Clerk II	Pensacola
Brittany L Reid	Deputy Clerk	Pensacola
Ellen F Riley	Administrative Secretary	Ft. Myers
Teresa D Robinson	Administrative Secretary	Orlando
Rosanna Robles	Administrative Secretary	Miami
Barbara Glenn Rook	Commission Deputy Clerk II	Lakeland
Liliana J Roque	Administrative Assistant Ii	Miami
Stephen L Rosen	Judge	St. Petersburg
Adam I Ross	Mediator	Ft. Lauderdale
Carol Ruffin	Deputy Clerk	St. Petersurg
Sheila A Ryder	Deputy Clerk	Melbourne
Doris Salgado-Sama	Administrative Secretary	Miami
Isabel M Schuchman	Commission Deputy Clerk II	Miami
Thomas W Sculco	Judge	Orlando
Carolyn C Slowikowski	Mediator	Pensacola
Suelean J Smith	Deputy Clerk	Ft. Lauderdale
Margaret E Sojourner	Judge	Lakeland
E Douglas Spangler Jr	Judge	Tampa
Callie M Stamper	Administrative Secretary	Jacksonville
Timothy S Stanton	Mediator	Tampa
Angelique I Steele	Commission Deputy Clerk II	Port St. Lucie
Cory Strickland	Administrative Secretary	Tallahassee Clerks
Yadira Suarez	Commission Deputy Clerk II	Orlando
Sharleen J Sudbury	Commission Deputy Clerk II	Melbourne
Michele Suero	Commission Deputy Clerk II	Miami
Christine A Sullivan	Administrative Secretary	Ft. Lauderdale
Theresa Sullivan-Hadden	Administrative Secretary	West Palm Beach
Stuart F Suskin	Mediator	Gainesville
Kelly Tiska	Deputy Clerk	Port St. Lucie
Karla A Trumbull	Commission Deputy Clerk II	St. Petersurg
Kathy M Valdez	Administrative Secretary	Panama City
Bethany L Valliere	Mediator	West Palm Beach
Keren Vega	Deputy Clerk	Miami
Joan H Venable	Comission Deputy Clerk II	Jacksonville
Jonathan E Walker	Judge	Panama City
Priscilla A Walker	Commission Deputy Clerk II	Tallahassee
Angelique S Washington	Deputy Clerk	Tampa
Jack A Weiss	Judge	Ft. Myers
Alena H Wilson	Deputy Clerk	Daytona Beach
Nolan S Winn	Judge	Pensacola
Joann Winters	Commission Deputy Clerk II	Miami
Ronnie K. Witlin	Mediator	Miami
Rita L Young	Mediator	St. Petersurg

Important Points from 2017 Three Member Panel Draft Report

The Florida Three Member Panel will meet in January in Tallahassee. The Three Member Panel is a statutory body created and created/enabled by Section 440.13(12), Fla. Stat. It deals with reimbursement rates and schedules. And, it is charged with submitting biennial recommendations "on methods to improve the workers’ compensation health care delivery system." Section 440.13(12)(e)4, Fla. Stat. The 2017 meeting has received some publicity because the agenda and Draft Report make mention of a pharmacy formulary. That is worthy of attention and discussion. However, there is much more in the draft report of the Panel.

The Panel notes that the workers' compensation system here is significant. It says "Florida has a $3.64 billion workers’ compensation marketplace." This industry and system, the Panel says, impacts "hundreds of thousands of employers, thousands of health care providers, and hundreds of insurance companies." It does not mention workers' specifically. but clearly the Florida workers' compensation system impacts literally millions of Florida employees (injured or not, the system is here for all employees). I have said it before, this system is literally "Huge" (See, Where did it Come From, Where is it Going, and How “Huge” is it Anyway?, Lex and Verum, June 2014, http://www.nawcj.org/docs/newsletters/newsletter_2014-06.pdf). 

The Panel has previously noted its support for Florida workers' compensation being exempt from certain requirements of Chapter 120, Fla. Stat. Since 2010, all State agencies have been required to assess the financial impact of rules and regulations. The concept is simple, government should be conscious of the implications of its actions. So, when regulations are proposed by agencies, they are required to assess the financial impact of those regulations. 

If certain criteria are met, then the proposed regulation has to be approved (ratified) by the legislature (the body that is elected by the people of Florida to pass laws). The main criteria at issue here is when regulations will result in a $1 million impact or cost within 5 years of enactment. The Panel notes that workers' compensation is large, affects so many, and virtually any change in fee schedules for medical services will exceed that total. Therefore, the Panel advocates the Division should be exempt from this requirement to enhance its nimbleness and effectiveness. Legislative bills in 2015 sought this change, but did not pass. 

Following attention to repackaging of pharmaceuticals, there were recommendations from the Three Member Panel in 2013. Legislative changes were made regarding reimbursement for pharmaceuticals. The 2017 Biennial Report Draft says that the reimbursement for medication in Florida has changed markedly in the period 2011-2015. Highlights include (all italics direct quote):

The total payments for physician-dispensed repackaged drugs decreased 73%

The total payments for pharmacy-dispensed repackaged drugs decreased 65% 

The total payments for all repackaged drugs decreased 73%

The total number of repackaged drug prescriptions dispensed by pharmacies decreased 28% . . . (and for physicians) a 78% decrease. 

The total for physician-dispensed non-repackaged drugs increased 626% 

Pharmacy-dispensed nonrepackaged drugs total payments increased.
The total payments for all non-repackaged drugs increased 33% 

The total payments for all drugs dispensed by physicians and pharmacies increased 2% 

The 2017 Draft report also discusses electronic medical billing. It documents that the Division of Workers' Compensation held a meeting in 2014 and solicited input from stakeholders regarding electronic billing. From this meeting, the Division concluded (all italics direct quotes):

E-billing continues to grow in Florida. 

There was general agreement that E-billing may lead to quicker payments to providers and reduce administrative costs compared to issuing and processing paper bills

Pursuing a mandate and implementing a “one-size fits all” approach may prove to be the least effective method to expand the use of Ebilling. 

The Division of Workers’ Compensation should continue to promote mutually-agreeable E-billing practices between the provider and the insurer.  

The Draft Report concludes that the Division should "continue its current practice of permitting health care providers to electronically submit medical bills to insurers," essentially continue to allow but not mandate electronic billing. This allows flexibility, but little consistency for the "hundreds of thousands of employers, thousands of health care providers, and hundreds of insurance companies." Essentially, Florida today may have hundreds of available e-billing platforms available to its "thousands of health care providers." Whether any make use of these hundreds of various programs is up to each provider. Would consistency or standards help the market move in the direction of e-billing?

There appears to be no appetite in Florida for mandatory e-billing. If either the medical providers or insurance carriers were clamoring for such a process, it seems likely that there would be more discussion and perhaps movement toward mandatory standards or participation. The Three Member Panel's recommendation for continuing the current course is predicated on the absence of such clamoring ("unless providers and insurers specifically request the Division to mandate a standardized E-billing requirement . . .").

The debate of electronic medical billing came up in a recent conversation at the National Disability and Workers' Compensation Conference in New Orleans. The mandate of several states was mentioned, generally as outlined in When Will Electronic Billing Come to Florida. That post noted that only four states mandate e-billing, New Jersey, Minnesota, North Carolina and Texas. Six other states "have adopted an electronic medical billing framework for their workers' compensation systems:" California, Georgia, Illinois, Louisiana, Oregon and Washington. While these are not mandating use, they are seeking some uniformity among likely "hundreds of insurance companies" in those states. 

The benefits of e-billing are obvious. The process will reduce cost, decrease duplication of effort regarding data entry, and lead to greater access to treatment and cost data. When these benefits were discussed in New Orleans, several experts corrected the "misconception" of "mandatory e-billing." They assured me that although some states "say" that e-billing is "mandatory," no state enforces the use of e-billing. One suggested to me that actual compliance with the requirement in some "mandatory" states may be as low "as the teens." One attendee confided in me that states lack the will to enforce regulations on physicians. 

That conversation reminded me of the first meeting of the National Summit in Dallas last summer. As we discussed health care in the broadest workers' compensation context there, the impact of the "affordable care act" was raised. Some expressed that it might impact workers' compensation positively, because now "everyone has health insurance." That drew laughter and derision. Other participants assured us that "millions" remain uninsured after full implementation of this federal law. Despite health insurance being "mandatory" for all Americans, it appears that coverage may remain optional for a great many. 

These two definitional misinterpretations of the word "mandatory" reminded me of Captain Jack Sparrow (Pirates of the Caribbean, The Curse of the Black Pearl, 2003). In it, various characters periodically attempt to rely upon the "Code of the Brethren," or the "Pirate's Code." Seen by some as a binding governing document, it is humorously discounted and derided throughout the movie. Captain Barbossa notes at one point "the code is more what you'd call 'guidelines' than actual rules." And, perhaps that is true of the "mandatory" that is applied to e-billing and health insurance? Perhaps the benefit of "mandatory" e-billing is limited to a good feeling about "progress" without any commensurate actual requirement of actually using the system?

Perhaps there are those out there who have different perspectives on how "mandatory e-billing" works? Are there other "mandatory" elements of workers' compensation that are in fact voluntary due to enforcement issues? Are jurisdictions better served by "mandatory" systems that are not, or voluntary systems? Are voluntary systems with standardization better than those without? Many questions remain about electronic billing.