MINUTES OF THE

      SENATE COMMITTEE ON COMMERCE AND LABOR

 

      Sixty-seventh Session

      January 27, 1993

 

 

 

The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 8:00 a.m., on Wednesday, January 27, 1993, in Room 227 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Meeting Agenda.  Exhibit B is the Attendance Roster.

 

 

COMMITTEE MEMBERS PRESENT:

 

Senator Randolph J. Townsend, Chairman

Senator Sue Lowden, Vice Chairman

Senator Ann O'Connell

Senator Mike McGinness

Senator Raymond C. Shaffer

Senator Leonard V. Nevin

Senator Lori L. Brown

 

STAFF MEMBERS PRESENT:

 

Denise Pinnock, Committee Secretary

Brian Davie, Senior Research Analyst

Frank Krajewski, Senior Research Analyst

 

OTHERS PRESENT:

 

Malcolm H. Weiss, M.D., President, Medical Benefits Consultants

Pat Larson, R.N., Director of Nursing, Superior Health Care

William Prezant, Lobbyist, FHP Inc.

William Cunningham, M.D., Medical Director, FHP Inc.

Tom Anderson, Associate Regional Vice President, FHP Inc. of Nevada

Scott Schroeder, Lobbyist, National Association of Injured Workers

 

 

Chairman Townsend opened the meeting and introduced Dr. Malcolm Weiss, President, Medical Benefits Consultants.  Dr. Weiss submitted written testimony (Exhibit C) supporting managed care for worker's compensation.  He introduced Pat Larson, R.N., Director of Nursing, Superior Health Care. 

 

Senator O'Connell asked how many caseloads they had per team.  Ms. Larson said the private sector figures allow for 10,000 insureds per registered nurse.  A registered nurse heads each team. 

 

Senator Lowden asked about the mechanism for suspending physicians from a preferred provider list.  Dr. Weiss explained they have a peer review system for dealing with problems with physicians.  He stated if the provider list were open to any physician desiring to be on it, the system could become too cumbersome to be effective. 

Senator Lowden asked about self-referrals, which is when a physician refers to a facility where he is part owner.  Dr. Weiss stated studies in the state of Florida showed the use of facilities greatly increases when the physician was part owner.  He said the federal government was clearly against self-referral due to the abuse. 

 

Dr. Weiss agreed, at Senator Townsend's request, to provide statistics on the effects of lifestyle choices.

 

Senator McGinness asked how many clients Ms. Larson and Dr. Weiss had.  Ms. Larson stated in a paid provider organization (PPO) the management company does not know how many insureds there are.  They know how many employees there are.  She said they believe they are covering about 25,000 insureds. 

 

Senator O'Connell requested Ms. Larson give an average of time lost.  Ms. Larson pointed out the senators are looking at the issues in terms of worker's compensation, whereas she and Dr. Weiss were looking at the issues in terms of private medical care.  She said surgical techniques have improved, resulting in shorter periods of lost time.

 

William Prezant, Lobbyist, FHP Inc., a health maintenance organization, gave corporate background on FHP Inc.  He introduced William Cunningham, M.D., Medical Director, FHP Inc., and Tom Anderson, Associate Regional Vice President, FHP Inc. of Nevada.  Dr. Cunningham testified in favor of PPO's.  He explained the necessity for screening physicians for PPO lists.  They are screened for capabilities, facilities, and willingness to work in a managed environment.  Dr. Cunningham stated the nurses are patient advocates.  The FHP Inc. teams try to educate the employer and employee in methods to ensure quality care. 

 

Senator Brown asked about the make-up of their teams.  Dr. Cunningham stated the main core of the team was the nurse and the claims examiner.  There is also a loss control engineer who is involved early in the case.  There is a loss control evaluation done on all employers before they are insured to determine the safety of the workplace.  At Mr. Prezant's urging Dr. Cunningham clarified that FHP Inc. provides both worker's compensation and health care coverage.

 

Senator Brown asked what the average caseload was for their teams.  Dr. Cunningham estimated 200 to 225 cases. 

 

Senator Lowden asked whether the witnesses were familiar with the term "willing provider", which means any physician who is willing can be a provider.  Dr. Cunningham answered that in California the employer has a 30-day right to direct care.  They can direct care to anyone they want and the employee is required to go where the employer directs, unless the employee preselects.  An employee can, before injury occurs, choose his own physician.  Dr. Cunningham said if the willing provider would abide by the rules and there was some measurement of their ability to abide by those rules, it would be a workable situation.  Senator Lowden pointed out Nevada would need to develop language on the criteria for suspending or purging physicians from the list. 

 

Mr. Anderson commented on the blending of worker's compensation with health care coverage.  He stated the goal was to have one provider of medical care without distinction between the two. 

 

Senator Lowden questioned how the lost time and rehabilitation payments would be made.  Mr. Anderson stated those would be sold as separate benefits. 

 

Senator Townsend asked the witnesses to provide a fiscal analysis comparing costs of using an exclusive provider, a health maintenance organization, and a PPO.  Mr. Prezant stated that without "getting in the system" it would be very difficult to provide.  Senator Townsend said he was not looking for a comparison based on Nevada's system but, rather, on the witnesses' own system. 

 

Scott Schroeder, Lobbyist, Nevada Association of Injured Workers, testified against managed care on the grounds it would cost too much to implement.  He said the state of Washington used a computer program which screened physicians.  Mr. Schroeder also stated his support for eliminating self-referrals. 

 

Senator Lowden agreed with Mr. Schroeder that SIIS nurses should do their own utilization review.  She said Don Jayne, General Manager, SIIS, had testified the nurses are too overwhelmed.  Senator Lowden questioned whether Mr. Schroeder advocated hiring more personnel for SIIS.  He stated he really believed the system needed increased personnel to comply with the statutes. 

 

Mr. Schroeder spoke of the ombudsman program which helps workers feel at ease by having their rights and responsibilities explained.  Ombudsmen also go to hearings with employees.

 

Senator Townsend stated the committee would start taking action on the information gathered on the following Thursday and Friday.  He said the committee would move on everything not in the Governor's proposal, on Thursday.  Thursday evening there would be a joint hearing with the Assembly Committee on Labor and Management to hear the Governor's proposal.  Following the proposal the committee would hear testimony from the public.  There would be no action during the adjournment in Las Vegas.  On reconvening in Carson City the committee would make necessary adjustments to the BDR and vote Thursday or Friday to introduce it.  It will be introduced and processed as an emergency measure, so the Assembly will get it the same week the committee returns from Las Vegas. 

 

There being no further business, the meeting was adjourned.

 

 

 

 

            RESPECTFULLY SUBMITTED:

 

 

 

                                    

            Denise Pinnock,

            Committee Secretary

 

 

 

APPROVED BY:

 

 

 

 

                                     

Senator Randolph J. Townsend, Chairman

 

 

DATE:                                

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Senate Committee on Commerce and Labor

January 27, 1993

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