Mystery of rising costs may be unlocked
TORONTO, Feb. 3 /CNW/ -
Anyone treating injuries from Ontario vehicle collisions must now send
reports and bills to auto insurers via the new Health Claims for Auto
Insurance system. Data on injuries and treatments is to be analysed,
with patients' identities protected.
By James Daw
Some 4,700 clinics and lone practitioners have been ready and waiting to
treat injuries caused by vehicle collisions in Ontario, at an
Yet no one has had a way to sum up the millions of pieces of paper they
would send to 127 different insurers. No one could even say how more
than 60,000 persons a year were injured, how they were treated or how
soon they recovered.
Tuesday (February 1) marked a potential milestone for change, however.
A single, paperless and secure system became the mandatory way for
clinics and practitioners to pass their patients' information,
treatment proposals and invoices to insurers.
The primary goal of the new Health Claims for Auto Insurance system, or
HCAI for short, was to improve efficiency. But it will also provide a
source of data that could be analysed to improve care, provide
explanations and, maybe, control costs.
All Ontario drivers are required to buy a minimum level of accident
benefits to pay for treatment of injuries, assistive devices and income
support, regardless of fault. The cost of claims for these benefits
doubled in Ontario in five years to $3.8 billion by 2009, taking up 39
per cent of total auto premiums. Yet the precise reasons for cost
increases of this magnitude remained a mystery.
"Auto insurance is the single largest payer of out-patient
rehabilitation services…including physiotherapy, chiropractic,
occupational and psychological therapy, (which are services) not
generally available through public healthcare system," notes one
physiotherapist and researcher.
"Until now, there was no standard data collection required," says Viivi
Riis, who worked with consultants and employees of the Insurance Bureau
of Canada to develop HCAI under the watchful eye of provincial
insurance and privacy commissioners.
An earlier version of HCAI launched in 2007 did not prove up to the
task. But the redesigned system handled 1.3 million standard forms in
2010 as it was ramped up toward full capacity this month. It weathered
a dramatic surge of activity in August before the province imposed a
$3,500 cap on spending for most minor injuries.
Riis notes that any initial analysis of HCAI data will only be able to
compare the age, gender, postal district and insurer of those injured,
the nature of injuries, the number and types of therapists and
treatments delivered, how often, for how long and at what cost. (No
information that would permit the identification of individual injured
persons may pass into the database.)
Later, says Riis, the standard forms may be refined. Practitioners may
be asked to describe any pre-existing conditions, physical limitations
and treatment goals using numbered codes instead of sentences the can
only be examined one at a time.
Pierre Côté, a scientist in the Division of Health Care and Outcomes
Research at the Toronto Western Research Institute, foresees the
potential to track compliance with treatment guidelines, to monitor
patterns of care and possibly to develop a tool to predict how long it
will take an injured person to recover in Ontario.
"To achieve these goals, they will have to make sure they are getting
high-quality data," he warns.
Independent researchers could potentially ask the ministries of health
and labour to assist in cross-referencing anonymous data on auto
insurance, workers compensation and public healthcare. "I have done
this in Saskatchewan," he said.
It might then be possible to explore questions such as whether there are
differences in the healthcare experience and health outcomes of
patients in the different healthcare funding streams.
There will be limits to what can be achieved, says Côté. "Using
administrative data will not have the richness of a clinical dataset in
terms of measuring pain intensity, functional limitations or other
things…like levels of depression and health-related quality of life."
Peter Stymiest, chief operating officer of the LifeMark Health chain of
private clinics, expects the efficiency of the new system will free up
administrative staff for customer service and education.
"We don't expect dramatic cost savings," says Stymiest, whose company
offers physiotherapy and other treatments through 38 clinics in
Ontario, plus others across Canada. He holds out some hope that
analysis of HCAI data will lead to better care.
"The value is really the ability to analyse (treatment) outcome
information, the clinical interventions that will lead to determining
best practices in Ontario," he said in an interview. "We'll have an
Ontario solution to handling common injuries like whiplash…information
that is related to our system and the way that we work.
"I think that will be a huge value (to know) what interventions are
working, what timelines are reasonable, what outcomes are expected," he
added. "I think we will find a lot of people are getting good care at a
reasonable cost. At the same time, we are going to see what the
exceptions are, and where there are issues."
LifeMark clinics are among the 117 in Ontario accredited by CARF Canada,
part of the Tucson-based Commission on Accreditation of Rehabilitation
Facilities, which compares clinics with internationally recognized
organizational and program standards. Stymiest says various insurers
have chosen LifeMark clinics as preferred care providers.
But insurers have raised serious doubts about other clinic operators,
and several Toronto-area clinics are being sued for allegedly
submitting fraudulent claims for assessment and treatment.
Christopher Kiah, president of Allstate Insurance Co. of Canada, says
every jurisdiction in North America where auto insurers pay for
significant medical benefits on a no-fault basis tends to see rising
costs, fraud and abuse.
He expects insurers will gradually recoup their investment in
substantial cost of developing the HCAI system through efficiency
gains. The added benefit, he says, would come from collecting data that
might highlight adverse trends and potential abuse in the system.
James Daw is a journalist and researcher at the Insurance Bureau of
James Daw is an award-winning journalist and Certified Financial Planner
who worked for 34 years as a reporter and columnist with the Toronto
Star. He has joined the Insurance Bureau of Canada with the mandate to
continue researching and writing about issues and trends of importance
to consumers and businesses in Canada.
SOURCE INSURANCE BUREAU OF CANADA
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