What are22 some of the injuries that require a hand23 therapist?24 Please identify yourself for25 50 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 the record.2
My name is Erica3 Kopcha. I'm Director of the Hand Therapy4 Program at Progress Physical Therapy.5 Certified hand therapists6 require a specialty certification in7 order to manage complex hand injuries and8 upper extremity issues that can occur9 whether on the job or through various10 other types of trauma. Typical physical11 therapists are unable to perform these12 tasks. Our assessment abilities and13 skill-set is unique to those injuries.14
What are15 the typical injuries that require hand16 therapy?17
Hand fractures,18 tendon injuries, nerve injuries, trauma,19 gunshot wounds, car accidents, oftentimes20 with City workers restraining prisoners21 with our corrections officers, subduing22 suspects on the street for our police23 officers, things of that nature.24
And are you25 51 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 aware -- let me go back to Premier again.2 Are you aware of the current --3 I assume this is the current panel that4 was handed up?5
I have asked for a6 copy of that panel from CSI and from the7 City and I have not been given it. It's8 like a secret thing.9
So10 La Fortaleza, two locations, and then11 nine NovaCare locations.12
All right.17 Is there anything else that you would18 like to add? That's fine. If not, I'd19 like to bring -- oh, Councilman Greenlee.20
Just real21 quick. Thank you, Mr. Chairman.22 Again, for Premier, just so I'm23 real clear on this, all your contacts24 with either CompServices or the City on25 52 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 this matter of being taken off the panel2 has all been verbal? Have you ever3 gotten anything in writing?4
No, not at all.9 And I've sent the savings reports, I've10 sent the utilization reports, I've sent11 copies of the contract. I've said, Look,12 can you please at least adhere to the 9013 days' notice? No response.14 Now, they did pick up -- during15 that first week, they picked up the phone16 and called me. They would never respond17 to an e-mail, because that would18 constitute a paper trail. So they picked19 up the phone and they called me. And no20 one wants to -- like CSI is saying, We're21 not privy to the reason. The City is22 saying, I take -- Barry did say, I take23 full responsibility. This is not -- CSI24 is not to blame.25 53 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 I said, All right, but how did2 NovaCare end up back on the panel when3 they got thrown off two years ago for4 giving gifts -- trying to give gifts to5 the City? And I wanted to know this:6 What analysis did you do? Like did7 NovaCare come in and say, Hey, we can8 save you X amount of dollars? What did9 they tell you? What did they try to sell10 you?11
I just12 want to be clear. Everything has been13 verbal, right? There's been no --14
That's right. In18 fact, I got wind of this hearing today on19 Monday, and I sent e-mails out to them,20 because I didn't know what it was about.21 I didn't find out until 4:30 yesterday22 that this hearing was taking place. I23 was literally up until 3:30 in the24 morning in Pittsburgh, hopped a flight to25 54 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 Philadelphia this morning and slept two2 hours. I'm just saying that I tried on3 Monday --4
Sounds5 like you've been drinking some coffee,6 too.7
I wish. I haven't8 had coffee or I'd be talking a mile9 minute more faster than I am right now.10 But what I'm saying is, I11 tried. I sent an e-mail to them on12 Monday saying, Hey, I've gotten wind from13 one of my network providers there might14 be a hearing. No response. It's like15 it's secret.16
All17 right. Thank you.18 Thank you, Mr. Chairman.19
Okay. Are20 there any other questions for these21 witnesses?22 (No response.)23
I'd like to24 ask Episcopal and Northeastern25 55 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 Occupational Medicine and Aquahab.2
Good8 morning. Thank you for your appearance,9 your attendance. As you heard in the10 last panel, I would like you to kind of11 give a little bit of background about the12 company, how long you've been in13 business, how long you've had a14 relationship or did have a relationship15 with the City, what interaction with16 CompServices or the City have you had or17 didn't have as a result of how you were18 terminated, just what the circumstances19 surrounding all this. Also, where your20 locations are and the number of people21 you employ would be helpful.22 So whoever would like to start.23 Please identify yourself -- and these are24 old systems, so you're going to have to25 56 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 speak directly into the --2
Good morning,3 Mr. Chairman and Councilmembers present.4 Thank you very much for the opportunity5 to give our presentation today.6
Industrial Health13 Services at Episcopal Hospital. And we14 also own R&B Medical Management, which15 was located at the Northeastern -- known16 as the Northeastern Industrial Health17 Center before we closed that facility and18 amalgamated it into the present location19 at Episcopal Hospital.20
We have been23 involved in the delivery of healthcare24 for work-related injuries, and we have25 57 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 been involved with the City of2 Philadelphia since the inception of its3 managed care workers program, which4 started in 1993. As a matter of fact, we5 bid -- we replied to the RFP that the6 City of Philadelphia sent out at that7 time, and, of course, we did lose out,8 unfortunately, to bigger companies, but9 we were invited to join to be a panel10 provider. 24 We have, I believe, provided25 58 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 very good healthcare to the injured2 members or the employees of the City of3 Philadelphia. We have -- as I said4 previously, we had two locations. 11 Now, prior to closing that12 location, we contacted both the City of13 Philadelphia and CSI to make sure that14 that was not in any way going to affect15 our relationship with the workers'16 compensation program of the City of17 Philadelphia. 23 The main reason for that24 closure that we did was the fact that, as25 59 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 you probably all remember, is that2 Northeastern Hospital closed as an active3 hospital and only maintained an4 outpatient type of presence, and the5 biggest loss there was the loss of the6 emergency room, which took care of the7 work injuries in our assigned area during8 the off hours. We no longer could9 provide that, and the injured workers of10 the City of Philadelphia would get11 treated in far-away emergency rooms to be12 followed by us. Trying to get like a13 quick x-ray report or be able to look at14 the x-ray images from the -- through the15 computer system was no longer available16 to us. 20 There was no continuance of21 care in that regard, and we thought that22 that, plus the fact that the physical23 plant that we were located at was not24 improved despite my plea to improve25 60 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 them -- the elevator was breaking down2 about a couple of times a month and, of3 course, the injured employees can't walk4 very well sometimes, and I was very5 afraid that they were already injured and6 even get more injuries should they fall7 going up and down the steps. 21 We followed what was asked of us,22 including attendance in the monthly23 Medical Director's Meeting, submission of24 reports and even reports that we already25 61 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 5
CSI. CSI is the8 institution that needed medical reports.9 So we sent them to CSI.10
Actually, I was17 not notified. It was my partner,18 Dr. Bonner, who received a phone call19 from somebody at CSI and apparently, to20 my understanding, somebody that neither21 of us who met before nor have talked to22 before.23
Were there24 reasons given for your termination?25 62 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
There was no2 reason given for our removal from the3 network providers.4
I'm Dr. Bill7 Bonner, and I was at the Episcopal site8 when the call came in from an individual9 who I hadn't met before. You must10 understand that we've been involved in11 this program for 17 years' time and we12 saw CSI come from a five-person company13 into a big inner city company that it is14 today, and we knew most of the important15 people in that office like over the16 years. And I received a call from a17 person who had just been hired on to say18 that in the next one month's time that19 all the patients --20
I'm sorry. So23 then I received a call that in the next24 one month's time, all of the City25 63 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 patients would be transferred out of the2 office, with no explanation, no reason.3 I asked, Why? What happened?4 And she said, Well, I don't5 know. This is what has -- like I was6 called to tell you that this is what is7 going to occur.8
So there9 had been no prior correspondence or calls10 relative to dissatisfaction, no11 complaints?12
Been no13 notifications about complaints, been no14 warnings, been no probationary periods,15 been no reprimands, been no -- Gabe16 Rosales had attended the Medical17 Director's Conference two days before he18 was -- or before the call came in to our19 offices. He had met with the Risk20 Management team. He had met with all the21 medical directors up there. He spoke to22 the Medical Director for the City of23 Philadelphia, and nothing was said. He24 walked out the door, came back, he gave25 64 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 me the report, conference went well, here2 are some things that I would like to do,3 and two days afterwards, I received this4 call, shocked.5
And, again,9 you said you've had a relationship with10 the City for 17 years?11
In April, I signed15 a new contract to provide continued care16 to the City workers. I think that's17 attached to our information that we sent.18 And we received no notification by19 written mail. We received only that20 call.21 I did then, after I received22 the call, I was able to reach Lee Herzer23 from CSI. He was kind enough to return24 the call, was kind enough to arrange a25 65 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 date and time for myself to come down to2 meet himself, and he arranged for me to3 come down to meet Mr. Barry Scott.4 Dr. Rosales and I came down,5 and we did meet with Lee Herzer and Barry6 Scott, and were basically informed that7 it was a fait accompli, that the8 decisions had been made without any real9 explanation on why.10
So there11 were no specifics that were given to you12 as to dissatisfaction or price or13 over-utilization?14
Well, they had15 talked about a number that they -- as we16 rolled out this workers' comp program,17 systems evolved, and probably about ten18 years ago, we began to check to see like19 the number of new patients that come into20 a particular office and compare that to21 the numbers of returns, and to have that22 kind of as a compass as to are doctors23 bringing patients back too often. And as24 we discussed with the medical directors,25 66 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 we informed them that that idea is okay,2 but you have to keep in mind that there3 are a number of other things that affect4 that relationship as to the new patients5 to the number of returns. If I have a6 large number of new patients, well,7 that's going to make that ratio look8 small, and on the other hand, if I'm an9 old department and I am seeing a lot of10 patients that I've seen for 10 or 1511 years' time, as Dr. Rosales and I have --12 the other day before this contract was13 taken off of us, I saw a patient in the14 office, a Chief Inspector from the Police15 Department, who I've known for 15 years'16 time. He comes in, still on the City17 panel, still being seen. And I have tons18 of patients that I've been caring for for19 decades now that continue to come back.20 Dr. Rosales is a certified21 trauma surgeon, and the case managers at22 CompServices, Inc., they tend to send him23 the, quote, problem cases, the cases who24 are out for quite some time and they're25 67 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 trying to get a resolution, they want2 somebody to pick up the case and try to3 bring some sort of resolution to the4 case. So he and I receive these5 transfers in.6 So if you have a large number7 of old patients that are coming in,8 you're getting a large number of9 transfers in that aren't going back in a10 couple days' time and your numbers are11 small, you're seeing a small number of12 new patients, well, of course then your13 numbers are skewed somewhat. And these14 issues had been all discussed, and CSI15 and the Risk Management team all16 understood that. And we've worked with17 these numbers for the past ten years'18 time and there's never been a major19 concern, just as a barometer as to you're20 a little off, let's try to work things21 out, but never a major concern.22
Thank25 68 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 you, Mr. Chairman.2 Doctor, if I could just ask,3 and I know you said this, just first4 clear for the record. In taking you off5 the panel, you've never received anything6 in writing?7
As far as9 the notification or the reason, correct?10
During12 your years, I think you said something13 about sending in progress reports or some14 reports?15
Okay.18 Have you over the years gotten things19 back from the City either commenting or20 giving instructions, or from21 CompServices, in writing either saying22 you need to do something else or --23
-- you're25 69 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 doing well or anything like that?2
You never4 get anything in writing back from any of5 entity?6
We did not. And7 we meet once per month, and there's never8 been any sort of reprimand where we need9 to pull you guys aside and say, Hey,10 guys, you stepped out of line here, you11 need to fix this or else.12
And they13 don't do written evaluations, if you14 will, of any kind, positive or negative,15 right?16
Okay.18 All right. Thank you.19 Thank you, Mr. Chairman.20
Sir, could21 you please identify yourself for the22 record and again proceed with your23 testimony within those guidelines.24
My name is Tate25 70 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 Rice. I'm the Vice-President of Clinical2 Operations at Aquahab Physical Therapy.3 Our location is at 3600 Grant Avenue in4 the Northeast, and we have approximately5 15 employees that work there full time6 and a handful of part-time people as7 well.8 The City contract for us9 represents about 30 percent of our10 business. So we do between 200, 25011 visits a week. We'll probably get three12 or four evals a week from the City, or13 had been. We've been contracted with14 Premier Comp Services since January 2009.15 We've been contacted by Selena Aron at16 CompServices in the fall of 2008 to let17 us know we were going to be on the panel18 starting in 2009. And over the time, the19 caseload built pretty well and was, for a20 business, very good for us.21
The company itself24 is about 15 years old.25 71 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
Did you2 have any contact with the City prior to3 the CompServices' notification that you'd4 be on the panel?5
No. From what I6 understand -- I have been with the7 company about four and a half years now.8 My predecessor had had some contact with9 CompServices, but nothing that ever10 produced anything. So I sort of got a11 call somewhat out of the blue in the fall12 of 2008 letting me know that we were13 going to be on the panel. And then14 starting at the beginning of October, I15 got a call from Sharon Kress at Premier16 Comp Solutions letting us know that the17 City had decided to no longer use the18 panel that Premier Comp had created and19 they were going with their own panel, and20 since that time, we haven't seen another21 new referral since then.22
Do you know23 how many companies were with Premier24 Comp, how many was under their umbrella?25 72 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
Four3 companies were under -- and all of them4 were terminated?5
Well, La Fortaleza11 is still on the --12 COUNCILMAN KENNEY:13 La Fortaleza was part of it?14
So the four18 that were affiliated with Premier were19 removed?20
And that22 would be Progress, your company, and23 what's the other one?24
Bustleton,25 73 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 Outreach.2
I realize3 there's only four companies we're talking4 about here, but geographically there5 seems to be a bit of a thread. All of6 them are in the Northeast part of the7 City. So I don't know whether that is8 just happenstance or there's an issue9 there that's related to where the10 companies are located.11 How many --12
Well, what I can13 tell you is that of the 30 people that we14 saw week in, week out, I would say15 probably 95 percent of them lived in the16 Northeast.17
Well, the people20 that we had been seeing we're allowed to21 continue to see, so...22
We haven't had any25 74 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 new referrals, correct.2
I'm assuming5 NovaCare, since they're around the corner6 from us.7
Just one14 quick question on this for anyone. I15 understand one of the listings is by zip16 codes. Do you have a certain amount of17 zip codes that you cover or you covered18 when you were in there? Is that how that19 works?20
That's correct.21 For the medical piece, it is divided up22 per zip codes. And our area covered, I23 think, what, six zip codes?24
Seven zip codes.25 75 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
Well, like our4 center at Episcopal -- so it was centered5 around the zip codes around that6 particular hospital there. At the time7 that this program was devised back in the8 early '90s, as you may recall, the whole9 City workers' comp program was based out10 of the Hahnemann Hospital here and like11 all the patients were seen there. At12 that time, well, they asked us to come13 down to check it over and to give some14 recommendations as to like what should be15 done, and we came up basically on the16 idea that it needs to be broken down and17 sent out to certain areas around the town18 that the injured person could be seen and19 sent back to their jobs.20 Secondly, though, we asked that21 they be placed in impoverished,22 poor-providing hospitals where the poor23 are being cared for and to put these24 departments in hospitals that are25 76 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 providing a fair amount of the poor and2 indigent care. And that's one reason why3 like we opened up at the Episcopal4 office, because it was a big industrial5 area there, but the idea was to bring6 these patients in to these impoverished7 areas to help support these communities,8 because we then refer patients out to the9 outlying Fortaleza; for instance, the10 minority-owned PT department in that11 area. So we'd refer patients out to12 them. I know that Fortaleza is upset13 with our offices being shut down.14 The second issue is is that if15 you look at the geography of it, now with16 our office taken out of it, you have the17 Hahnemann site here in town. They've18 transferred all of our patients up to19 Frankford, and the other site up there is20 Jeanes. Frankford Hospital to Hahnemann21 is 13 miles as the bird flies. No22 industrial health center in this whole23 area.24 So if you're talking about the25 77 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 geography of it, I'm not sure what the PT2 locations are, but as far as the3 healthcare, the medical end of it is,4 they've taken out a site that can provide5 for the 23rd, 24th, 25th of the Police6 Department as opposed to sending all7 those officers up to the Far Northeast.8 It's going to take them during the day up9 to an hour to travel up there.10
Let me just15 correct myself. We did have a total of16 nine zip codes prior to all of this. And17 also, just to follow up on -- Dr. Bonner18 said that this 13 radial miles from19 Frankford to Hahnemann and six radial20 miles from Frankford to Jeanes. So21 that's a big hole in a triangle that has22 no existing occupational health center at23 this time for the City.24
And do you25 78 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 have anything to add in addition to what2 you've already testified to?3
No. I mean, you4 know, it's an impact on the business.5 The only thing I would say is, I know6 that part of the reason I think that the7 zip codes are created and everything was8 obviously to keep business within the9 City limits, and speaking as somebody who10 works for a company with a location in11 the City, it's going to harm us. I mean,12 there's no question about it.13
Okay. Any14 questions for these witnesses?15 (No response.)16
Thank you17 very much for your testimony.18 I'd like to ask Mr. Scott and19 anyone from the City who is available to20 testify basically offering their own21 testimony and commenting on whatever else22 they'd like to comment on.23 (Witnesses approached witness24 table.)25 79 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
My name is Barry2 Scott. I'm Deputy Director of Finance3 for Risk Management. Thank you very4 much, Councilman, President -- sorry;5 Chairman.6
Thank you for the8 opportunity to testify as well.9 It's the mission of Risk10 Management to provide high quality11 healthcare and control the costs of12 claims against the City, and it's also13 the job of Risk Management to limit the14 number of injuries and illnesses that15 City workers experience. Unfortunately,16 in the course of their jobs, City workers17 experience a number of injuries and18 illnesses. We try to reduce that with19 our safety unit and reduce the number of20 incidents that we have, but we do have21 incidents. When we do have them, we try22 to handle them in the most expeditious23 way possible.24 We have contracted with a Third25 80 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 Party Administrator, CompServices,2 Incorporated, to provide us with a total3 package of care for medical care as well4 as management of a legal system and5 defense of claims. The Third Party6 Administrator is responsible -- and as we7 mentioned, they're a wholly-owned8 subsidiary of Independence Blue Cross.9 They provide care for over 3,00010 work-related injuries we experience a11 year.12 One of the responsibilities of13 the Third Party Administrator, one of the14 primary responsibilities, is to contract15 with and credential medical providers and16 provide a network medical panel for the17 City's program. Historically that18 medical panel has -- at one time it was19 PGH where all City injuries were handled.20 Since then under this program, we've21 expanded to have a number of hospitals22 and provide a number of facilities that23 could provide injury care to City24 workers. Each year we have more than25 81 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 23,000 doctor visits and more than 29,0002 physical therapy visits under this3 program.4 Providers' continued5 participation in the program is6 contingent upon their appropriate care of7 injured City workers, their adherence to8 City medical protocols, the adherence to9 the American College of Occupational and10 Environmental Medicine Guidelines and11 satisfactory performance in occupational12 medical care and appropriate conduct with13 the City patients and relevant14 performance measures.15 With me today are Dr. Wilma16 Korevaar, the Medical Director for17 Employee Disability from the City's Risk18 Management Division, also Risk Management19 counsel, Hilary Cornell. Also here are20 Lee Herzer, the Vice-President of21 Operations for CompServices,22 Incorporated; Michael Petrone, the23 Program Manager for the City's program;24 and Sue Gramlich, the Assistant Program25 82 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 Manager.2 I'm ready to answer any3 questions -- happy to answer any4 questions that the panel may have at this5 time.6
Thank you7 very much for your testimony, for your8 attendance here today.9 Part of the genesis of this10 whole hearing has been a bit of the11 confusion as to when an inquiry is12 made -- and all of our Council offices13 get inquiries -- either how do we become14 part of the City system to provide15 services or why have we -- why was it16 decided to stop sending referrals or17 employee cases to a particular company.18 And I know from my own perspective when I19 or my staff makes those inquiries, I have20 been told that the reason that we hired21 CompServices, Inc. was to remove the City22 from or at least distance the City from23 that decision-making process. But then I24 wind up -- I pursue attempting to get a25 83 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 company that's been in business for 202 years in the City providing physical3 therapy to get onto a panel and was not4 successful and told that they couldn't5 get on because CSI didn't feel that they6 were appropriate. And I accept that. I7 mean, that's what I've been told.8 On the other hand, I have9 companies that have been doing business10 with the City or providing services to11 City employees for 17 years, for 1312 years, for seven years, for two years13 that are eliminated from doing City work14 without any notification. I mean,15 normally you would think that if someone16 is not meeting standard or not living up17 to what they said they were going to live18 up to, that there would be a phone call,19 a meeting, a contact to say, Look, we've20 evaluated this particular quarter, we're21 not happy with your performance and we're22 giving you 30 days to come up to speed or23 by next quarter you could be in jeopardy24 of losing your position. I mean, simply25 84 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 stopping the referrals coming to a2 company with 25 and 30 employees, who are3 making investments in their company based4 on the expectation of continued work with5 the City, especially since no one,6 according to their testimony, has ever7 complained that they've been anything8 other than providing decent service,9 seems to me to be at least not very10 businesslike and somewhat offensive to11 companies who are established in the12 City, employing City residents, employing13 folks and paying taxes, all the sudden14 after a three- or four-week period come15 to the conclusion that they're out,16 without even having a letter sent to them17 or a phone call made to them. And I just18 don't understand how that could happen.19
Well, first, let me20 just say our ideal is not to send any21 business to any of these providers,22 because our ideal is not to have City23 workers getting hurt. And so we are24 always trying to reduce the number of25 85 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 injuries that we have among City workers2 and City workforce and trying to reduce3 the number of people we're sending to4 these providers.5 To the extent that we have6 business that we do send to these7 providers, we are working to make sure8 that they provide care in a good way.9 We've looked at a number of measures of10 their quality of performance and track a11 number of those measures in order to12 evaluate their performance. We also get13 feedback from the departments whose14 injured workers go to those treatment15 sites. And it is that information, both16 performance measures and feedback that we17 get from departments, that help to inform18 us about what our feedback is to19 CompServices about the medical providers20 on the network panels.21
Who does22 the evaluation of the City workers, who23 gets sent, how long they're there, what24 type of therapy they receive and how25 86 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 effective that therapy is? Who makes2 that evaluation?3
Well, it's a4 managed care system. It's a managed care5 system. The primary care doc -- we have6 a number of -- we have six primary7 treatment sites. Those six primary8 treatment sites are where you go to your9 main doctor. You then are also farmed10 off to specialists, as needed, where the11 doctor is not able to handle your12 particular issue. That's where the care13 decisions are primarily made.14 We review those with nurse case15 managers that CompServices has, and16 CompServices also has a medical director.17 The City also has a medical director in18 Dr. Korevaar. Dr. Korevaar provides19 oversight for the medical program and20 resolves issues where there are conflicts21 or concerns about the medical care with22 regard to what a patient is receiving.23
How are24 those conflicts or concerns articulated25 87 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 to the provider of the services if in2 fact they contend at this hearing today3 that they have never had any interaction4 on a negative side with CompServices,5 Inc. or with the City, it just happened6 that one day they realized that they were7 out?8
Could you11 please identify yourself for the record.12
I'm sorry. I'm13 Wilhelmina C. Korevaar, M.D., and I have14 a contract with the City. I work in Risk15 Management as the Medical Director for16 the Employee Disability Program, and I've17 served in that capacity since 1996,18 initially through CompServices and since19 2000 directly.20 One of the reasons why I was21 brought into Risk Management was so that22 injured employees, their representatives23 or the departments could contact me about24 grievances or complaints. I could review25 88 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 the records, then contact either the2 medical director or the case manager at3 CompServices so that feedback could be4 given to the provider. And there is a5 grievance process, just to address one of6 the things that exist, in which the7 employee will then be asked to write a8 grievance, the provider to provide a9 written response. That's one aspect of10 the way in which the program is11 monitored. Because it's a managed care12 program, it's important that the injured13 employees have an avenue for grieving.14 If they don't get along with the doctor,15 for example. Because there are limited16 sites, we need a way in which the injured17 employee can get to a site where he or18 she is comfortable.19
When you're20 talking about the six sites, primarily21 you're talking about hospitals?22
But that's25 89 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 a separate layer than the folks who2 testified here earlier, correct?3
So of the5 six sites, if I am an injured police6 officer and I go to -- is Hahnemann one7 of them?8
And I go to10 Hahnemann and I don't like my doc and I11 want to complain about that and get sent12 to another of the other five sites,13 that's a process?14
All right.16 How does that then trickle down to the, I17 guess, on-the-street folks who are18 actually providing the physical therapy19 and rehabilitation?20
The doctors at21 the sites that are hospital based and the22 physical therapy sites are zip code23 allocated, and it's the work site zip24 code. The idea being that you may be25 90 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 able to work in a modified capacity and2 still get to treatment and that treatment3 will be relatively close to where you4 work, and it is up to the treating doctor5 to write a prescription for physical6 therapy.7 Now, there are many work8 injuries that do not require any physical9 therapy and then there are work injuries10 that require some physical therapy. On11 average, there should not be more than12 six to 12 physical therapy visits per13 injury. So it really should not ever be14 the case that three to five new visits a15 week should account for 30 percent of16 business, unless there are too many17 visits. And so one of the other things18 that CompServices does on behalf of the19 City is monitor the number of visits to20 the physical therapy sites and the21 overall cost of physical therapy, and as22 a result of that monitoring,23 periodically, let's say every two to24 three years, the physical therapy sites25 91 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 may be changed because there is a2 perceived problem with over-utilization,3 exceeding guidelines.4
Now, does5 that contract with CompServices, Inc.6 require them to interact, interface,7 communicate with the physical therapy8 providers that in fact, in our managed9 care opinion, you're seeing too many10 folks too many times?11 I don't know what the12 individual situations in these particular13 four companies are, because I haven't had14 a chance to investigate how many people15 they've seen and over what period of16 time, but shouldn't either CompServices17 or the City, as they do with other -- as18 Independence Blue Cross does with other19 providers, say, Hello, this is your case20 manager, we got a little issue we need to21 sit down and talk about, these five folks22 have been here more than 15 or 20 times,23 it's out of line, we need to get that24 back in sync, as opposed to just stop25 92 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 sending them folks?2
CompServices has3 case managers, and those case managers4 interface with the physical therapists as5 well as the physicians who are continuing6 to prescribe the therapy once six weeks7 of therapy is exceeded. And I meet with8 the physicians once a month, and one of9 the things that we go over repeatedly is10 the physical therapy over-utilization.11 Now, the doctors tell me that12 the physical therapists somehow are13 independently continuing to treat the14 patients, and the physical therapists15 tell the case managers that the doctors16 continue to write the prescriptions even17 though they're saying this person has18 plateaued.19 So there is a lot of20 communication. However, your point is21 well taken, clearly the communication22 isn't leading in the proper direction.23
But the24 communication should, I would think, be25 93 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 initially in an effort to resolve the2 issue or to improve the issue. Because3 what happens to me is that when I hear4 the testimony about the lack of5 communication, I have to take them at6 their word. I mean, they're sitting here7 telling me that the only contact they get8 from CompServices is, yes, we received9 your reports, no news is good news,10 everything seems to be fine, you know,11 and all the sudden we're out. And what12 happens is that I look at the current13 panel and I see La Fortaleza, which14 remained on two panels, and I see nine15 NovaCares and then four Mercy Health. I16 still need to understand the business17 process and practice of saying to a18 company that's been working for the City19 or with the City for 17 years or ten20 years or five years, Things are going21 bad, you're not going in the right22 direction, we're getting ready to notify23 you 90 days or 60 days, whatever the24 contract says, you either got to clean up25 94 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 your act or you're not going to be with2 us. I mean, I know that happens with3 medical practices, with other types of4 medical providers, that, Look, we're not5 going to contract with you again if you6 don't get your numbers where they need to7 be, as opposed to saying nothing.8 Now, maybe CompServices or you9 guys are aware of contact with these10 particular companies or others that have11 been removed that would indicate that12 what they're telling me is in fact not13 accurate, but I sense that it was pretty14 much a surprise to them that they were no15 longer getting any referrals.16
With regard to17 the doctors, they've been informed that18 the panels would be changing since July19 at the meetings, and I did have other20 provider sites' physicians come to me at21 the end of the monthly meeting to ask22 about specifics. So --23
These are24 the docs, though.25 95 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
These are the2 doctors.3 With regard to the physical4 therapy sites, we do count on5 CompServices to maintain contact with the6 administrators of those pieces. Mercy7 Work Care has administrators, NovaCare8 has administrators, and Premier Comp9 Solutions has an administrator. And then10 those administrators are the ones11 responsible to communicate with the12 individual provider sites that they13 oversee.14
But based15 on the testimony of the prior16 individuals, that contact didn't happen.17 I mean, where the rub is is that --18 there's two issues: Whether or not they19 overtreated or the doctors20 over-prescribed and whether or not these21 folks were ever notified of any of this.22 I mean, and that's where I still don't23 have any clarity as to who at24 CompServices or Risk Management is25 96 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 responsible for picking up the phone and2 saying, Dr. Bonner or Mr. Mohollen, get3 me your business person or your director,4 let's get in here and talk about this.5 Because it doesn't seem that that6 happened. It just seemed that they ended7 and were replaced by someone else.8
And I can speak to9 some of that. There's some extent in10 which the communication didn't happen as11 it should have, and I did apologize to12 Linda Schmac and I also apologized to13 Dr. Bonner about the communication not14 happening appropriately. However, in the15 case of Episcopal/Northeastern, there16 were a number of contacts with them over17 a period of time which expressed concerns18 about treatment and care that was19 received there, and those contacts were20 made between CompServices primarily.21 We have Dr. Korevaar with us a22 few days a week. She's not with us full23 time. We really count on CompServices to24 be the primary conduit for communication.25 97 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 They do that through --2
Currently it's5 Dr. Dituvich (ph), but they have a new6 medical director, Dr. Dragoon, who is7 coming on board now.8
Are either9 of those docs the ones that are examining10 this information and making11 determinations?12
Yes, they are, and13 they also have the nurse case managers14 who are examining that information.15 There are three real lines of authority16 there. The nurse case manager is the17 primary one who deals with you, the18 patient, and your provider about your19 care, and then the nurse case managers20 then report to Ms. Gramlich, the21 Associate Program Manager for22 CompServices. Then the Medical23 Director -- they also report to the24 Medical Director of CompServices. Then25 98 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 CompServices also has a Director of2 Provider Relations. Her name is Carrie3 Blouse, and she's the one who oversees4 the relationship between CompServices and5 all of their providers.6 The providers provide care not7 only to City of Philadelphia, they8 provide to their other clients as well9 these medical panels. And so the10 communication that happens between the11 case manager and the medical director at12 CompServices and provider relations at13 CompServices is information that14 CompServices reports on to us. They keep15 us informed somewhat about that, but16 they're primarily concerned with17 communicating with the provider about how18 their provider is performing along a19 number of metrics. Those communications20 went on in the case of Episcopal and21 Northeastern.22 With regard to physical therapy23 providers, we really have been -- we have24 not done what we should have in terms of25 99 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 communicating with physical therapy2 providers, and we've -- we're in the3 process of changing that so that we're4 communicating more with the physical5 therapy providers now.6
Let me go a7 little bit backward, because my8 understanding from previous testimony --9 and maybe it's accurate or inaccurate --10 that NovaCare -- and it's a fine company11 in the City and I happen to know the12 folks that are involved there and I have13 nothing but respect for their company,14 but I understand that at one point in15 time, they were removed from the16 provision of services. What were the17 circumstances of their removal and what18 were the circumstances of their19 redemption?20
They weren't21 removed completely, but the number of22 sites that they had was reduced, and it23 was because of over-utilization.24
The number25 100 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 of sites they had were reduced?2
No. This is the6 current panel. Prior to this panel,7 NovaCare had fewer sites. They had like8 four or five sites on, and then we had9 the Premier Comp sites, who you heard10 from this morning. So those sites were11 on, and those were sites primarily in the12 Northeast that were selected, because we13 wanted to make some changes to try to14 tinker with what was available in that15 section of the City.16
So17 basically the additional NovaCare sites18 replaced the Premier Comp sites?19
Going back,21 though, to when they were removed, they22 at one point had more than nine sites.23 The physical therapy utilization got very24 high and we noticed that it was coming25 101 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 out of the NovaCare sites, and that2 prompted us to reconfigure the physical3 therapy sites and to bring in the four4 sites from Premier Comp Solutions. We5 were hoping that that would bring the6 physical therapy utilization down, but it7 didn't. It actually went up even more.8
Let me ask9 you a question. La Fortaleza was part of10 the Premier group, right?11
No. They've13 never been -- they've always been an14 independent group, and their utilization15 has remained pretty steady. They haven't16 taken the cases and started to just turn17 them, and that's why they've remained on18 the City panels through these other19 changes.20
See, I21 think part of the issue that brings us22 here today is that -- and I do respect23 the Administration's striving for this24 transparency, but the issue here seems to25 102 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 be less transparent, because there's2 decisions that are being made that affect3 companies that employ folks without even4 a period of time, like within a year,5 that you can say, by the way, we're not6 sending you any more folks. How do you7 create a business plan and maintain your8 business if at any given time you can9 have the rug removed from under your feet10 and without, according to their11 testimony, without any notification?12
But no business13 in healthcare has any business counting14 on a single employer to maintain their15 business. That isn't a wise business16 plan at all.17
But that's22 kind of after the horse has gone to the23 barn, that we recognize there's been no24 notification, we think that's wrong,25 103 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 we're sorry, but in the meantime, we've2 reinstituted four more sites to a company3 that had five sites already. I mean, to4 me -- with a company that had been5 reduced once before.6 So it seems that -- I mean,7 it's not like they didn't have their own8 problems when they lost their four sites9 previously, and now not only do they have10 five, they have the additional four.11
But there's no12 guarantee when you're on any panel, as a13 physician or physical therapy site, that14 you will remain on that panel. A panel15 is an employer designation. That's16 really all it is, and panels change all17 the time.18
But it's19 not just a private company employer20 designation. This is a public company21 with public requirements, that at least22 folks need to know. I mean, this is a23 legislative body that votes on budget24 issues that are related to Risk25 104 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 Management, the Finance Department,2 things that we have -- we're the Board of3 Directors of this company and I have4 elements of the company making decisions5 that really don't feel any need to inform6 anybody about and just go ahead and do7 it.8
No. I'm11 speaking about my role on the Board of12 Directors of the City of Philadelphia,13 the 17 members of City Council, who have14 oversight over this government, along15 with the Mayor, who is the Chief16 Executive Officer. I don't understand17 how one segment of the government18 independently can make decisions based on19 companies that are existing in the City20 just shifting business around from one21 folk to another without any notice. I22 mean, how do you not notify the people23 who are losing the work or the folks who24 are responsible for the oversight of the25 105 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 spending of the money? It just seems2 that there's this -- and I'll tell you3 personally why I get upset about it, is4 when I make a call to make an inquiry5 about a company that wants to6 legitimately compete to get in, I'm told,7 You know what, the City is not involved8 in that. We hired that Third Party9 Administrator to get away from that10 problem. Or if I call to complain or11 make an inquiry as to why a company that12 comes to me as an elected official and13 says, We got knocked off without being14 told, I call to find out why that15 happened and I get an answer, You know16 what, we hired that Third Party17 Administrator so we didn't have to deal18 with this. So that was their decision to19 make. And then privately I am told --20 and I'm not going to be specific about21 the case -- that the Third Party22 Administrator says, You know, we don't23 always agree when they want to get rid of24 somebody. We kind of argue that they25 106 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 they're okay and we should keep them, but2 the City decides that they want them out.3
I mean,6 it's very confusing, and when it all gets7 confusing like this, you start to wonder8 how people wind up getting removed and9 then how people wind up getting replaced10 and what's the motivation.11
The motivation12 always is quality of care and cost for13 the City. That's the motivation. What14 we are looking at is the quality of care15 that's received by our injured workers16 and what the cost of that care is. We17 are looking to balance those things in18 cases of thousands of injuries that come19 through the centers annually, and we are20 looking at a number of -- as I said, CSI21 looks at primarily the metrics. We look22 at the relationship with the patients,23 with the individual employees, in order24 to make sure that City employees are25 107 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 respected in their care.2
The decision is8 usually made jointly. CSI has -- CSI has9 the responsibility to manage that panel10 for the City of Philadelphia. The City11 has the ability to override or overturn12 what CSI has said, because we can have13 some input. We need to have some input.14 But we have had cases where -- and it's15 not something that we're happy about, but16 we've had providers -- and none of them17 here today -- who have abused City18 employees, they have made sexual19 advances. There have been a number of20 things --21
They22 shouldn't be eliminated; they should be23 indicted and arrested. But that's a24 whole different...25 108 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
I'm just saying in2 terms of managing the care and in terms3 of the kinds of controls that we want to4 have in terms of our ability to be5 flexible, this program requires a lot of6 ability to be flexible, and that's why we7 use CSI to contract -- to provide that8 contract.9 Also, just to sort of follow up10 on Councilman Goode's question from11 earlier today, there is a minority -- the12 Premier Comp Solutions was named in CSI's13 contract at about $96,000, and they14 received over half a million dollars in15 the last fiscal year. So there was a16 commitment. That commitment was met and17 exceeded.18 COUNCILMAN KENNEY:19 Councilwoman Krajewski, do you have20 questions?21
Thank22 you.23 I don't know, but do we have a24 list of the new providers?25 109 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
How5 about the names of the ones that you6 removed? Do we have a list of them?7
Could11 I have a list or the Chair have a list of12 the ones that we removed?13
I'm sorry.18 In addition to the list of those removed,19 what the reason was for the removal.20
Right.21 I mean, do you have any22 documentation to support that using these23 new providers will result in additional24 savings to the City?25 110 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251
Well,3 we'll send that over with it, too. I4 appreciate all that information being5 sent over to the Chairman.6 That's the main questions I7 wanted to ask.8
Just so the9 record is clear, based on the10 recommendations from CompServices and11 their metrics and their analysis, who12 makes the decision to remove a provider?13
It's a decision14 that's made jointly between CompServices15 and Risk Management.16
So17 CompServices is making the decision or18 they're providing you with the19 information so you can make the decision?20
They would need our25 111 11/17/10 - LEGISLATIVE OVERSIGHT - RES. 1007251 approval to remove someone from the2 panel.3
Based on --7 there's no legislative responsibility or8 legislative authority deemed to9 CompServices to remove anyone. They are10 a contractor, as I understand it, with11 the City to provide resources and12 information and analysis, but the City13 makes the final decision on the removal.14