Success Story: WCB Billing Improvements

When someone injures themselves on the job, they are eligible for health care like anyone else. However, unlike other types of patients, Worksafe BC covers the costs of their treatment. Accurately identifying a patient presentation as Worksafe-related ensures that the hospital receives these additional funds and optimizes the patient’s access to care. ER Physician Dr. Jason Wale noted that some patients in the ER were classified at triage as MSP patients despite later revealing clear work-related injuries.

Dr. Wale received a grant from the South Island Medical Staff Association to coordinate meetings with various Island Health departments including finance, IHealth, and ER triage nursing unit assistants to make the necessary changes. With the support of Executive Director Marko Peljhan, Director Bindy Bains and Senior Project Analyst David Greig from Health Information Management, and Benjamin Kason, Regional Manager for Registration at Island Health, Dr. Wale spent the past year doggedly following up on small front-end changes to the triage process, and electronic record changes to enable better classification of cases as they arrive at the ER.

The latest results of these changes are impressive. A pre-intervention audit showed 250 island health cases per month used to be classified as ‘work related injury’ but had ‘MSP’ as the billing class; this number has dropped to 125, indicating an improvement in 50% of the WorkSafe cases. This reclassification means an added revenue of at least $37,500 per month or $450,000 per year per Island Health. This number may be much higher if downstream care costs are factored in including subsequent specialty clinic visits, for example. It is Dr. Wale’s hope, supported by Marko Peljhan, to redistribute a portion of the captured funds to Island Health ER’s to fund equipment purchases, nursing education or other initiatives. This model of directing a portion of saved revenue to the daily needs of the frontline physicians and staff responsible for the savings can provide motivation for future change initiative ideas from clinicians.

Dr. Wale and his Island Health colleagues are still focused on addressing the remaining 125 Worksafe cases per month that are currently missed. They are encouraged by these results to date and heartened by the positive collaboration.

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