- Special Projects
That’s the latest response to a decades-long problem with the state’s workers’ compensation program as detailed last week by Civil Beat’s John Hill.
In an effort to streamline the current paper-based system, a new group convened by the Department of Labor and Industrial Relations has been tasked with bringing the system into the digital age. But that won’t make doctors who don’t see these patients suddenly open up their practices to take care of injured workers.
What would work?
Stop putting the patients — and their doctors — in the middle.
The crux of the problem is that most doctors don’t want to deal with the onerous paperwork requirements that the workers’ compensation claims require, in addition to waiting for significant delays in being paid for their services. Primary care doctors may not be equipped to handle the complicated muscle and joint injuries that require subspecialty care. But many subspecialists are not willing to see patients who have a work injury without someone else coordinating their care and getting approvals for tests.
Patients are left waiting until their situation is investigated and approved, and this can lead to a worsening of their condition, especially if they are still on the job.
What if patients could have access to the same doctors they see for their other medical conditions and let the insurance companies work out the details themselves?
When I first started working at Straub Clinic and Hospital in 1999, we had a Department of Occupational Medicine that handled cases of workers’ injuries, motor vehicle injuries and more. But once that was dismantled, there were no providers in my department who knew all the complicated rules of documentation and paperwork to take on the cases, even of our own patients.
Who wins if regular medical insurance pays for the visits initially?
Why make them wait for care? Simple injuries are best treated early, and even complicated issues are much easier to handle when it’s been one week from the date of injury instead of one year. A less serious disability and a quicker return to full duties at work, and keeping their job, are more reason that patients may benefit the most in this proposed scenario.
People might be more willing to admit they have an injury at work if they can be seen in a timely fashion. Numerous times, people will tell me that they don’t want to claim their injury as a worker comp case because they are afraid it will get them fired or that they won’t be able to see their regular doctor who they trust for their care.
What results is fragmented, with different providers at various medical centers trying to coordinate their care, but without their full medical record to rely on. If pre-existing conditions of arthritis or joint problems are present, this would be readily available in the medical records since the same doctors could be treating them.
Doctors would win, too.
Many more primary care providers would be willing to see patients for these injuries if we knew that we had the full resources of our specialist colleagues like we do for other medical conditions. When payment is provided by regular medical insurance companies for worker’s injuries at the onset, then the specialists have no reason to treat these patients any differently than anyone else. Delays in finding someone to see an injured worker would be shortened, because there would be many more doctors available to provide this care.
Primary care providers would also be kept in the loop. All of the care given would be noted in the regular medical record, and this would help to see what has been done and also how this might affect other seemingly unrelated medical conditions as well, such as pain medication that might increase blood pressure or affect blood sugar.
Documentation could be minimized, since the added burden of the extra paperwork and forms is one of the many reasons that there are so few doctors right now who are involved in workers’ care. Simple additions to the charts that note what extra time or percentage of the visit was dedicated to the work-related case would be a way to allow insurance companies to handle their own repayment from the workers’ compensation insurer later. Easier charting is a win for all providers involved.
Insurance companies would also benefit.
Not just the worker’s carriers but the regular medical companies too. Earlier care costs less. Provider networks that are well established and take care of their members’ other medical conditions could easily be utilized because the payments would be the same to the doctors. Where the money comes from can be figured out later, among the insurance companies themselves.
Why make patients suffer while doctors who could see them can’t because they won’t get paid? No one can expect doctors to just provide care for free!
The reality is that when the benefits are fully utilized according to the coverage available, regular medical insurance has to cover for any additional costs for that condition already. In that situation, they have no control over how the care was provided. This would at least allow them to be aware of the situation at the onset, not just when it is dumped on the medical insurer to cover for all further care.
That could work well for everyone.