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CWCI: AB 1465 Would Increase Costs, Unlikely to Improve Access

  • State: California
  • Topic: WEST
  • - Popular with: Legal
The California Workers’ Compensation Institute said its analysis of Assembly Bill 1465 found t…

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Ron Perelman Apr 16, 2021 a 6:04 am PDT

I would expect nothing less from CWCI. If we had a statewide MPN, patients might just get good and prompt care and return to work sooner. Their analysis is not reality. Just talk to any treating doctor. However, the MPN needs to be run by the CMA or another medical organization, not the state. UR needs to be run by a real disinterested party to work. The system, as it exists, needs our help, and this might just do it

Daniel Rosenberg Apr 16, 2021 a 11:44 am PDT

In their previous analysis, the CWCI concluded that MPNs resulted in a whopping 2% total savings for employers, which were more than offset by frictional costs. What lead to the change? Clearly it was the quality of their work.

Here, the CWCI missed several key points:

1) Medical treatment will NOT increase, since UR still exists regardless of the MPN.

2) Contracultural discounts—which account for 99% of the savings they consider in their analysis—are achieved through contracts with payers, NOT MPNs. They are mixing apples and oranges.

3) MPNs are the NUMBER ONE barrier for an injured worker achieving medical care. Period. End of discussion.

4) Their analysis of the validity of MPNs (whether they meet the access standard) is flawed. First, they are trusting the listings, which are riddled with retired physicians, or those no longer accepting work comp patients; second, they are counting every specialty—not particularly relevant, medically.

5) They performed little analysis of specialty treaters, or ancillary services. As long as our patients are being asked to fly across the state for services we can perform in house—just because the carrier wants to save a buck—I don't want to hear anyone tell me that MPNs don't hurt people.

6) They ignore key economic extraneities related to MPNs. For example, how does an injured worker, or their representative, determine what MPN ID covers them? They can't. This information isn't stored or organized ANYWHERE—not even the carrier can tell you. One carrier, for example, can use more than 200 MPNs, each with names virtually indistinguishably from one another.

Anyone who says that MPNs aren't the most significant issue plaguing injured workers has their head in the sand.

CWCI—please contact me so I can provide you accurate data on MPN validity and you can better serve the injured workers devastated by this kind of partisan sloppiness.

Tom Martin Apr 16, 2021 a 8:03 am PDT

The current MPN system is broken.

Massive treatment delays continue to prevent employees from returning to work, prolong TTD status, and increase Permanent Disability.

Employers and injured workers will benefit from the increased competition. Those in opposition have clearly revealed they won't.

Anne Bazel Apr 16, 2021 a 8:20 am PDT

Of course they would say there won’t be improvement of access. This statement simply makes no sense. It’s well established that CA cases are longer and patients can’t get timely care because of tight control by MPN system and they just can’t get timely referral. MPN listings contain providers who never had any intention to see injured workers. One thing for sure it will eliminate MPN discount and decrease insurance’s margin. OMG. I’ve heard, since Anthem basically controls majority of MPN it forced providers to accept their PPO rates, which is about 40% below fee schedule.

Domingo Castillo Apr 17, 2021 a 5:33 am PDT

The current MPN system is full of fraud! Many doctors are afraid of truly stating what injured workers really need and are afraid of being placed on probation and or removed from the MPN lists. I’ve heard that doctors will get calls telling them they are being Monitored as to their medical treatment recommendations, level of impairment and addressing body parts and other complaints that the insurance carriers are denying and disputing. We need a Neutral, Fair, Non-Insurance Controlled System in which MPN doctors and SPQME’s are Not Intimidated or Threatened by Insurance/Carrier/MPN representatives that they will be removed simply because they wish to tell the truth. We all know that their is a Monitoring System that is backed up by the insurance carriers to Warn and Remove or simply Not Renew the doctors MPN Status. I call this fraud and it’s wrong!
Domingo Castillo
Castillo & Associates

Kimberley J Pryor Apr 19, 2021 a 11:28 am PDT

Wolves guarding sheep. Abolish the 104 week TTD cap and see how quickly the wolves are replaced with actual guardian dogs who will facilitate treatment.

Stream of consciousness ramble warning!

Under the current system, the MPN delay game is in place to ensure that injured workers are denied treatment until their temporary benefits run out. At that point, they cannot go back to work, nor can they afford to live while waiting for treatment that could get them healthy enough to get back to work.

Then comes the low ball settlement offer and SSDI application (if they the worker is so lucky) and the "non-submit" grossly inadequate, MSA settlement tactic.

All the while the injured worker's physical and mental health is deteriorating.

They may have even taken another job for far less wages and no health insurance, just to feed their family.

They start to lose everything they ever worked for (one of my client's spouses committed suicide as the result of the strain the injured spouse's disability took on the family).

They blame their attorney for not helping them.

WE the tax payers and citizens at large foot the bill for all of the financial and other societal costs.

All the while the trillion dollar insurance industry and big business take in the BUCKS and spew their lies about nasty applicant attorneys and greedy workers.

I have often commented that it is only a matter of time until one of the workers injured by comp system goes on a vengeance shooting spree or blows their own brains out in public to express their suffering to the world.

I know I am not the only one who has had to talk a desperate client off a ledge.

Would the "powers that be" listen then? Doubt it. Love of money is the root of all evil, but the business judgement rule trumps all in workers' comp.

All this suffering for a 2% illusory savings margin. Y'all be crazy...and evil.

Now one or more of you feel free to insult me, my writing style on this blog, etc., as you have done in the past. I am used to it now.

I leave you with my favorite Art Buchwald quote:
"It is an honorable calling that you have chosen. Some of you will soon be defending poor, helpless insurance companies who are constantly being sued by greedy, vicious widows and orphans trying to collect on their policies. Others will work tirelessly to protect frightened, beleaguered oil companies from being attacked by depraved consumer groups.

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