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Friday, March 20, 2015

Work Comp Needs to Focus on Improving Value of Medical Treatment

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Other
  • -  0 shares
OAKLAND, Calif. – Speakers at the California Workers’ Compensation Institute’s 51s…

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6 Comments (8 Replies)

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Anonymous Nov 3, 2016 a 7:58 am PDT

If you really want to improve quality of care, get rid of UR and IMR as we know it. They are destroying what little care we can give. It is interesting that those who talk about "care" and "outcomes" are not doctors, but businessmen. All they care about is profits and premiums,
Profits= outcomes. First of all, medicine is still an art, not a science. There are accepted procedures for known conditions, but as practioneers, we must deal with living patients, so our methods will vary. UR/IMR does not allow for the "practice" of medicine.
We have many bad actors in the system. They are mostly chiropractors who are businessmen, and we know who they are. They prescribe shockwave, compounds, etc and treat and treat. Let's get control of them by not allowing them to be PTPs at all. An MD should be the only PTP. Then support your MPN doctors. You wanted MPNs and you got them. You need to trust them or get rid of them. If you trust them, then trust their judgement. You won't need UR/IMR. Use UR/IMR for big things like surgery,etc. But get real doctors doing this like your state medical associations or COA. They would be happy to do this. Get rid of insurance company lackeys, who deny everything. You will then see the care and outcomes improve.

Susan Powell Nov 3, 2016 a 7:58 am PDT

While I'm in agreement about this doc's comments about UR/IMR, he sounds he would like to be the only physician allowed to treat. No one Doc has all the answers. Lp

Manila Manila Nov 3, 2016 a 7:58 am PDT

UR and IMR have a one size fits all mentality where medical,protocols are blanketly adhered to, particularly in the area of psychological treatment. This handcuffs psychologists who hear over and over agin from UR that if there is "no functional improvement" after 4 visits then no more will be approved. By the time a worker is seen, the problems are entrenched and the expectation for "functional improvement" after 4 sessions is absurd. Then 75% of bills are mispaid. If you want quality care, pick quality doctors, give them the authority to do what is needed and pay them a premium instead of a discounted rate for the extra work needed for comp patients.

Garry Crosby Nov 3, 2016 a 7:58 am PDT

agree with the above. UR/IMR Docs need to have the same standard of care education as the treaters and so the present system has no retribution for those docs. Get rid of UR/IMR, let MDs be the front runners but resist those who r occ meds/physical med rehab docs --they r not trained appropriately to eval/treat ortho issues

Anne Bazel Nov 3, 2016 a 7:58 am PDT

All the comments about IMR/UR are true in the comments. They delay or completely remove care. What we are forgetting is their purpose. They were not meant to provide better care, they were meant to control and restrict care. Medical Practice is exactly what name applies, it is "practice." National Guideline are just what they are "Guidelines", not bible. Every patient is different and every doctor "practices" differently. Through medical school and residency we were educated that medical decision must be based on complete History and Physical. In Work Comp system, the decision is made by people who never see the patient and have no understanding of individual issues.

IMR/UR designed for one thing only...to save money to insurance company. Look at SCIF, the fall back insurance, making a multi-million surplus. An insurance company ran by State, unassumingly less efficient than commercial insurance. I wonder how much the private insurance companies are really making. The profits are hidden behind administrative expenses. They increase medical costs curbing expenses so they can cry wolf and cut medical expenses even more.

The article talks about Washington system being so excellent. I hear different stories. Patients have difficulty finding a doctor to treat them. Sometimes, they chose not to report the injury and end up going to commercial carrier. When the commercial carrier finds out it was actually WC injury, they refuse to pay for treatment and, now, the IW can't get treatment anywhere and he is late to report it. This is the real reason for "better" outcome.

WILLIAM YATTAW Nov 3, 2016 a 7:58 am PDT

UR/IMR removes un-necessary and un-needed care. To often we injuried workers are receiving services that are not even related to the injury they suffered. I am all for seeing the workers get the care they really need, but eliminating UR/IMR is not the answer.

Lisa Italia Nov 3, 2016 a 7:58 am PDT

Medical treatment outcomes is the missing piece of our system. Guidelines are not the enemy, nor should they be the final word in every case. The point is whether the treatment will help the patient achieve better function and return to work. I can't tell you how many cases we've seen where the doctor treats and treats, and the patient still ends up with high permanent disability and cannot return to work. These are not catastrophic cases. Many do not result in surgery. Treatment is based mostly on patient complaints, and often seems to chase the pain without any real results. If we truly care about helping injured workers, we need to look at the outcomes of treatment. The studies of other states suggest that more is not better - it's just more.

D C Nov 3, 2016 a 7:58 am PDT

This system is not to only to provide treatment that will get a person back to work. It is to cure AND relieve the effects of an injury. Those on the claims side do not seem to understand this. They are human beings and deserve medical treatment and relief from pain, even if it is lifetime.

Lisa Italia Nov 3, 2016 a 7:58 am PDT

And if there were unlimited dollars in the workers' comp system, we could offer every comfort in the medical universe. But that is not the reality. WC has always had a focus on helping people return to work. In the end, that benefits most injured human beings more than palliative treatment.

Rhonda Wofford Nov 3, 2016 a 7:58 am PDT

Workdoc makes an interesting point, that the "experts" that they quoted are talk about improving the "value" and "quality" of care, but the measures for doing so that they cite all restrict access to treatments and the choices that the actual physicians in the trenches can make. That's like saying to a carpenter, I want you to build a "quality" better house with less wood and poorer quality nails; so that, I can get more "value" for my money. That's just stupid.

Statistics show that most IW's don't go to work the day of the injury hoping to get injured. Also, during the initial part of treatment, most injured workers want to get back to their job and their life with the least amount of disrutpion. However, inusrance carriers refuse to pay for the treatments that have been shown to actually keep them working. For example, many simple strains and sprains can be greatly improved by icing down the injury. Alternatively, a shot with a long-lasting local anesthetic mixed with an anti-inflammatory can greatly reduce the pain and length of injury. Also, massage and immobilization of the injury, all have improved outcomes. However, carriers refuse to pay for these treatments and they are time-instensive; so, providers can't provide and still keep their clinics open for business.

How do we know that these treatment work? Just look at the treatments provided to professional athletes whose return to work is far more important than any costs associated with their medical care. They are iced down after every game they injections, massage, and immobilization to keep pain and inflammation down. That is because these players are multi-million dollar assets that they need to keep working. So, it would be a better proposal to allow for a 60-day moratorium on UR/IMR and allow for aggressive initial treatment focused on the immediate return-to-work. That can only be accomplished by paying providers to experiment with non-traditional treatment like icing, injections, massages, immobilization, etc..

Janet Phinick Nov 3, 2016 a 7:58 am PDT

You hit the nail on the head....if we focus on providing the highest quality of care in the first few hours or days of the injury, the "outcomes" would be exactly what the insurance companies are looking for: lower long term costs. I have been auditing WC claims for the past 12 years, and I hear the same song, over and over. It is an exciting time to be in WC in California because the State is looking for answers, and they are out there. We need to work together to move this mountain and shift the paradigm away from short term profits. The adversarial system has failed. It's time to play nice and focus on getting good doctors back into the system.

Anonymous Nov 21, 2016 a 10:49 am PST

They absolutely need to improve the quality of care, but like work doc stated I do not think they will do this by what was stated. It sounds like they want to cut treatments costs and sell it like they are helping injured workers just like they did with SB863. It also appears like they will attempt to cut treatment that relieves the effects of an injurythat helps those in chronic pain but not necessarily gets them back to work.

They should not abandon the patients who may need lifetime of opioids for failed back surgeries, RSD etc.

Someone should also look into investigating work comp clinics and work comp mill physical therapy facilities. I have been to St Joseph and other great facilities and I have also been to two work comp mills. One physical therapy mill was at an industrial clinic that is state wide. They were having me do inappropriate exercises according to my surgeon after I showed him what they were doing. It was like a mill there. The patients were all doing the same exercises while the therapist ignored them and talked about their social life. One put me on a machine and said how it the knee doing? I replied I have a back injury and this is hurting. He looked at my chart and quickly got me off of that machine (so lame).

Another experience was at a physical therapy only mill. They have around 5 of this name in Southern CA. There was one physical therapist for around 15 patients. After my lumbar fusion he had me sit in a chair and twist as far as I could both ways and hold it. He also had me sit in a chair and bend forward as far as I could. These are things my surgeon told me NOT to do. Of course I went numb in my lower extremities and reinjured myself after that session.

I asked to go back to a hospital physical therapy facility like St Josephs or somewhere reputable. I showed the new physical therapist from a teaching hospital what the previous physical therapist had me do and he was shocked. He said there is no way that person was an actual physical therapist as you should avoid twisting and bending soon after a lumbar fusion.

Someone should really get out there and investigate some of these places. This has to be preventing many from getting better, having inadequate physical therapy. It has been like night and day going to legitimate facilities. (end of physical therapy rant)

Robert Bicego Nov 3, 2016 a 7:58 am PDT

Garbage in, garbage out. History is written by the victors and in California the victors are the insurance carriers. Most injured workers succumb to political labeling and carrier PR sound bite propaganda thereby consistently voting against their own self interest.

And whatever happened to cure OR relieve? I guess words just get in the way my friends....

Barbara Ramiller Nov 3, 2016 a 7:58 am PDT

its cure AND relieve. big difference the AND makes.

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