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Farmers Propose Integrated Care Pilot Project

  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  0 shares
Studies published over the past 20 years concluded that integrating the medical side of workers…

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

Yeah, I want to see how they would get reporting and review of medical records and get patient back to work from the doctors who have no idea how Medical Legal part of Work Comp works. That would be very funny to observe.

Steve Cattolica Nov 3, 2016 a 7:58 am PDT

If the program is to be successful, there is another aspect of the program that will be important to consider. That is, the reimbursement offered by the designated health plan. There is an undisputed difference in adminsitrative burden and cost when treating an injured worker compared to the same treattment, for the same worker, in a non-occupational setting. When an occupational injury is declared, the provider will need to shift into "work comp mode" with respect to reporting and documentation. Will Dr. "Smith," or other plan provider be reimbursed differently when the occupational injury is being treated than the same injury if it is non-occupational? Or...will there be offered a highbrid reimbursement schedule that somehow provides the same reimbursement for both, but properly reflects the higher costs according an average of increased costs over the population and mix of occupational and non-occupational healthcare? If this issue is not somehow accounted for by the program and the chosen healthplan, it may result in an access issue - unless the health plan requires that medical providers must choose to participate regardless of the reimbursement or lose their health plan contract.

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