What would you change? (California) (California)

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What would you change? (California) (California)

Postby hybates@ca.rr.com on Thu Oct 21, 2010 8:25 am

If you had access to a magic Genie who could grant you one wish in regards to making a change in the way WC claims are handled, be it legal medical, benefits, etc. etc.

What would you change?

If it was me, I'd change the way doctors get paid, maybe have a flat rate schedule for injuries or something like that where the doctors would have some skin in the game, Right now, we seem to incentivize doctors to not make injured workers better - the longer treatment goes on, the more money the providers make.

Anyways, if you could change something about WC what would you change?

:ugeek:
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Re: What would you change? (California) (California) (California

Postby stevepsca on Thu Oct 21, 2010 11:01 am

Don't know what your 'stake' is in the WC system.
However, as an IW, I can't say that Drs are not prolonging treatment under the 'new' system, since SB899 anyway.\
With the MPN, UR process, MTUS/ACOEM treatment guides the treatment is controlled somewhat effectively.\
The delays result from the medical/legal process and delays in getting MSC hearings where necessary to resolve disputed medical issues.

PQME/AME's take an inordinate length of time, due IMHO to the lack of PQMEs now available in the DWC medical unit stable of Dr available to act as med/legal evaluator.
When AA/DA can't come to agreement on AME, a PQME is again removed from the IW's access to resolve a disputed issue...timely as may be the case if the parties could agree in the first place.

As for change... get the changes necessary to bring the pendulum back toward the center of things. More equitable to the employer/carrier and the injured workers.

Get the system fully expediated, PQME/AME process, MSC scheduled timely, etc.
The OMFS may or may not require adjustment, or reworking all together.
Right now, we seem to incentivize doctors to not make injured workers better
I don't see any incentive to delay a IW progress where an office call is paid at about $40....(?) Hardly worth the PTP time.
Keep in mind, whether it's Industrial/Occupational medicine, or general practice/specialty, medical care in this country is a fee for service system. If you want the providers to become stakeholders consideration to the system used at Mayo Clinic's, or Cleveland Clinic may be the best approach. Dr's are paid a salary, excessive diagnostics aren't necessary as the patients medical records are readily available in the system. Dr's are trusted with the presumption of correctness in a treatment plan.

This discussion could go on and on... but that's my take, as a IW to your request for change. Expedicate and apply the statutes/CCR's as intended. Without manipulation by the parties.
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