It’s COMPlicated – Medical Care

Is “recovery” the focus of medical care in workers’ compensation cases?  We hope so, but it can be lost in discussions about utilization review, drug formularies, medical fee schedules, who has control of medical care, and other complex issues. 

Recommendations about medical care were the last two of the 19 essential recommendations in the report of the National Commission on State Workmen’s Compensation Laws, and those weren’t about the quality of medical care.  They were: 

• “There be no statutory limits of time or dollar amount for medical care on rehabilitation services for any work-related impairment,” and,
• “The right to medical and physical rehabilitation benefits not terminate by passage of time.”

Recoveries require more than these two recommendations.  They require quality medical care provided within the maze of hurdles connected with workers’ compensation.  The stakes are high.  A WCRI report found that among 17 states, the percentage of injured workers with more than seven days of lost time who never returned to work for more than a month ranged from 9% to 18%.  The toll of these losses on the lives of the injured and society should not be ignored.  In addition, the price of medical care is now the biggest component of workers’ compensation costs in most states.

Some progress has been made in the 50 years since the commission’s report.  Significant advances in the delivery of medical care have made it more effective: MRIs, CAT scans, arthroscopic and laparoscopic surgeries, physician extenders, improved medications, and most recently telehealth options.  But these don’t solve the conundrum of how to connect injured workers with physicians who are able to help them achieve optimal outcomes. 

Physicians rarely get training on the unique challenges of treating patients with workers’ compensation injuries, or of how to focus on recovery rather than disability and to work through the pain without surrendering to the trap of opioids.  Some states do have programs related to improving or identifying the quality of physicians.  Texas has a designated doctor program to provide a resource when disputes arise on medical issues.  California and other states have established treatment guidelines.  Colorado has a physician accreditation program.  Tennessee has a certified physician program in development that will be rolled out this spring.

However, these states are in the minority.  In the U.S., we are better at identifying what doesn’t work than what does.  For example, no consensus has developed on who should control medical care; potential moral hazards come into play, whether it is the employer or the injured worker.  Some say that the injured worker doesn’t have the knowledge to choose their physician, but how many employers have the expertise to choose physicians on outcomes and not on cost?  Also, access to treatment is problematic in some specialties and in rural areas.  And these are just a few of the many issues that have an impact on recovery.

Rather than waiting for another commission, now is the time to hear from those who see the dilemmas of workers’ compensation up close.  What do you see that has made a difference, or what do you think are the most promising areas for improvement?  The dialogue that can follow may hold the key to future improvements.

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