The workers' compensation system in each state provides a mechanism to make medical care available to individuals when they have a work-related injury. Some states allow employers to direct care while others allow the injured worker to choose a physician. Most states provide unlimited care to cure or relieve the work-related injury or illness. But therein lies the problem.
Research indicates that individuals treated in the workers' compensation system sometimes fare worse than those who receive similar care for non-work related injuries. Those with work-related injuries may take longer to recover, have more work disruption and greater resulting impairment.
The misaligned incentives within the workers' compensation system—from the injured worker to the insurer and the medical providers—are a big part of the problem. Unfortunately, the number of medical providers willing to treat workers' compensation injuries and who understand the unique issues associated with them are dwindling. Meanwhile medical costs are out of control; twenty years ago, costs associated with a workers' compensation claim were roughly 40% of the total claim. Today, medical costs account for 60% of a total workers' compensation claim, and employers are helpless when it comes to controlling costs.
Qualified Providers Can Help You Control Work Comp Claims
You can attack this wicked problem by proactively seeking out qualified physicians to interact with your injured workers. These providers should offer high-quality care and specialized service.
Seek qualified professionals who:
- Understand patient-management challenges such as delayed recovery and return to function.
- Are willing to address issues of causation and final impairment.
- Are accessible, appropriately credentialed and have the relevant professional experience.
- Use evidence-based treatment methods and focus on functional recovery with the least disruption to work.
- Are willing to satisfy the unique needs of the worker, the employer and the insurer by treating all parties with courtesy.
- Are willing to provide timely guidance and collaborative communication.
4 Steps to Finding the Right Providers
After identifying the desirable qualities of a workers' compensation injury physician, how can you find the best candidates? Outcome data are a great source of information about physician quality, but can be hard to find. In addition, you can assess some subjective and observable variables that often indicate high-quality care.
1. Identify potential candidates.
- Ask for referrals from nearby large, well-established and well-managed employers.
- Visit the website of the American College of Occupational & Environmental Medicine (ACOEM) at http://acoem.org, and click on Find a Doctor to search for providers with specialized occupational medicine or workers' compensation training.
- Look for other reputable online sources for occupational health, industrial injury or workers' compensation clinics.
2. Travel to the selected providers' locations to inspect facilities and meet staff.
- Is the location convenient?
- Will they accept new workers' compensation patients?
- Are they open during normal business hours; do they have extended hours?
- Is same-day urgent care available?
- Can they provide onsite job evaluations, injury prevention education, or other onsite services?
3. Evaluate credentialing or competency.
- Look for someone with an acrredited medical education and post-graduate specialized training.
- Providers should possess a current and unrestricted medical license and a proven record of medical competency.
- Eliminate physicians with an extensive malpractice history or licensing board complaints and sanctions.
- Board certification in the physician's current field of practice is desirable, but not always available.
4. Evaluate experience and knowledge.
- How much experience and knowledge does the physician or practice have with treating work-related injuries?
- The physician should treat work-related injuries regularly and be knowledgeable about workers' compensation and key terms.
- The physician should be familiar with the Family and Medical Leave Act and the Americans with Disabilities Act.
- Look for a membership in a workers' compensation professional committee or national organization that shows the physician's commitment to the field.
- If necessary, identify physicians who are familiar with your specific industry hazards and regulatory requirements.
After you have completed your basic assessment, allow the medical facility to review your claims management protocols. If both parties are comfortable and want to move forward, consider entering into a memorandum of understanding that outlines the roles and and expectations of your working partnership.
By using these tools, your organization will be well on its way to better claims management, better outcomes and lower medical costs for work-related injuries and illnesses.