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.
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:
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.
2. Travel to the selected providers' locations to inspect facilities and meet staff.
3. Evaluate credentialing or competency.
4. Evaluate experience and knowledge.
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.