Yesterday ProPublica published the first in what is apparently a series of articles on the workers comp systems around the country. This first effort focused on ‘reforms’ and generally indicated these are driven by big employers seeking to cut workers benefits and medical costs.
There is much coverage of grievous injuries, lost limbs, different compensation systems in different states and the role of big business in writing reforms.
I would suggest that writing about reforms, without discussing what’s driving the medical care reforms, is an oversight. And there was precious little discussion of cost drivers, but a lot of discussion about cost control methods, including a tortured passage attempting to describe California’s utilization review process, and the issues inherent therein. Unfortunately, the coverage of this issue focused on the denials of care, not on the reasons therefore, the process that is used, and why some requests should be denied (more on that in a later post).
Re California, I asked friend and colleague Alex Swedlow for his thoughts on how ProPublica characterized cwci’s research; here’s his perspective…
The article would benefit from a full discussion on how much and what type of care is approved and denied. It’s true our study showed that about 91% of the disputed denied treatments are upheld by Independent Medical Review. What is missing from the article is that denied disputes are only 6% of all treatment reqests and that the California worker’s comp system approves 95% of all treatment. And the 5% that is ultimatly denied is another story.
The dramatic increase in utilization review in California has been driven largely by the plaintiffs bar, which has been using the IMR process to extend disability. One has to wonder why they have been doing this. In addition IMR increases are driven by by the overuse of drugs, the changes in medical practice patterns since the treating physician presumption was overturned, and the desire on the part of many to address the overtreatment that is rampant in Worker’s Compensation.
Moreover, there was no attempt to explain why employers are seeking to direct injured workers to specific providers or panels of providers. This was presented as a problem for injured workers, when that is inmost instances absolutely not the case.
In fact, the care direction by employers was treated as somehow harming injured workers.
I was excited when I heard propublica I was going to be taking this topic on. I have been impressed by propublica’s work on many fronts. There is much about Worker’s Compensation that needs improvement. Unfortunately, my take on this article is that it is quite one sided, and does not address many of the significant issues that are leading to harm for injured workers, employers and taxpayers. As an introduction to the topic, it is seriously flawed.
While there may be other articles coming in future weeks and months, the expectation that has been set by this article is that the system is somehow tilted in the employers favor. I can assure you that in most states, this is far from reality.
I’d suggest that the story is far from complete. It ignores the rampant profiteering that is the primary driver of the reforms described in generally negative terms, fails to point out the complicity of the claimants bar in extending disability, and completely misses the damage done by profiteering physicians over-prescribing opioids and benzodiazepines and failing to work closely with payers and employers.
Data point- the back surgery scandal in California led to many unnecessary back surgeries, much pain for claimants, and tens of millions in excess costs for employers and taxpayers.
There is no question big business is behind much of these reforms just as there is also no doubt state medical societies are overwhelmingly to blame for rampant abuse of the system in states such as Florida and Maryland.
Data point- the medical society and a drug dispensing firm used the same lobbyist who successfully kept doc dispensing operating in MD thereby increasing costs and extending disabilty.
Finally the story fails to address a critical point – namely the nature of the workforce, employment, injuries and the health care system has fundamentally changed in the last 100 years.
Of course it doesn’t work now. Women are a majority of workers, employment in services long ago overtook manufacturing and industry, Medicare exists, health care systems have radically changed, and the working population is much older fatter and less fit.
It would have been quite helpful to discuss states where things are working well. Washington is one and Ohio has made great strides as well.
What does this mean for you?
If asked by a non-work-comp person about the article and subsequent pieces, you may want to suggest that reality is somewhat different from the world portrayed by ProPublica.
Joe – excellent summation. Hope ProPublica interviews you for another point of view in future articles.
I heard the whole thing on NPR this morning and they noted they will feature the ProPublica story and educate the public all about the workers’ comp system on NPR all week.
They noted workers comp reform in several states are hurting injured workers and tax payers who are now covering expenses like food stamps because medical care is being ‘taken away’. They interviewed claimants and their families telling stories about the impact the claim has had on their lives, and specifically how CA reforms allowed employers and insurers to take away medical care and how this has added an average “18% profits” to carriers in recent years. (However, they noted judges are overriding the reforms and returning services such as 24/7 home health to the claimant who was interviewed.)
While driving I immediately thought Joe P. has to write something about this and someone has to present NPR and ProP with the other side of this! The story today was missing so much information and essentially misrepresenting the majority of the workers’ comp industry (despite state variations.)
There was no mention of the use of evidence based medical guidelines, or the thousands that successfully return to work after an injury; no mention of the opioid abuse or of those that eventually become ‘one with their couch’ following a comp injury. I hope the rest of the week gives a much more accurate picture of our industry.
I agree that the other side of the story seems to be missing. I know that a large amount of focus over the years has been getting better at early return to work, reduction of unnecessary or unrelated medical services, and reduction of opioid usage. These are all reforms that are good for the injured worker, even though they also benefit the carrier and the employer. There will always be stories of an injured worker who has been failed by the system (or the circumstances of the claim.) However, there are an equal amount of stories about how an employer was forced out of business by abuse and fraud pushing their premiums to an unaffordable cost. Not to mention the ever-so-popular discussions about the rising cost of medical treatment. I am curious to know if these discussions will be coming soon as part of the series.
There is also a more subjective aspect to the workers comp issues in states with out of control systems. The pursuit of a workers comp claim becomes a substitute career for the injured worker, complete with new identity, relationships, appointments, files and scheduled appearances. This new “career” is enabled by the plaintiffs bar and accommodating physicians who give recommendations and treatment that are often not in the patients best long term interest. The enablers have a huge economic stake in this game. Unfortunately, the longer the worker is trapped in this maze, the more difficult to return to a meaningful life and self identity. the NPR and ProPublica coverage barely skimmed the surface of the complex and intertwined issues that have developed over many years.