In the last couple weeks there’s been a wealth of new reports, analyses, and studies released about various aspects of the work comp world. Too many to give each the attention it deserves, so a synopsis of a few will – alas – have to suffice.
Yesterday David DePaolo posted on his contention that there aren’t “any valid scientific studies demonstrating that the introduction of an RBRVS fee schedule would result in a mass exodus of physicians from workers’ compensation”. After asking for examples of same, he received seven plus an article that his own WorkCompCentral published six years ago. (thanks to Mark Walls’ LinkedIn Group for the tip)
David hasn’t reviewed each of the “studies” he received, but a quick analysis indicates the scientific rigor of most is rather less than, well, rigorous. Several appeared to be telephonic surveys of doctors’ offices (several studies didn’t provide any information on methodology). At least one [opens google docs] made several conclusive statements without any discussion of how they arrived at those conclusions. Another authored by the same writer provided background on the methodology, which was a phone call to physician offices where the person answering was asked if the physician accepted workers comp patients.
A quick read indicates the methodologies used appear to be rather less than scientific, the conclusions based on opinions of cause and effect rather than rigorous analysis. That’s not to say that low fee schedules may well influence physician participation, but rather to point out there’s not much in the research provided to conclusively demonstrate the linkage.
From the good folk at WCRI comes the latest research on narcotic usage in workers comp. While this particular aspect of the subject (interstate variation in usage of narcotics) has been explored in some detail by NCCI, WCRI’s report looks specifically at usage for non-surgical lost-time claims in 17 states for the period 2006 – 3/2008. The report indicates usage on a per-claim basis was highest in LA MA NY and PA, with those four states plus CA, NC and TX showing a higher proportion of claims with long-term usage of narcotics than average.
Shockingly, few long term users were monitored according to medical treatment guidelines…
Meanwhile, the government shutdown in Minnesota means the state’s WC Division is closed for all but critical services.
On the good news front, the ‘low cost’ (well, it’s relative…) movement has entered the surgical device industry, with the WSJ reporting the emergence of a new business model; “Low-cost orthopedic parts [are] cheaper versions offered with a no-frills sales approach. This typically means not sending sales representatives into operating rooms to advise surgeons, which is a common but cost- and labor-intensive practice.”
I’d note that there are several companies currently focused on this space in workers comp, but with a different model. They find out about a scheduled surgery, identify the devices to be used, and order them on behalf of the insurer – usually at a much lower price point than that charged by the facility.
Jul
6
Joseph,
Why do these guys keep wasting time on surveys that are so poorly done you can’t get any statistically relative information from them? In the words of my father, “If you know the right way to do something and choose to half-@$$ it, then why are you doing it”.
A simple question they should ask themselves…. Keep up the good posts!!
From a Practice Administrator’s perspective: You don’t need a ‘study’. The answer is “depends on the conversion factor”. First we hear the doctors aren’t going to accept Medicare, now they won’t take workers’ comp. And, of course, if they aren’t taking Medicare or work comp, they arn’t going to take Medicaid. There is only a finite number of patients. Sort of retiring, doctors are going to keep seeing patients. As long as work comp maintains a fair reimbursement, it will be an acceptable payer to many physician practices.