For those who think UR is not needed, I’d suggest considering something CWCI’s Alex Swedlow said at a recent presentation…
“you know we spend all this money on police and firefighters and we still have crime and arson. Maybe we should pull the cops and fire trucks out of downtown Oakland and see what happens.”
May
31
Good point Joe, so who is the police of UR? The DWC performs audits, but those are extremely superficial. They look at timelines, mandated language, etc. Who is confirming that they got the answer right? If there is a dispute in UR then we go to the PQME. According to another CWCI study med-legal have increased over 150%. It seems like UR may be fueling that PQME fire along with driving the cost containment fees up. Not to mention who is policing the PQME’s which are supposed to be our dispute resolution. Have you read a PQME lately? I will not even go there… Care is difficult to manage with road blocks alone and that is what many payers think they can do with UR. There is always a cause and effect. Look at the 24 visits cap which has had MUCH more of an impact on curbing physical medicine than UR. How has that affected the industry as a whole though? Did capping physical medicine affect surgical, pharmaceutical and other interventions that we see on the rise?
Just like politics the system has gotten too polarized. All stakeholders (physicians, payers, IW’s) end goals should be return to work. If we treated all injured workers like they were related to us we could progress forward out of the current stalemate we are getting ourselves into. This is not to say that we don’t need roadblocks or accountability in our system it just needs to be delivered in a manner where the injured worker knows that his care and interests are paramount.