Medical issues generally come from three places
|
Medical inflation
It's been running at double digits for several years. Among the big drivers: rise in surgery costs and rise in prescription costs.
Public policy issues They are part of why work comp healthcare cost is so high. Resolving them will take renewed legislative fortitude at the state level. |
These are usually issues that arise from decisions made
right
in the medical provider's office. From a workers' comp and occupational medicine point of view, initial decisions by providers occasionally appear problematic in some way.
- The treatment prescribed is less effective
than
other options. Or it is more expensive than
other treatment options that are equally effective.
- It's not focused on getting the injured employee
back
to work.
- It involves traditional surgery that could be replaced
by non-invasive treatment with faster recovery, less overall cost.
- Utilization is questionable: For instance,
drugs and
dose levels may be prescribed that exceed what is needed to be effective, especially with painkillers.
- Accepted treatment practices are not
followed.
Minnesota state treatment parameters for work injuries
are intended to avoid excessive treatment, but not all doctors and chiropractors are familiar with them. Wisconsin recently implemented treatment guidelines. Currently, South Dakota doesn't follow treatment guidelines.
- Billing oversights
These come in many flavors: The statement from the provider charges twice for the same service, charges for a higher level of service, itemizes a packaged service for a higher overall cost, or charges for service or equipment that was not provided.
- Disability ratings are incorrectly applied
Minnesota's, Wisconsin's and South Dakota's systems for rating the severity of permanent disabilities caused by work injury are intended to ensure fair compensation, but few doctors have the special expertise to apply the disability ratings accurately.
- Has other medical, emotional or financial problems that cause him to want to prolong medical care and work comp wage-loss benefits
- Abuses drugs
- Does not understand his treatment program, or doesn't follow it
- Needs guidance on what to do, where to go. Or maybe just needs a push
These and other employee issues impact medical care's effectiveness. Sometimes they become intertwined with employment issues--termination or lack of light-duty work, for instance. Major employee issues arise in only a small portion of cases, but those cases can become extremely expensive because of complications with medical recovery and return-to-work. |
