Physicians View of Workers’ Compensation

At the 2019 NCCI Annual Issues Symposium, a panel discussed the physicians view of workers’ compensation. The speakers were:

• David Dietz, MD – moderator
• Edward Bernacki, MD – Executive Director of Health Solutions, University of Texas
• Will Gaines Jr, MD – Dept of Occupational and Environmental Medicine, Baylor Scott & White Health
• Jill Rosenthal, MD – Chief Medical Officer, Zenith Insurance Company

There are just over 3300 board certified Occupational Medicine physicians in the United States and 2017 there were over 2.8 million workplace accidents. This means the majority of workplace accidents are not receiving treatment from board certified Occupational Medicine physicians. Occupational medicine is not a normal part of the education in medical school, meaning physicians are not trained to look at things such as medical causation.

Physicians who are not occupational medicine specialists are also not focused on return to work. This can also be a challenge if you are using patient satisfaction scores to evaluate physicians as the scores may be negatively impacted when the doctor pushes for return to work when the injured worker does not want that.

Studies done by Dr Bernacki and others show that opioid use and excess physical therapy are the biggest cost drivers on workers’ compensation claims. Other factors include co-morbid conditions, mental disorders and legal involvement.

There is tremendous variation in medical networks. Many networks are focused on coverage in certain geographic areas to meet regulatory requirements, and many others are focused on discounted pricing. Unfortunately too few networks are focused on quality of care and medical outcomes.

More healthcare systems are monitoring the prescribing of opioids by physicians. This includes limiting the initial dosage, length of dosage, and requiring naloxone to be prescribed when the dosage is over a certain amount.

We are seeing lots more nurse practitioners and physician assistants as the primary treaters in both group health and workers’ compensation. This is because of a shortage of physicians. Being a primary care physician or an occupational medicine physician is extremely challenging because of the record keeping required. Because of this, new medical school graduates are steering clear of these areas to specialize in less labor intensive areas that are also more financially rewarding.

It is important to balance technology with the human touch. The technology can only give you part of the answer. You actually need to engage with the patient and examine them to understand the full picture of the problem. One issue that creates lots of conflict in workers’ compensation is utilization review physicians rendering treatment recommendations without actually having examined the patient.

Telemedicine is gaining traction in the group health setting but the uptake for this has been much less in workers’ compensation. The patients in an occupational medicine system seem to be more skeptical of a telemedicine physician rendering treatment recommendations. This can also be a challenge around telephonic nurse triage.

One area of dissatisfaction for physicians across all settings is that they do not feel adequately compensated for reviewing medical records before the office visit. They can bill for the 30 minute visit, but not for the two hours of record review before the visit. Physicians also do not get compensated for all the “case management” they do having discussions with patients over the phone or through an app instead of with an office visit.

On the payer side, one of the larger complaints is the poor quality of the notes from the physician. Many electronic record keeping systems focus on clicking boxes instead of taking narrative notes. Voice dictation systems are not as reliable as they should be and require proofreading on the part of the physician. Patients also complain that physicians are more focused on their computer screen with the electronic records than they are in engaging with the patient.