Monday, June 27, 2011

Debate on Access to Care Lacks Validation

Access to medical care (or impairment thereof) is often cited when a state imposes either regulations (California change to RBRVS) or statutes (Illinois' most recent "reform") that either restrict or cut medical fees.

But does this really happen?

I ask this because this morning in our WorkCompCentral News correspondent Peter Mantius asked participants affected by the recent Illinois "reform" whether this effort went far enough. The medical community proclaimed that there would be a mass exodus of physicians from workers' compensation because of new fee schedule and treatment restrictions. The business community said there wasn't enough "reform".

But the drum beat of the medical community in response to restrictions put on either the practice of medicine (e.g. guidelines) or billing that physicians are going to go elsewhere for their business lacks scientific validation.

In other words, I have not seen one study in any state following the restriction of fees or procedures that documents that there is a corresponding failure in the delivery of treatment to injured workers (and if there are studies please send them to me!).

This drum beating is no different than employer drum beating that failure to control workers' compensation costs will ship business to other states. The truth is that this statement has never been validated and in fact the evidence is contrary.

For example, though California business proclaimed that business, and ergo jobs, were fleeing the state like  a forest of animals running from a fire, the statistics reflect just the opposite - prior to the workers' compensation "crisis" business in California continued to expand at an accelerated rate. It wasn't until after workers' compensation reform in 2004 that there was a decline in business expansion.

The above graph was generated when typing "business expansion california history" into Google - and the data is supported by reference to various historical documents and periodicals. If you were to believe the logic of the drum beating pundits, workers' compensation reform in California in fact was responsible for an exodus of business, not the opposite!

We know that in reality it's the old Bill Clinton cliche - "It's the economy, stupid!"

It's NOT workers' compensation that affects whether a business stays or goes - especially when one considers the reality that overall, nationally, workers' compensation represents only 1.4% of total payroll costs. What causes business exodus are economic factors well beyond the impact of work comp.

And just the same with the medical equation. There is nothing statistically that I have seen, or argued, that would suggest that access to medical care would be restricted when fee schedules are in place or when treatment guidelines are enforced.

What DOES happen is that surgical specialists see a decline in business while general practitioners, those first line of care physicians, see an increase. And frankly this is good, because there is too much surgery going on out there that is not medically warranted - reference all of the various studies throughout the years that cite the devastating effects of unnecessary back surgery (Melhorn, Talmadge, Barth, amongst may others etc.).

In the meantime Illinois continues to debate the efficacy of its "reform" with the business community stating it did not go far enough and the medical community stating it went too far. I was taught in law school that if both sides are unhappy with a bargain it's probably a good deal. Ergo Illinois - business and medicine, stop complaining and get back to work just like you want your injured workers to do!

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