Tuesday, June 21, 2011

SCIF Restrictions on Drugs is Entitlement Reform

The California State Fund (SCIF) has issued a letter to its medical provider network (MPN) participants that they will be required to refrain from prescribing opioids for a period longer than two months and not prescribe compounded medications without prior approval if they wish to continue to participate as a provider (see WorkCompCentral News, "State Fund Targets Opioids, Compounds with MPN Rules: Top [2011-06-21]").

The California Society of Industrial Medicine and Surgery (CSIMS) argues that this restriction imposes on a physician's professional practice and may cause a violation of California Business & Professions Code Section 2241.5(a), that states notwithstanding any other provision of law, physicians and surgeons can prescribe controlled substances to a person in the course of treatment for a condition causing intractable pain.

Some are saying that this restriction will cause doctors to leave SCIF's MPN and consequently injured workers will be without adequate access to care.

SCIF argues that its restrictions are well defined in evidence based medicine and that any physician practicing in accordance with the guidelines should not have an issue.

Regardless of who's right and who's wrong, what is most interesting to me is how these market forces will play out - who's the dog in this fight, and who's the tail? Will physicians abandone the single biggest player in the California workers' compensation system? Or will SCIF run out of doctors to provide treatment to injured workers? Indeed, will other carriers follow suit? Will this cause a doctor shortage, or a core, fundamental change to the system?

The way I see it, SCIF's experiment is causing a flap not because it is an imposition on physicians' professional standing, but because it is entitlement reform.
SCIF's imposition of its market rules on providers that want to be part of its economic microcosm is a strong armed attempt to change the culture of work comp - maybe that's whats needed. The legislature can impose all the laws, rules, and restrictions it wants, but to get fast, effective change in the culture of workers' compensation one needs to go where the dollars flow.

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