Tuesday, July 5, 2011

Taken to Task for Criticizing Access to Care Arguments

In a post last week I opined that there wasn't any valid scientific studies demonstrating that the introduction of an RBRVS fee schedule would result in a mass exodus of physicians from workers' compensation, and asked that if there were such studies to forward them to me.

Carl Brakensiek of the California Society of Industrial Medicine and Surgery (CSIMS), and Robert Weinmann (The Weinmann Report) both took me to task for my statements and Mr. Brakensiek sent me 7 study reports and an article that my publication, WorkCompCentral, issued from May, 2005 about Maryland.

I have not yet reviewed these reports in any detail, and I have posted them here so that when I do review them you can "read along side" me - to either come to the same conclusions I do, or to debate my comments.

The WorkCompCentral story (Surgeons Fleeing Md. System, but No Fee Fix in Sight [10/27/05]) is not a study, and in fact does not have any facts in it to suggest that there was any actual data presented to the Maryland legislature to support the conclusion of the medical community in that the state's new Medicare-based fee schedule is driving orthopedic surgeons out of the system. Since this is not a study, nor since it does not reference any study, I will exclude it from my review.

From my brief initial review, the other articles in general concern only one aspect of the equation of access to medical care in workers' compensation cases - whether a physician would be willing to accept a workers' compensation patient for treatment. This in of itself does not reflect an access to care issue, it simply reflects that certain physicians won't provide services to workers' compensation claimants.

The other side of the equation would be a study of whether injured workers in fact DO get treatment, and/or whether treatment options have been artificially restricted by changes in physician fee schedules.

In other words, the question should not be posed to a provider whether a physician would accept a patient, but should be posed to the injured worker community whether they had difficulty finding a physician for the recommended treatment.

But such observations are premature since I have not given these reports sufficient study. Here is a list of the reports provided me, each one linked so you may read it yourself.

One or the studies, "RBRVS-Based Fee Schedules In Workers’ Compensation: Implications for California" (Johnson, Huth, Bush - 2002) was sponsored by CSIMS and involves telephonic surveys of orthopedists and neurologists.

Another of the studies, "Impact of Medicare-based Workers' Compensation Fee Schedules on Injured Worker Access to Neurologic Care in Texas & Hawaii" (authors unknown, 2005) was sponsored by the Association of California Neurologists and is a report on a telephonic survey of neurologists offices in Texas and Hawaii.

A 1998 study, "The Medical Fee Schedule Under the Workers' Compensation Law" (Martin, 1998) was prepared by the Legislative Reference Bureau of Hawaii in response to a legislative request for such study.

Three of the studies ("Trends in Medical Specialists Participation...", "2008 Model for Predicting...", and "Workers' Compensation Medical Fee Schedules...")were principally authored by Steven Levine, MD, PhD, Clinical Professor of Neurology at the David Geffen School of Medicine, UCLA.

And the final sample is a report authored by Allard Dembe, Sc.D. and Robert Harrison, MD, MPH, ("Access to Medical Care for Work-Related Injuries and Illnesses: Why Comprehensive Insurance Coverage is Not Enough to Assure Timely and Appropriate Care" - date of publication unknown).

Here was my promise to Mrrs. Brakensiek and Weinmann - I would read each report thoroughly and will comment on what I find and, if in fact these reports are valid scientific evidence of access to care issues as a consequence of fee schedule restrictions then I would state so right here, AND I would write a letter to the California legislature concerning my findings. I also promised that I will call it as I see it, and if these reports do not appropriately lead to access limitation conclusions I would also say so.

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