Thursday, October 20, 2011

Georgia Showing Politics Steers Science

This morning's story about the Georgia State Workers' Compensation Board studying whether to seek legislative authority to adopt treatment guidelines got me thinking - why is it that different states have different guides?

I learned in school as a child that basically all human beings are biologically the same.

There should be no difference in one's biology if a person is from California, New York or Georgia.

So why is it that the states that do adopt treatment guides all do something different?

For example, California adopted the guides from American College of Occupational and Environmental Medicine (ACOEM) as a part of its 2004 reform, but also has guidelines that supersede ACOEM.

Texas, as a part of its last reform adopted guides, but the state couldn't decide what it wanted so it adopted both ACOEM and those from Work Loss Data Institute (WLDI).

Florida just has its own guides and did not adopt a national standard.

Do doctors receive medical training differently in California than in Texas, or Florida, or Georgia?

Or do the politics of a state determine whether a person's biology is treated differently than another state?

Watching the debate unfold in Georgia, me thinks it's the politics.

John Poole, legislative consultant to the Georgia Self Insurers Association told our reporter that guides are being considered to control medical costs in the workers' compensation system.

Donald J. Palmisano Jr., executive director of the Medical Association of Georgia, wonders why this would be  necessary in light of Georgia's utilization review process.

Jason Perkins, a member of the executive committee of the Georgia Trial Lawyers Association, said discussions about the treatment guidelines have centered on increasing medical costs.

Phil LeFevre, senior account executive for the Work Loss Data Institute, said the board is concerned with both costs and outcomes for workers. He said the state board has not decided whether to write its own guidelines or adopt WLDI or ACOEM.

And of course both WLDI or ACOEM stand to gain market share in the guidelines business so there is motivation to push for a guideline standard.

The first objective of any work comp guideline adoption program should be to ensure that injured workers receive quality medical care that results in the return of a worker to productive status.

And each treatment case will be different because though everyone's biology is standard, no one's life experience is standard, so what is effective for one person is not effective for another without some additional accounting for an injured workers' coping tolerances.

We have seen increasing evidence lately that accounting for psychosocial factors is nearly more important than accounting for biological factors in terms of controlling costs - because when you really get down to it, controlling costs is the primary reason treatment guides are adopted or implemented, NOT to ensure the delivery of quality care.

I don't believe that controlling costs and delivering quality care are mutually exclusive though. Indeed they are complimentary if the design has as a primary focus the delivery of VALUE, which means not focusing on procedure costs but looking at the totality of all variables consequentially related to a work injury.

Back to my original question - why does each state have something different? I believe, as I have opined in the past, medical treatment in workers' compensation is more political than scientific.
workers compensation, work comp, injured worker

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