Friday, June 14, 2013

What Value In Progress Reports?

Alex Swedlow, president of the California Workers' Compensation Institute, noted researcher and all around great guy, challenged me yesterday at the annual WCIRB meeting in San Francisco: What is the single medical billing procedure that is the most common in California's workers' compensation system?

Physical therapy? Nope.

Prescription drugs? Not close.

Laminectomy? Please...

How about progress reports?

Yep, progress reports.

And what is the most frustrating, and burdensome procedure for physicians in workers' compensation?

Progress reports (Alex didn't tell me that - I've garnered that from years of talking with physicians).

Why is the industry so focused on medical reporting, and in particular the ubiquitous progress report? Simply because it is mandated in the Labor Code and regulations.

Take a look at the Treating Physician's Progress Report, PR-2 - what do you see?

First off, a request for lots of unnecessary, redundant, and valueless information. For example, why, if we know the injured worker's name and claim number, do we need to know his address, date of injury, date of birth, occupation, phone number, etc.?

Why do we need to know all of the same information about the claims administrator? Who gets this report? The claims administrator - do you really think that the claims administrator doesn't know who he, she or it is?

And why is the employer's phone number required? The employer doesn't want to be bothered - this is a matter that's being handled by the claims administrator.

Note in the grey box at the top - the options for the reason for this report. The very first option is, "Periodic Report (required 45 days after last report)".

Talk about a cost driver! Why does the law mandate a report every 45 days regardless of status? What value is derived from this activity other than billing for an office visit and preparation of a report that calls for lots of redundant, time consuming, valueless information? Why must the patient information and claim administrator information be included every single time a progress report is submitted and what is so magical about 45 days?

The report then asks for subjective complaints, objective findings, diagnosis, and treatment plan - the use of additional pages in narrative format is encouraged.

What is the purpose of this form? What value is derived from mandating this reporting? The content of the form does not drive statistical understanding of cost drivers in workers' compensation because the data on the form doesn't go beyond the claims adjuster or, perhaps now, independent medical review.

Data on a claims progress is kept in other, more accessible, less burdensome and more easily understood format.

I think about when I was practicing workers' compensation law and rifling through files getting an understanding of a claim and the medical condition and history of an injured worker. I never, ever, paid much attention to the progress report because there simply wasn't any valuable information provided. The progress report did not help me manage the claim - in particular the mandatory 45 day reporting which basically was always a status quo report.

Everything in the progress report is transmitted to the claims administrator in different fashions via more efficient communication systems.

There is always much consternation about the cost of the medical component to workers' compensation. The negotiators of the latest California reform put a lot of effort into medical treatment controls and now we have independent medical review, bill review, limitations on treatment protocol, etc.

But no one has taken a look at the ponderous reporting requirements in workers' compensation and whether any of this mandatory report writing returns any value to the system.

I suspect that we'll see some research in the future on this cost aspect - but is that even necessary? Why not just tackle the issue now?

A lot of time is spent in the legislature about restricting continuous trauma claims from workers with minimal contact with the state, about funding prescription drug monitoring programs, and excess disability slush funds.

Not much time is spent looking at existing procedures and systems to question whether any of this is really necessary in order to administer claims and whether any of these activities returns value to the system.

Time to start...


  1. interesting that Mr. DePaolo does not find a medical report, the only source of actual medical status information, and the only source of medical information to support a treatment plan, to be very useful. Also interesting that a lawyer does not find this kind of information useful, though not surprising given how attorneys like him manage their clients. Other than the probably unnecessary 45 day requirement, I find it hard to see how the system will be improved by eliminating medical reports. Unless, of course, we are prepared to say that the Work Comp system in California is simply a dispenser of benefits absent any bona fide medical basis.

    1. Paul - I didn't say to eliminate the report. I did say to examine the need for it every 45 days (which you picked up on) and I did say that much of the form is redundant and unnecessary. And why does a medical report have to be "the only source of actual medical status information, and the only source of medical information to support a treatment plan"? You don't have any better way to communicate status? Like a phone call... please... By your disparaging remarks about attorneys, I have to assume you are a provider that finds BILLING for medical reports profitable...