As it was recently reported by Joan Collier on PC360 (http://www.propertycasualty360.com/2011/09/13/new-ncci-report-focuses-on-workers-comp-prescripti), the NCCI recently released a new study about prescription drug costs in workers’ compensation. And as I read the study, I was reminded of one of the most critical parts of your workers’ compensation program: Who are the treating providers?
In many states, employers have the ability to make the initial choice of doctors for their injured workers, yet employers let the employees choose who they want.
Why is that a problem? First and foremost, employees are most likely to choose either the emergency room or their family doctor. Emergency rooms are busy places whose primary task is to make sure that people are not in imminent danger. The job of the excellent doctors that staff emergency rooms is to treat the client. They do not have the time to have detailed conversations with injured employees about their work duties and how they might be modified to get back to work. More often than not, an injured employee will wind up spending much more time out of work than they should because of this.
The only time an injured employee should go to the emergency room is when there is a real 911 emergency or when there are no other treatment options (such as a third shift employee). Even when someone gets hurt on third shift, you can often postpone the initial doctor visit for a few hours until your preferred doctor gets into the office.
The family physician presents some different issues. They think of the employee as their client and most commonly, they will grant the requests of that client. If the employee asks for a week off, the doctor will grant it. Why not? It keeps their client happy. Also, family physician offices are set up to deal with the small number of health insurance companies that operate in their state. The staff knows exactly how to deal with those companies. It’s cumbersome for them to figure out how to file the proper paperwork for a workers’ compensation company with whom they have no experience.
Most family physicians have no experience with occupational medicine. Occupational physicians understand health in the workplace and the importance of getting employees back to work because of the training they have had. You can find doctors who are members of the American College of Occupational and Environmental Medicine at https://webportal.acoem.org/custom/FindADoctorAcceptance.aspx?token=
Don’t have a certified occupational doctor in your area? You can still make this work. The key to choosing the right doctor, certified in occupational medicine or not, is communication. While it’s not possible for you to train a doctor to be an expert in occupational medicine, you can teach them enough about how workers comp works to get better outcomes for your clients.
First and foremost, does the doctor know that the employer—your client– is willing to accept the employee back for modified/alternate duty? If a doctor isn’t confident that their restrictions will be accepted, they will almost always just send them home. Once they know that the employer will accept their injured employees back, then you can start to communicate with them about what information you need about the injured employee. Employers need to know what restrictions the employee has due to their injury. What is the timeline for return to full duty work? These bits of information can help employers make the best decisions possible about returning the injured employee to work.
In states where the employer doesn’t have first choice of physician, things can be more difficult. With few exceptions, even when employers can’t choose a doctor, they can still recommend one. Telling an employee, “Dr. Doe has treated many of our employees and does a great job” is often enough to convince an employee to seek that doctor out for initial treatment.
How does all of this tie back to the problems with prescription drugs in workers’ compensation? Physicians that understand how to treat injured workers are more effective in getting those employees back to work and healthy. This shortens the duration of an employee injury and leaves less opportunity to have the “long tail” workers’ compensation claim where prescription drugs take up so much of the total cost.
Communicate with your physician regarding whether or not they dispense prescriptions in their practice. The NCCI report highlights the growing share of prescriptions that are being dispensed directly at the practice, and often at an increased cost.
Having the right doctor can dramatically reduce the cost of a workers’ compensation claim and having the wrong one can make that cost explode. Agents need to help their clients choose the right one so that injured employees get better and back into the workforce as quickly as possible.
Kevin Ring is the Lead Workers’ Compensation Analyst for the Institute of WorkComp Professionals, the Asheville, NC-based organization that trains insurance agents to help employers reduce Workers’ Compensation expenses. A licensed insurance agent, he leads workshops, analyzes Workers’ Comp programs and is the co-developer of CompImpacta Workers’ Comp software suite that helps insurance professionals in working with employers. He can be contacted at 828-274-0959 or kevin@iwcpro.com.
