July 20.

That's the deadline for comment on the latest version of the California physician fee schedule. An earlier version of of a revised physician fee schedule has been modified.

The initial proposal was supposedly "budget neutral". With this new version, costs have been added into the system, supposedly funded from cuts in spinal hardware costs and cuts in ambulatory surgical center fees.

The initial proposal followed the release of a study by the The Lewin Group on introduction of RBRVS into the California workers' comp fee schedule.
The Lewin Group study can be found here:
http://www.dir.ca.gov/dwc/RBRVSLewinRep ... rt2010.pdf

Many physicians were highly critical of the first proposed fee revision.

The DWC walks a fine line here. There is enormous pressure to find system cost savings. Medical costs have been increasing significantly (along with loss control costs). Unless medical costs are under control, it's hard to see how indemnity benefits will be brought to adequate levels.

But there needs to also be attention to keeping doctors in the system.
My recent post, "To Treat of Not to Treat", examined this from the perspective of some of the doctors. The question raised was whether it was worth it for doctors to take workers' comp cases:
http://www.workerscompzone.com/index.ph ... 707-091110

The comment forum on the revision to the fee schedule is open til July 20th:
http://www.dir.ca.gov/dwc/DWCWCABForum/ ... hedule.htm

Here is a link to the comments posted so far (note: the DWC often takes down these links after the comment period expires):
http://www.dir.ca.gov/dwc/ForumDocs/Phy ... mments.pdf

Among the comments so far, comments from neurologists and physical medicine doctors are particularly notable. The commenting doctors note that reimbursements for diagnostic procedures such as EMG/NCV testing would be substantially reduced. This would lead to an exodus of neurologists from the comp system, they predict.

As reimbursement schedules are adjusted, someone's ox is likely to get gored. But these changes can substantially affect worker access to treatment.

That's why it's good for doctors to give their input now, up front.

Stay tuned.

Julius Young
www.boxerlaw.com

Many of my Northern California readers know that all roads run through Oaktown.

Not literally, of course, but Oakland, site of my Boxer & Gerson office, really is the heart of the Bay Area. It's where the burbs of CoCo County meet, where the North Bay begins to transition into the South Bay.

Reputedly a place where there is "no there there", its a place where many different ethnic enclaves intermingle, a place of mean streets, hipsters in lofts, hillside architectural gems, and more good restaurants on one mile (College Avenue) than in some whole upper middle class counties in the Golden State.

Oakland is also home to many of the key players in workers' comp.

The Callifornia Workers' Compensation Institute, an insurance industry organization, is headquartered here. The WCIRB (Workers Compensation Insurance Rating Bureau) is here. The Division of Workers' Compensation has administrative offices in Oakland. The Commission on Health, Safety and Workers' Compensation is headquartered here. Non-profits dealing with worker safety, such as Worksafe, are sited here. And of course, the WCAB has a large district office in Oakland.

Federal deficit commission members Erskine Bowles and former Senator Alan Simpson have noted that the United States has cancer; a cancer of debt that could destroy our economy and way of life as we know it.

But if the country has cancer, so does Oakland.

The Oakland City Council has given pink slips to 80 police, about 10% of the force. With the city out of money and facing huge shortfalls, cops agreed to contribute more to pensions if they were promised job security. Rather than make cuts in libraries and some other services, the Council has decided to issue the layoff notices. Without passage of higher taxes, cuts could be deeper next year.

It's ironic that this comes after a second round of downtown violence following protests over the BART officer shooting of a young African American male.

Our office, like most in downtown Oakland, emptied out early last week as word arrived that the jury verdict in the Oscar Grant shooting would be forthcoming within the hour.

At least four depositions set of clients with Boxer & Gerson clients were immediately canceled as court reporters waited in our lobby for the lawyers to arrive. As streams of workers left downtown, police were gathering around our building and around the sites of many of the other workers' comp offices.

After several hours of peaceful speeches and protests, some looting ensued. It appears that some of the damage was led by anarchists and
graffiti spraying protesters. Of course, black owned businesses were not spared from the damage.

If you've seen a TV screen in the past week you probably know most of that.

But it's disconcerting to see the heart of the Bay Area on economic life support.

Many of us in the "comp community" like Oakland. We may live here, or we come here to work and get used to its gritty charms and its fab weather.

I'll bring you more on this story from time to time.

Julius Young
www.boxerlaw.com

Last month I noted in a post "Nail Biters" that Assemblywoman Mary Salas had nudged out former Assemblyman Juan Vargas in a race for the Democratic nomination in the 50th Senate District.

Not so. The margin between Salas and Vargas was not more than a few hundred votes. As some slow returns filtered in, Vargas took a small lead.
There were over 12,000 Riverside County ballots that had not been tallied.

With those ballots in, Vargas had a 22 vote lead. Vargas declared victory today in the primary. The 50th stretches across parts of San Diego, Imperial and Riverside Counties. The winner of a Democratic primary in the district is basically assured of election in November.

There's word tonight that Salas has requested a recount.

This is a bitter battle that has attracted major interest from various California interest groups. Vargas attracted large amounts of cash from insurance interests and tort reform groups.

Millions, actually.

Salas was backed by applicant attorneys, trial lawyers and most unions. I'm aware of only one union backing Vargas, AFSCME.

Although I cover some of the legislative background from time to time, you, dear reader, may be wondering why the fascination with this race.

Consider the picture. Business interests smell blood.

They seek a more receptive audience in the legislature if there is a Brown administration. The goal will be to find some Democratic votes to block legislation.

And if Whitman is elected, those interests seek Democratic friends who will join with Republican minorities to move legislation.

Holding onto Democratic California Senate seats is not a forgone conclusion.

State Senator Dean Florez is termed out. Kern County Supervisor Michael Rubio is seeking to replace him, but issues have arisen regarding whether Rubio resides in the district.

In a coastal counties district, State Senator John Laird survived to fight another day in a runoff, but faces a tough race against the GOP's Sam Blakeslee. The runoff is scheduled for August.

It's all inside the beltway River City stuff that many readers may find as interesting as watching paint dry.

But there's a reason why people who do care are pouring millions into these races. They matter.

Politics is sometimes played as a blood sport. These races are prime examples.

Stay tuned for my piece on the Top 10 developments in California workers' comp in the first half of 2010.

Julius Young
www.boxerlaw.com

Hey, it's not Aaron Burr versus Alexander Hamilton. No dueling pistols here.

But we are in modern times. We have dueling lawsuits.

This time it's Arnold Schwarzenegger versus State Controller John Chiang.

Schwarzeneger has filed to get a court order to force Chiang to cut state woker pay to minimum wage levels while the state has no budget. Chiang has filed his own action, seeking to throw out the order to cut salaries that was sent to him from Schwarzenegger's Department of Personnel Administration.

Here's more on the Chiang lawsuit in a piece by Wyatt Buchanan from the San Francisco Chronicle:
http://www.sfgate.com/cgi-bin/article.c ... &tsp=1

It's a duel of great interest to the folks who work for DIR/DWC and the WCAB.

Stay tuned.

Julius Young
www.boxerlaw.com

As a blogger on California workers' comp issues, I sometimes get interesting calls.

Yesterday's call? From doctor's group (to protect confidentiality, I'll mask any particularizing details).

The medical practice is debating whether to join an MPN and whether it wants to treat injured workers under California's workers' comp system.
The caller was seeking input from sources with knowledge about California's workers' comp system.

At first, I envisioned a need to educate the caller about issues that concern providers....utilization review....fee schedule issues....medical treatment guidelines.....lien claims.......

I quickly realized that was unnecessary. The caller already understood what was going on in those areas quite well.

The caller was really looking for something else. What's the benefit in treating workers' comp cases? Why should our doctors do it?

This physician noted that the medical group was already very busy with non-workers' comp patients. The group was a member of various HMO
groups.

Why should they take workers' comp? Was it worth getting involved in the hassles of paperwork documentation and authorization disputes?

I wondered whether their HMO contracts bound them to treat injured workers. The caller didn't think so.

I noted that with changes coming under Obamacare, healthcare reforms could affect treaters in unanticipated ways. Perhaps the doctor group wanted to diversify into workers' comp.

The caller was unmoved.

Did the doctors feel a sense of civic duty to treat some share of the state's working folks? After all, many of the doctors live in the community. The workers they would be treating serve the doctors in various capacities. I appealed to the communitarian, altruistic impulses of the caller.

The caller was unimpressed.

I tried an economic argument. Perhaps, I noted (not having stats to back up my hypothesis) if the doctors did not take comp cases, would that have a negative effect on the economics of local MRI facilities and surgicenters which may be partially owned by these doctors? Would other treating doctors refer patients to alternative surgicenters and MRI centers instead, negatively affecting the calling doctors' investments?

The caller noted that this argument could resonate with some of his partners, but might not be compelling.

As the call ended, I wondered how often this debate goes on in partnership meetings at doctors groups. Was the call just an "outlier", or was it a mainstream wake-up call showing deep dissatisfaction among doctor groups with practice in the comp system?

Julius Young
www.boxerlaw.com