Thursday, August 30, 2007, 07:39 AM - QME processWouldn't touch it with a ten foot pole.
That's what California doctors seem to be saying about becoming QMES (qualified medical examiners). The California DWC (Division of Workers' Comp) revealed this week that the number of QMEs in California has dropped 25% since 2004. There has been an exodus of about 350 QMEs each year. The number of doctors signing up to take the QME exam is significantly less than the number of doctors dropping out.
QMEs decide many critical issues in California workers' comp cases. In addition to determining whether there was a valid work injury in the first place, they often determine what periods of temporary disability are appropriate, what medical treatment is needed, as well as the rating for permanent disability. Without a stable corps of capable and fair QMEs, the California workers' comp system may crumble.
Workcompcentral.com writer Colleen Murray, quoted DWC spokesperson Susan Gard, as saying that the DWC is working on the problem by trying to have new and easier forms to use. Gard also apparently referred to new DWC regulations which would increase physicians' chances of being chosen to serve as a QME in the communities where they live. Perhaps that is a reference to the problem that has developed with the "fly-around" QME doctors who have "offices" in pretty much every town. That's a problem I addressed in an earlier blog post "The Tanning Salon Doc," which you can see by clicking here:
http://www.workerscompzone.com/index.ph ... 4f787d6811
But any DWC revision of the QME regs is under wraps for the moment.
The exodus of QMEs may mirror a general exodus of doctors from the California workers' comp system. Anecdotal evidence has been streaming in about doctors who no longer want to treat comp cases due to the red tape involved with utilization reviews and treatment guidelines. In some smaller communities this has reached crisis proportions as specialty doctors are no longer available to treat workers. You can see my earlier post on this ("Hasta La Vista Chico") by clicking here:
http://www.workerscompzone.com/index.ph ... 670342ae49
Workers and attorneys are often finding that when they are provided lists of doctors on the MPNs (medical provider networks), many of the doctors simply aren't willing to treat workers' comp patients. Not with a ten foot pole.
Tuesday, August 28, 2007, 10:23 PM - Understanding the CA WC systemI'm not talking about Nat King Cole's lazy, hazy, crazy days of summer.
No, I mean the good ole days for insurers and large self-insureds. They have seen a rapid decrease in workers' comp payouts since 2004 and a large increase in profits.
Yet another study has been released confirming this. This time it's a product of the National Academy of Social Insurance (NASI) out of Washington, DC. You can access a link to the study by clicking here:
http://www.nasi.org/publications2763/pu ... mpensation
NASI's mission statement is "to promote understanding and informed policymaking on social insurance." It bills itself as non-profit and non-partisan.
According to the NASI study payments in California declined overall by 12.2% in 2005, including a 16% decline in medical payments and an 8.6% decline in payments to workers.
These figures seem low, particular when compared to recent studies by U.C. Berkeley researchers Frank Neuhauser and Colleen Donovan. Neuhauser and Donovan recently reported to the California Commission on Health, Safety and Workers Compensation (CHSWC) that permanent disability payments for ratable AMA impairment cases are being reduced by just under 50%. You can see the Neuhauser/Donovan study by clicking here:
http://www.dir.ca.gov/chswc/Reports/mem ... _aug_9.pdf
Whatever the actual figures are, California has now bucked the trend. In other states, comp costs rose by a modest 1.7%. The steep California reduction has come at a large cost to injured workers. You can see the California Labor Federation report by clicking here:
http://www.calaborfed.org/pdfs/Legislat ... .27.07.pdf
And the "back story" is that payments to California workers have dropped far more sharply than insurer premiums, leaving insurers paying out to workers (or for their medical treatment) less than 50 cents on the dollar of each premium dollar collected from employers. My earlier post on this (California Workers' Comp "Fixed" So that Insurer Profits are Greater Than Benefits Paid To Workers") can be found here:
http://www.workerscompzone.com/index.ph ... 4f787d6811
Just some things to think about as we move closer to Labor Day.
Saturday, August 25, 2007, 10:06 PM - Political developmentsSuppose you are a grocery store manager. In addition to your regular salary you participate in a compensation scheme that rewards you based on the store's profit. Among items that affect the store's profit is workers' compensation costs.
An employee reports a claim to you. Would you be inclined to discourage the worker from filing the claim? Would you suggest the employee use group health benefits and apply for state disability instead of filing a comp claim?
Readers of the blog may remember that recently this very situation arose in Roseville at Bel-Air Market, a Raley's subsidiary. The store manager Nicole Leddy and assistant manager Amy Looper have been charged with workers' comp fraud in Placer County. You can access that post ("Don't Mess With Our BBQ") by clicking here:
http://workerscompzone.com/index.php?m= ... 597825e701
But is it legal for an employer to deduct workers' comp costs from store profit for purposes of computing entitlement to profit-based bonuses? This was the issue in the August 23, 2007, decision of the California Supreme Court in the case of Prachaisoradej v. Ralphs Grocery Co.
The court's majority, prevailing in a 4-3 decision, said yes, the practice is legal. Justices Baxter, Chin, George and Corrigan approved of the practice. Justices Kennard, Werdegar and Moreno dissented, arguing that the practice of deducting comp costs was illegal. Their dissent was eloquent, and you can read it along with the majority opinion by clicking here:
http://www.courtinfo.ca.gov/opinions/do ... 128576.PDF
Tone deaf to the realities of the workplace, the California Supreme Court issued its decision in Prachaisoradej just several weeks after the fraud indictments of the Bel Air Market managers. How ironic.
But there may be a silver lining if workers begin to report employer coercion to local district attorneys. One presumes that Ralphs Markets would be concerned if its managers fraudulently discouraged workers from filing claims in hopes of obtaining better bonuses. Ralphs Markets may have won this case, but the Bel Air Market indictments serve as a warning to the grocery industry and other industries utilizing these bonus arrangements.
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Friday, August 24, 2007, 07:42 AM - Political developmentsA California coalition of small business owners-calling itself Small Business for Affordable Healthcare-has announced support for the concept of mandated employer funding for health care coverage.
The group released a survey yesterday that claims over half of California small business owners would favor paying to a statewide purchasing pool to acquire affordable health coverage for their employees.
The conventional wisdom has been that small employers are a monolith that opposes any attempt to require employers to provide health care coverage. Several California employer groups have been very active in lobbying for workers' comp reform and against health care reform that contains mandated costs for employees. The California Chamber of Commerce and the National Federation of Independent Business come to mind.
There are, of course, several health care reform proposals alive in the legislature (Schwarzenegger's plan, the Perata-Nunez plan which is AB 8, and the Sheila Kuehl "single payer" plan). Schawarzenegger's plan would require employers to pay 4% of payroll into a state fund. AB 8 would require employers to pay 7.5% of payroll.
The Small Business for Affordable Health Care coalition joins a coalition of several large employers-Safeway and Pacific Gas & Electric among them-in pushing for reform this year.
You can read the small business coalition's report by clicking here:
Wednesday, August 22, 2007, 10:39 PM - Political developmentsThe California Division of Workers Compensation is proposing to adopt guidelines for treatment of chronic pain. The guidelines are largely based on the "Official Disability Guidelines," known as the ODG guidelines.
By clicking the following link you can read the proposed treatment guidelines and participate in an online forum to comment on the proposed guidelines:
http://www.dir.ca.gov/dwc/DWCWCABForum/ ... ;RegID=212
The online public forum on the guidelines closes on September 4. So far, comment from many doctors specializing in chronic pain treatment is positive. Check out the comments from many of California's leading pain management specialists. But you do not have to be a doctor to add your comments to the public forum.
In choosing the ODG guidelines, the DWC has for the first time rejected ACOEM as a basis for official treatment standards. Clearly ACOEM has been an inadequate standard for dealing with chronic pain.
But remember that this is the comment phase. The final version could be different, particularly if major system stakeholders object to this version.