Friday, July 13, 2007, 07:49 AM - Medical treatment under WCWe can check Barry Bonds' batting average every day. Heck, with a few clicks we can see how Minnie Minoso or Mickey Mantle did in the 1960's.
But would it be a good thing if we could get the batting average of surgeons? Or psychiatrists? Or lawyers? A study just unveiled of heart surgery outcomes in California got me thinking.
The study is a study of the results of coronary bypass graft surgery by California surgeons and hospitals. You can see it by clicking here:
http://www.oshpd.ca.gov/HQAD/Outcomes/S ... /index.htm
There's very little data available on outcomes in medicine (or law, for that matter, though civil trial results can be tracked). If you as an injured worker are treating with a doctor, is your doctor a "good" doctor?
Even understanding what "good" means is sometimes elusive. Good bedside manner? Sympathetic? Thorough? Cutting edge knowledge of latest medical literature and therapies? Willing to order tests and consultations?
Or do we define "good doctor" as one who has a high percentage of patients who get well, are healed, have their pain controlled? Or is it a doctor who orders only those tests that are really necessary and who prescribes medication very carefully?
Or is the criteria patient satisfaction? Years ago I learned that the worst lawyer or doctor may be beloved by a patient who has confidence in the professional. Not every charismatic doctor is a good surgeon. And doctors who liberally prescribe medications and "procedures" may not necessarily have excellent results in increasing the functioning of patients.
And can a specialist be a "good doctor" if the specialist fails to recognize and suggest referrals to treat complications the patient has that are outside the expertise of the specialist? If a hand doctor is an excellent hand mechanic but fails to investigate neck or shoulder problems, when is that doctor's approach no longer "good"?
If a doctor is treating at an occupational clinic that receives a high volume of referrals (and thus some pressure) from a particular employer or insurer, how do we define "good"? Does a "good doctor" minimize the certification of temporary disability or minimize the ordering of tests? Whose interest is being served?
In workers' comp a doctor who does a poor job with paperwork may create problems for the injured worker. Reports need to be done. UR denials need to be addressed. Treatment rules are complicated. Not every "good doctor" does an adequate job for patients in the comp system.
Alas. Unlike the stats we have on Mantle, Minoso and Bonds, we have no stats to measure most of this.
Things to ponder.
Friday, March 23, 2007, 08:31 AM - Medical treatment under WCFew people in California haven't heard Mick Jagger of The Rolling Stones squawking "I Can't Get No Satisfaction." He was wailing with existential angst about finding meaning in a world bombarding him with useless information about how white his shirts could be (as well as his search for "girl reaction").
Would most California injured workers echo his unsatisfied refrain? Are California's injured workers satisfied or unsatisfied with their medical treatment? Anecdotal horror stories have indicated that they are not. The 2003 and 2004 reforms affected medical treatment in several key areas:
-medical treatment standards (the "ACOEM guidelines") were adopted as the presumptive standard of medical care allowed
-provisions were added allowing utilization review ("UR") of medical treatment requests by insurer-hired outside doctors
-employers were authorized to setup Medical Provider Networks ("MPNs") of employer selected physicians
-workers subject to an MPN lost the right to "free choice" of a doctor unless they predesignated a doctor before they were injured
-the MPN provisions were declared retroactive, allowing insurers to force many workers to terminate treatment with doctors they had seen for years
-strict limits on chiropractic treatment and physical therapy were instituted on post 1.1.04 injuries
These reforms have squeezed billions of treatment dollars out of the California comp system. But there are lots of unhappy campers. Just how many?
The UCLA Center for Health Policy Research study of worker satisfaction with treatment was published in February 2007. You can find the Los Angeles Times account of the study by clicking here:
http://www.latimes.com/business/la-fi-c ... s-business
And you can download the actual study at this site:
http://www.healthpolicy.ucla.edu/pubs/p ... ?pubID=216
Getting satisfaction. Or not. In future posts, I will discuss the results of this study as well as problems with the study. And I'll be looking at an effort being made to roll back these changes through the California initiative process.
Friday, March 9, 2007, 09:11 AM - Medical treatment under WCEver have concerns about whether you are taking the right medicines in the right dosage? Ever wonder whether the different pills you are taking could cancel each other out or have unintended health side affects?
I see cases where some injured workers are taking as many as 10 different types of pills. Some of the pills are for general health issues... blood pressure, diabetes, asthma... along with muscle relaxers, pain pills, anti-anxiety pills, sleeping pills, anti-depressants, and narcotic pain pills as well (plus pills to prevent stomach damage from the other pills).
Often there is no coordination between the workers' family doctor and the workers' comp primary treating doctor (this is one of the concerns cited by advocates of "24 hour care," which would break down the walls between workers' comp medical treatment and group health treatment).
California's medical treatment guidelines (which are currently the ACOEM guidelines) seemingly favor medication therapies over modalities such as physical therapy, acupuncture and the like. But, in some cases, could those pills be leading to more adverse health effects and disability? Do drug dosages or drug interactions turn some workers into "zombies"?
With a huge volume of medication floating around, the possibilities of medication errors increase. I recall one workers' comp client who suddenly died; his family joined me in suspecting that he was overmedicated with narcotics, but the coroner refused to do testing and he was buried before toxicology testing could be done.
This is serious stuff. This week, the California Medication Errors Panel unveiled a major new report. You can find a pdf version of the full report by clicking here:
The Medication Errors Panel was established in 2006 by the California legislature. Comprised of 17 members, its task is to study and make recommendations on the problem of prescription drug errors.
What are the key recommendations of the study?
-the panel recommends that more pills be prescribed electronically (note: many pharmacists have trouble reading the doctor's handwriting)
-labeling needs to be done in various languages to better serve California's large immigrant population
-a state-funded pilot project to collect data on medical errors at pharmacies
-adding the purpose of a pill to the prescription label
If you are an injured worker, here's a simple precaution you can take. Make sure your family doctor knows what pills you are taking. And make sure your workers' comp doctor knows what pills you take for other health issues. Ask whether any of the pills cancel each other out. Ask about side effects. If your doctor doesn't answer to your satisfaction, ask the pharmacist. Remember, we are talking not just about your workers' comp treatment. We are talking about your health.
Thursday, March 8, 2007, 07:50 AM - Medical treatment under WCShould California doctors who treat workers' comp patients be allowed to dispense medication out of their offices? If so, should they receive big markups on the medicines they dispense?
We are not talking occasional medication samples that a physician may give to the patient. Rather, we are talking about doctor offices that "repackage" medications and dispense them to patients.
Granted, there may be some benefit to the worker. The worker need not make separate trips to a pharmacy. There is convenience in having it all done under one roof. The doctor's office may be willing to fill the prescription even if there is trouble getting through to the insurance adjuster to get authorization.
On the other hand, the practice may set up economic incentives for doctors to over-prescribe, or to select the most expensive alternatives.
The California Division of Workers' Compensation has drafted repackaged drug price caps. Drugs dispensed in-office by physicians will have to be billed at Medicare rates plus a small dispensing fee. This is a major change, since some doctor offices have been receiving major markups on drugs dispensed in-office.
Recently, an Alameda County Superior Court judge denied a medical group's request for an injunction to halt the application of the new repackaged drug rules.
We have seen this sort of thing before. Several years ago, owners of "surgery centers" were able to charge high prices for surgeries done is private surgical suites.
The official California Medical Fee Schedule did not directly cover those procedures at surgi-centers and as a result there has been extensive litigation over surgi-center liens.
Workerscompzone believes that doctors are entitled to a reasonable profit for the service they provide. But it does injured workers no favor if doctors can dispense medication in-house at unregulated prices. For once, the DWC may have hit it right.
Tuesday, March 6, 2007, 08:45 AM - Medical treatment under WCHospitals, like other things in life, are not all equal.
If you are a California injured worker, you might want to check the following site to see highly rated hospitals in your area. The site CalHospitalCompare.org is a project of the California HealthCare Foundation. CalHospitalCompare.org rates hospital quality.
You can get to the site by clicking here:
Not all California injured workers have free choice to select their own doctor. Since the SB 899 comp reforms pushed by Schwarzenegger in 2004, employers and insurers can set up managed provider networks (MPNs). If an MPN has been adopted and properly implemented, workers who have not predesignated a doctor before being injured at work may be forced to treat with MPN network doctors. Thus, an injured worker may have little say-so over which hospital is used for their treatment.
But workers -- and employers and insurers -- have a vital interest in patient quality care, so CalHospitalCompare.org is a worthwhile site to note.