ymcgavin@socal.rr.com
Senior Member
Posts: 1351
Joined: Jun 2002
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Wednesday December 21, 2005 7:32 AM
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Hi David,
Prior to SB 228 and AB 227, CSIMS funded a study to outline the effects a change from the then current version of the OMFS, to Medicare's RBRVS system, would impact an injured workers access to care. According to my reading of this study, it concluded there would probably be an impact, and it would be adverse.
This study, is availiable to the public on CSIMS website. It can be read and downloaded here. It is named the HJH Study.
My reading of WCC's excerpts of Dr. Kent's letter adds further fuel to the clearly accurate prediction by CSIMS, and the CMA, that the "access to care" problem has already reared its head, and has been exacerbated by the fact that:
"Medical specialists fear a new fee schedule that (is to) be drafted next year and based on the system used by Medicare. Prior reforms reduced payments to doctors by 5% and prohibited any further adjustments until Jan. 1, but the Schwarzenegger administration plans to switch to schedule fixed to a percentage of Medicare rates next year.
Physicians are unable to give proper medical care because of insurers' reliance on the American College of Environmental and Occupational Medicine (ACOEM) guidelines, and the Division of Workers' Compensation's "failure to promulgate proper treatment guidelines."
The DWC passed regulations that allow physicians licensed outside of California to deny or modify treatment plans through utilization review.
The $100 lien filing fee imposed by the reforms is "universally despised" and discourages physicians from treating injured workers.
Highly qualified physicians are "capriciously denied access" to medical provider networks while others are forced to accept big discounts from the fee schedule in order to participate in the networks."
Speaking from first-hand experience, I have already seen a mass exodus of physicians willing to accept new industrially injured workers and provide treatment --- which is consistent with the findings of the HJH Report that was solely based upon adoption of the Medicare based RBRVS Fee Schedule.
The misuse of ACOEM by the payor community to deny treatment; the use of out-of-state UR physicians who are not licensed in California to practice medicine; the $100.00 lien filing fee; and, the fact "highly qualified physicians are "capriciously denied access" to medical provider networks while others are forced to accept big discounts from the fee schedule in order to participate in the networks" has also, as an unintended legislative consequence, aggravated this exodus of physicians from the occupational treatment arena.
As aptly noted in the HJH study, if the fee schedule is too low, physicians will simply refuse to accept new injured worker referrals. The additional hurdles imposed by improper application of ACOEM as a mandate, rather than a flexible guideline; the perceived blanket denials issued by out-of-state UR physicians; the $100.00 lien filing fee; and, the fact physicians are either denied access to participating in an MPN, or are forced to accept big discounts in order to belong to an MPN, are creating additional reasons for physicians to change their practice profile ---- all of which contributes to the predicted "access to care" problems predicted by CSIMS prior to implementation of AB 227, SB 228, and SB 899.
Reform was necessary --- but the draconian reforms that were implemented have resulted in an "access to care" problem that will certainly increase. The "access to care" problem adversely impacts injured workers obtaining the appropriate care necessary to rapidly assist them in regaining function and returning to work.
York McGavin
ymcgavin@socal.rr.com 
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