New Fee Schedule Unlikely to Improve Access

Friday, March 7, 2014 | 1

The Workers Compensation Research Institute says the new fee schedule could improve access. What nonsense!

WCRI said that the new fee schedule could change utilization patterns because it would increase pay to primary care providers. In the same breath, WCRI admitted that "the institute does not expect that to be the case in California."

The WorkCompCentral story by Greg Jones, 2014-02-21, stated that "a 2012 WCRI study concluded that prices paid for office visits in California were 30% below the median of the 25 states that were reviewed, with only North Carolina and New York paying less."

By eliminating independent payment for reports under 99080 and by eliminating independent payment for review of boxes and crates of medical records under 99358, harm has been done that cannot be repaired by raising an office fee by $8. THAT is what was done in 2007 in California when office visits for CPT 99213 were raised from $45 to $53. The new codes under the RBRVS make similar smidgens of adjustment. THAT may be enough to fool WCRI, but it won't fool even the most junior accountant or office manager in any medical or surgical office.

The WorkCompCentral story by Greg Jones said that "there are some who think that California's payment rules prohibiting payment for record review ... will impede the ability of injured workers to receive treatment." It is then noted that "Medicare doesn't reimburse record review." That's because, "the Centers for Medicare and Medicaid Services considers the cost of reviewing records to be bundled with the office visit payment."

What utter and complete nonsense! Now that that miserly process has been shoved into workers' comp, it is still somehow expected that after an hour or so with a patient another few or several hours will be devoted gratis to review of records. The treating doctor will be obliged to spend less time with the patient to allow time for review of records. In most cases, that adjustment will not suffice.

Robert Weinmann is a neurologist in San Jose. This column was reprinted with his permission from his Politics of Healthcare blog.