Paduda: Golden State's Med-Legal Mess

Friday, July 22, 2022 | 0

In the esoteric world of workers’ comp, California’s medical-legal problems rank near the top of issues bound to frustrate/infuriate.

Joe Paduda

Med-legal (analogous to physician review or independent medical exam) may have even moved up a notch or two, as expenses have zoomed after a change in the med-legal fee schedule that went into effect in April of 2021.

The change was intended to:

• Simplify the payment structure by replacing several variations with one flat fee.
• Increase the number of qualified medical examiners.
• Increase the number of oncologists and toxicologists.
• Reduce overuse of supplemental reports.
• Do this all without more than a 25% increase in aggregate med-legal fees.

CWCI’s research indicates that results appear to be far less than intended:

• The number of QMEs increased slightly — up 134 — with most ortho surgeons, not oncologists and toxicologists.
• There was no decrease in supplemental report services (such as billing for more pages reviewed).
• And the average paid per month for comprehensive evaluations went up more than 50%.

Thanks to CWCI for sharing the details. Need more?

Sign up for CWCI’s webinar set for 10 a.m. Pacific Wednesday. Senior research associate Stacy Jones, who wrote the study, and CWCI general counsel Sara Widener-Brightwell will review the changes and discuss the results of the study. The program will be followed by a live Q&A session.

What does this mean for you?

As if we needed it, another entry in the hall of unintended consequences tells us, yet again, that regs have to be carefully thought through, responses anticipated and planned for, profiteer strategies gamed out and then — and only then — finalized.

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.