Can California's Workers' Comp System Be Fixed?

Tuesday, March 24, 2015 | 0

Dr. David Deitz, MD, PhD, was last up at the California Workers' Compensation Institute's conference. His task was to bring it all together by asking an apparently simple and straightforward question: "What can California learn from Washington?"

Or put another way, “Can California’s workers' comp system be fixed?”

Possibly.

First off, there still isn’t much of a focus on quality of care in California. Outcomes in workers' comp are still worse than in group health – despite more care for many of the same conditions. Many state systems still rely on judicial, administrative or otherwise “non-medical” authorities to make decisions about what are essentially medical issues; fortunately, California does not. Cue the independent medical-review complaints…

That’s good news; however, just by virtue of being a work comp patient, things aren’t so good. A 2005 Journal of American Medical Association analysis indicated 83% of studies (175 out of 211) found that just being a workers' comp claimant was associated with worse outcome after surgery.

There’s a lot of research and analytics and reporting in the non-workers' comp medical world related to outcomes, costs and cost effectiveness, with “a lot” especially true when compared to the paucity of such research in workers’ comp outside of the Washington Department of Labor & Industries, CWCI and a couple other sources.

Dr. Deitz referred to a “massive number of care improvement initiatives that are going on throughout the health care system” (paraphrasing), a trend that will continue with or without the Affordable Care Act. Again, this may help work comp as better care = better care for work comp too and a healthier population.

David also noted the questions we are encountering in workers' comp are nowhere to be heard in the real world; there are no questions about evidence-based medicine in group health. EBM is embedded in the very fabric of health care contracting, delivery and measurement. It is accepted fact, a core operating principle and fundamental. And the work comp systems would benefit immensely from a healthy dose of EBM.

One supporting data point is what’s happened in Texas, where they named a medical director and adopted guidelines, strong utilization review, formularies, electronic data interchange and measurement of results. While Texas isn’t perfect, it’s gotten a lot better.

Unfortunately, along with Washington, Texas is one of only two states that has made significant progress in adopting changes that have significantly improved medical care delivered to injured workers. However, it’s not for lack of opportunity. Dr. W. Brose’s HELP Pain Medical Network is just one source of high-quality, workers’ comp-specific and relevant data on treatment outcomes.

The money quote – “workers’ comp is the most costly and inefficient way to deliver medical care that humankind has ever invented.”

And care improvement is possible in work comp but requires systematic reform.

We have a system that is inefficient, very expensive and delivers poor quality care. That has to change.

Dr. Deitz’s final point – improvements in workers’ comp medical care MUST happen.

Joe Paduda is owner of Health Strategy Associates, a Connecticut-based employer consulting firm, and co-owner of CompPharma, a consortium of pharmacy benefit managers. This column was reprinted with his permission from his Managed Care Matters blog.