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Weinmann: KP Public Affairs Assumes Advocacy at CSIMS

By Robert Weinmann

Wednesday, September 5, 2018 | 260 | 0 | min read

The California Society of Industrial Medicine and Surgery (CSIMS) aligned with AdvoCal-represented private physicians engaged in industrial or occupational medicine for 37 years.

Dr. Robert Weinmann

Dr. Robert Weinmann

No more. The new CSIMS player for association management and legislative advocacy is KP Public Affairs, and the man who will lead this effort is Bryce Docherty, an experienced lobbyist and KP Public Affairs partner. We wish him well.

KP will be picking up some major challenges. The Division of Workers' Compensation (DWC) has made it known for several months that it wants to change the medical-legal fee schedule.

DWC denies the move is a ploy to lower payments (neither does it imply that it's going to raise them, either). Instead, DWC blurts out that all it wants to do is "clarify the use of complexity factors relating to causation, medical research, record review and apportionment." 

In translation, this language means that DWC wants to make it increasingly difficult to use billing codes that pay more than the minimum allowed. In other words, it would not automatically be a complexity factor if a doctor were sent 40 or 50 or even 100 pounds of medical records, no matter how many hours it took to look them over and comment accordingly.

Likewise, DWC reportedly also intends to make the issues of causation and apportionment more difficult than they already are, no matter how much so doing harms injured workers whose access to high-powered specialty reviews is likely to  be compromised by such attempts. 

That is why Docherty was quoted by Elaine Goodman in WorkCompCentral, "New Management Hopes to Bring 'Renewed Energy' to CSIMS," as saying, "We're focused like a laser on the med-legal fee schedule issue."

Docherty and company will also face other longstanding issues, one of which is wrongful denials of medical  care by utilization review (UR), often by physicians who are not even licensed in California and who therefore are not subject to review or discipline from the California State Medical Board, or for that matter from any other state medical board, since out-of-state medical boards do not have jurisdiction in California.

Likewise, the utilization review reliance on the independent medical review (IMR) process, mostly regarded as a rubber stamp for the vast majority of UR denials, needs to be reassessed. In fact, the IMR process resembles the secret dossier process of pre-revolutionary France when nobles could file "lettres de cachet," which meant that an arrest warrant could be issued without the  accused knowing the identity of  the accuser.

In workers' comp, the doctor who gets an IMR denial isn't told who issued the denial. Rebuttal is effectively foreclosed, except if one can argue "prejudice," which one can't reasonably do without knowing who the accuser is. 

We trust that the KP Public Affairs team will dig into all of these issues (besides Docherty, that includes Christina DiCaro, Alex Torres and Tammy Hodgkin). 

Stay tuned: We'll expand this issue into "Lawmakers Want Auditor to Review Timeliness of Care" from WorkCompCentral. Clearly, the rate at which care prescribed by treating physicians and their consultants is denied is an impediment to timely care.

Dr. Robert Weinmann writes the Politics of Healthcare blog, from which this entry was taken with permission.

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