The Workers' Compensation Executive Forum conducted in St. Louis last week by the Self Insurance Institute of America (SIIA), was a vast improvement from the prior year's San Antonio event. Medical treatment and cost was a priority topic, and information related to managing this growing area of concern seemed to dominate the agenda.
One of the big takeaway points for me was how important selecting the right doctor is in the process of treating an injured worker. And by the right doctor I do not mean the cheapest. I mean the best; The one with the best outcomes. It was blatantly clear from the sessions at this conference that the best medicine is also, in most cases, the best cost control.
This has unfortunately not been a priority area for our industry. We have assembled massive networks of physicians with an eye largely focused on procedural costs and negotiated discounts, and it appears this practice is costing us money and sacrificing the health of those in our care over the long run. A study disclosed last week that was conducted for one carrier showed both stunning and appalling results. The single jurisdiction insurer discovered that 4% of the doctors in their network accounted for 70% of their medical costs.
Read that line again. It is almost impossible to conceive.
Doctors, many of whom were added to the network by agreeing to specific discounts, were driving the cost of medicine higher with substandard or unnecessary care. Expert after expert showed that this does not have to be the case, and presented evidence that selecting the right care, the proper care, would ultimately heal the injured worker faster and at a lower cost than the pricing centric focus of today.
While I recognize that many states do not allow employers or their representatives to direct medical care, there was helpful advice along those lines as well. Most of those states do not prevent the employer from suggesting or recommending physicians for specific treatment. Helping your injured worker find a good doctor (and of course, by good I am not thinking of cost) is beneficial for all concerned. Find out who the best doctors are in your area. Compile a list, and don’t be afraid to use it. There is nothing wrong with advising an employee that they are free to choose, but that you’ve had great results with Dr. X.
Except in New York, of course, where recommending a good physician is apparently a crime. I’m not sure about recommending a bad physician. Go figure.
Understanding your physicians performance is critical in determining what (and who) works for you and your employees. Who has the best outcomes? Whose patients heal the fastest? Which doctors have the best successful return to work rate? What is their prescription history? Constant awareness to these metrics and others will help both lower your extended care costs and improve treatment for the patients.
Selecting the right doctor for the job, it turns out, is the best prescription for what ails us.