It is Spring across the nation. The season’s many familiar rituals, like flowers in the field, are in full bloom. Foliage is turning green, birds are singing, bees are humming, and State Legislatures are getting down to the task once again of “fixing” their workers’ comp system.
It is an annual event that strikes hope for a few and dread for many. Workers’ Compensation reform can often represent the silly season of legislative activity, and this year California seems to have garnered the position of ringmaster. While there are several (IMHO) ill-advised bills before the State Assembly this year, the one that seems most misguided is AB 1465. That bill, if passed into law, will require the administrative director of the state’s workers’ compensation system “to establish a statewide medical provider network, called the California Medical Provider Network.”
Currently, California law allows employers to establish Medical Provider Networks (MPN), which their employees must use in the event of a workplace injury. These networks serve several functions. They give employers some direct control over the quality of care provided to their employees, as well as provide negotiated discounts for that care. Conscientious employers can use them to assure that the most qualified medical providers are used while assuring that less competent providers are excluded. The new law would give employees the choice to treat within their employer’s MPN or the CAMPN.
The proposed law is, not surprisingly, opposed by The California Coalition on Workers’ Compensation, the American Property Casualty Insurance Association, the California Chamber of Commerce, the California Association of Joint Power Authorities, and Public Risk Innovation, Solutions, and Management.
We have absolutely no idea what a CAMPN would look like, or how the state intends to qualify the medical providers within it. Poorly executed, it could become a cavalcade of kooks and crooks; a network that dramatically drives costs up while completely undermining the results of previous reforms. California is, after all the state that brought us cases of massive medical fraud that involved pay for play and counterfeit implants. And it wasn’t the state that rooted those players out. It was largely the Feds.
Are they prepared to adequately establish and manage a network of medical providers that will weed out the bad players who treat injured workers as a profit center? Unlikely.
Some states, such as New York, require any physician, chiropractor, podiatrist, or psychologist to be authorized to give medical care by the Chairman of the Workers’ Compensation Board. While that does not constitute a medical provider network, a review of that state’s suspensions and revocations based on poor treatment protocols or unethical activity can provide a hint to the challenges that lay ahead for a populous state such as California in this effort.
Bottom line, there is simply no need for a state to establish and manage its own Medical Provider Network. The effort if successful will only drive up costs while doing nothing to ensure improved care for injured workers. And even worse, it may actually reduce the quality of medical outcomes.
In a year where the state can’t figure out how to open Disneyland or get its teachers back in the classroom, a bill to establish an unwieldy and unnecessary state-run MPN puts California at the top of the heap when it comes to the legislative silly season.