The title of this post is lifted straight from KevinMD.com’s blog post of the same name. It’s a mysterious title, and makes workers’ compensation treatment sound like something done in a back alley with rusty equipment by failing medical students. The point of Dr. Schumann’s post is really to explain that workers’ compensation is confusing for doctors.
Primary care doctors typically have no specialized training in conducting disability evaluations, and even less understanding of the byzantine world of workers’ compensation.
On this point, I wholeheartedly agree. Workers’ compensation is anything but a logical process–sure, it has its own internal logic, but to an outsider, the whole process is just wacky. Even lawyers seem to understand, if not accept, the internal contradictions. Much electronic ink has been spilled on some lawyer listserves that I monitor over whether an injury qualifies as a foot injury or a leg injury, because the classification will result in a wholly different amount of money to the injured claimant.
Workers’ compensation seems to take the battle of the experts to extremes–in getting a final rating from the Commission, lawyers must put forward the reports of their experts, who are expected to follow very specific guidelines. Not just any doctor can do it; and not just any doctor knows how to do it. The result is that the Commission gets reports from the same doctors time and time again. I’m not saying that those doctors are fudging their results, or that they don’t believe in their reports, but I will say that there are probably claimant or insurer/employer biases and prejudices that influence the reports. Show me an expert, and I’ll tell you what he’s going to say. 95% of the time, I’d be right. This makes the world of workers’ compensation seem like a game. That’s unfortunate, because it’s a game with serious consequences to the injured claimants, and also to their employers and the insurance companies. But it’s the only system that we’ve got.
The second point is that those doctors and clinics who specialize in workers’ compensation medicine often mark-up drugs that they “sell” to the injured worker. Of course, the workers’ compensation insurer is the party expected to foot the bill. The analysis by Dr. Schumann is that those clinics have an incentive to mark-up the cost of those drugs. They probably do. The other side of the analysis, though, is that not all workers’ compensation claims are viable–the doctors sometimes shell out time and money and prescriptions, and never get reimbursed because a claim is denied or a workers’ compensation case fails. The prices of other products must be raised to compensate for those losses. In 2011, 32.7% of the 23,336 claims were disputed. Less than 60% of claims yielded an award of temporary total disability (basically, payment of wages for time lost because of the injury). I haven’t found statistics to show what percentage of those claims are disputed and lost by the claimant, but that it an important number to determining whether the profit made by doctors who peddle drugs is obscene, outrageous, or just modest.
The other part to this equation is that people injured on the job often have no place to go–if they need medication, their insurance will often not pay for it when they determine that it was the result of an accident. Many injured workers are uninsured. Of course, they are happy to get the care and medicine that their doctors recommend. If it comes with a higher price tag, so be it.
It’s not a perfect system, but it’s the game they have to play.