The Final Word: Physician advocacy assures access to care for injured workers

Tuesday, September 01, 2015 12:46 PM
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by Gregory Dean Smith, DO, PhD, MDiv, ACOFP-dist, CMS WCPIC chair

It has been a busy year for the members of the CMS Workers’ Compensation and Personal Injury Committee (WCPIC). The committee worked feverishly to be ready to present our initial thoughts to the Division of Workers’ Compensation (DOWC) by June 1 as they changed to an RBRVS (resource-based relative value scale) system. The committee only had one month of preparatory time to present our thoughts and ideas for the division’s stakeholders meeting the beginning of August. With that in mind, I appointed a subcommittee to meet as often as needed to have our report ready in time to present to the shareholders.

I would like to thank all members of the committee for their work, with Lynn Perry, MD, Joseph Ramos, MD, Tashof Bernton, MD, and Kathryn Mueller, MD, putting in additional time and effort as the subcommittee worked hard to allow us the needed time to finish the report and submit the document in a professional fashion to present to the stakeholders meeting.

At the beginning of the year we realized that we needed to condense our yearlong agenda into three manageable parts to allow us to be prepared and focused for the work ahead. We wanted to take time to:

  1. Consider the requests of CMS members as we proceeded throughout the year,
  2. Work on completing all projects regarding rules and regulations, as well as developing a budget request, and
  3. Work on developing a new webpage on CMS.org to aid in increasing membership both for CMS, as well as assisting in recruiting physicians to consider treating more patients in the workers compensation arena.

We realized that the pool of workers’ compensation physicians is shrinking in Colorado with respect to those physicians who are seeing workers’ compensation patients. We are also down to approximately 60 physicians who are willing to perform Division IMEs, which is placing a strain on those now doing them, and putting a strain on the system to have these reports completed in a timely fashion for both the patients and their legal counsel. In the coming year(s) we want to use the new webpage to offer advice, begin offering webinars to assist the physicians here in Colorado, and distribute information to those physicians out of state doing IMEs and medical reviews. One recommendation is that all physicians participating in the workers’ comp system should be at least level one accredited in order that they might know the basic rules of the Colorado system.

With the rules and regulation subcommittee submitting their final report, we went before the DOWC director’s hearing and left them a seven-page packet that contained recommendations that the committee felt would benefit all physicians involved in workers’ comp – both primary care physicians and specialists. There were concerns that many procedures were going to take major reimbursement hits: Physicians using the QSART test, as an example, with initial budget submission taking the test from approximately $1,000 to $295 based on changing to RBRVS system. By working with DOWC staff, we were able to return it to its previous level of reimbursement. We were concerned that many procedures were going to take major hits, but after working out the budget process we feel we obtained a fair market value for all procedures with no one procedure taking a major hit. The committee recommended that overall procedures should see a modest increase in the coming year of 5 percent to offset inflationary expenses in physicians’ offices.

Finally, although we only had four minutes to present to the DOWC director (as did all groups), we discussed the amount of time that was being wasted by physicians having to deal with physician reviewers and adjustors not being fully informed of medical procedures we requested. Many physicians are being denied care for their patients that in the past would have never been a problem.

Personally, I would like to thank the WCPIC committee, CEO Alfred Gilchrist for his oversight and insight, Terry Boucher who serves as our DOWC liaison, and Marilyn Rissmiller for all her hard work crunching numbers and having all of the information we needed at a moment’s notice.

I would be remiss not to thank our CMS President, Tamaan Osbourne-Roberts, MD, for his faith in us, and for attending meetings when he had time to give us his thoughts and ideas of where we should lead this year.


Posted in: Colorado Medicine | Initiatives | Workers' Comp and Personal Injury
 

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