"Workers' comp programs need solutions that not only provide access to the best diagnostic providers who ensure quality care, but at the same time, effectively control the costs of these services," said Don Duford, president and CEO of One Call Medical Inc.
Duford advises workers' comp payers to look into diagnostic management strategies that include specialty networks, rigorous provider credentialing, stringent quality guidelines, and advanced analytics.
Diagnostic testing in workers' comp differs from the general health plan environment. In group health, for example, a patient with a shoulder injury would typically undergo an MRI, be given medication, and told to return in a couple of weeks.
"The problem in workers' comp is if you send the injured worker home for two weeks you're paying for that time," Duford said. Therefore, identifying the best facilities and providers for diagnostic testing in the workers' comp system is of paramount importance.
Several types of facilities do diagnostic testing. Outpatient hospital facilities typically have higher quality but have fewer quick appointments, are slower to return results, and cost more than the others. Self-referrals to doctors' offices raise concerns of abuse and whether the test is actually needed.
"For the workers' comp patient, a highly qualified free standing center is the best place to go to control the quality and efficiency," Duford said. Controlling the cost and quality of the testing comes down to a system of managing various factors.
- Credentialing. "We credential to the National Committee for Quality Assurance standards," he said. "We also look for them to have American College of Radiology accreditation."
- Compliance, as quick scheduling is crucial to the effective processing of a claim. "Centers must find a slot within two days or less so they don't have to wait," Duford said. "The other compliance that's critical is that the center forward to us the test results within two days."
- Adherence to guidelines established by associations such as the American College of Radiology and the American Association of Neuromuscular & Electrodiagnostic Medicine.
- Medical advisory boards. Partnering with top diagnostic providers in the industry can help foster provider credentialing and quality programs.
- Education and training to improve diagnostic referral best practices.
A good strategy for managing diagnostic testing can create a win-win for the payer and injured worker. "They're paying less per test, getting higher quality, and better efficiency for the claims examiner," Duford said. "And the worker gets taken care of."
Read more at the WorkersComp Forum homepage.
November 1, 2010
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