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"If we help the physician understand what is needed and that we are really trying to help the doctor and the patient, physicians are very receptive," said Kimberly George, managed care practice leader at Sedgwick Claims Management Services.

George was among a group of workers' comp participants attending a meeting earlier this year convened by the American College of Occupational and Environmental Medicine and the International Association of Industrial Accident Boards and Commissions. The upshot of the gathering was the recent release of the report, A Guide to High-Value Physician Services in Workers' Compensation: How to find the best available care for your injured workers.

• Willing to accept patients covered by workers' comp insurance.
• Employs best practices in providing high quality and compassionate medical care.
• Respects and fulfills the extra responsibilities that the workers' comp system creates.
• Produces better overall outcomes at comparatively better total cost over the course of an injury or illness, as high-quality care produces better outcomes for workers and better value for payers.

Finding such physicians can be tricky. As the report notes, "Many parts of the country are dealing with a chronic and worsening shortage of physicians who are willing to treat workers' comp injuries and who are familiar with the special issues that arise in occupational injury and disease."

But George said she received clear feedback from the physicians attending the ACOEM/IAIABC meeting: they are in business to do a job. "If they are treating patients in the workers' comp system, they want to know how they're doing," she said. "They said, 'don't only give us a case after you send it somewhere else first.' Provider partnerships help align incentives because we're giving them patients from the beginning and not just trying to transfer care to them."

Developing such partnerships begins with finding qualified physicians.

Look for signals. Proactively seeking out and working with competent physicians may be the best approach to improving the workers' comp system, according to George. She suggests looking for physicians who send out signals they are likely to produce good overall outcomes within the system, such as calling and asking about return-to-work programs or functional requirements of a patient's job.

"Those providers who really are providing treatment within evidence based guidelines and those supporting the philosophy of RTW, those are easy indicators that there's a provider probably doing a great job," George said. "Even direct charges are a little more on the medical side, if it's an improved health care delivery model -- where the patient is getting in and being seen and reports are coming back timely -- you typically have that leading to quality care for the injured worker and recovery and a positive impact for the cost of risk."

Developing relationships. Getting physicians to work well within the workers' comp system does not need to be daunting. Much of it centers on creating partnerships with high-quality physicians. Helping physicians understand the nuances of the workers' comp system is the first step. That means communicating the expectations up front.

"One problem is understanding what networks an injured worker is in," George said. "We may have 50 employers all with a variance of managed care programs. So when an injured worker shows up, don't assume the physician knows what is expected -- what network they are participating in, what pharmaceutical program, what is the employer's RTW."

Providing physicians with a variety of best practices and resources is also key. George suggests sharing ACOEM's Stay at Work/RTW document.

Read more at the WorkersComp Forum homepage.

November 15, 2010

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