Increase providers' understanding to improve comp system, expert advises
"If we work together, everybody wins. That's the culture we want to create," said Bharon Hoag, executive director of the Ohio State Chiropractic Association.
The association recently held a seminar on workers' comp fraud and abuse. Some 29 chiropractic physicians and their staffs attended the daylong event.
"Unfortunately, chiropractors have a reputation of over-utilization with chronic conditions," Hoag said. "Often, the reality is that there is clinical and medical necessity for the care but the communication between the provider and workers' comp was less than accurate. This is often a result of poor recordkeeping or lack of knowledge when it relates to the rules and regulations of the Ohio Bureau of Workers' Compensation."
Instead, Hoag said the association wants health care providers to have a better appreciation for the system and how they can work within it. Education is key.
"A lot of providers really don't understand the rules," Hoag said. "We want our providers to see the value of working with the bureau, not against them. At the end of the day, this is about the rights of the injured worker."
By helping providers better understand the workers' comp process, Hoag says they can become allies in the system. "Not a line item of expense but a good utilization tool to get injured workers back to work as quickly and cost effectively as possible," he said. "Chiropractic care can be a huge factor in balancing the financial factors in workers' comp."
One way chiropractors can help reduce costs in the system is through the holistic approach they use. Hoag says working within the system instead of against it will demonstrate the value of chiropractors to the workers' comp system.
"It's very cost-effective to get [injured workers] off prescriptions and other forms of care that do not truly fix the problems; to keep them out of surgery and chronic regimes," he said. "For pennies on the dollar, the bureau would be much happier if they understood what [chiropractors] were doing. We want the bureau to see the reality of what our provider is doing."
Having an in-depth understanding of the workers' comp process will also help chiropractors be better advocates for their patients. A recently adopted Ohio State Chiropractic Association mission statement encourages physicians to do just that.
"To advocate for medically appropriate chiropractic health care services means to appeal a decision to deny appropriate health care service in compliance with applicable Ohio workers' compensation and public health laws, in accordance with the standards of chiropractic care, as well as professional ethics, and pursuant to the reasonable grievance or appeal procedure established by the Industrial Commission of Ohio and the Ohio BWC," the statement says.
Chiropractors are in a better position to challenge what they view as unfair decisions when they are more familiar with the statutes and processes guiding workers' comp. The seminar, and future ones, focus on providing the physicians with knowledge to work within the system more confidently. "They came out a bit empowered," Hoag said.
Read more at the WorkersComp Forum homepage.
July 11, 2011
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