Iowa Work Comp: Choice of doctor bill isn’t about choice so much as it’s about controlling the outcome of your own life.
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The choice of doctor bill in the Iowa Senate is getting a lot of press lately. There are stories here, here and here. After 28 years of practicing workers compensation I’ll throw in my two-cents. For what it’s worth, I’ll warn you at 54 I’m cranky, have little tolerance for being patronized and say it like I see it. If that’s too much for you then you needn’t read any further.
The Issue: Iowa’s workers’ compensation laws don’t allow the injured worker the right to choose the treating physicians. Treating physicians under Iowa law are selected and paid by the employer; which in many instances is a workers’ compensation insurance company. There are a few self-insured manufacturers in Iowa; they tend to be quite vocal about wanting control over selecting the company doctor. There is a bill before the Iowa Senate that would change which party has the right to select the treating doctors. The bill would allow injured workers the right to say which doctor can cut on them. Now you know the issue – it’s who will pick and then pay for medical treatment.
There are a few self-insured manufacturers in Iowa; they tend to be quite vocal about wanting control over selecting the company doctor. That's mainly because they doctors are then beholding to them.
The employer’s position is being stated in the Des Moines Register by someone from Pella Corporation. Pella is a good business in Iowa and no one would want to see them go. Being a good corporation is only part of the game though; being a good corporate citizen is also essential. When employers say it’s about getting the injured employee to the right doctor I find it hard to believe. Qualified doctors are all around Iowa. This isn’t Tanzania, Africa. We are talking the Midwestern United States not the bush in a remote location in the bush of Africa. This isn’t about an employee picking his or her family doctor versus the employer having specialized knowledge and access to which doctors know best how to treat a particular injury. Let’s not patronize the people of Iowa. Posit all you want but let’s not be insulting to the good people of Iowa and their elected officials; they weren’t born yesterday.
Here is what I mean: “Myron Lynn, compensation manager for Pella Corporation, says the doctors companies choose are familiar with the kinds of injuries workers suffer and can save time in diagnosing injuries a family doctor rarely sees. "It's access to quality medical care, getting the person quickly to the right doctor whose specialty is treating the kind of injury that the individual has, working with the physician to get the person back to work as quickly as medically advisable to do so," Lynn says, "and back to full wages." The position Mr. Lynn states is disingenuous at best and patronizing. Those doctors the employer selects aren’t specialists that only they have access too. Injured workers have the same access to any of the orthopedic surgeons available in the market place. What the employers really are talking about is controlling the gate keeper and the words that the doctor speaks and when. The doctors know to sing the right tune or they won’t be on corporate America’s workers’ compensation dance card.
Here is what the employees face. They are injured, off work, earning 3/4rds of what they normally do and trying to make ends meet on the home front. Already nervous and facing an uncertain future they have little if any control over the medical care and opinions. They are totally beholden to this tug-of-war between the big insurance business, the AMA and some lawyer trying to help them get back to square one with the bills and work. Even if you’ve never been involved in such a claim you should be bright enough to figure out the little guy is backed into a corner with a six-shooter half loaded with dead bullets. You may wonder how bad it can get.
Allow me to give you one example. I’m familiar with a doctor in central Iowa who will treat an injured worker and as soon as the medical treatment is finished he is known to say the injury isn’t work related. Why would it take an orthopedic surgeon months to come to the sudden realization an injury he’s treated is not work related? You may wonder why that is. Well it’s really pretty simple. There is no co-insurance or schedule of fees for workers’ compensation medical treatment. There is no trying to get the co-insurance payment from the patient or worse yet, having surgical fees reduced by a waiver of the co-insurance as negotiated by BCBS. In other words the reimbursement rate is higher. And why would the workers’ compensation carrier continue to send injured workers to this doctor. It’s all about money. They know these are compensable injuries. They know we know. But because they can generate a report from a ‘credible physician’ that says otherwise they have a 50-50 chance of walking away and paying less then what the law requires them to pay or even nothing.
Doctor’s Position: If a surgeon is licensed by Iowa’s Board of Medicine, then so be it they can slice and dice with the rest of them; it’s really about what comes out of their mouths at the conclusion of the doctor-patient relationship that matters to those who choose the “who”. Doctors aren’t dumb; they know how to get employers to keep sending them a stream of patients. If the doctors don’t cozy up to the patient and also limit their opinions on permanency, restrictions and when to send the injured patient back to work, then the steady stream will continue to break the threshold of the clinic entrance door. And they know that if they are too friendly in their opinions to the injured employee, then the clinic door bell will stop ringing. For the doctor’s it’s about paying the overhead. They are simply caught in the middle and probably want to be left alone to treat their patients without interference from case mis-managers, insurance mal-adjusters and attorneys trying to straighten out or to bend the facts. Let’s not try to fool each other this isn’t about it having access to a better cadre of medical experts; it’s about controlling the expert opinions. The doctors that regularly deal with workers’ compensation patients just want to know who to send the bill. Whoever has the out right choice rules the roost and they will suck up to either, just to get the bill paid. But what if they didn’t have to suck to either? Then what? Wouldn't that be better and wouldn't we be more apt to obtain objective medical opinions? Of course we wouldn.
Employer’s Position: If Pella Corporation really wants to do what is right by their injured employees then they would allow them to choose their own doctors, but they don’t and won’t. And all of us involved in the system know why.
Employee’s Position: Many of these employees have serious medical conditions that require surgery that can kill them or seriously impair the quality of their lives. Many employees feel degraded by this system that takes from them the right to be taken seriously or even listened to. It’s their body. They should have the absolute right to say who gets to cut on it.
The Iowa Industrial Commission Position: When they are awake they are sick and tired of seeing what they see and hearing what they know to be true but politically they aren’t allowed to speak publicly about. If it were them they would want to know they had the choice of which surgeon to choose. That said they don’t want any more work and would rather see a system in place that reduced the tension and acrimony with these claims.
The Politicians Position: The politicians just want the campaign contributions to keep coming in. This isn’t brain surgery. Employees don’t contribute like the Iowa Medical Association contributes to political campaigns. And politicians don’t worry about “the employer” selecting their treating physicians. After all they get special handling by insurance companies. When did any politician not get to select their doctors? Here is Pat Ward being just as patronizing.
“Republican Sen. Pat Ward of West Des Moines said she thinks those are isolated incidents.
“There’s no question that misdiagnosis occurs on occasion and that’s a very sad thing,” Ward said.
Ward predicted that one of every 100 injured workers is satisfied with their care from their employer-chosen doctor. To change the law would add unnecessary expense for businesses, she said.”
I believe there is a better way.
The “Pool of Doctors” Solution: Here is a solution falling somewhere in between what both want. Let’s first set forth each of their positions. Any doctor could apply to the Iowa Industrial Commission for privileges to be in a workers’ compensation medical pool. Any doctor in the medical pool could be selected by the employee for appropriate treatment. The employers would have the right to object to any doctor in the pool but once into the pool the employee could select them for treatment. A pool of doctors would give the employer the right to encourage all of their company doctors to submit their names into the pool. The employees would not be allowed to go outside the pool unless doctors within the pool were not qualified to treat the condition or didn’t have privileges in the hospital system where the employee resided. Physicians outside the pool could be selected by agreement or application to the Industrial Commission. Truthfulness would be restored to this system and doctors like Dr. No Causation would find themselves out of work.
Iowa Law -
Who chooses the Medical Care? The employer provides medical care reasonably suited to treat the employee’s injury, and has the right to choose the medical care. If the employee is dissatisfied with the care offered, the employee should discuss the problem with the employer or insurance carrier. In certain situations the employee may wish to request alternate care. If the employer, or insurance carrier, does not allow alternate care, the employee (through appropriate proceedings) may apply to the workers' compensation commissioner for alternate medical care. (85.27)
If the employer-retained physician gives a rating of permanent impairment, which the employee feels is too low, the employee does have a right to another examination by a doctor of the employee’s choice at the employer’s expense. (85.39) What types of benefits does the law provide? Medical Benefits - The law provides for the payment of all reasonable and necessary medical care incurred to treat the injury. This includes reasonably necessary transportation expenses. Mileage for use of a private auto is reimbursed at a rate set by the state of Iowa, currently at 58.5 cents per mile. (85.27)
Under certain circumstances an employee who has to leave work for medical treatment may be eligible for payment of lost wages. (85.27)
While a contested case proceeding or a dispute on reasonableness of a fee is pending, the medical care provider cannot seek payment of its charges from the employee. (85.27)
