MEDICAL CARE COORDINATION Medical care coordination means making sure your injured employees receive the BEST possible medical care. You must make medical care coordination the central focus of your workers' compensation management program, especially if your company does not have a transitional duty program. Medical costs are hovering around 60% of workers' compensation costs, so it's worth it to pay attention to the quality of medical visit. The physician usually decides if and when your employee returns to work and under what restrictions. Therefore, to the extent you can, make sure you obtain the best physician who can provide a smooth resolution of medical problems and the earliest, medically appropriate return to work date for injured employees. When you establish a medical provider arrangement, discuss the cost of medical visits up front. Make sure the doctor is happy with the rate you are paying. If not, you may not get the best quality care, and the doctor certainly won't spend any extra time with your employees. TPA SPECIAL doctors have many different names. Ask your TPA whether they evaluate and designate the best doctors, with the shortest durations, in their network. If so, set up a process so your employees use that network. I recently worked with a company that had high network penetration, but it wasn't the SPECIAL doctors, it was the regular network. If a physician charges more than the standard fee, it is often worth your while to pay the difference because you know you are getting the best, most relevant medical care for your injured employee. Establish working relationships with the medical providers your employees will use throughout the life of their claims. Physician Communication issues fall into three categories chronologically: 1. Before care begins 2. Throughout the course of treatment 3. Until the claim is closed Familiarize yourself with the workings of the treatment facilities and if , in your state, you get to choose, make sure your medical facility has physicians with backgrounds in workers' comp injuries, a good physical therapy unit, providing a variety of follow up treatments. Resource to find out how medical care is selected in your state: http://reduceyourworkerscomp.com/workers-compensation-state-laws-and-regulations.php Make sure physicians and treatment facilities are well versed in using the Workability form and faxing it back in a timely fashion. Make sure they are familiar with your return-to-work program and transitional duty program, so they can work with you to provide the best modified duty job for that injured employee. Their cooperation with your return-to-work program, using your forms, returning your calls and getting medical reports to you in a timely manner is one of the critical points in a cost containment program that can become either a bottleneck or a huge help. Several types of doctors participate in a workers' compensation claim. Each type plays a particular role; you should understand and learn when to best use them. (workersxzcompxzkit) Visit the clinics and hospitals your employees use to ensure these facilities are safe, considerate and adequately staffed. They should also have qualified personnel trained to treat work injuries. Find out who the doctors and other medical personnel are and their specialty areas, so in the event a work related injury occurs, and your injured employee goes to a certain facility, you will be well versed with the doctors there and the kinds of services they can offer. Calendar visits for every 12 months, so you can stay abreast of current staffing. TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3 By: Anthony Van Gorp, private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact [email protected]
