I never went to medical school. I do not have the luxury of putting cool stuff before and after my name. I’m just a person, like everyone else. However I happen to be a person that knows a lot about medical stuff. Not the fancy technical side of medicine involving neurons and parts of the brain but the “Real” side. This comes from job experience. It comes from watching injured people in insurance claims go through tons of medical procedures that failed. It comes from listening to people cry to me on the phone about how worried they are because it has been a year and they still have a lot of issues and they don’t know how they are going to get back to work. I never say that I have heard it all, but boy have I heard a lot over the years.
Our System Is Broken
This result is because our system is broken.
The only people that really win are the 3rd party outside vendors that provide a closed period service. They are in and out, cash their check, and move on to the next one.
The injured work doesn’t win in the long run. They are post-operative numerous surgeries that later on will cripple them in the golden years of their life.
Employers lose money on increased insurance premiums, loss of productivity, and strain on existing workforce to cover those out of work on injury.
Positive Doctor Outlook
So where do we place the doctor in all of this? Do they win as a 3rd party outside vendor, or do they lose because they maybe failed to get a patient back to how they once were? The doctors are unable to put humpty dumpty back together again. They just jammed the pieces back in and went to catch their 2p.m. tee time at the country club.
At least this is possibly your perception. Sure, the doctors have financial gain by treating those injured in insurance scenarios. Insurance carriers pay—not well, but they pay their bills. They usually pay them fast. Carriers deal with a lot of injury claims too, so there is incentive to please the Carrier and show them how great you are as a doctor. Maybe they will feed more patients your way, if you are in a State where you can direct care. This is a win-win scenario.
Negative Doctor Outlook
Or perhaps it is the other way. Doctors think that Carriers just ignore these poor injured people. People who get jerked around from insurance hack doc to insurance hack doc until one gives them the diagnosis they want. Then the carrier cuts benefits and litigates the file, only to settle for 33% of the real value. Carriers hate to pay bills unless they want to, so you constantly have to fight with them on reconsiderations, hearings over unpaid bills, on so on. If you are the treating doctor and the case goes to litigation, their Legal Counsel deposes you for hours, trying to find a crack until they finally do, then they try to destroy your credibility in the insurance community by labeling you a “Plaintiff doctor.”
Injured Worker Point of View
Let’s look at it from the injured worker’s point of view. They are in pain, and the work doctor told them to just take an Advil. They tried to go to their Primary care doctor and that doc wouldn’t touch them, since you stated you were injured at work and she “Doesn’t want to get involved in that headache again.” So you start to doctor shop around. Your neighbor sends you to a guy that is real good. He listens and has good office hours, but he doesn’t really prescribe you much to help with the pain. This doc suggests a pain management clinic, and all of the sudden you have lots of help with pain, including multiple narcotic medications, injections, procedures, diagnostics, ablations, and so on. Now you don’t even care what goes on, as long as your pain medicines continue to be paid for. Surprise, you are now almost a full-blown addict because not only have you been on massive amounts of narcotics but you also have been taking more and more of them, since the normal doses do not give you enough “help” anymore.
Everyone shrug your shoulders if you want, but all of these above views are out there. We have probably handled, seen, or heard of this happening. So who is to blame here? Where can we point the finger, and how can we start to repair this breakdown between adjuster, doctor, and claimant?
The Most Blame Can Be Pointed Toward The Doctor
In my opinion, all parties are to blame. But for me there is more blame to be pointed towards the doctor. The doctor has the most power in the scenario. They are directing care, prescribing medication, and they are in charge of overall care. The facts and studies are out there. Narcotic pain meds are prescribed more now than ever. Billing standards, frequency of care, and treatment modalities change when an insurance claim is present. I recall reading a statistic that an early MRI associated with acute back pain increased the likelihood of surgery by 8 times. That’s an eight-fold increase in the likelihood of surgery! Plus remember that most of these diagnostic tests are not needed, and in fact most patients do not possess any of the red-flag symptoms associated with the need for surgery.
We all know that once surgery is performed, the likelihood of return to work becomes less and less. As the months and years go by, what was a simple acute back strain has morphed into a full blown claim disaster. Let’s face it; the life of that injured worker is over. In those States where you cannot direct care, any attempts to thwart surgical intervention fail miserably. Claims adjusters go into disaster mode, and prepare themselves (And the reserves) for a lifetime claim.
For whatever reason, these doctors do not properly inform these patients of the ramifications of surgery, both immediate and long-term. It seems like they do not want to upset or cause conflict with the patient. I would love to see where in medical school does it state that the patient is always right, and you as the physician should just do whatever they want done?
The answer to this question lies in the title of this article. It is good food for thought to remember that the doctor that finished in last in their class at medical school still has the same title as the doctor that finished first.
My normal Disclaimer—not all doctors are bad, not all that finished last in school are bad, and not all claims with surgical intervention have this outcome.
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].
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