A significant issue facing workers’ compensation professionals is rising medical costs. We all deal with escalating expenses, and there are a number of vendors who have offered various solutions to limit this escalation. The question becomes what can that workers’ compensation professional do to mitigate the expenses?
Understanding that there are multiple methodologies to mitigate rising healthcare costs, one of the first steps noted is prevention. Candidly, that is well outside the purview of the workers’ compensation professional.
However, several methodologies can be employed. One of the first that comes to mind is early detection. Simply put, what is my injury, and what pathology occurred outside the parameters of the occupational endeavor? Such tools as Early Compensability Assessments and applying the adage that common things happen commonly, and rare things happen rarely, will limit the scope of the compensable event to what occurred. Consequently, the tangential medical expenses associated with pathology that is not a function of the identified event will be eliminated.
The next step would be a determination of the appropriateness of treatment. Currently, nearly every jurisdiction has some form of preauthorization requirement, so that the requested treatment undergoes a critical analysis to ensure that the intervention to be pursued is clinically indicated, appropriate, and serves the needs of all parties concerned. This tool does not address compensability, only that the intervention suggested meets the standards of evidence-based medicine.
A third step would be care coordination. Is there an individual that all parties can rely upon, to ensure all best practices are pursued and, in a fashion, demonstrating the efficacy of the intervention? Making sure that the injured employee gets all appropriate care, at the appropriate time, will mitigate the expense ratio.
Lastly, employing the best health information technology. We have all heard stories where a wrong prescription was dispensed because the pharmacist was unable to correctly read the handwriting of the healthcare provider. There is a huge clinical difference between Lasix, a diuretic, and Levophed, a stimulant. There is a case in Florida where a pharmacist misread the prescription, dispensing the simulant which led to the demise of the patient. This problem could have been avoided with electronic medical records.
In summary, there are limitations to what the workers’ compensation professional can do, but there are specific tools that can be employed. Utilize and employ preauthorization wherever possible to have an additional voice endorsing (or not) a specific treatment or intervention. Get a handle on what the actual sequela of the identified incident is and make sure you’re not treating an ordinary disease of life clinical situation. And having accurate clinical records that are readable to all is crucial. If there is a question, ask for an answer. These simple steps will reduce your medical expenses, possibly shorten the life of the claim and improve the clinical situation for all parties concerned.