Physicians Who Quit Comp: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

Have you ever wondered why so many physicians refuse to treat workers’ compensation patients? The answer is actually easy to explain. Physicians have a difficult time dealing with our present-day work comp system, which is exceptionally tedious and, for many physicians, simply not worth the time and expense. In fact, it’s surprising that more physicians have not already quit. In today’s blog we will explain why doctors are leaving comp and what, if anything, can be done about it.

Most people will agree that a physician is entitled to a reasonable fee for services rendered. But who determines what is reasonable? To answer that question, various fee schedules were created to establish reasonableness. In workers’ compensation, physicians who treat injured workers are subject to the state’s Official Medical Fee Schedule (OMFS).

Although it may be difficult to believe, the OMFS was originally designed to attract physicians to work comp by allowing for sufficient payment. On average the OMFS pays 40% above Medicare rates. However, recent events have greatly upset the medical community by tearing apart the work comp fee schedule. Before being allowed to treat injured workers, claims administrators are requiring physicians to enroll in their MPN’s Preferred Provider Organization (PPO). A PPO contract acts to further reduce a physician’s fee by applying a discount over and beyond OMFS rates, often resulting in a payment less than what Medicare pays. Doctors are caught by surprise when they receive meager payments, especially given the amount of administrative work required to treat an industrial patient. It becomes financially unfeasible for doctors to continue dealing with workers’ compensation. Physicians end up quitting with alarming regularity, vowing never to treat another industrial patient again.

Currently, an educational campaign is being waged within the medical community where physicians are being encouraged to leave workers’ compensation under the theory that the work comp system needs doctors more than doctors need work comp. Afterall, an employer’s MPN cannot function without an appropriate number of physicians enrolled in their network. The purpose of an MPN is defeated when injured workers seek treatment outside the network due to a lack of available physicians. It is believed that if enough physicians refuse to treat industrial patients, MPNs all over the state will collapse. The campaign to withdraw from MPNs is already off to a flying start as a major medical office known for treating hundreds of industrial patients recently withdrew from every MPN in the state. Expect others to follow suit.

There is a rather simple solution to this problem: In order to keep physicians from leaving workers’ compensation, employers and insurance companies should pay medical providers pursuant to the state OMFS without applying an additional PPO discount.

We at Friedman + Bartoumian wish to emphasize to our friends and clients that a medical exodus from MPNs will likely continue unless the issues identified in this article are addressed and remedied by the workers’ compensation community before it is too late.