CMA’s Workers’ Comp Survey Finds 'Reforms' Hostile to Physicians and Harmful to Patients
[Posted 11/03/05]

The Workers’ Compensation reforms that took effect in 2004 were supposed to cut costs without harming patients or reducing access to care. CMA surveyed its membership this year to gauge how these reforms are working. Unfortunately, CMA found that access to care for injured workers is doubly in jeopardy—first, because needed care is being denied, and second, because physicians would rather quit the program rather than deal with the persistent, unnecessary hassles and second-guessing that they face when treating injured workers.

The results of the survey, released this week, found that 63 percent of responding physicians say they intend to leave or reduce participation in the workers’ comp program. Of these, a third said they would quit entirely, raising questions as to who will treat workers injured on the job.

Frustrated physicians report that their requests for treatment authorizations are not being answered within the 14 days required by law, leaving injured patients without timely treatment and often in pain. They also cite frequent denials of requested care rendered by individuals unqualified to render medical judgments that are often reversed on appeal. And although the laws call for prompt payment, physicians reported that payments are delayed on average a month beyond the legal maximum time of 45 working days.

“Doctors treating injured workers are locked in a system that is hostile to physicians and often harmful to the patients they serve,” says CMA CEO Jack Lewin, M.D. “Utilization reviews are so cumbersome and misused that patients are not getting the treatment they obviously need. The bottom line is that law is not being followed, and we not only worry that the reforms are endangered, but we worry that the health of working Californians is at risk.”

In releasing the report, CMA officials emphasized that premium reductions from the reforms are a vital and important achievement. But they noted that workers’ comp carriers and the Division of Workers’ Compensation (DWC) are not paying sufficient attention to the effect the “reforms” are having on quality of care. CMA urged DWC and Governor Arnold Schwarzenegger to look critically at why the reforms have failed to achieve the ultimate goal of getting injured workers back on the job.

“The issue of getting the reforms right is important because any gains from the new law will not be sustainable if they are not accompanied by real improvements in how care is delivered to injured workers,” says Dr. Lewin.

CMA has asked DWC to reexamine its utilization review regulations, to implement a strict audit program, and to aggressively enforce the law through substantial penalties for noncompliance. CMA also urged the agency to end medical decision-making by nonphysicians and out-of-state physicians outside the reach of California law.

Click here to download CMA's workers' comp report.

Contact: CMA Media Relations, 916/444-5532 or knikos@cmanet.org.