The treating physician plays a very important role in the direction and duration of a WC claim. Physicians influence the injured worker's return to work, permanency rating, frequency and cost of care, as well as their eligibility for WC benefits by giving an opinion as to whether the injury is work-related or not.
Neumark, Barth and Victor (2007) utilized data collected from 750 interviews with employers and injured workers in California, Massachusetts, Pennsylvania and Texas, as well as data from the WCRI database of over 16 million workers' compensation claims. They focused on the impact of provider choice. In this study, provider choice is defined as by the employer or employee. More specifically, it looks at outcomes when an employee chose to treat with someone they've previously treated with, or when they choose a new provider.
So, how do you think that an employee's choice of a new provider or a provider that they have previously treated with impacts the following issues? Take a minute to jot down your answers. I gave you a freebie with the title of this post. The results may or may not surprise you.
- Claim costs
- Duration of time out of work
- Substantial return to work
- Worker's perception of degree of recovery
- Worker's satisfaction with care
Claim costs
When an injured worker chose a new provider, whom with they had not previously treated with, medical claim costs were found to be 22% higher (Neumark, Barth & Victor, 2007).
Duration of time out of work
According to the study, there was no evidence to support that employer choice or employee choice to treat with a doctor who had previously treated them (like a family physician), resulted in differing outcomes. However, when an injured employee chose a new provider, costs were 12-20% higher, as well as an increase in indemnity benefits by 15-20%.
Return to work
When an employee chose a new provider, RTW outcomes were drastically impacted. The time an injured worker was out of work was 40-48% longer, and the chances of a substantial RTW were 28% lower.
Perceived physical recovery
When an employee chose a new provider, there was no significant difference in the employee's physical recovery.
Satisfaction with care
When an employee chose a new provider, the perceived satisfaction with care was much higher, despite no evidence of increased physical recovery compared to those employees who did not choose a new physician.
Surprisingly, whether an injured worker first seeks treatment with a doctor that they have previously treated with, or a new doctor chosen by their employer, has little impact on certain aspects of a claim. The most influential choice (in regards to claim costs, duration of time out of work, RTW, physical recovery, and satisfaction with care) is when an injured worker seeks treatment with a new doctor with whom they've never treated. There are likely some very good explanations for this, including attorney referrals, an injured employee's lack of knowledge surrounding what to look for when choosing a doctor, as well as the reason for seeing the second doctor (for example, surgery). This study has important implications regarding policymaking regarding panels, but also highlights the importance of utilizing physician panels. Guiding injured workers to experienced and appropriate medical providers is just one of the many benefits of physician panels.
As an Eastern client, if your state permits it, you already have a physician panel in place. Some states, like PA, have strict requirements that must be followed by employers for the panel to be enforced. If you have questions, feel free to contact your Eastern agent or claim representative for assistance.
Source: Neumark, D., Barth, P. S., & Victor, R. (2007). The impact of provider choice on workers' compensation costs and outcomes. Industrial and Labor Relations Review, 61(1), 121-142.
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