Tuesday, August 30, 2011


SB 923 (DELEON) if passed into law will require the Administrative Director of the Division of Workers Compensation to adopt the Medicare fee schedule for medical treatment and medical-legal diagnostic tests for injured workers. These tests are the gauges that insurers use to document level of injury, need for treatment, and reimbursement to the injured worker. Specialists do this level of testing: it is used not only to establish level of impairment, but also to document apportionment, a key item for employers. By abandoning the already low Office Medical Fee Schedule and changing to the even lower Medicare schedule, the proponents assure themselves of loss of medical specialists. This writer believes that is the purpose of the bill, that and one other item ...

Tee Guidotti in an e-mail to LinkedIn asked what happens "if well established practitioners ... turn their backs on injured workers?" The proper reply is that what is actually happening is that the proponents of SB 923 (Deleon) have turned their backs on the specialists and spurned the injured workers at the same time.

That is why SB 923 (Deleon) is opposed by the California Medical Association, California Conference of Machinists, California Society for Industrial Medicine and Surgery, California Chiropractic Association, California Orthopedic Association, California Applicants' Attorneys Association, Latino Comp, The Latina/Latino Roundtable, La Raza Roundtable de California, Voters Injured At Work, Interfaith Community of Los Angeles, LULAC (League of United Latin American Citizens), and by individuals, e.g., Dolores Huerta, Jeffrey Coe, MD, B.J. Hastings, MD, Robert Weinmann, MD, Michael Post, MD, Roger Kent, MD, and many others.

A warning shot against the bill was fired by Stuart A. Bussey, MD, JD, member of the bar, and primary treating physician (PTP) whose committee testimony acknowledged that the bill would give his primary care practice "a boost" but would also leave him "holding the bag" (the malpractice one, methinks) when he would be unable to get specialists for patients who needed specialized evaluations.

... oh yes, I did promise above to mention "one other item," so here it is. My research indicates that U.S. HealthWorks (USHW) asserts it can't easily recruit primary treating physicians (PTPs). So USHW sponsors a bill that would take away money from the specialists and redistribute it to the PTPs. Only the bill doesn't explicitly say that's what USHW management will do.

USHW receives payment for the services provided by its PTPs. A portion of this money goes to the non-physician management company and investors that actually own the PTP clinics. The rest goes to the PTPs for direct patient care. There is no assurance that once the bill passes into law the management company won't increase its own fee to itself. In a nutshell, there's nothing in the bill that would make sure that the money would go to the cadre of beleagured USHW PTPs.

A better way to accomplish the stated goals of the proponents of this bill would be to revise the current Office Medical Fee Schedule (OMFS). In its current form, SB 923 deserves to be thrashed and trashed.

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