Wednesday, October 17, 2012

Connecticut: A Simple Suggestion to Help Control Costs

There's a great post today by Jon Coppelman over at Workers' Comp Insider that compares and contrasts the work comp systems of Massachusetts and Connecticut in light of the recently released Oregon Rate Study.  (Side note: see David DePaolo's post on the Oregon study here - good data, but certainly needs to be read in proper context).

After a thorough overview of each state's woes (which happen to be equally painful, but polar opposite sets of issues), Jon suggests the following for Connecticut: "... regulators must confront entrenched stake holders and begin to exert control over runaway costs." 

Well said.  And I have a suggestion for where the good people of Connecticut might start: Let us talk to the treating physicians.

The employer/insurer community in Connecticut is severely restricted with respect to being able to initiate a peer-to-peer conversation with a claimant's treating physician.  Communication between payor and the attending physician where such communication would involve unilateral disclosure or discussion of material information is not allowed.

Payors, however, may request the physician to complete the "Employee Medical & Work Status Form" or provide progress notes. Copies of this communication, as well as any responses from the physician, must be provided to the injured worker or his/her representative (Payor and Medical Provider Guidelines to Improve the Coordination of Medical Services, 2010).

But there is no allowance for the insurer to engage a peer physician to launch a call to the treating doctor and say, "Hey Dr. Smith... can we chat about why Joe has been on Oxycontin for three years? The evidence suggests that might not be good for him. Are there mitigating circumstances? Do you need help with weaning? How can we be of assistance?" In Connecticut, that conversation can't happen. And that's a shame. 

The goal of a peer-to-peer conversation is not to coerce or connive our way to a cheaper treatment plan.  That is a disservice to all stake holders and peer review companies that conduct clinical conversations that way have no place in our industry.  Yes, we will challenge the current treatment plan if it falls outside of the medical treatment guidelines.  But we do that with a specific end in mind.  The goal of a well conducted peer-to-peer conversation (which is admittedly harder than it might initially seem) is to engage, to understand, to educate, to guide... in a word, to help

These conversations play an important role in the dissemination and adoption of contemporary research and best practices.  Without them, treating physicians are often left with an unattractive and biased alternative information source: the local drug rep. 

Allowing for peer-to-peer conversation in Connecticut is not a magic bullet that will, by itself, lead to significant cost reduction.  But it's a start.

On Twitter @PRIUM1

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