David Deitz, MD PhD was last up at CWCI, his task to bring it all together by asking an apparently simple and straightforward question:
What can California learn from Washington?
Or put another way, “Can California’s workers comp system be fixed?”
First off, there still isn’t much of a focus on quality of care in California. Outcomes in workers comp are still worse than in group health – despite more care for many of the same conditions. Many state systems still rely on judicial, administrative, or otherwise “non-medical” authorities to make decisions about what are essentially medical issues; fortunately California does not. Cue the IMR complaints…
That’s good news; however just by virtue of being a work comp patient, things aren’t so good. A 2005 JAMA-published analysis indicated 83% of studies (175 out of 211) found that just being a WC claimant was associated with worse outcome after surgery.
There’s a lot of research and analytics and reporting in the non-workers ‘comp medical world related to outcomes, costs, and cost effectiveness, with “a lot” especially true when compared to the paucity of such research in workers’ comp outside of L&I, CWCI, and a couple other sources.
Dr Deitz referred to a “massive number of care improvement initiatives that are going on throughout the health care system” (paraphrasing), a trend that will continue with or without, ACA. Again, this may help work comp as better care = better care for work comp too + a healthier population.
David also noted the questions we are encountering in workers comp are nowhere to be heard in the real world; there are no questions about evidence-based medicine in group health. EBM is embedded in the very fabric of health care contracting, delivery, measurement. It is accepted fact, a core operating principle, fundamental. And the work comp systems would benefit immensely from a healthy dose of EBM.
One supporting data point is what’s happened in Texas, where they named a Medical Director and adopted guidelines, strong UR, formularies, EDI, and measurement of results. While Texas isn’t perfect, it’s gotten a lot better.
Unfortunately along with Washington, Texas is one of only two states that has made significant progress in adopting changes that have significantly improved medical care delivered to injured workers. However, it’s not for lack of opportunity. Dr W Brose’s HELP Pain Medical Network is just one source of high-quality, workers’ comp-specific and relevant data on treatment outcomes.
The money quote – “workers’ comp is the most costly and inefficient way to deliver medical care that humankind has ever invented.”
And care improvement is possible in WC but requires systematic reform.
We have a system that is inefficient, very expensive, and delivers poor quality care. That has to change.
Dr Deitz’ final point – improvements in workers’ comp medical care MUST happen.