Insight, analysis & opinion from Joe Paduda

< Back to Home

Mar
26

ProPublica’s slanted “reporting” is a public disservice

After several attempts to get the ProPublica and NPR reporters working the work comp beat to see both sides of a very complex “system”, better understand the drivers and dynamics, and correct their errors publicly, I’m giving up.

Clearly, they don’t want to hear anything that doesn’t agree with their superficial and clearly biased view of the work comp system, are quite willing to distort and misuse industry data to support their position, and have an agenda they are determined to promote, damn the facts.

The latest screed from PP continues what is by no measure “reporting”, but rather a bald-faced advocacy effort using anecdotes in an attempt to indict an entire system, to simplistically and cynically post pictures of terribly injured workers to get readers to blame the awful insurance companies, to distort and misuse data to promote their ideological position.

I’m going to elaborate on their misuse of NCCI and NAIC data to tout the high financial “returns” of the work comp system next week; for now I’ll focus on the employer direction issue.

In the original Demolition article, reporter Michael Grabell said:

In 37 states, workers can’t pick their own doctor or are restricted to a list provided by their employers. [italics added for emphasis]

That is categorically false.  I sent a detailed explanation of why and where this is false, provided the background documents from WCRI, and followed up.

Did he correct the original article?  No.

Did he update it and note the mistake?  No.

Did he admit his initial statement was wrong, even in a private message? No.

However, in his latest polemic, he states:

37 states now restrict injured workers’ ability to choose their own doctors. Green states [citing a graphic] allow employers and insurers to choose workers’ doctors, at least initially. Blue states restrict workers to doctors approved by their employer, state, or insurer [italics added for emphasis] or to those in their employers’ managed care plans.

This isn’t a minor oversight or wordsmithing; Grabell’s reporting has been an attempt to show how the work comp system is slanted in favor of employers, and his mischaracterization of WCRI reports clearly is intended to support his position.

There’s something more insidious here.  Grabell is attempting to show that somehow workers choosing their doctors is better, that those awful employers and insurers are just out to screw the worker.

In the vast majority of cases, that’s utter bullshit. (sorry, no other way to describe it). And if Grabell had actually wanted to get the story right, and not just promote his ideological position, he would have talked with employers who are doing everything they can to identify the best docs and get their injured workers to those docs.

In emails and conversations I pointed out to Grabell that the reason employers want control is to prevent injured workers from being harmed by profit-seeking physicians, and suggested he look into physician dispensing of opioids, especially in Florida; the Drobot case where hundreds of workers reportedly received horrible care; and other examples (Illinois prison guards) where profiteering physicians have gamed the system, harmed workers, and cost employers and taxpayers millions.

And I heard…crickets.

What does this mean for you?

This isn’t reporting, it is advocacy.

37 States Now Restrict Injured Worke Ability to Choose Their Doctor


13 thoughts on “ProPublica’s slanted “reporting” is a public disservice”

  1. I disagree. It is not a new concept that employers are driven by bottom line profit and return on investment. The employer’s decision of which doctor to use is also going to be driven by these factors. I do not want my doctor chosen by who comes in the cheapest. I want my doctor to be the one I trust every day to care for my health.

    1. Bob – thanks for the comment.

      You are right; employers are driven by RoI – which is precisely why they want the best docs delivering the right care.

      The best doctors are those who deliver the best care – not the most care – to the injured worker on a timely basis. Your general practitioner likely doesn’t understand the work comp system, is not concerned with return to work, and while she may well know you well, she has not been trained or educated in disability management.

      In addition, employers are NOT looking for docs who are cheap, in fact many employers are willing to pay well above the fee schedule to get the best docs.

  2. As a case manager specializing in workman’s compensation, I can tell you that employers are very concerned about their employees getting the best care available, from the best specialists. And, as you pointed out, the best physicians are busy practitioners who treat the injured worker correctly and quickly without dragging out treatment that benefits their bottom line.
    Don’t give up, Joe. We need someone to set the record straight.

    1. Diana,

      I beg to differ with you. There are two women in CA, and I suspect a lot more, who have been harmed by the doctors chosen by their employers or carriers, and by the system itself.

      What the ProPublica reports are doing is shining a light on the dark side of workers’ comp. Of course there are good outcomes in comp, just like every day, the national news networks gives us good news, there is a lot of bad news that gets more attention.

      That is the point of these reports, and if you contact the Injured Workers groups, they will tell you stories that will curl your hair between your toes.

      Should we ignore the dark side just so that people in the industry can feel good that they are not evil, profit-hungry Ferengis?

      We need to address the carriers, doctors, TPA’s and service providers who are dragging the system down, not attack the messengers who point out the flaws in the system.

      When an adjuster asks an injured worker why haven’t they died yet, something is horribly wrong. Ask Cecilia Watt or Linda Ayres, and those cited in the PP reports what is wrong with the system.

      Because in the end, as Jack Nicholson said in “A Few Good Men”, some people can’t handle the truth.

  3. Mr. Paduda,

    In California, doctors can only become MPN’s if they sign a contract with the employer and/or insurance carrier agreeing to take a set fee generaly below fee schedule. Is this how you find the best doctors? Can you honestly say that the employers and/or insurance carriers chose their MPN doctors solely on the basis of outcome of care?

    1. Mr Gaines, thanks for the comment.

      In California there are also several very small MPNs; Kaiser has one, Safeway has one, and other large employers do as well. Most of these select MPNs do not discount care.

      I’ve never been a fan of large networks; most would agree they have far outweighed their usefulness. Regarding employers/insurers selection of doctors, there are a large number of employers who have identified and aggressively use Kaiser On-The-Job, perhaps the pre-eminent occupational medicine provider in the country. Unfortunately, KOTJ isn’t available everywhere; as a result Concentra has garnered solid support at a marginal discount if any.

      That’s not to say every employer and insurer thinks this way; many most certainly do not.

  4. I am politically and ideologically very liberal; however, having worked in the California Workers Compensation industry for 20 years now, I have to wholeheartedly agree with Joe on this. The myth that the insurance companies are the bad guys is simply not true, I have been asking for years for someone to do an expose on the applicant attorneys and fraudulent medical providers in California for years. Take a look at frivolous claims, medical billing, lien treatment, etc.

  5. Joe,

    What’s wrong with advocacy if it helps injured workers get the benefits they deserve? Or is it ok to deny them benefits because they were injured through no fault of their own?

    And besides, everyone slants the news. If they didn’t, Fox and MSNBC would not exist. It would be ok if the former did not exist, though.

    1. Richard
      There is a lot wrong with advocates masquerading as reporters. Fox is a perfect example.

  6. So employers and carriers are not fond of certain doctors and providers who typically render lower PPI/PPD ratings, render medical causation statements that are helpful to the employer and dont take into consideration causation within the context of the statute, release employees to return to work based on the employers statement of job duties that are not exactly accurate..etc..? Good points here by all, but can we agree that there are bad apples on both sides? Most HMO, capitation, and narrow network group health plans have more choices than some of the states that allow for employer directed care, networks, or panels. With a child with a medical condition I am glad that we have choice.

    Happy Friday everyone.

  7. If you’re going to report what is wrong with the system, report both sides. Where is the balance in the PP articles? If there are no controls on workers’ comp costs, the door will open further to fraud and abuse. The result of that? Businesses closing due to inability to pay for the insurance coverages that are mandated by the states. The result of that? Loss of jobs. This would certainly multiply the horror stories of loss of livelihood in someone else’s biased report, wouldn’t it? Anyone with experience in workers’ comp is aware of the horror stories and the successes on both sides. If you’re going to produce a report, give us accurate information or we will go to a more reliable source. It’s really that simple.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates

SUBSCRIBE BY EMAIL


 

SEARCH THIS SITE

A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

DISCLAIMER

© Joe Paduda 2019. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.

ARCHIVES

Archives