Nebraska big business and big insurance has introduced a bill to impose evidence-based medicine and utilization review (EBM/UR) on Nebraska workers. The proposal, LB 584, designates a California corporation to review what kind and how much medical care our injured workers are to receive. I have many criticisms of the bill that will be discussed from time to time. One of my fundamental problems is who reviews the care proposed by Nebraska doctors for our injured workers.
Most EBM/UR systems involve reviews by doctors, many of whom are retired, from other states. These doctors aren’t familiar with the high-quality doctors who practice within the state. Illinois has a form of EBM/UR, and my Illinois colleagues informed me that some of the utilization review had been outsourced to India. The Illinois Department of Insurance has recently dealt with these out-of-state reviews by requiring that Illinois doctors must be reviewed by other Illinois doctors. Peer review of care ought to done by peers, not some stranger half a planet away.
Would the business and insurance interests pushing EBM/UR want their treatment recommendations for a loved one second-guessed by a retired physician in another state or an offshore physician? Especially when that treatment recommendation was made by a trusted Nebraska physician who knows the loved one’s individual circumstances? I understand that business is always concerned about costs, but the worker must be protected. Workers should be treated as businesses would like their loved ones be treated. Sadly, big business and big insurance doesn’t seem to think the Golden Rule applies to injured workers and their families.
New legislation has been proposed to reduce the quality of medical care for workers under the guise of reducing costs
Evidence-based medicine and utilization review (EBM/UR) of medical care for workers’ compensation are currently being pushed by big business and big insurance interests.
We are facing such legislation in Nebraska this year.
One reason supporters of this way to control medical care for workers give seems to be that medical care currently provided is “inefficient.”
This is a euphemism for medical costs are too high. I view this as critical of physicians and other health-care providers who are taking care of injured workers. The Florida Medical Association (FMA) has recently responded to this type of criticism of the medical profession. In their case, the Office of Insurance Regulation (OIR) and National Council on Compensation Insurance (NCCI) say workers’ comp rates are being raised because drugs are dispensed directly by doctors. But an OIR report, according to the article linked below, “shows virtually no difference in the cost of such drugs whether dispensed by doctors or pharmacies,” so the FMA disagrees with blaming their doctors for rate increases.
This quote is from the story linked to above: “The truth is that the NCCI and carriers have used physician dispensing as a scapegoat for hundreds of millions of dollars in rate increases when other medical costs have been the real cost drivers in workers’ compensation,” the group charged. “The numbers are fabricated in an attempt to eliminate doctor dispensing.”