The Workers’ Compensation Research Institute (WCRI) recently issued a FlashReport on initial treatment delays for workers’ comp patients across 18 study states. The study focuses on the median number of days from injury to first medical treatment by type of provider, type of service, and type of injury.
Louisiana (along with California) consistently had long wait times from initial injury to first treatment. In particular, Louisiana took longest or second longest in major radiology (34 days), physical medicine (44 days), neurological and neuromuscular testing (140 days), and pain management injections (112 days). One bright spot – Louisiana was second fastest (5 days) for laboratory testing.
For Trey Mustian, an attorney representing injured workers, reforms like the Medical Treatment Guidelines are to blame for Louisiana’s sluggish claim progression. “Physicians must now submit a 1010 form requesting authorization for treatment before seeing a patient for the first time, unless they want to risk not getting paid for treatment cost exceeding 750 dollars,” Mustian explained.
“There is still a huge learning curve with many physicians in Louisiana regarding compliance with the Medical Treatment Guidelines process. Not only does the Guidelines process slow down initial treatment, it also delays treatment in general because employers now feel that they can deny treatment with relative impunity. Plus, denied treatment that is not appealed within 15 days requires the physician to start the authorization request all over again,” Mustian added.
Office of Workers’ Compensation Administration (OWCA) Director Sheral Kellar, in emailed comments to Louisiana Comp Blog also referred to the Medical Treatment Guidelines, but offered up the process as a positive development. “With implementation of the Medical Treatment Guidelines (MTGs) in 2011, Louisiana adopted a conservative approach to health care. In fact, the Medical Treatment Guidelines require the failure of conservative care or a showing of functional improvement before a health care provider may pursue more invasive alternative treatment,” Kellar explained.
Kellar further defended the Medical Treatment Guidelines on the basis of approved care. “Anecdotal information suggests that the MTGs are working well inasmuch as, approximately ninety percent of care recommended by health care providers is approved within five days of the requested treatment. The WCRI FlashReport identifies Louisiana among the states with the longest delays from initial injury to first treatment only in cases where conservative care has failed – major radiology service and pain management injections.”
Dr. Douglas Lurie, an orthopaedic surgeon, understands the criticism of the Guidelines process as the root of the delays, but sees a difference. “There are two subsets of providers – those that do a lot of workers’ comp and those that don’t,” Lurie said. “For those like myself that do a lot of workers’ comp, the 1010 process is almost second nature. However, I know some providers that do less workers’ comp that struggle with some of the legal language in the 1010 form, which may discourage them from taking comp patients. Especially with the national carriers, I have additional delays at every single step, not as much with the local carriers.”
The study examines claims with more than seven days of lost time for injuries occurring from October 1st, 2014, through September 30th, 2015, evaluated as of March 31st, 2016. The 18 states in the study are Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin.
Purchase a copy of this study from WCRI here.