Texas workers’ comp reimbursements slashed

Medical group says quality of care is threatened

Under a new guideline adopted April 25, 2002, by the Texas Workers’ Compensation Commission, "Injured workers will find it difficult, if not impossible, to obtain the quality medical care that the Texas legislature has promised them," warns Fred Merian, MD, president of the Texas Medical Association (TMA) and a family physician in Victoria. In a formal response to the new guidelines, which were slated to go into effect Sept. 1, the TMA has joined forces with the Texas AFL-CIO in a joint suit aimed at blocking implementation.

Reimbursement to be slashed

According to the TMA, the new guideline cuts reimbursements by 17%-41% for surgeons, radiologists, pathologists, internists, and physical medicine specialists who treat injured workers. "Primary care physicians are currently operating at Medicare levels," Merian explains. "We would actually get some increase in our evaluation and management codes, but the surgeons get the biggest decrease. The insurance companies end up benefiting from this."

The big losers, he says, will be the workers, because most physicians cannot afford to treat patients under the new reimbursement guideline. "Surgeons will have to see patients in the emergency room, of course, but for knee injuries, back injuries, carpal tunnel injuries and others that can be seen in the office, physicians will have trouble taking care of these," he asserts.

This will inevitably lead to a decline in quality of care, Merian warns. "Patients will be seen in the emergency room for initial injury treatment, but they can’t have an emergency room physician as their primary care provider. Yet under the new guideline, there is no alternative. It’s the worst way to get treatment; there’s no ongoing care, and every physician keeps repeating the same test. What is required is longitudinal care by the same physician.

This recent action by the state’s Workers’ Compensation Commission completes a double whammy against workers, Merian adds. "This state got the legal profession out of workers’ comp several years ago. They made it much more difficult for patients to go to jury trial, but they did set up another system to take care of them. Now what they’re essentially doing is ensuring they won’t be treated. The quality docs they have won’t keep working with them for these rates."

Making a bad system worse

The new guideline adds insult to injury. The workers’ comp system already is considered incredibly hassle-filled by Texas physicians. "I just got a fax from one of the insurance companies asking me to write a letter of medical necessity for a prescription I gave a patient," says Merian. "I get three or four of these a week, and I have been treating many of these patients for injuries for several years, and they are already on the medications. In addition, you can’t charge anything above your regular office visit fee without sending them a copy of the records. This means you can’t bill electronically and you’re likely to receive payment way beyond the 45 days in which they are supposed to pay us. Essentially, this stops you from taking cases like these."

As of this writing, the TMA was expecting to receive a judge’s ruling on the lawsuit on Aug. 19, 2002. "He will have to rule that day or in a few days to act by Sept. 1," he notes.

[For more information, contact: Fred Merian, MD, president of the Texas Medical Association, 401 W. 15th St., Austin, TX 78701-1680. Telephone: (800) 880-1300. Web: www.texmed.org.]