California’s Injured Workers Deserve The Right Care at The Right Time
By Roger Belcourt, MD, MPH
When workers get injured on the job in California, the first health care provider they see is a primary care physician.
Or, we should say, the first person they try to see is a primary care physician.
The crisis in primary care is extreme: fewer and fewer doctors are choosing to become primary care physicians, creating a shortage that may become even more extreme as more people become eligible for health care coverage under President Obama’s landmark health care program.
By some estimates, the national shortage of primary care providers will grow to beyond 40,000 to 50,000 in the next decade.
When there are not enough qualified primary care doctors dedicated to serving our state’s injured workers, these workers are forced to seek treatment in costly emergency rooms or from family physicians not specialized in workers’ compensation cases. And, their road to recovery is slowed; increasing lost-time from their jobs and lives. Not a good outcome for them and very costly to employers and California.
While the reasons for the shortage are complex, one thing is clear: In California, we need to assure that primary care providers are fairly compensated to have any confidence that there will be enough of them to treat the state’s injured workers.
In California, the official medical fee schedule that compensates primary care physicians has long been obsolete, and reflects the value of medical services as it stood several decades ago. Our workers compensation physician fee schedule is one of the lowest in the nation. Every neighboring state and 49 of the 50 states in America pay primary care physicians better. So what? Doctors are leaving primary care and many are simply leaving California.
That’s why we in the Western Occupational and Environmental Medical Association (WOEMA) are working for passage of Senate Bill 923 by Sen. Kevin de Leon. This summer, the State Senate passed the bill by a vote of 39-0 – a rare coming together by Democrats and Republicans
The California Division of Workers’ Compensation has long recognized that change is needed and recommends adopting a physician fee schedule based on the Resource Based Relative Value Scale. It is fair and sensible.
Some have expressed concern that access to specialty care may be diminished in a fee schedule conversion. While we appreciate the spirit of these concerns, they overlook the methodology of this resource-based system. They also overlook the fact that insurers, many not based in California, have raised premiums and helped themselves to out-sized profits while hiding behind the current provider reimbursement system that lets them not pay the providers fairly – and take their profits out of California. It is time for a change that makes sense.
This new system is flexible and allows for different conversion factors to ensure that injured workers get the appropriate care from all the providers they need to access, while at the same time managing costs. It is working well in many other states.
Notably, as so many states have embraced this system, not one of the 33 states has ever flipped back to their prior compensation system.
In our state, the reality today is that access to primary care providers already is a significant issue negatively impacting workers and their ability to get the health care. Delayed access to care leads to slower recovery from injury, more time lost from people’s jobs and lives, and much higher cost.
For California workers, the legislation will address today’s primary care crisis and ensure that access to all care is provided for injured workers. That’s why it is necessary and why 39 of California’s State Senators voted for it. It’s good law and makes for a better California.
Roger Belcourt, MD, MPH, is Board President of the Western Occupational and Environmental Medical Association.