Letter from the desk of Camilla J. Frederick, MD, MROCC, Medical Director QCOH
The American College of Occupational and Environmental Medicine (ACOEM) recently put out the following position statement. QCOH has been using ACOEM evidenced based protocols for treatment since 2008. The treatment guideline is placed in the chart for the provider to review while treating the patient. In addition, we review charts and include a review of how the practitioner uses the guidelines. This is just another way that QCOH strived to provide "Best in Classâ occupational health services in the Quad Cities and Clinton Areas.
Ensuring Quality of Care in Worker's Compensation Programs: Fair Fee Schedules and Evidence-Based Guidelines
The adoption of scientific, evidence-based treatment guidelines founded on a rigorous analysis of the scientific evidence provides a powerful means to increase the effectiveness and value of medical care to injured workers. Evidence-based guidelines also provide a rational framework from which to address and remedy shortcomings in workers' compensation fee schedules.
Traditionally, workers' compensation fee schedules do not properly recognize and reimburse physicians who go beyond traditional medical services and do the extra work required to restore injured workers to optimal function and to promote rapid return to work. As has been documented, the provision of high-quality workers' compensation services requires more physician attention and time to patient education and client communication, increasing the cost of delivering workers' compensation services compared with routine health care.1-3 As a result, low fee schedules can discourage the participation of qualified occupational physicians and undermine the economic viability of occupational health programs designed to meet the needs of employers and employees. An appropriate fee schedule promotes the development of quality occupational medicine programs and services, which in turn ensure higher quality of health care to injured workers while reducing the costs to employers and insurers. Outpatient provider fees are not a major cost driver in the workers' compensation system, but lack of access to high-quality, front-line health care drives up costs. Several studies have documented that improved reimbursement to occupational health providers and reduced administrative oversight can lead to better patient outcomes and reduced costs.4-13
Appropriate fee schedules, when used with evidence-based treatment guidelines, will ensure that workers receive appropriate medical care in a timely manner (by increasing the number of high-quality providers and programs) and will control costs by reducing unexplained variations in care and ineffective services.
Adopting the American College of Occupational and Environmental Medicine (ACOEM) Occupational MedicinePractice Guidelines, 2nd Edition,14-15 and an appropriate fee schedule will improve quality of care, encourage participation by qualified providers, and reduce costs because:
The Practice Guidelines, as developed, are based on expert analysis of all of the best available scientific studies.16 All users (i.e., physicians and other health care providers, third-party payers, reviewers, and regulators) can have confidence that services recommended by the ACOEM Practice Guidelines will lead to a meaningful improvement in patient care;
Where alternatives exist, the Practice Guidelines specifically incorporate "cost-effectiveness" in recommending particular treatment plans;The Practice Guidelines emphasize early and scientifically rational treatment for injuries, a philosophy that has been demonstrated to reduce costs and improve patient outcomes; andThe Practice Guidelines emphasize preventive services as a way of reducing costs overall, especially costs for chronic care.
Accordingly, ACOEM supports reimbursement policies that recognize expressed adherence to its Practice Guidelines as justification for a (to-be-determined) higher fee schedule (i.e., an appropriately determined conversion factor). Such a reimbursement system is totally consistent with a general move across public and private insurance programs and increasing physician acceptance of reimbursement systems that "pay for performance." With particular respect to the workers' compensation system, such a policy will likely result in: 1) enhanced physician participation; 2) ease of administration; 3) more occupational health programs in areas currently underserved; and 4) improved quality of care and patient outcomes.