Sacramento, CA (WorkersCompensation.com) – Looks like a controversial proposal to create a statewide Medical Provider network is California is off the table — for now. Following an amendment by the bill’s sponsor last month, the idea is now likely to be the subject of a study for the next year. It currently is on the Appropriations Committee’s Suspense File.
As initially proposed, Assembly Bill 1465 would have required the California Division of Workers’ Compensation to build a physician network which injured workers could access as an alternative to the MPN used by their employer, employer’s insurer, or TPA. The idea was to improve what some view as an access to care problem.
But a recent study on the proposal suggested little to no benefit and exorbitant costs. The California Workers’ Compensation Institute’s Impact Analysis Report estimated overall costs of at least $314 million to the state’s workers’ compensation system. The study also discounted the notion that there is a problem with access to care.
While the idea of a statewide MPN is being studied, those on both sides of the issue have strong opinions about it.
“I think, anecdotally, there are a lot of problems with access,” said Julius Young, a plaintiff’s attorney and partner at Partner at Boxer & Gerson LLP. “Where workers try to pick doctors on networks, [they find] they’re listed on the network but not willing to treat workers’ compensation cases. A large part of the problem is these leasing of networks to employers and insurance carriers, and the doctors in the leased networks aren’t willing to treat workers’ compensation [patients], they have no intention to treat workers’ compensation. So there can be a lot of time burned up trying to find somebody when a worker wants to change doctors for some reason.”
In a blog post today, Young wrote that he hopes the study will include “some relevant questions.” For example,
- How well is the current provision for “Medical Access Assistants” performing? Is this being widely used, and could that provision be improved?
- How well is the Division of Workers’ Compensation policing the MPN networks under the current law? Are workers and attorneys using current complaint procedures, and what difficulties exist in current enforcement?
- Why do injured workers and applicant attorneys find that so many doctors on MPN network lists are either not taking any workers’ comp cases at all or are very limited in which cases they will take?
Employers and insurers strongly opposed the idea, saying it would not only drive up costs but could impact outcomes. The proposed MPN would have initially been comprised of any licensed physician in good standing with the California Medical Board who is currently in any California workers’ compensation network. Eventually, it could have included any licensed physician in good standing with the medical board.
“The main concern is that employers have worked to put together networks with doctors who provide quality care,” said Jeff Rush, Workers’ Compensation Program manager for the California Joint Powers Insurance Authority, one of the largest municipal self-insurance pools in California. “The state seems to have a come-one-come-all policy in terms of who would be in the network.”
Rush also questions the funding for a statewide MPN. “I don’t see a way in which the state could hire enough employees to do this for employers, many of whom created their own network,” he said. “Employers who’ve gone through the effort [to create their own MPNs] would have to pay the state for a competing network.”