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Why SB 923 is bad for injured workers

Posted on 06 September 2011 by admin

SB 923 would force the Administrative Director of the Division of Workers’ Compensation to adopt a fee schedule for physician services based on the Medicare RBRVS model at conversion factors that are so low, it would cause the best medical specialists to decline to treat injured workers. This has happened in every state that ever attempted to adopt a Medicare-based fee schedule at such low rates.

SB 923 is bad for injured workers and their employers because:

  • Both low income and high risk occupations such as firefighters, public safety officers, nurses, hotel custodial employees, farm workers, construction workers, restaurant workers, freight handlers, teachers, and maintenance workers typically sustain more serious injuries that require immediate medical care from specialists, not general practitioners.
  • If workers are denied access to care from medical specialists such as general surgeons, orthopedic surgeons, internists, neurologists, rehabilitation physicians, anesthesiologists, radiologists, etc., and forced to obtain their treatment from general practitioners, it will delay their healing and return to productive, income-producing work.
  • If injured workers cannot obtain diagnostic tests and measurements such as EMGs, MRIs, echocardiograms, pulmonary function tests, and X-rays, they will not be able to prove the full extent of their impairment, thereby short-changing their permanent disability benefits. Employers will also suffer economic harm due to an inability to prove apportionment to non-industrial causes and for prolonged temporary disability benefits.
  • The ongoing maintenance of the Medicare Fee Schedule for California workers’ compensation will be very cumbersome, labor intensive, and expensive for employers who have to bear the cost of the frequent updates. California workers should not have their access to health care and rehabilitation dictated by the whims and vagaries of Washington politics.

Revenue neutral in California is 115% of Medicare. The sponsors of SB 923 cannot name one state that pays 125% of Medicare or less that doesn’t have a severe access to care problem for injured workers.

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