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The Devaluation of Treatment

The Devaluation of Treatment

It appears that we are getting to the point in the workers' compensation arena where the cost of utilization review and diagnostic work up exceeds the cost of providing treatment. We have known for some time that the cost of Utilization Review in some cases is comparable to the cost of the treatment requested. This has certainly been the case when it comes to a request for a few chiropractic visits. However, with the addition of Independent Medical Review (IMR) the comparison is getting to the point of absurdity.

We have learned that the cost to the carriers for the typical IMR may be in the range of $450.00 to $850.00 per review!

Keep in mind that in order to properly evaluate an injured worker per the American Medical Association Guidelines, (AMA) nerve conduction studies and MRI studies are more required in most cases to determine the extent of impairment. The nature of the injury is also looked at by reviewing physicians to determine what care will be authorized. Most treatment guidelines are organized at least in part by diagnosis.

In many cases we can find that thousands of dollars have been spent to confirm a diagnosis that most doctors could easily come up with on their own clinically and to review whether or not the treatment requested should be authorized.

An argument can be made that this system simply makes no sense. Some have opined that carriers will be authorizing more care to avoid these new costs – I fear not.

The employers and insurance carriers did not work so hard to create a system that results is spending more money. The plan is part of an overall strategy, in my opinion, designed to limit access to care by making the process more difficult for the doctors and the injured workers.

The insurance companies can take a big picture long term view of these things. In my opinion, they don't care if they spend three times the money denying treatment in a particular case as long as treatment is reduced overall in time.

It would appear that in the context of these new costs requests for care should be very specific and limited.

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