“Accomplishment”?

By Steve Cattolica

Exasperation

Deception

Desperation

Vindication

Suspicion

Exacerbation

Apprehension

Comprehension

Cooperation

Anticipation

 

All words that could describe emotions aroused by California’s workers’ compensation medical-legal reports and the accompanying medical-legal fee schedule (MLFS).  However, in everyday conversation some of the root words might be shortened to four letters. The Division of Workers’ Compensation, (DWC) recently hosted a public meeting focused on rebuilding the current medical-legal fee schedule. Testimony was predictable, but thoughtful, earnest and enlightening.

There are many, many very intelligent people involved in the workers’ compensation system. They were well represented in Oakland last week for this meeting.  They want to help.

Heavily weighted with medical provider and allied industry comments, speakers expressed all these emotions and then some.  While fewer employers chose to speak, their comments ran a similar spectrum.

Administrative Director George Parisotto, began the meeting with a refreshing plea and promise to the audience asking them to participate in subsequent discussions which would render and refine the rhetoric to a workable and financially sound rebuild of the MLFS…time frame to be announced.  

Once upon a time in California workers’ comp, it was well understood and standard operating procedure that if regulations were to accomplish their purpose, they needed to be grounded by in-the-trenches practicality.  Likewise, if the regulations were to be followed, all the affected constituents were be consulted and given the chance to contribute to the finished product.  To my knowledge, this is the first such open opportunity of its kind given the regulated public in the post Gray Davis era.

One wonders who will be given the privilege of leading this process to conclusion.  Clear vision, patience and a strong personality will be needed.   This group are not sheep blindly following some shepherd.  There’s got to be at least one individual with the requisite experience and fortitude to get the job done.

Whether the outcome of these deliberations is a flat fee or several flat fees; properly rewards the value of a quality med-legal report or is undervalued (again); is augmented by consideration for the quantity of medical and other records to be reviewed; includes a missed appointment fee; requires more rigorous continuing education requirements; includes a better system for choosing the QME’s specialty; provides feedback to the QMEs whose reports are inadequate or any of the other equally worthy innovations presented, the focus must remain on the constitutional mandate that the result be substantial justice.

An overly simple (check box) solution won’t cut it.  Nor will a fee schedule based on some other state’s system. We can thank Governor Pete Wilson’s administration for the language of Labor Code Section 5307.6 which in 1993 introduced the requirement that the MLFS produce “fees which provide remuneration…at a level equivalent to that provided to physicians for reasonably comparable work…” a squishy standard that can cut both ways.  Fortunately, as RAND reported to CHSWC over a year ago, there are no fee schedules or systems of remuneration in this nation that come close to the “reasonably comparable work” required of California’s med-legal evaluators.  

California’s system of workers’ compensation calls for a California response, then we will add “accomplishment” to the list.

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The California Workers' Compensation Services Association -  www.ca-wcsa.org

CWCSA provides real-time workers' compensation medical practice consultation services, medical-legal report reviewing, on-site in-service training and targeted advocacy for those who need results.