February 23rd, 2017

How Relationships with the Right Initial Treating Providers Can Improve Outcomes and Minimize Costs

Workers Comp 0

When an employee sustains an injury on the job, one of two scenarios will play out.  For minor incidents, the employee may simply obtain first aid at the workplace.  However, in more serious cases the employee will need to seek medical treatment from a doctor or medical facility.  Assisting your employees with selecting a medical provider with whom they can treat will play a large part in determining the treatment outcome and ultimate cost of that injury.

While employers may not require employees go to specific medical providers, they can recommend doctors based on their experience in treating occupational injuries and record of creating positive outcomes for both employee and employer.  In fact, employees will follow the recommendation of their employer in the vast majority of cases.

Here are a few considerations to evaluate as employers develop an injury reporting process and evaluate options for initial treating providers:

BWC-Certified/BWC-Certified Network/Non-Certified Providers

Medical providers will fall into one of three categories:

BWC-Certified

Non BWC-Certified

BWC-Certified Network

Doctors who treat work-related injuries should be certified with the Ohio Bureau of Workers’ Compensation (BWC).  As part of this certification, treating physicians agree to accept the BWC fee schedule.  There are no out-of-pocket costs for an employee who is being treated for a job-related injury and medical providers may not balance bill employees or employers for the difference of billed charges and BWC fee schedule.  Medical bills are submitted to and paid by employers’ workers’ compensation managed care organization (MCO) and these costs are “charged” to the employer’s workers’ compensation policy with BWC.

There are some providers who choose not to treat workers’ compensation injuries for various motivations.  These are non-certified providers.  In many cases the medical office will have a sign at the door, front desk or reception area notifying that they do not treat workers’ compensation injuries.  If, by chance, an employee is treated at a non-certified provider, the MCO may pay the bill for the initial treatment but not any subsequent treatment with that provider.

The last category is network providers.  Many managed care organizations maintain their own provider networks of BWC-certified providers.  Providers within an MCO network have agreed to even further discounted fees below the standard BWC fee schedule. 

Occupational Health Focus

While the provider network is an important consideration, an additional factor is whether or not the provider has a focus on treating occupational injuries.  Treating occupational injuries, which have a return-to-work outcome orientation, is very different from typical non-occupational patients.  In many cases, establishing a relationship with an occupational health clinic is more beneficial (even if they are out of network) because they are more effective at generating positive return-to-work outcomes and lower costs.

Occupational Health Center/ Emergency Room/Urgent Care/Family Practitioner

Many injured employees go to a hospital emergency room or urgent care center for workplace injuries.  Of course, if an injury is serious in nature, the employee should go to one of these facilities.  In some cases (such as employers who operate overnight shifts), it may be the only option.  However, for other less urgent injuries, an occupational health facility is the better option.  This is true for at least two reasons:  (1) the employee will likely get quicker treatment and (2) the cost billed to the employer’s policy will be lower.  Average wait times in urgent care facilities can range anywhere from about 30 minutes to over one hour depending on the severity of the injury.  In most occupational health facilities, an employee is seen within 15 minutes of their arrival.  

For more information on initial treating providers, view this educational webinar offered by CareWorks, the endorsed managed care organization of the Ohio Council of Retail Merchants.