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Will Changes To The Workers’€™ Compensation Medical Fee Schedule Block Access To Quality Doctors In NY?

The New York Workers’ Compensation Board is seeking to alter the way physicians are compensated for the care of injured workers within the state.

In a “discussion document” dated July 28, 2014, the Board argues that specialists, surgeons and diagnostic centers are grossly “overpaid” under its current fee schedule, while primary care physicians and general practioners are significantly “underpaid”. 

To fix these inequalities, the Board has proposed a translation from its present fee schedule to the “resource-based relative value scale” (“RBRVS”) used by Medicare. This means that the Board would reimburse doctors at Medicare rates, plus a New York “conversion factor” of 30%.

Simple math shows that under these guidelines, fees to specialists and surgeons would likely be slashed in half.  With such a significant reduction in payment, why would a busy specialist even bother with Workers’ Compensation claims at all?  It’s a legitimate concern that has many wondering whether injured workers will now lose out on access to high quality medical care as a result of specialists exiting the system.

It is doubtful that primary care physicians and general practioners will make up the gap left behind by specialists and surgeons, either.  While these doctors stand to earn more under the proposal, most are not familiar enough with the bureaucratic demands (forms, anyone?) and legal requirements such as testifying in court, properly documenting causation, etc. that are required when treating a Workers’ Compensation patient.

The Board may ultimately have it’s way, but there can be no doubt that injured workers will get the short end of the stick here.  Access to high quality health care is not a luxury; it’s a necessity to help injured workers fully recover, get back to work and get on with their lives.  Any roadblock standing in the way of this goal is simply kicking an injured worker while they are down.

Do you believe changes to the medical fee schedule will deter high quality providers from participating in the system?  Do you feel these changes are in the best interest of injured workers within the state? Leave your comments below!

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