Understanding What Employers Can Do to Manage Medical Costs

medical costs

Effective medical cost management is fundamental to a successful Workers’ Compensation program for employers. Managing medical costs allows employers to provide a positive experience for injured employees, ensure appropriate treatment is given from the onset for injury recovery and return to work, help reduce the life of the claim and, of course, contain costs.

The first step in medical cost management is having an understanding of the rules that govern the jurisdiction in which an employer conducts business. The rules for getting medical treatment through Workers’ Compensation vary from state to state so it’s critical that employers are familiar with them. In addition, if an employer has employees who live in a neighboring state, it’s important to also know its governing rules as an injured employee may file a Workers’ Comp claim where he or she resides. Prescient National’s claims department is available to assist clients in understanding their jurisdictions’ medical treatment rules.

Three Approaches to Medical Treatment

Although the rules are too complicated to go into here, depending on each state, there are three general approaches to providing Workers’ Comp medical treatment:

1. Employers choose the medical providers and direct care

2. Employees can choose their medical provider

3. Employers provide a medical panel – a list of physicians or medical networks from which their employees can choose; the list typically contains a minimum number of doctors and specialists and often there are limits on the number of occupational clinics that may be included (again, depending on the state)

In selecting the medical providers, employers should not only partner with reputable professionals but also with those who understand the Workers’ Compensation system and how to treat and manage injuries, including an employer’s return-to-work program, the provider’s willingness to conduct post-accident drug testing, the need for opioid management, and the importance of timely referrals to specialists for severe injury cases. Prescient National can provide a sample medical panel to employers in the states where they conduct business.

Even if employees choose their own medical providers, it’s still worthwhile for employers to know appropriate local medical providers, in case the employee asks them for advice or a recommendation.

Managing a Claim from the Onset

The optimum time to manage a claim is right at the beginning with the first medical visit a pivotal time at which an employer can make the biggest impact. This is when an employer can set a positive tone of genuine care and concern in getting the employee on the road to recovery and being productive once again. In addition, with the right provider partnership, the focus will be on injury treatment along with discussing the availability of light-duty return-to work options. Serious injuries will also be properly addressed so the employee gets the care needed upfront.

The first doctor visit also lays the groundwork of how the entire claim will unfold. This is the patient’s first impression and can make a difference between having an employee who has a positive experience and one who is unhappy with the physician and process. If an employee feels the doctor is a poor choice it can impact the way the claim goes. Depending on the state’s Workers’ Comp rules, an employee may or may not be able to change physicians.

If there is an issue and the injured employee is unhappy with the provider, we will work with each case on its own merit to pinpoint where the problem lies. If needed, for example, we may suggest a nurse case manager accompany the employee to the next doctor’s appointment to serve as the employee’s advocate, to listen to what the physician is saying and make the employee more comfortable.

Appropriate Medical Treatment

It’s also important for an employer to understand a physician’s policy on opioid use for treating injuries. Opiates are not effective for most injuries, can lead to additional issues for an employee or exacerbate existing problems, extend the life of the claim, and can contribute to an employee remaining out of work, which is both harmful to an employee’s wellbeing and costly for an employer.

Medical cost management is an employer’s most efficient path to the resolution of an employee injury. This is what employers want most – for an injured employee to heal as efficiently as possible, return to work and close out the claim. Having the right medical providers is instrumental in achieving these objectives and in influencing a positive experience for employees.

Prescient National is available to consult with clients who want to discuss their medical providers, including evaluating their list of providers and offering recommendations. We also provide a Nurse Analyst when needed to help understand complicated medical procedures and conditions and offer injury expertise.

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