Workers compensation cases are a great fit for orthopedic-based ambulatory surgery centers, says John DiPaola, MD, an orthopedic surgeon at Occupational Orthopedics in Tualatin, Ore. In fact, his practice is exclusively limited to workers comp. But many orthopedic surgeons and other physicians are strongly biased against workers comp, preventing ASCs from getting these cases. Here Dr. DiPaola lists six common physician biases against workers comp cases and why they are unfounded.
1. Generally negative view. Working with physicians to prepare them for workers comp cases, Dr. DiPaola comes across many misperceptions. They often think it pays low, involves less healthy patients and is better left done in hospitals than ASCs. Even if a physician sets aside those biases and takes on a case or two, he faces a very unfamiliar claims-administration process that may run counter to his clinical instincts and the way his office is run. "The process can be daunting and take a lot of time if you haven't done it before," he says.
2. Bias on patients' health status. "Physicians have the false impression that injured workers do not recover as fast as other patients," Dr. DiPaola says. In fact, workers comp patients tend to be younger, ages 20-55, and have mostly soft-tissue injuries that have a good recovery rate. Unlike victims of car crashes, who have serious trauma, these patients can usually be treated electively rather than in the hospital.
3. Patients seen as unfit for ASCs. Workers comp patients are actually ideal for ASCs, both physically and psychologically. "These patients typically do very well in the ASC and can become a source for substantial new revenues," Dr. DiPaola says. In general, they don't have a lot of medications or serious chronic illness that might require hospital-based surgery. As front-line workers with physical jobs, they tend to work out of small, one-story buildings and prefer the size and feel of an ASC. "Large, anonymous buildings like hospitals make them uncomfortable," he says.
4. Perceived low payments. While reimbursements vary by state, workers comp usually pays more than Medicare. However, making money on these case requires efficient handling of administrative needs. "Physicians offices and ASCs need to anticipate what administrators require without a lot of back and forth," Dr. DiPaola says. Setting up an internal system to handle these cases will help physician offices handle a high volume of cases, which will enhance profitability. Since many physicians don't take workers comp, "there is a huge demand for physician who will accept these cases," he says.
5. Discomfort with administration. Workers' comp administrators need physicians to provide information such as what percentage of the patient's injury was caused at work, as opposed to non-work causes, such as arthritis. They also have to know how long it will take for the patient to recover, which makes physicians nervous. "In general, physicians don't like to make a prediction," Dr. DiPaola says. "They think they might be sued if it's not right." In fact, no one expects the prediction to be anything more than an estimate. If the patient exceeds the predicted recovery time, the physician is asked to make another prediction.
6. Unwillingness to learn new skills. Skills like predicting recovery time and apportioning injury between work and non-work causes are not taught in residency training. Physicians have to learn them. They can take courses on this and Dr. DiPaola has helped colleagues with these skills. "Motivation is important," he says. Once motivated, physicians have successfully learned a wide variety of new skills, such as sports medicine. "Physicians need to spend the time to figure it out," Dr. DiPaola says.
Learn more about Occupational Orthopedics.
Read more about workers' comp:
-Ohio Workers' Comp Bags Largest Ever Restitution Payment: $830K From Jailed Anesthesiologist
-California Surgery Centers Face 20% Reduction in Workers' Compensation Reimbursement
1. Generally negative view. Working with physicians to prepare them for workers comp cases, Dr. DiPaola comes across many misperceptions. They often think it pays low, involves less healthy patients and is better left done in hospitals than ASCs. Even if a physician sets aside those biases and takes on a case or two, he faces a very unfamiliar claims-administration process that may run counter to his clinical instincts and the way his office is run. "The process can be daunting and take a lot of time if you haven't done it before," he says.
2. Bias on patients' health status. "Physicians have the false impression that injured workers do not recover as fast as other patients," Dr. DiPaola says. In fact, workers comp patients tend to be younger, ages 20-55, and have mostly soft-tissue injuries that have a good recovery rate. Unlike victims of car crashes, who have serious trauma, these patients can usually be treated electively rather than in the hospital.
3. Patients seen as unfit for ASCs. Workers comp patients are actually ideal for ASCs, both physically and psychologically. "These patients typically do very well in the ASC and can become a source for substantial new revenues," Dr. DiPaola says. In general, they don't have a lot of medications or serious chronic illness that might require hospital-based surgery. As front-line workers with physical jobs, they tend to work out of small, one-story buildings and prefer the size and feel of an ASC. "Large, anonymous buildings like hospitals make them uncomfortable," he says.
4. Perceived low payments. While reimbursements vary by state, workers comp usually pays more than Medicare. However, making money on these case requires efficient handling of administrative needs. "Physicians offices and ASCs need to anticipate what administrators require without a lot of back and forth," Dr. DiPaola says. Setting up an internal system to handle these cases will help physician offices handle a high volume of cases, which will enhance profitability. Since many physicians don't take workers comp, "there is a huge demand for physician who will accept these cases," he says.
5. Discomfort with administration. Workers' comp administrators need physicians to provide information such as what percentage of the patient's injury was caused at work, as opposed to non-work causes, such as arthritis. They also have to know how long it will take for the patient to recover, which makes physicians nervous. "In general, physicians don't like to make a prediction," Dr. DiPaola says. "They think they might be sued if it's not right." In fact, no one expects the prediction to be anything more than an estimate. If the patient exceeds the predicted recovery time, the physician is asked to make another prediction.
6. Unwillingness to learn new skills. Skills like predicting recovery time and apportioning injury between work and non-work causes are not taught in residency training. Physicians have to learn them. They can take courses on this and Dr. DiPaola has helped colleagues with these skills. "Motivation is important," he says. Once motivated, physicians have successfully learned a wide variety of new skills, such as sports medicine. "Physicians need to spend the time to figure it out," Dr. DiPaola says.
Learn more about Occupational Orthopedics.
Read more about workers' comp:
-Ohio Workers' Comp Bags Largest Ever Restitution Payment: $830K From Jailed Anesthesiologist
-California Surgery Centers Face 20% Reduction in Workers' Compensation Reimbursement