by Steve Cattolica
“I can see clearly now the rain is gone; I can see all obstacles in my way….”
Johnny Nash, June 1972
For those of us around in 1972, Nash was speaking our language…rain gone, no dark clouds, nothing but blue skies, sunshiny days, bad feelings disappear, rainbows, a clear path…I better stop there.
‘Transparent’ can be defined as, “allowing light to pass through so that objects behind can be distinctly (clearly) seen.” The opposite of transparent is opaque.
As the costs of claims handling rise, employers and policy makers look for the reason why. Naming the causes - some are apparent, even obvious - does not fully answer the question. The picture is opaque. Individual contributors to the rise in costs are hidden. More can be done. More must be done.
Would-be explanations offer what could be boiled down to the adage, “be careful what you ask for.” Recently, I read about pricing of prescription drugs and was left thinking that it wouldn’t matter how much buyers learn about pricing. There’s almost nothing that can be done to change the outcome. The buyer ends up paying the same amount regardless.
Transparency should plainly show all the components of a service clearly and empower improvement, not reinforce the status quo.
by Dr. Robert Weinmann, MA - January 30, 2019 (Weinmann Report)
Duty of Care (King v. CompPartners) was reviewed in this column on 10/16/18. The case involved the sudden discontinuation by a Utilization Review (UR) physician of patient Kirk King's klonopin. King filed suit based on negligence and malpractice because the UR doctor arbitrarily discontinued his medication and thereby caused him to have four epileptic seizures. Eventually the case went to the California Supreme Court which decided that "the exclusive remedy for disputes arising out of the UR process belongs to the workers comp system." The case was remanded to the District Court. King was barred from pursuing a tort claim.
We wrote in this column that the decision protects UR physicians from malpractice lawsuits. But Justice Mariano-Florentino Cuellar wrote in his opinion that it might be time for the California legislature to take a look at the law since it could now be argued that protections in the law for injured workers "may not be set at optimal levels and the legislature may find it makes sense to change them."
It makes no sense that treating doctors are subject to Duty of Care, a protective legal concept that protects patients from cavalier care, whereas by contrast UR doctors, who do not interview or examine the patients, are not.
It makes sense to change the law so that both UR and IMR (Independent Medical Review) doctors can be brought under the same Duty of Care umbrella as their PTP (primary treating physician) counterparts. Legislative action is now an issue in Hawaii and California.
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