Effective January 1, 2013, the Department will launch a statewide Medical Providers Network (MPN) for treating injured workers and expand the Centers of Occupational Health Education (COHE). Doctors who want to treat injured workers will have to apply to be part of the MPN. The Department predicts these programs will improve quality of care and save the State over $200 million over the next four years.
After January 1, 2013 you can only treat with a non-network (MPN) provider for the initial office or emergency room visit. For additional care, the worker must transfer to a network provider. Workers should ask their regular doctors to enroll in the network. Currently, out of state medical providers are not required to be part of the network (MPN.)
You can see if your doctor is enrolled in the network by going to www.FindADoc.lni.wa.gov. As I understand it, there is quite a backlog in the application review process.
L&I can remove a provider from the network if they:
• Put injured workers at risk of harm.
• Fail to maintain network credentialing standards.
• Do not follow other L&I requirements, such as administrative policies.
The Department can remove a provider from the MPN for causing “risk of harm” to the patient. Just like insurance companies, the Department sets guidelines and criteria that must be met, before allowing certain types of treatment. The law says “reasonable and necessary” treatment should be covered, regardless of the Department’s policies. The Department’s view of “reasonable and necessary” treatment often differs from the treating physician’s view. If the treating physician stands up to the Department and fights for you, the physician risks getting booted from the MPN, and thus unable to treat injured workers. The Department may determine the doctor is causing a “risk of harm” by not following its own guidelines. It could be the Department’s way or the highway.
The Department’s guidelines are not necessarily a measure of the best practices or standard of care in medicine, particularly for specialists. The Department’s guidelines were, by definition, intended only to be guidelines. There must be flexibility. Furthermore, providers should not be penalized or threatened with removal from the provider network for disputing a treatment decision.
These programs may shrink the pool of available medical providers willing to treat injured workers. It is already a system cumbersome with paperwork requirements and it can be difficult to find a provider willing to take on a worker’s compensation claim.
Dane D. Ostrander
Williams, Wyckoff & Ostrander, PLLC