NYSCA Responds to the Medical Treatment Guidelines Proposed by the State of New York Department of Insurance to the Workers’ Compensation Board

In March of 2007 Governor Eliot Spitzer issued a directive regarding Workers Compensation reform to State Insurance Department Chairman Eric Dinallo. Mr. Dinallo was instructed to form a task force with the expressed mission of updating the guidelines used by the New York State Workers’ Compensation System. In the directive, the governor stated that Chairman Dinallo was to create a task force comprised of representatives from industry, organized labor, and both houses of the state legislature. There were no representatives from any provider groups, including chiropractic, directly appointed to the task force. A subsequent news release from the NYS Insurance Department Chairman revealed the task force had selected participants who were “highly credentialed physicians and other professionals to serve as essential advisors in the creation of the guidelines which” reportedly, “express the consensus of the expert professionals.” The task force was given the mission to review the current NYS Workers’ Compensation guidelines and compare them to current evidence-based guidelines as well as guidelines used in other states. In December 2007 the task force delivered their recommendations to Governor Spitzer and Chairman of the New York State Workers’ Compensation Board, Zachary Weiss. The New York State Workers’ Compensation Board has subsequently been instructed to develop regulations to implement the recommendations of the task force. Although these guidelines were reputedly “designed to deliver quality, lower-cost care for injured workers”, the NYSCA believes the real agenda is cost containment at the expense of the injured workers. According to Eric Dinallo, Superintendent of the New York State Insurance Department at the time, “the proposed medical treatment guidelines for treating workers injured on the job will benefit those workers while helping to hold down the cost of workers’ compensation insurance for all New Yorkers. Unfortunately, these guidelines do not meet either of these goals. It is opinion of the NYSCA that since the chiropractic profession was not represented on this panel,the treatment modality that we offer was not thoroughly or properly evaluated. The guidelines are intended to “provide a consistent quality standard for the medical care of injured workers” and are reportedly “evidenced-based and reflect the sound clinical judgment of the physicians.” In theory, the guidelines “translate the medical literature into a usable and practical tool that assists busy medical providers in the provision of appropriate health care.” The question is: do the proposed guidelines achieve these goals? Some of the deficiencies in the Medical Treatment Guidelines as proposed are detailed below. More information can be found on the NYSCA website concerning the complete position paper which goes into these topics in great depth. 1. The guidelines are supposed to “provide a consistent quality standard for the medical care of injured workers” and are reportedly “evidenced-based and reflect the sound clinical judgment of the physicians.” These guidelines do not follow the standards of guideline development, nor do they provide documentation of where their recommendations were obtained. 2. The Workers’ Compensation system must clearly address the needs of the injured worker. Policymakers should shift the focus from the bottom line to treatment value and quality of health outcomes. These guidelines do not consider the cost shifting that occurs when patients seek more conservative care as opposed to costly medical/surgical and pharmaceutical care. They also do not have a plan in place to perform vocational rehabilitation so for those more injured patients; the State is looking at shifting the costs to the private insurance sector 3. A 2004 Rand study of the ACOEM guidelines, which are the basis of this proposal states that it “found the ACOEM guidelines to be of uneven quality.” While surgical topics were relatively well addressed, panelists were uncertain whether content was valid for physical modalities or other common and costly therapies. 4. The RAND study also stated that it “heard” numerous “anecdotes in which payors had used topical gaps in the ACOEM guidelines to deny care that might otherwise have been considered appropriate and necessary.” 5. A Workers Compensation Research Institute (WCRI) survey of injured workers in California, where comparable guidelines have been in effect for more than 4 years, revealed that there was a very low patient satisfaction rate with treatment and unfavorable clinical outcomes. In other words, the more severely injured workers felt that they were not receiving the best care for their injuries. The NYSCA has been in contact with Dr. Levin, the newly appointed medical director for NYS Workers Compensation. We hope to schedule a meeting between him and our officers and other representatives very shortly in order to explain our position on the guidelines as proposed. Be assured that the New York State Chiropractic Association considers this a high priority issue for the profession and we will do all that we can in order to protect the patients we serve. The following links are for the Proposed NYS Workers Compensation Medical Treatment Guidelines and the Draft of the Proposed NYSCA Chiropractic Treatment Guidelines along with the NYSCA position paper on the Medical Treatment Guidelines Proposed by the State of New York Department of Insurance to the Workers’ Compensation Board. NYSCA Position Paper on the Proposed State Insurance Department WC Care Guidelines NYSCA Proposed WC C-spine Guideline NYSCA Proposed WC T-spine Guideline NYSCA Proposed WC LBP Guideline Final Request for Comments on Medical Treatment Guidelines