NYSCA Prepares Its Comments in Response to NYS WCB Proposed Medical Treatment Guidelines
On June 30, 2010 the New York State Workers Compensation Board published its “Proposed Medical Treatment Guidelines.” A public comment period of 45 days commenced at that time and will end on August 16, 2010. The NYSCA Workers Compensation Task Force has spent considerable time and energy reviewing the “Proposed Medical Treatment Guidelines,” researching supporting documentation and crafting a response to the Workers Compensation Board. We anticipate that the final NYSCA response will be delivered to the Workers Compensation Board prior to the appointed deadline.
In an effort to remind the members of the NYSCA as well as the entire chiropractic profession, patients and general public of the organization’s position regarding the proposed guidelines, the following story has been republished for review. It is the feeling of the NYSCA leadership that the documentation sent to the Workers Compensation Board should be available to the public for review. The NYSCA will publish its current comments and recommendations to the NYS WCB shortly after they have been submitted to the board sometime on or about August 16, 2010. Please check this website for the updates.
The chiropractic profession, patients and the general public are invited to review NYSCA’s original position paper regarding the Medical Treatment Guidelines:
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.
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.
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.
NYSCA Position Paper on the Proposed State Insurance Department WC Care Guidelines
Please be sure to check at this site for the NYSCA’s response to the New York State Workers Compensation Board’s “Proposed Treatment Guidelines.”
