WCA Comments on Proposed Changes to Medical Fee Schedule

On July 28, 2014 the Board released a “discussion document” proposing significant changes in the workers’ compensation medical fee schedule, which has not been significantly updated in two decades. The Board’s document proposes a transition of the fee schedule to the “resource-based relative value scale” (“RBRVS”) used by Medicare.[1]

The Board’s proposal raises serious questions about access to quality care for injured workers.  Rather than creating incentives for specialists and high quality health care providers to enter the system, it is likely to drastically reduce the number and quality of specialists available to treat injured workers.

The proposed RBRVS fee schedule also fails to fully consider the bureaucratic burden on health care providers in the workers’ compensation system.  Physicians are now required to be fully familiar with hundreds of pages of Medical Treatment Guidelines (covering five separate body parts and chronic pain), over 100 pages of Medical Impairment Guidelines, the principles of functional loss evaluation, the variance procedure, the procedure to obtain authorization where a variance is not required and the treatment is not covered by the Medical Treatment Guidelines, principles of causal relationship, reporting, billing, testifying and more.

The inadequate medical fee schedule, multiplicity of forms, limitations of the Medical Treatment Guidelines, complexity of the Medical Impairment Guidelines, and the many other burdensome obligations of the workers’ compensation process have increasingly deterred providers from participating in the system.

The proposed revision of the medical fee schedule would only serve to exacerbate the existing set of disincentives for specialists and high-quality physicians to participate in the system.  Instead we recommend that reimbursement rates for specialists be increased, and the bureaucratic burden reduced in order to attract more quality physicians to provide health care to injured workers.

The full text of the WCA's comments to the Workers' Compensation Board regarding the proposed fee schedule can be found here.

The deadline for submission of comments to the Board is October 1, 2014.  Comments may be submitted by email to feeschedule@wcb.ny.gov.

[1] Subject Number 046-710, 7/28/14, available at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_710.jsp; also http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/MedicalFeeScheduleDiscussionDocument.pdf