Big Foot Needs a Pain Pump
There are questions for the ages.
- Does Big Foot exist?
- Will the Cubs ever win another World Series?
- Why should work comp carriers do Utilization Review & Peer Review?
Although I really can’t comment on Sasquatch or the Cubs, I have strong opinions about UR/PR. The textbook answer includes certain buzzwords regarding:
- Medically necessary and appropriate;
- Reasonably related and compensable;
- Based upon established criteria;
- Ensure best outcomes.
These are all the true and well-rehearsed answers you will hear from UR/PR vendors. I’m going to give you another politically incorrect answer you will only hear whispered. In the industry, we call it the Economic Treatment Plan Syndrome.
Simply put, there are some rogue physicians whose proposed treatment plans are developed to benefit their (i.e. the physician’s) economic well-being versus the well-being of the patient. And you, the payer, get stuck with the bill.
In a perfect world there wouldn’t be rogue physicians. All treatment plans would be scientifically supported and identical whether it’s a high deductible/high co-pay medical plan or a work-comp-pays-all policy.
Call us. We do better in an imperfect world.
Posted in OMCA