Workers' compensation medical provider networks should be significantly different than group medical insurance networks. In group medical panels should be as large as possible. One attempts to persuade as many providers as possible to participate for the agreed upon reimbursement. In workers' compensation, however, we look for a much smaller panel; one that includes the right doctors with the clinical, philosophical and communication skills required to be a good workers' compensation provider.

These physicians should be inclined to help workers return to work as soon as possible rather than looking for opportunities to delay that return. Good work comp providers recognize the fastest way to recovery is to have the patient in the workplace and not at home. These providers also possess the communication skills that allow them to effectively convey this message to their injured patients and to deal appropriately with employers. Most of all, they must be willing to communicate openly and effectively with OMCA nurse case managers.

OMCA providers are recruited through a variety of methods. Frequently we take the suggestion of another physician, employer, adjuster or attorney. Once identified, our Provider Relations staff visits the physician to determine if the physician and his/her staff will help us treat injured employees in a manner most conducive to returning them to work safely and promptly.

Physicians who wish to participate in an OMCA panel are properly credentialed to verify their educational and clinical credentials. All panel members are required to carry malpractice insurance and may be dismissed from the panel with appropriate notice.

The evaluation issue is a continual one. Periodically, providers who routinely support return-to-work, conservative care and good communication will fall short. If this becomes a chronic concern, OMCA Provider Relations staff will consult with the provider to determine what issues might be involved on this change in treatment/communications patterns. Typically always, these issues are resolved through informal conferences, reinforcing the advantage of good communications within a relatively small panel.

Medical providers in the OMCA network are educated in issues that are important to workers' compensation and the role that the medical provider plays in that system. They become aware of the importance in returning workers to their jobs and the impact of total temporary disability on both the employer and the employee. Providers learn the importance of disability ratings.

Reimbursement is critical in developing a workers' compensation network. A common philosophy in health care is to recruit providers at the absolute lowest rate possible. In other words, why pay more? This approach may work for large group medical insurance panels. In those cases the only issue at stake is the cost of the clinical care. Workers' compensation is much different.

In workers' compensation, we ask the physician to provide the best of clinical care. But then we ask so much more. We want our workers' injuries treated promptly. Routine acute care (small cuts, light sprains, etc.) must be good. We want the worker back as soon as possible - no two hour waits in the office. We want the provider to be supportive of the employee's return to work if that is clinically appropriate. The provider must communicate with the nurse case managers, to develop and communicate a treatment plan, and participate in return-to-work and limited-duty discussions. We want the provider to follow OMCA guidelines in promptly and appropriately referring injured workers to the right specialist for more specialized care. These "extras" don't and shouldn't come for free. We foster a close relationship with our providers and attempting to significantly discount their reimbursement is not in the best interest of the employer, the carrier, the physician or the employee.