In the long negotiations that led to the workers' compensation reform package, one of the most contentious issues was who should pick the doctors treating injured workers.
In the end, the governor and lawmakers settled on a uniquely California approach: creating HMO-like networks of doctors. California was a pioneer in the formation of health maintenance organizations, and if the reform bill is approved today as expected, the state will launch a new cottage industry in managed care.
The bill would give employers more control over the system by allowing them to select the doctors in the networks. Traditional HMO plans could also handle workers' comp cases, opening up the possibility that workers could see their regular doctors for work-related injuries. Workers' ability to choose doctors would, as in group health plans, be confined largely to the networks.
Dozens of new networks of workers' comp doctors probably would pop up in the state and significantly expand a relatively new line of business for healthcare giants like Kaiser Permanente and WellPoint Health Networks.
But many question whether the HMO model, which has a tortured history in California, would work effectively and generate significant savings in the workers' comp arena.
Under current rules, workers injured on the job can pick their own doctors after 30 days of treatment by a physician selected by the company or insurance carrier.
Employers have complained that this has allowed workers and their lawyers to shop around for doctors who would provide a diagnosis leading to a disability claim. Employers wanted to stop that alleged abuse; labor groups sought to preserve doctor choice for workers.
Beginning in 2005, the bill would allow employers or workers' comp insurers to establish a pool of medical providers composed of occupational doctors as well as other physicians. A worker injured on the job would be seen by a doctor from that network, and if the employee disagreed with the diagnosis or treatment prescribed, he or she could seek opinions from two other doctors in that group. If there was still a dispute after that, then the worker could request an independent medical review.
The bill contains one notable exception: If workers notify their employer in writing before an injury that they have a personal physician, they would be able to see that doctor for a workers' comp case, regardless of whether that provider is in the employer network. But this provision would expire in May 2007 and would apply only to workers whose employers provide group health insurance, which is far from everyone.
