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Part Two: Recapping the 2017 Workers' Compensation Medical Access Executive Summary

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The 2017 Worker' Compensation Medical Access Executive Summary was recently released, which collects data from injured workers, healthcare providers and insurance companies in the Commonwealth of Pennsylvania to consider the effects fee schedules and utilization of provider panels have on access to quality care and lost days from work.

The summary was derived from survey data collected through surveys with injured workers, healthcare providers, and insurance companies. In part one of our series, we detailed the findings from healthcare providers and insurance companies. Now, we'll highlight what the summary found from the injured workers of the study.

Overall Findings

The medical access summary highlighted a number of interesting statistics and facts pertaining to injured workers. All three groups in the survey (injured workers, providers and insurance companies) experienced a decline in response rates.

1. Injured workers: 10.7% response rate down from 11.4% 

2. Providers: 24.3% of providers were represented (some responses represented multiple providers in a practice) a decrease of 3.2% in representation from 2016 

3. Insurance Companies: The 3% response rate was down from last year at 9.5% 


Injured Workers

Additionally, responses from injured workers revealed several trends:

1. The initial diagnosis correct rate remains steady. The accuracy of the initial diagnosis was reported at 77%. This is slightly better than the misdiagnosis rate of 26% reported in a 2012 study in Mayo Clinic Proceedings.

2. Average days lost per injury was at a five-year low of 22 days at the time of the survey without an increase in the subsequent injury.

3. Average days lost was reduced by more than half since  2013. However, not all workers who were interviewed had returned to work at the time of the survey. 

4. For workers, the percentage of those being seen by a doctor within 48 hours of the injury (87. 5% in 2017) has been steady over the past five years, fluctuating between 86% and 89%. The data suggests that increasing this percentage may lead to a reduction in days lost without subsequent injury. 

5. Satisfaction with care under workers' compensation was equivalent to satisfaction with care in other settings, too. Overall, 89.9 percent of injured workers reported satisfaction with the care they received, which tied a five-year high. Simultaneously, 88.5% of the injured workers rated their care under workers' compensation the same or better compared to other healthcare experiences. 

6. The majority of injured workers utilizing a panel reported their right to selecting a provider was respected. In 2017, 76.1% of injured workers reported they had their right to select a provider respected. 

7. Injured workers who used panel providers indicated greater satisfaction with the timing of their return to work. 74.1% of workers reported satisfaction with when they returned to work as compared to 72.7% of workers who did not use a panel. The increase in satisfaction may reflect better communication between both parties. 


Conclusion

The summary found that workers have timely access to quality care that allows workers to return to work upon completion of recovery. It also found that:

1. A majority of injured workers were satisfied with the care received both related and unrelated to workers' compensation. 

2. The PA Workers' Compensation Fee Schedule remains competitive with other lines of insurance within the healthcare industry. Compensation to providers at the established fee schedule should not be a barrier to access to care but may fall short of regulatory intentions aimed at cost containment. 

3. When employers utilize panels, they are generally administered correctly. Injured workers treated by panel providers experienced fewer days of work lost without an increase in injury, which suggests the use of panels is beneficial to all workers' compensation stakeholders.

Dugan & Associates is Here For You!

Our team at Dugan & Associates is ready to fight for your right to workers' compensation/personal injury benefits. If you're weathering a loss of income from a workplace injury, an increase in medical bills or distress due to an accident - don't worry! Led by Mitch, our group of devoted injury lawyers will make sure you receive the maximum monetary compensation available to you. Give us a call at 412-353-3572 or contact us online today!

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