Saturday, September 24, 2016

Dr. Horiagon responds to Pinnacol's Phil Kalin's Amendment 69 bashing.

For an introduction to this response by Dr. Horiagon 
visit this link

By Tom Horiagon MD MOccH

This commentary is written is response to an article appearing in:

Mr. Kalin's assertions fly in the face of the facts. 

Let's address the big errors: Kalin cites the CHI report that had to use very tortured and adverse assumptions in order to derive a year 10 deficit. This long-range prediction assumes no dynamism or adjustment by the ColoradoCare board of directors, no structural cost savings, no effects of decreased administrative costs, no effects of decreasing unnecessary capital expenditures in over-served areas, and adverse assumptions about Federal actions. 

It is also worth considering the source. CHI is an extension of the hospital lobby and hospital networks that thrive by market segmentation and running away from under-served populations will be losers under Amendment 69. 

The claim that Colorado's workers compensation system is one of the nation's best is beyond preposterous. The notion that ColoradoCare would take away access to occupational medicine specialists in Colorado is a lie. 

The fact is that hardly any of the physicians participating in Colorado worker's compensation have any training in occupational medicine beyond what they got in the Level II certification course. 

The Regional OSHA Director cannot recall ever receiving a notification from a Colorado physician about unsafe or unhealthy work environments. 

Misdiagnosis, mismanagement, and mis-attribution are highly prevalent in the Colorado system but interestingly, these errors almost universally are to the benefit of employers and insurers. Physician incompetence is rewarded in the current system. 

The physician consultants who make their livings almost exclusively by "knocking out" workers compensation claims are despicable frauds who wither in the face of substantive criticism of their findings and opinions. They sell their signatures and can be counted on to reliably defend employers and insurers irrespective of the facts. I have never met one who wasn't a coward. The statements about the cost effects of Colorado insurers are basically anyone's guess. 

If treatment of injured workers is made more mainstream, long waiting periods between visits and an adversarial physician encounters will be eliminated. Access to real specialists will be facilitated. Patients tend to improve when their physicians advocate for them. 

The suggestion that workers compensation insurers work with employers to make employees safe is utterly vile. Pinnacol Assurance, acting in the light of Colorado legislation passed just after the Ludlow Massacre, sits on claims data that would identify workplace injury and illness hotspots. Its reaction is to advise employers how to make claims less likely rather than improve workplace conditions. 

Pinnacol does not interact with CDPHE, OSHA, or NIOSH. The idea that mileage payments for medical treatment would be eliminated under ColoradoCare is utter fiction. 

The claim about lower priority in subrogation cases is a little complicated but understand that Pinnacol currently has a mechanism to cost-shift cases from workers compensation to Medicaid and has never had to face a subrogation claim from HCPF. 

Administrative judges employed by DWC/CDLE settle many open workers compensation cases with unresolved medical issues by allowing unrecorded side agreements between the parties that direct workers to get further care from Medicaid. 

Pinnacol is already getting away with metaphorical "murder" in the area of subrogation and doesn't have a valid complaint or concern. 

Mike Grabell of ProPublica has written a great series on the deterioration of the social safety net that is workers compensation. (e.g. "Insult to Injury") I highly recommend it. The thrust of the article series is that workers compensation systems today exist for the benefit of employers and Mr. Kalin wants workers to believe that they should vote against their own interests.

Regarding the CHI report

There are two fundamental issues overlooked by Colorado Independent Health Institute and others. Colorado Care would be a fundamental shift from a profit driven health care system to citizen oversight of experts managing the system.   
Secondly, their belief that the system will go bankrupt is a false assumption. It fails to understand that our system is way overpriced, the most expensive health care system in the world that produces lower health outcomes than other developed nations. So the payment methods and significant negotiation for equipment, services and institutional care will, over time, lower the cost of care in the state. AND, gradually a shift toward more primary care and prevention and early intervention for all citizens will, in the long run, lower the cost of care. The focus will be more on primary care and less on high technology treatments that too often have limited benefit.  
A citizen board becomes, then, a serious cost constraint on a price driven system that is running out of control. Constraint is the word...without necessarily reducing the benefit of a refocused health care system away from high tech and expensive medical care. Health care, not just medical care.   
by Richard Passeth |Aug 8, 2016 | 6:20pm

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