Rosenberg: Fixing MPN System a Humanitarian Problem| Staff Compensation Information

By Daniel Rosenberg

Friday, April 23, 2021 | 0

WorkCompCentral posted a blog post by Workers Compensation Attorney Gregory Grinberg criticizing AB 1465, a bill that would expand access to health care through the creation of a nationwide network of medical providers.

Daniel Rosenberg

Ignoring Grinberg’s ad hominem attack on Senator Lorena Gonzalez, he argues that MPNs result in higher quality and lower cost, and therefore should be sustained without competition in the free market. The problem is that his points are empirically wrong: MPNs add costs to employers and result in poor medical care for their injured workers.

The California Workers’ Compensation Institute conducted a comprehensive study of MPNs and found that they produced savings of a negligible 2%. Those savings were more than offset by additional frictional costs for the system, a study by the Journal of Occupational and Environmental Medicine found. Worse still, a recent study by the Employee Compensation Insurance Ratings Bureau found that medical treatment delays, often due to the broken MPN system, are a major driver of downstream costs for employers. Injured workers who do not receive treatment within the first 30 days are 40% more likely to experience permanent disability.

In terms of quality, there are a handful of employer-run MPNs that rate care – and it may make sense to offer protection for them – but they are extreme outliers in the system.

The only criteria for participating in the majority of MPNs is willingness to accept the highest discount on the official medical fee schedule. Most MPNs do not create or maintain metrics on the quality of clinical care provided. Discharge from an MPN is rarely based on quality. Most of the time it is about requesting “too much” care or refusing to accept ever steeper discounts.

The California Society for Occupational Medicine and Surgery is aware of a medical practice that has filed a complaint with the Employee Compensation Department against a carrier for fraudulent audit activities. The DWC made the claim only to have the practice immediately removed from the carrier’s MPN for no reason. Another practice had an MPN offer to attend while doctors refused to offer psychological treatment. In another practice, an MPN forced its patients to fly across the state for medical care they could have provided themselves, all because the MPN offered a steeper discount from another provider.

In California, vengeful retribution, poor maintenance, and blackmail are inherent in the MPN system. To say otherwise means to be either ignorant or cruel.

The CWCI made waves earlier this week when it released a painfully lackluster report that concluded that AB1465 would result in higher costs. The analysis contained several shortcomings, including ignoring the previous own agency conclusions on the issue cited above.

In short, here are five reasons the CWCI report is wrong:

• “Time to initial treatment” was chosen as a measure of MPN health. This might tell us how quickly we seemed to have a broken arm on an urgent care visit, but it hardly tells us that injured workers have meaningful access to care. A detailed analysis would show workers wait months for care, operations take years, and patients are ripped off by their doctors and forced to drive or even fly hundreds of kilometers for treatment. I see it in our practice every day.
• There is no reason to believe that medical treatment without MPN will increase as there is a review of utilization regardless of the MPN of the injured worker. Economic profiling has not been shown to lower utilization (as if it were inherently better), and it is really just a socially acceptable word for blackmail.
• Contractual discounts, which make up most of the savings that the CWCI says will be eliminated, are obtained through contracts with payers rather than MPN. CWCI mixes apples and oranges. Certainly payers can find ways to entice vendors into offering discounts without their current Soviet control of the market.
• The CWCI does not analyze the economic externalities related to MPN. What legal costs, billing fees, disability payments, and lost wages are associated with an unchecked red tape the size of the California MPN? The number is staggering. Excluding its effects makes the analysis meaningless.
• The CWCI analysis of the validity of MPNs (whether they meet the access standard) is naive. The MPN lists are valued at face value without critical analysis. A closer look would show that MPN lists are being filled with people who are no longer treated in the system, are retired, have passed away, etc. I know because we called every pain management doctor in the state of California. We found that many of the largest MPNs contain 90% inactive doctors. One of the largest in the state has only seven active practitioners in all of California! CWCI says it is valid.

The CWCI believes that the DWC does not have the resources to maintain a status MPN. Ironically, this is the most compelling argument in favor of a government MPN. If the DWC cannot manage a turnkey MPN that already includes state regulated and licensed providers, then how does it manage thousands of indistinguishable shadow MPNs, many of which are simply shell companies with dreary mailboxes, and password-protected websites that no one has can access?

Obviously it is not – and has confessed so much. There is no real oversight of MPNs in California by the DWC.

These inefficiencies lead to delays in treatment and increased litigation. Both make the California employee company one of the most inefficient healthcare systems in the world. The creation of a state MPN results in lower costs across the system, including for employers who are victims of these abuses.

Grinberg rebukes: “… just cancel your MPN and have the applicants treated with the ‘doctor’ his lawyer has with a wink-nod-secret handshake contract.”

As if the wink-nod-secret handshake agreement with the insurance carriers were better. I’ll also remind him that the doctor doesn’t need quotes. We have schools and medical boards that regulate the profession.

The MPN system has become too large and complex to be verified. There are thousands of MPNs, each more disorganized and broken than the other, and there is no way to determine which one covers the injured worker or carrier. Employers rely on freight forwarders to curate networks of high quality, affordable providers. The networks have broken that trust, however, by pursuing short-term price cuts at the expense of long-term cost savings and ethical medical care.

It is time to enable access to care and let the free market deliver the efficiencies that insurance carriers want to avoid at the expense of your premiums.

Let’s not crush the words: repairing the MPN system is a humanitarian problem. A vote for AB 1465 is a vote for efficiency and human decency.

Daniel Rosenberg is Director of Revenue Cycle for Integrated Pain Management at IPM Medical Group and a member of the California Society of Industrial Medicine and Surgery.