As a physician who specializes in helping workers injured on the job, I know exactly how hard it can be for patients to recover from physical trauma in the workplace. Every patient’s situation is different and requires a specialized approach based on years of education, training and experience. That’s why I am completely opposed to legislation that is currently being considered in the Pennsylvania House of Representatives that would make it harder for doctors like me to help injured workers recover.
State Rep. Ryan Mackenzie, a Republican who appears to be in the pocket of the insurance industry, is pushing House Bill 18 on the premise that it will reduce costs in the Workers’ Compensation system. However, the true impact of the bill would be to limit the menu of options available to doctors who are trying to help injured workers get back on their feet. It’s just bad public policy, period. Lawmakers should do the right thing and prevent this bill from becoming law.
The legislation is supposed to reduce costs by limiting the types of drugs that doctors can prescribe to patients who are part of the workers’ compensation system. This is a bad bill, plain and simple.
Doctors will be required to use a pre-approved formula to determine which drugs would be eligible to be used to treat patients. However, we have no idea who would be responsible for deciding which drugs would be approved as part of the formula. Instead of a panel of medical experts who care about patients, it will be a bunch of representatives from insurance companies and pharmaceutical manufacturers. These are the kinds of people who only look at the bottom line instead of the best path for a patient to recover.
This bill would be a barrier for doctors who are trying to treat their patients. For example, it’s not clear how the formula would be developed or who would ultimately decide what factors would be considered. Would it simply be cost-driven? Or would the panel that will make the decisions also weigh the effectiveness of various kinds of treatment? Will it be a patient-centered process or one driven by often-heartless insurance companies? It seems pretty likely that the insurance industry executives pushing House Bill 18 have the latter in mind.
I am also very concerned about the lack of oversight in the bill. The Legislature could vote to make this sweeping change, but not have any real idea how it’s working out in the real world. This is because the panel created by the bill is basically accountable to no one. As a doctor, I am outraged by the idea of turning over critical medical decisions to an unelected group of bureaucrats. There is simply no way to ensure that this doesn't happen in the legislation, meaning there is no way to fix the bill – it must simply be defeated.
Another huge issue with this legislation is the appeals process. If I disagree with the rigid formula and want to prescribe a certain type of medication to a patient that isn’t covered, I would have to go through a burdensome process with an uncertain outcome. Meanwhile, my patient would not receive the care they need. Our health care system is already complex enough – we don’t need to make it even more difficult for doctors to treat people with serious injuries. Frankly, this could result in the legislation having the unintended side effect of actually raising health care costs in Pennsylvania. Again, there is no way to fix this – the bill is bad to the bone.
Ultimately, this bill is likely to do nothing to reduce costs associated with workers’ compensation. Instead, it will be a tool for insurance companies to deny the treatment that patients need. That's completely outrageous since workers agree to give up their right to sue employers in exchange for high-quality medical treatment as a part of the “grand bargain” of Pennsylvania’s workers’ compensation law. This bill would go back on that promise.
Doctors are required to go through years of education and training to develop the expertise required to do our jobs. We know that every patient is different and needs a personal approach to recovery. The proposal contained in House Bill 18 represents unnecessary interference in medical care that will ultimately reduce the options available to treat injured workers.
House Bill 18 is currently awaiting a vote in the Pennsylvania House Labor & Industry Committee. Hopefully, lawmakers in Harrisburg will come to their senses and vote down this counter-productive legislation.
Dr. Gene Levinstein is a physician who specializes in treating injured workers. Learn more about Workers’ Compensation issues at PAWorksNow.com.