Best Wash. Docs Rewarded with Less Bureaucracy

Washington’s Department of Labor and Industries has removed a layer of bureaucracy for physicians who have an established history of recommending and performing surgeries that lead to injured workers recovering more quickly.

In a year-long pilot study with Qualis Health, the health-care-improvement organization that evaluates surgical requests for L&I, 111 surgeons no longer will have to receive prior approval from Qualis before operating on injured workers to repair shoulder, knee and carpal tunnel injuries.

Each of the 111 physicians participating in the study performed at least 20 surgeries on L&I claimants over the past two years. In that time, each provided the necessary documentation and justification for the procedure so that all surgery requests were approved by Qualis.

The pilot program and study began in July. If it is determined that the number of unnecessary surgeries doesn’t rise as a result of less oversight, L&I likely will expand the program to train and include additional physicians.

L&I-funded studies, conducted by the University of Washington, show that injured workers who get prompt and appropriate medical treatment tend to recover and get back to work more quickly. That results in lower workers’ compensation claim costs and less missed work. One obstacle to receiving timely treatment is unnecessary delays in authorizing procedures.

“Our primary goal, always, is to provide injured workers with the best medical care available,” said Dr. Gary Franklin, L&I’s medical director. “One way we can do that is by eliminating unnecessary paperwork and delays, and making life easier for physicians and medical staff who understand our system and provide appropriate care. If this pilot program proves successful, we hope to expand it to include more physicians.”

Qualis conducts approximately 60 reviews a day for L&I. About 40 of those are for outpatient surgeries. Some reviews take as little as four hours. Others, where adequate supporting data isn’t provided by the physician, can take a week or more.

“Qualis Health and the Department of Labor and Industries share a common mission to ensure that injured workers receive timely and effective care while eliminating unnecessary administrative burden upon physicians,” said Dr. Jonathan Sugarman, president and CEO of Qualis Health. “This study will assist us in testing new approaches to eliminating activities that do not add value and do not support the rapid delivery of high-quality care.”

This pilot program is but one project L&I has undertaken to improve medical care for injured workers. L&I also funds two Centers of Occupational Health & Education in Spokane and Renton.

A recent study of injured workers treated by physicians enrolled in the Renton center found that they recovered more quickly and had lower claim costs. The UW study estimated the Renton center had saved the state’s workers’ compensation system about $5.8 million in one year.