Doctors demand WorkCover review

AMA
21 October 2010.


Patients injured at work could face greater difficulty finding a doctor to treat
them unless the WorkCover scheme undergoes a major shake-up, an
AMA Victoria survey reveals.

"A number of doctors have already stopped seeing WorkCover patients," said
AMA Victoria spokesperson and orthopaedic surgeon Dr Gary Speck.
"A larger proportion will stop treating WorkCover patients over the next
few years unless things improve."

The AMA Victoria survey shows doctors are frustrated with the insurer’s
red tape, poor processes and inadequate reimbursement of fees for patients.

"WorkSafe’s claim and treatment approval process can be long and
complicated so patients are forced to wait longer than necessary for treatment,”
Dr Speck Said. “This inevitably leads to poorer outcomes. It also puts
psychological pressure on the patient and delays their return to work."

According to an independent study of return to work trends, the number
of patients who were out of work six months after their claim has increased
by one third – from 23 per cent of patients in 2005-06 to 31 per cent
of patients in 2008-09.

Dr Speck said doctors encountered an enormous amount of red tape
when treating WorkCover patients. "There are often lots of hiccups along
the way, particularly when the insurer questions whether your recommended
treatment is best for your patient.

"Doctors want to look after their patients not manage their insurance claim."

A 2007 independent review of Victoria’s accident compensation legislation
undertaken by QC Peter Hanks recommended a review of WorkCover fees
and return to work initiatives as soon as possible. However the Victorian
Government dismissed the recommendation, saying it did “not consider a
comprehensive review of fee schedule is warranted at this time".

AMA Victoria’s survey respondents demanded a review of fees, along
with payment for telephone consultations and improved return to work initiatives.

To cover costs, some doctors said they were considering charging WorkCover
for paperwork. Others would begin billing patients directly and leave
WorkCover to reimburse the patient.

"The Victorian Government and Opposition must ensure action is taken to
improve return to work initiatives and patient rebates to ensure Victorians
injured at work have timely access to medical care," Dr Speck said.


BACKGROUND

AMA Victoria’s October 2010 survey involving 332 doctors found:

15.5% of respondents no longer see any WorkCover patients

38% spend less than 3% of their time on WorkCover patients

89.2% of respondents believe the payments offered by WorkCover are
inadequate for treatment, paperwork and telephone consultations with
WorkCover agents

47.2% say the payment is significantly less than for other patients

97% were disappointed that the Government rejected the Hanks
Review recommendation for an independent review of WorkCover
fees and return to work initiatives, saying an independents review of
fees and return to work initiatives would be welcomed

40.7% believe a more realistic fee schedule would improve access for
WorkCover patients

47.5% say a more realistic fee schedule would improve access if the
paperwork and administrative issues were also addressed

85% would see more WorkCover patients if they were paid the AMA
fees list or the AMA fees list plus a paperwork/telephone allowance

In response to WorkSafe’s red tape requirements, almost half (48.7%)
think they should charge WorkCover for the additional time on paperwork

84.9% say the best way to deal with WorkSafe’s request for information
by phone is to charge WorkCover for the time taken on phone calls or
ask WorkCover to put their request in writing and charge for the report

If WorkCover rebates don’t rise sufficiently over the next few years:

54% would see fewer WorkCover patients

48.1% would charge patients privately and ask WorkCover to reimburse
 the patient

30.8% would charge WorkCover directly for the additional bureaucratic
requirements