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This workers' compensation 'reform' bill punishes workers, will worsen opioid crisis

Friday, February 2, 2018   (0 Comments)
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PennLive

 by George Rodriguez

 

This workers' compensation 'reform' bill punishes workers, will worsen opioid crisis

 

As lawmakers return to Harrisburg this week, they have an opportunity and I believe an obligation to reject a reckless proposal that will put an insurance claims manager between every worker injured on the job and his or her doctor - jeopardizing the care that millions of hardworking Pennsylvanians deserve.

Legislation sponsored by Senate Insurance Committee Chairman Don White, R-Indiana, calls for a dramatic change to the state's workers' compensation law by establishing a pre-approved list of prescription drugs - a "drug formulary" for every injured worker. It is now pending in the House Labor & Industry Committee,

Effectively, this means that the insurance companies can overrule doctors and deny workers the medicine that was prescribed by his or her physician. It's a cynical ploy by the insurance companies and large employers to cut costs and increase their profits at the expense of injured workers.

The fact that the bill was written, introduced and passed in four days without benefit of any meaningful public input should serve notice that the bill's backers know that it cannot pass the smell test of public scrutiny.

Medical decisions should be made by a patient's doctor - not a national panel or organization dominated by the insurance industry.

I have treated over 3,500 injured workers over the 28 years in my practice and know from first-hand experience that this assembly-line approach will jeopardize the care that injured workers deserve. This bill protects profits - not patients.

As a specialist in pain medicine, I know that our pain medicine academy has not been consulted on any component of this bill. This lack of coordination with specialty physicians is extremely suspect and can be catastrophic to patients in severe pain who are stable and in good hands.

This bill effectively creates a "one size fits all approach" to what should be individualized medicine. In this era of more individualized medicines becoming available, this is exactly the wrong direction to take.

There is no scientific research that supports formularies to control patients with chronic and debilitating pain. Period. Formularies are primarily driven by cost. Insurers fight for the cheapest treatment option available for their list of approved treatments.

It does not matter that one asthma drug, for instance, is more effective and necessary than a cheaper alternative. If that drug is not on the formulary - because it is too expensive - that firefighter is out of luck and must pursue an expensive and timely appeal process, no less than 60 days if she wins initially and up to 18 months to lose on appeals.

This appeal process introduces further litigation costs into the system while the patient must suffer, hope, and wait. Meanwhile the worker is living on a limited income - if her claim is even paying.

The bill's proponents have the gall to claim that this measure will help address our state's opioid crisis.

It does no such thing. Lawmakers should consider language that mandates education for and penalties against the handful of doctors whose prescription practices can lead to harmful addiction.

The fact is that the portion of the opioid crisis related to prescription medications has been accelerated by the rapid discontinuation of patients from being appropriately prescribed these medications after insurers reject valid claims.

Pain specialists manage the use of opioids and have protocols in place to wean patients off these medications. I see this deadly disease first-hand. I do not need a faceless panel of "experts" to tell me how to treat patients.

Our doctors use routine urine drug screens and the Pennsylvania Prescription Drug Monitoring Program - not a cost-driven playbook written by people who have no idea what my patients need.

The question, really, is how much profit do these special interests have to make at the expense of Pennsylvanians injured on the job?

Lawmakers need to remember that, under current law, injured workers have surrendered their right to sue in exchange for a system that provides for wage loss and medical benefits. This legislation cuts at the heart of that bargain and would undermine a system that works.


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