THE OUTLIERS

A few doctors doing an outsized share?

Where have we heard this before?

In 2010 CHSWC taught us that 3.9% of QMEs, often with sham “offices” in dozens of zip codes, were conducting 40% of evaluations :
http://www.dir.ca.gov/chswc/Reports/2010/QMEstudy.pdf

That’s a supersized share.

Now, courtesy of a CWCI study, we learn that the top 10% of doctors who prescribe Schedule II opioids for injured workers in California account for nearly 80% of all workers’ comp prescriptions for these drugs.

That’s a supersized share.

The CWCI study claims that these Schedule II opioids (such as oxycodone, fentanyl, morphine and methadone), are being prescribed for even minor back strains and orthopaedic sprains.

Expensive, addictive, and potentially lethal, these drugs are said to be prescribed more often and in more potent quantities by the most frequent prescribers.

It’s a topic that makes me uncomfortable. I’m seen a couple of clients wreck their lives through their pain cocktails. At least one overdosed.

The study, by CWCI researchers Alex Swedlow, John Ireland, and Gregory Johnson, can be downloaded in pdf format here:
http://www.cwci.org/research.html

Longtime comp system vet Bill Zachry of Safeway charged in an e-mail blast that
“…the abuse of opioids is just a tip of the iceberg. Opioid abuse is part of a larger problem that a relatively small group of physicians and applicant attorneys perpetuate in Southern California. It is my understanding that this small group of physicians and attorneys also account for many of the Southern California medical treatment liens for treatment that was not performed in accordance with evidence based medicine and that was provided outside of the Medical Provider Networks.”

Zachry went on to opine that
“it is my opinion, that due to the massive profits that they get from self-dispensing, there is an inappropriate financial incentive for doctors to do the wrong thing, and, as a result, they are destroying the lives of injured workers.”

Zacrhry did not note it in his e-blast, but a recent RAND study noted that financial incentives may be playing a role in increased dispensing of controversial “medical foods” and “nutriceuticals”, particularly in Southern
California.

These developments will not make for appealing headlines for injured workers, attorneys and their friends in the medical community.

Outliers, be they be outsized QME mills or Dr. Feelgood pain-med prescribers, will come under increased scrutiny.

No amount of convention schwag or limo rides to the after-party should blind those in the system to what is going on. Abuses can kill the golden goose. We know that from past experience.

Zachry suggests that the best ways to stop opioid abuse is through a workers’ comp prescription formulary and through limiting dispensing out of physician offices.

Among Zachry’s suggestions:
-payers can achieve some limits by a “carefully crafted MPN contract”
-that employers and carriers have a pharmacy network with a formulary

More on those concepts in the future. Stay tuned.

Julius Young
www.boxerlaw.com
www.thecompguys.org

Category: Medical treatment under WC