By Maja Jurisic MD, AVP & Medical Director for National Accounts, Concentra
In 1911, Wisconsin became the first state to pass a statute enacting workers’ compensation. This was a compromise between labor and management. In return for limited liability, employers agreed to pay for reasonable and necessary medical care for a work-related injury or illness, as well as a predetermined percentage of wages and (if the injury/illness did not completely resolve) a lump-sum settlement based on the level of disability and/or impairment. Optimal functioning of a system based on compromise requires a fair measure of trust. The employee has to trust that the employer will pay: the employer has to trust that the employee will try to get better.
More trust is needed when you add other stakeholders to the mix. The injured worker has to trust that the payer will deal with him in a forthright way, and that the medical care being provided is of high quality. The employer has to be able to trust that the payer is responsible in approving only medical care that is reasonable and necessary, and that the medical care provider is competent, objective, and offering care that is vital for the work-related condition.
For the system to operate efficiently, the payer should be able to trust that the physician is providing only services necessary for the work-related problem, and that the injured worker is being a “good” patient. The physician should be able to trust that the employer and payer both care about the worker getting better, and that his patient is being truthful, as well as being compliant with the treatment program. Many of the issues and frustrations we see in the workers’ compensation system, and many of the administrative barriers to providing ongoing care are due to various stakeholders who don’t sufficiently trust each other to live up to their respective roles.
Some of this mistrust is born out of negative experiences. There have been employers who have cared less about their employee than about costs, payers who have dragged their heels in approving necessary treatment, injured workers who have exaggerated (or even invented) symptoms to further hidden financial agendas, and physicians who have ordered too many tests, done too many procedures and eschewed their role in managing the process of return to work.
Despite the reality that some individuals in each group have at times acted in bad-faith, I believe there is much to recommend keeping an open mind. Assuming the worst about other stakeholders a priori, and letting that assumption guide one’s interactions, can create an adversarial atmosphere. A climate of suspicion and cynicism makes it difficult for stakeholders to work well together, and bad outcomes become a self-fulfilling prophecy. If an injured worker believes the employer/payer don’t care, he might well think his only recourse is to hire an attorney, which data shows will likely increase the cost of the claim many times over. If the physician finds that his well-reasoned treatment plans are questioned and blocked at every turn by the employer/payer, he might well turn a deaf ear to their concerns. Positions on all sides become polarized and hardened, and the likelihood of poor functional outcomes increases.
The reality is that most injured workers do not have hidden agendas, most physicians are not trying to provide unnecessary care to increase their own revenues, and most employers and payers do not act in bad faith. Letting unhappy experiences in the 20% of cases that end up costing 80% of the work comp dollars govern our behavior in 100% of work comp cases does not serve any of us well. As Ernest Hemingway said, “The best way to find out if you can trust somebody is to trust them.”
About Dr. Maja Jurisic
After getting a BA with a major in history from Marquette University, Dr. Jurisic went on to Medical School at the University of Wisconsin in Madison, graduating in 1980. She completed an Emergency Medicine Residency at Wright State University in Dayton, Ohio, and was a partner in the emergency medicine group staffing St. Joseph’s Hospital in Milwaukee, Wisconsin from 1983 until 1991. Disenchanted with the endless recycling of social problems in the ER, she was thrilled to discover occupational medicine, where she can make a difference by helping patients renormalize their life after the disruption of a work injury.
She has been with Concentra since 1991. In addition to being board-certified in Emergency Medicine, Dr. Jurisic also became boarded in Occupational Medicine. She is an AVP and serves as the Medical Director for National Accounts at Concentra. She edited Concentra’s Clinician Manual (called Occupational Medicine Redux), as well as contributing 11 of its chapters. She serves on Concentra’s Total Care Medical Expert panel, and is the author of the chapter on patient education in the second edition of Low Back Pain (OEM Press).
Dr. Jurisic is active in the State Medical Society, serving on the Executive Council of the Occupational Medicine Section, and has been appointed by the State of WI Department of Workforce Development to the Healthcare Provider Advisory Committee to the Worker’s Compensation Advisory Council.
Concentra, a subsidiary of Humana Inc., is a national health and well-being organization delivering effective health care solutions with innovative technology platforms, patient-first focus and clinical excellence. As a leader in consumer health care services, the company offers an expansive destination for great medical care with primary and urgent care services, physical therapy, occupational medicine, and preventive care and wellness services. With its exceptional patient experience, more than 330 national medical centers, 270 workplace health clinics and direct-to the patient services, Concentra is improving America’s health, one patient at a time.