Physicians in several states are not taking any new workers' comp cases. Their complaints are many: low pay being the #1 reason, as well as high overhead and costs of treating injured workers, delays in dealing with Utilization Review companies, time and effort to fill out reports, regulatory burdens, etc.

Dr. Steven E. Levine, a Clinical Professor of Neurology at the David Geffen School of Medicine, UCLA, reports that state medical fee schedules based on a low-multiple of the Medicare RBRVS (Resource-Based Relative Value Scale) fee schedule correlate to low participation of neurologists and orthopaedists in workers' comp cases in those states, e.g., California, Texas, West Virginia, Florida, and Maryland.

RBRVS in a nutshell.  In a radical departure from basing physician payments on usual and customary charges, Medicare established a standardized physician payment schedule in 1992. Medicare assessed the resources required to perform tasks and calculated a relative value for all types of procedures, e.g., office visits, complex surgery, etc. The RBRVS includes adjustments for geographical differences in resource costs.

Cold hard facts for California. The Levine study indicates that 92% of orthopaedists and 80% of neurologists reported accepting workers' comp cases in 2002. But in 2007 these numbers dropped to 65% and 37%, respectively. Presently California has the second lowest workers' comp fee schedule in the country. At a recent annual meeting of the LexisNexis California Workers' Compensation Editorial Board, one consultant reported that over 50% of the physicians on the City and County of San Francisco Medical Provider Network list refuse to take workers' comp cases.

What it means. #1 – A decline in medical access for injured workers. #2 – Difficult to get physicians back into the workers' comp system once they leave.

Something's gotta give. Some states are going to the bargaining table with physicians. Hawaii, which used to have the second lowest payment schedule in the country, implemented a new system that allocated higher fees to surgery and other specialty care. The result? Hawaii moved up in the ranks and has now the 10th lowest payment schedule in the country, according to the Levine Study. Idaho physicians last year boycotted the workers' comp system when the state introduced a fee schedule for the first time. The result? After intense lobbying by the medical profession, the regulators increased fees.