House to Debate HF 530, the Doctor Shopping Bill

Next week Democrats intend to pass a bill that upsets the careful balance in workers’ compensation struck over the past 96 years. The bill reverses the current system that allows an employer to choose care for injured workers, and instead places the choice of doctor in the employee’s hands. This will destroy an employer’s opportunity to contract for health care and thus will raise insurance premiums greatly. This move will wipe out Iowa’s optimal position as a high benefit low insurance premium state.

The bill, HF 530, provides that an employee may select their own doctor by having that doctor on file with the employer. The doctor need not be a specialist or occupational physician, and any referral to such a specialist must be paid for by the employer. Currently employers can send injured workers directly to the appropriate specialist thus avoiding the cost of the referring doctor. Under the bill, the added step of referrals and the inability of employers to contract for health care will drive up the cost of care and thus raise workers’ compensation insurance rates.

This bill attempts to “fix” a system that is not broken. Employees already have a procedure to request a change of doctor and in the overwhelming majority of cases such requests are granted. However most workers never feel the need to request alternative care. Less than two percent of those treated for work related injuries ever request alternative medical care.

Iowa workers already enjoy the highest maximum benefits of any state in the Midwest. Iowa’s rate of $1,206 per week outstrips the next highest performer, Minnesota, by $456 per week, and is far ahead of Nebraska, Illinois, South Dakota, Kansas, Missouri, and Wisconsin. In fact, Iowa is ranked third nationally, behind only the District of Columbia and New Hampshire.

Despite these high rates Iowa still enjoys very low workers’ compensation insurance rates. Iowa ranked 41st highest in total premiums in the 2008 edition of Oregon Workers’ Compensation Premium Rate Rankings. The impact of HF 530 could be staggering to Iowa’s rates. In 2007, the National Council on Compensation Insurance (NCCI), the national manager on insurance data, estimated that the elimination of employer directed care in Iowa would increase premiums by up to $93 million per year. This doesn’t even include the impact on self-insured employers or state and local government.

Independent research into this subject has revealed that employees choose a provider based on familiarity rather than expertise. The result, according to the independent research group Workers Compensation Research Institute (WCRI), is an increase in medical payments, higher indemnity benefits, lower odds of returning to work, and increased time out of work.

In light of these facts, one must question what the goal of this legislation is. Increased costs and decreased service cannot possibly be beneficial to Iowa workers. Not to mention the severe blow to Iowa’s already bad business climate.

  • Chris

    If Federal employees can have choice of doctor, and several surrounding states allow it, then we should too.

  • Jim

    Chris ; What do you think the procedure to request a change of doctor as stated above means.

  • Corey Blackledge

    Please do not try to fix something that is not broken, however, all of these issues need to be conveyed to Iowans before an official vote is made. I would not have heard of this unless I was actively looking.

  • Dr. J

    Part of the aspect of HF 530 has advantages to me and my office since we are the only clinic in town.

    However part of me has concerns about this bill. Imagine if the injured worker decides he or she wants to go to an Ivory Tower for their treatment. Should the business be required to pay for treatment and evaluation if the local employee decides they want to go to the Mayo Clinic, the University of Iowa? The Clevland Clinic in Ohio? Should the business be required to pay if the employee decides to go to Doctor A for the first visit, then Doctor B for the second visit, and perhaps Doctor C on a third visit? Most employers have contracts with doctors so that injured employees get a pass to go to the front of the line, and not wait for an appointment. How much time off will occur while a patient waits one week or more for an appointment with “their” doctor? Often times the guiding principle for most business transactions is that who ever pays the bill has the ability to choose who they hire for a job.

    Ethical guidelines of physicians dictate that our first responsibility to a patient, is to that patient, regardless who is paying the bill. I really think the number of times that there is a gross neglect of this duty to the patient are truly few and far between. And the employee always has the right to request a second opinion, as does the employer.