N.D. doctors are critical of WSI

BISMARCK — North Dakota doctors described to legislators on Thursday a state workers’ compensation system in which their medical care decisions are often interfered with by non-medically trained bureaucrats and in which the paperwork and low reimbursement is not worth the trouble of seeing injured workers.

One physician wrote that the state Workforce Safety and Insurance agency “send(s) patients to us for evaluation and direct us not to make any recommendations” because to do so makes it more difficult for WSI to deny appropriate services.

The doctor wasn’t named in the written testimony presented to a legislative panel by the North Dakota Medical Association.

Other doctors from specialty practices said they are second-guessed by WSI doctors who have no specialized training in that area of medicine, that their WSI patients have been treated unfairly by WSI and subjected to “unreasonable fraud (accusations).”

Also in the medical association’s testimony: “A large health system reports that WSI has ‘lost or misplaced’ nine batches of claims submitted over the past two months.” It was not identified.

The testimony was to the Legislature’s interim Industry, Business and Labor Committee, which met at the Workforce Safety and Insurance offices. The committee ran short of time so the medical association’s executive director, Bruce Levi, did not read the testimony in full.

The testimony came the same day that the second of two recent consultants gave reports to the WSI board and the IBL Committee praising WSI claims processing and dismissing frustrations doctors have with newer systems of evidence-based medical care decisions.

A Bismarck physician who testified over the phone said about half his partners in his practice have quit taking workers’ compensation patients because of extra time and paperwork required to defend their treatment decisions. Dr. Troy Pierce, an orthopedic surgeon at the Bone and Joint Center, said, “If Workforce Safety is sending workers to us, they need to trust our judgment and not constantly question our treatment and get into a situation where the treatment algorithm gets interrupted.”

Pierce said WSI non-health care workers, “like secretaries,” are making decisions and “sometimes we feel we really have to fight to get the patient taken care of.”

Committee Chairman Rep. Rick Berg, R-Fargo, asked if it would help if WSI were to organize a preferred provider system.

“Absolutely. It would go a long way,” Pierce said.

North Dakota doctors also say WSI should pay the same as other insurers such as Blue Cross Blue Shield of North Dakota.

WSI recently increased doctors’ reimbursement but it was paltry, doctors testified. The Medical Association’s House of Delegates passed a resolution last year saying, in part, “Whereas the WSI Board of Directors recently approved a premium dividend credit for 2007-08 (for employers) estimated to reduce WSI reserve funds by $69 million, the recent … changes in the proposed fees for physicians will amount to reimbursement increases statewide of less than $1 million.”

WSI’s reserves stand at $1.25 billion, 168.8 percent of its estimated unpaid loss liability, or $171.5 million over limit set by state law.

Henry Neal Conolly, a consultant who studied WSI’s practices and presented his report Thursday, defended the recent WSI practice—backed up by a recent state law—of relying on guidelines built on “objective medical evidence.” It has caused, nationwide, some controversy because it upsets the traditional practice of medicine, he said.

While WSI can’t ignore the injured workers’ own physicians’ conclusions, “we will not say the treating doctor is presumed to be right,” Conolly told the WSI board and legislators.

Janell Cole works for Forum Communications Co., which owns The Dickinson Press.

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