The concept of a statewide MPN (Medical Provider Network) is dead for the foreseeable future.
The California Medical Provider Network (CAMPN) was originally proposed under Assembly Bill 1465, sponsored by California Assembly members Eloise Reyes and Lorena Gonzalez. The proposal would have required the California Division of Workers' Compensation to build out a statewide physician network which injured workers could have accessed as an alternative to the MPN used by their employer or employer's insurer or TPA.
The impetus for the bill? For years applicant attorneys have cited anecdotal problems with obtaining treatment for workers under MPNs.
The AB 1465 proposal came under heavy fire from employers and insurers. An April 2021 study by the California Workers' Compensation Institute (see link below) raised questions about the need for the proposal and the feasibility of it. CWCI claimed that based on its data, the time to initial medical treatment for injured workers covered under MPNs was not significantly different than for non-MPN claims. Moreover, CWCI claimed that based on its data, geographic access to treatment was not significantly different for workers under MPNs when compared with workers not covered by MPNs.
CWCI estimated the costs of the CAMPN at over $300 million.
Lacking sufficient support for the original proposal, the authors amended AB 1465 into a “study bill”.
Under the current version of AB 1465 (see link below), CHSWC would commission a study of MPNs, to be submitted to the Legislature on or before January 1, 2023.
Although the bill does not specifically require it, the following are some relevant questions which I believe such a study should examine:
• How well is the current provision for “Medical Access Assistants” performing? Is this being widely used, and could that provision be improved?
• How well is the DWC policing the MPN networks under the current law? Are workers ands attorneys using current complaint procedures, and what difficulties exist in current enforcement?
• Why do injured workers and applicant attorneys find that so many doctors on MPN network lists are either not taking any workers' comp cases at all or are very limited in which cases they will take?
• How are MPN provider lists being assembled, marketed and sold?
• Are billing discounts being forced on doctors, and if so how? How is this affecting doctor participation in networks?
• Does do bill review software and bill review companies engage in any practices that are discouraging physician participation in networks?
• “Economic profiling” many be legal, but how is it actually being done, and are there abuses which discourage physician participation or which harm worker medical access? How are insurers using data to do economic profiling?
• Do other states use statewide physician networks, and what are the advantages and disadvantages they have found?
As of May 11, AB 1465 would require the CHSWC study address the following:
“At a minimum, the study shall include all of the following:
(1) An examination of injury claims in which a worker was treated by a medical provider network compared to injury claims in which a worker was treated by a provider who is not part of a medical provider network to determine the length of time between injury and initial treatment in the two systems and the reason for potential delays before workers receive initial treatment.
(2) An examination of injury claims in which a worker was treated by a medical provider network compared to injury claims in which a worker was treated by a provider who is not part of a medical provider network to determine the frequency and causes of delays after a worker receives initial treatment.
(3) An examination of injury claims in which a worker was treated by a medical provider network compared to injury claims in which a worker was treated by a provider who is not part of a medical provider network to determine the distance, in miles, between the injured worker and the treating provider, including primary care physicians and specialty physicians.”
Here is the link to information on the current version of AB 1465:
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