Advanced medical practitioners fill gaps, face barriers

The steady increase in nurse practitioners and physician assistants treating injured workers has helped fill gaps created by physician shortages, but most state laws still require physicians to meet the legal bar on injury causation and compensability, maximum medical improvement and disability ratings.

A report released Jan. 23 by the Workers Compensation Research Institute showed that the percentage of first-office visits with physicians decreased from 81% in 2013 to 60% in 2022, while the percentage of first-office visits with physician assistants or nurse practitioners — collectively dubbed advanced medical practitioners — increased to 22% from 11% and to 16% from 5%, respectively.

Such health care practitioners undergo years of study and hands-on training and are able to prescribe medications in some states.

Bogdan Savych, a senior policy analyst at Waltham, Massachusetts-based WCRI, said the effects on claims costs when comparing the engagement of advanced medical practitioners to physicians were minimal to none, while disability durations were slightly longer – five days on average. He said the longer duration is likely the result of claimants needing a physician to declare they have reached maximum medical improvement and/or are ready to return to work.

The pandemic may have caused a surge in the use of advanced medical practitioners, Mr. Savych said, but the trend predates the start of it by nearly a decade.

Teresa Bartlett, Southfield, Michigan-based managing director and senior medical officer at Sedgwick Claims Management Services Inc., said that despite some limitations under state laws regarding who can treat injured workers, advanced medical practitioners “bring prompt access to medical care,” which can help with claim trajectory.

Many physicians have on staff such advanced medical practitioners and work alongside them, she said.

Kate Farley-Agee, Chicago-based vice president of network product management for Enlyte LLC, said, “The majority of these types of providers are just taking some of the workload off of the (physicians)” — typically for claims that are not considered complex.

Many advanced medical practitioners can conduct follow-up care for physical therapy and can ensure the injured worker is getting access to the types of care they need, she said.

Ms. Farley-Agee said some states with extensive rural areas are loosening up the rules on what nurse practitioners and physician assistants can do in workers comp. Kansas and Nebraska, for example, have tweaked guidance, she said.

There’s also more acceptance of not having to see a physician for every visit, Ms. Bartlett said.

“The stigma around seeing a nurse practitioner or a physician assistant has turned a corner, especially with COVID, when we needed so many more practitioners in the space,” Ms. Bartlett said. “This is here to stay, and that’s a good thing.”

The American Academy of Physician Associates “has long advocated for the inclusion of (physician assistants) as healthcare professionals authorized to treat injured workers in workers compensation cases,” Tate Heuer, vice president of federal advocacy for the Alexandria, Virginia-based advocacy group wrote in an email.

“Excluding [such] healthcare professionals from workers compensation claims and treatment options creates unnecessary barriers to care, limits access (particularly in rural and underserved areas), and can lead to delays in treatment,” Mr. Heuer wrote, adding that physicians assistants undergo more than 5,000 hours of medical training across several specialties.