Physician shortages continue to hinder the provision of health care services overall, and for workers compensation patients industry protocols, regulations and the nuances of treating injured workers have contributed to the wider problem, experts say.

Solutions for the workers comp industry are as varied as the circumstances contributing to the challenges.

Some physicians are deterred from taking workers comp cases due to the complex claims process, associated bureaucracy and lower reimbursement rates, said Dr. Eddie Sassoon, Sunrise, Florida-based acting chief medical officer for Broadspire Services Inc.

The sometimes litigious nature of workers comp claims is also an issue, said Carey Armistead, Charlotte, North Carolina-based vice president of workers compensation claims for Sompo International Holdings Ltd.

Doctors treating work comp patients are “subject to forms and addendums to reports and potentially being deposed or called to testify. … The litigiousness of work comp has made providers shy away from taking work comp patients as a whole,” she said.

Pandemic-related burnout and doctor retirements, which have affected the overall medical community, have trickled into workers comp, said Jean Feldman, Tampa, Florida-based senior director of managed care at Sentry Insurance.

“People are taking another look at what they want to do and what they’re willing to do,” she said. “It’s a value proposition for doctors.”

Rich Ives, Hartford, Connecticut-based senior vice president of business insurance claim for Travelers Insurance Co. Inc., said provider shortages vary by geography.

Rural areas and regions where hospitals and other medical facilities have merged have been hit by shortages, especially when specialist care is needed, Mr. Ives said. “It’s gotten a little more challenging,” he said.

Specialty care has been especially problematic for comp, Dr. Sassoon said.

“A shortage of specialty doctors can result in increased time for appointments and also getting the treatment started and getting the patient progressed along the way and back to work,” he said.

Various legislative and regulatory trends are helping to mitigate the effects of shortages, such as changes to state laws to permit nonphysician providers to care for injured workers, updated fee schedules to entice doctors, simplified requirements to work in the comp system, reduced paperwork and streamlined care coordination, easier access to telemedicine, and networks that better enable insurers to work with providers (see related story below).

Fee schedules have risen in several states, including Florida, Texas and California, where regular increases are required by law, but the increases have been incremental.

One trend alleviating the pressure is the steady increase in advanced medical practitioners treating injured workers, a move brought on by legislation designed to help fill gaps created by physician shortages, experts say. The nonphysician practitioners undergo years of study and hands-on training and can prescribe medications in some states.

A January report 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 rate of first-office visits with physician assistants or nurse practitioners increased to 22% from 11% and to 16% from 5%, respectively.

Researchers say the trend is good for the workers comp industry, because it has not affected outcomes other than a slight increase in temporary disability. Most state laws still require physicians to meet the legal bar on maximum medical improvement and disability ratings.

State regulations can also deter doctors from treating comp patients, experts say.

As a result, states “are looking at what is being required at the state level to see what we can do to help keep the physicians engaged in workers comp and not wanting to leave,” Ms. Feldman said. She pointed to California, which recently reduced the number of forms required for workers comp providers.

Removing some authorization barriers to practice in workers comp is another trend to watch, experts say.

New York Gov. Kathy Hochul this year proposed universally authorizing all eligible licensed health care providers to treat workers compensation claimants. Current New York law mandates that only providers who are authorized by the state Workers’ Compensation Board may treat injured workers.

According to a statement issued by the governor, the shift would allow injured workers to see their primary care providers and “no longer need to travel long distances or seek treatment from an unfamiliar provider just because their medical issue is work-related.”

Telemedicine is a trend that surged during the pandemic and has not waned, with more states amending laws to allow doctors to interact more with patients, even from other states in some cases.

That shift in patient interactions has been “very helpful” for workers comp, Dr. Sassoon said.

“A lot of times, especially in cases where there are issues with distance, the follow-up care doesn’t have to be necessarily at the office if they can do a Zoom evaluation to get updates on their progress.”

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Doctor shortage

Workers comp insurers lean into data, physician networks to build relationships

Provider networks and data analytics are important resources in improving care and outcomes for injured workers in light of ongoing physician shortages, experts say.

The networks, often dubbed preferred provider networks, are a well-established cost-control mechanism in the group health sector and in workers comp and can encourage physicians to participate in the system by driving better coordination of care, they say.

Much of it falls under “provider engagement,” said Kate Farley-Agee, Chicago-based vice president of network product management for Enlyte LLC, which developed a portal for communication with doctors. “We have found that this helps us in a number of ways, not only just with (managing) provider shortages but solidifying those relationships with doctors.”

With networks, “we have a huge opportunity to engage with providers more directly and to help them through the workers comp process because every state is different and there are different forms that physicians have to fill out,” said Jean Feldman, Tampa, Florida-based senior director of managed care at Sentry Insurance.

The networks also provide opportunities to monitor results, said Rich Ives, Hartford, Connecticut-based, senior vice president of business insurance claim for Travelers Insurance Co. Inc.

They also help comp insurers identify doctors who don’t work well with the comp system, a concern for payers as the industry struggles with the shortages, he said.

“We leverage our own data in our own experience to identify those providers in our referral system that we have good experience with,” he said. “If we identify providers that are not providing good quality of care, and our experience is not good … we will remove those doctors. We want to make sure that the care that is in our network aligns with our overall mission and vision for providing good quality of care.”