In California Workers’ Compensation, an Injured Worker’s treatment for their industrial injuries is limited. Insurance Companies limit the treatment by the employment of Managed Provider Networks (MPNs) which dictate the providers that an Injured Worker can use. Kaiser Permanente is a Medical Provider in the State of California which provides both treatment for Injured Workers as well as providing non-industrial Managed Care in the form of Health Insurance.
Many Employees in California rely upon Kaiser Permanente to provide their general health coverage. Some of these Employees have been Kaiser members for decades. Some of these Employees, in the event of an industrial injury, prefer to treat with Kaiser. They are comfortable with the facilities, they know that their providers have all of their medical records, and they have some faith that they will be fairly and respectfully in treated by Kaiser with respect to their industrial injury.
This article will discuss Kaiser Permanente and its Occupational Medical Program called Kaiser On-The-Job.
What is Kaiser Permanente (Kaiser)?
Kaiser is a Managed Care Institution. Kaiser provides Health Care Plans for Employers, Individuals, and for Medicare Recipients. Also, Kaiser provides Occupational Care for Work Injuries. Kaiser Permanente is frequently listed as a Medical Care Provider for many Managed Provider Network Plans or MPNs
What Occupational Services Does Kaiser Provide?
Kaiser has a Department called Kaiser On-The-Job. This Department provides medical treatment for workers’ compensation injuries. In addition, the Department provides for Medical Evaluations, Screening and Monitoring, Drug and Alcohol Testing, and Immunizations.
- The Medical Evaluations provided can include Pre-Placement and Post-Offer Examinations, Fitness for Duty and Return to Work Examinations, and Department of Transportation and Department of Motor Vehicle Examinations.
- The Screening and Monitoring services provided include Respiratory Clearance, Asbestos Evaluations, Lead Surveillance, Hazardous Waste Worker Evaluations, Firefighter Examinations, and Hearing Conservation.
- The Drug and Alcohol Testing provided can include Urine Specimen Collection and Breath Alcohol Testing.
- The Immunization Services provided include immunization for Hepatitis A & B, Tetanus, Diphtheria, and Pertussis.
Per Kaiser, “On-the-Job” provides: specialized care for work-related injuries, skilled physicians who are board certified or board eligible in occupational medicine or a related specialty, urgent and after-hours care available 24 hours a day, every day at many locations, coordinated clinical services, including physical therapy, radiology, specialty care, and pharmacy, and onsite staff who works with you, your employees, and any medical or insurance providers.”
They note that “[m]any of [their] dedicated occupational health centers are located on Kaiser Permanente hospital campuses, so it’s easy for ..employees to take care of their health needs in one trip.”
Further, the Kaiser promotes “On The Job” as “Cost savings — Employees in [their] care get back to work faster and at a lower cost; Available to all …employees — All of your employees [at a company for which Kaiser is a provider], not just … Kaiser Permanente members can access [their] occupational health services; Support for [the employer] throughout the process — [they will] get timely reports on employee work status, and we’ll work closely with you to coordinate … employees’ appropriate return to work. One-stop convenience — Nearly all of [Kaiser “On The Job”] centers are located in or near clinical facilities, offering convenient access to specialists, pharmacy, X-ray, physical therapy, and more; Advanced health information technology — Caregivers have real-time access to the electronic medical records of Kaiser Permanente members, helping them make quick, well-informed decisions that improve outcomes; and Culturally responsive care — Members receive care that respects their diverse.”
Why Do Insurance Companies Employ Kaiser in Their Managed Provider Networks?
Insurance Companies utilize Kaiser for many reasons. First, Kaiser is a Managed Care Facility. As a result, Kaiser has been able to promote itself as a “cost-saving” provider. They refer to various studies as proof of that assertion.
Note: As an advocate for Injured Workers, the term “cost savings” concerns me. Cost savings can be achieved by various means which are to the detriment of an Injured Worker. This can include the denial of treatment, the premature return of the employee back to their usual and customary occupation, the issuance of medical reports which do not support an award of permanent disability, the failure of the doctors to refer the injured worker out to address all work-related conditions, and the failure to award the he need for future medical care.
Kaiser asserts that they achieve this goal by following “state-mandated fee schedules, relying on an outcomes-based strategy to manage claims costs. Elements of this approach include: Integrated care — [their] occupational health physicians, nurses, care coordinators, and therapists are connected to the same electronic health record system. Real-time access to medical records means they can make well-informed decisions faster for better outcomes and higher patient satisfaction. Convenient locations — Many Kaiser Permanente On-the-Job facilities are located at or near [their] medical offices and hospitals. This means employees — even those who aren’t Kaiser Permanente members — can get the care they need quickly, so they can return to health and to work as soon as appropriate. Coordinated case management — Kaiser Permanente On-the-Job keeps employers informed with regular work status reports, and works with them to help ensure employees return to work appropriately.”
In the study they cite that they have be able to reduce costs per claim, medical costs per claim, average pharmacy costs per claim, fewer claims involving litigation, lowering medical costs for low back injuries per claim and lower costs for shoulder and upper arm injuries per claim.
Note: As an advocate for Injured Workers, implied within these reduced costs are the denial of treatment, early return to work, the provision of less costly medications, the less advice by doctors to injured workers that they should get a lawyer, and possibly less sophisticated reporting and analysis of claims by treating doctors as to addressing all affected body parts. A more sophisticated analysis would allow for more permanent disability and medical care for the Injured Worker.
As a Representative of Injured Worker’s, How Do You Feel About Kaiser?
Kaiser can be both good and bad with respect to treatment for industrial injuries. Unlike other treatment arrangements, Kaiser employs a “gatekeeper” doctor to manage the treatment. This means that you are sent to an Occupational Medicine Doctor for your treatment. You are then reliant upon that doctor to refer you to various specialties such as an orthopedic surgeon or internal medicine doctor.
Kaiser does have nice facilities and has many diagnostic testing available at the facilities. Also, they have pharmacies at facilities as well. Therefore, there is a convenience factor for injured workers.
What If I Need Legal Advice?
If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases. Contact us today for more information. Click Here.