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Reform urged
for workers’
comp fees
A 1995 law ties workers'
By Helen Altonn
compensation medical fees to
Medicare rates, too low
for most physicians
Star-BulletinA 10-foot fall from a ladder while descending into a tank at a city waste-water treatment plant plunged Kerry Shannon into a Hawaii medical-fee crisis.
His accident after 15 years as a city employee resulted in five operations over two years, including a bone graft and removal of his kneecap, Shannon said.
He said he was fortunate to find a doctor willing to take his case. But he has been unable to find a neurologist willing to treat his neck injuries because of low workers' compensation fees, he said.
Shannon said he takes medication daily, including "anti-inflammatories, painkillers and something for migraines," which he has six or seven days a month from compressed vertebrae.
"That's why I have to get a neurologist. I tried a couple of doctors and they said, 'Nope, because it's workers' compensation.'"
Hawaii medical organizations, physicians and injured workers are urging legislators to change a 1995 law that ties workers' compensation medical fees to Medicare rates, plus 10 percent.
"In one fell swoop, that decreased our fee schedule by 54 percent," said Dr. Ron Kienitz, chairman of the Hawaii Medical Association's workers' comp committee.
Hawaii fell from the second-highest workers' compensation medical fee schedule in the country to one of the five lowest, he said.
"It's absolutely unconscionable," said Kienitz, an occupational medicine physician.The situation "has not only driven good doctors from our state, it has robbed hard-working people of the ability to get better quickly and return to work."
Hawaii's medical groups for five years have tried to get workers' comp fees detached from Medicare, which is designed for seniors and has suffered declining reimbursements until a one-time increase this year.
The medical profession is urging adoption of the federal workers' compensation fee schedule, proposed in Senate Bill 2245.
Sen. Bob Nakata (D, Kahuku-Heeia-Kaneohe), chairman of the Senate Labor Committee, said he has asked for information to determine the impact on insurance premiums so his committee can act on the bill tomorrow. If passed, the bill goes to the Ways and Means Committee.
"I do want to get something out," he said, adding that it "makes some sense" to break workers' comp fees away from Medicare. "It is a different population."
Among those opposing the measure at a recent committee hearing were the state Labor Department, the city, the Hawaii chapter of the Society of Human Resource Management, and Argonaut Insurance Co. They argue that changing the law would cause confusion, increase workers' compensation and motor vehicle insurance premiums, and destroy part of the 1995 workers' compensation reforms.
State Labor Director Lorraine Akiba proposed setting up an advisory committee to review the issue, as recommended in a 1998 Legislative Reference Bureau report.
Medical groups see this as a delaying tactic by the state government -- Hawaii's largest employer. "The state is saving a lot of money by getting something for nothing, and the injured worker is being harmed by this," Kienitz said.
The Legislative Reference Bureau study two years ago showed "the injured worker is the one caught in the middle and not receiving care that is always accurate or always timely or top-notch," he pointed out.
The study found that 75 percent of physicians polled were limiting workers' comp patients because of the low fees and that 65 percent of physicians in practice more than six years were not taking any injured workers.
The report recommended raising the medical fees to 25 percent to 35 percent above Medicare rates.
Dr. Linda Rasmussen, with the Windward Orthopedic Group, said the 1995 fee schedule was aimed at curbing escalating workers' comp costs. But it is "totally not fair" to tie care of injured workers to rates based on treating the elderly, she said.
The federal fee schedule is about 35 percent higher than Medicare, she said, adding, "I'm now taking about $20 out of my pocket for every patient I see."
Many doctors and physical therapy clinics have closed their practices or left the state because they couldn't afford to treat injured workers, she said.
Up to 1995 the chiropractic profession was growing with 340 practicing statewide, said Dr. Gary Saito, executive director of the Hawaii State Chiropractic Association. The figure dropped to 210 by 1998, and others made modifications to survive, he said.
Dr. Derrick Ishihara, president of the Independent Physical Therapy Network of Hawaii, estimated that 15 to 20 of the state's 50 to 60 independent physical therapy clinics have closed. Therapists with more than one clinic had to consolidate and lay off staff, he said.
Kienitz said roughly 18 out of 40 orthopedic surgeons have left their practices or the state.
Dr. John Smith, retired orthopedic surgeon and chairman of the Department of Orthopedic Surgery at the Queen's Medical Center, said he cannot find orthopedic surgeons to see workers' comp and no-fault patients.
"These patients call me at home in tears, and I feel bad that I am unable to find anyone to assume their care. However, I can't blame the doctors, given the inadequate reimbursement."
