CalChiro Workers’ Comp Lobbyist Steve Cattolica Update
June 16, 2021
First, I would like to thank CalChiro for allowing me to join the team. With more than 30 years on both the provider and payor side of California’s work comp system – the last 17 here in Sacramento representing physicians that treat and evaluate injured workers – I look forward to contributing to growing the contribution chiropractic can bring to a health care delivery system that is in desperate need of transparency and accountability.
While 2020-21 opened with several bills that had the potential to improve health care delivery, predictably most are on the side lines dead or as two-year bills. Last year’s audit of the Division of Workers’ Compensation (DWC) provided much-needed third-party substantiation of charges that the DWC was illegally headhunting the corps of Qualified Medical Evaluators while giving short shrift to many more important oversight responsibilities such as updating the Med-Legal Fee Schedule (MLFS) and proper oversight of Medical Provider Networks (MPNs).
With the MLFS update now active, the DWC recently turned its attention to the underlying requirements that must be met to become a QME and maintain the privilege. That regulatory package is in active development with the promise of an upcoming public stakeholder meeting soon, with the stated goal to refine, if not finalize, language that promises to lessen the burden for Chiropractors to become QMEs, but slightly increase the requirements for M.D.s, PhDs and others. Administration of the QME test as well as its content is also “under construction.” Most important are new provisions meant to improve the overall quality of reports. Some form of mandatory and non-punative “third party” critiques of reports by retired judges, especially of reports from the newest QMEs, will likely become part of that process. Delivery of continuing education courses and the QME test itself will also benefit from upgrades in the technology and methods as well as the curriculum itself.
Look for an announcement of that DWC stakeholder meeting and plan to either listen in, provide constructive comment during that meeting or both!
More important than all of the above is the increasing pressure CalChiro is applying on MedRisk as a result of our ongoing lawsuit. We are now very close to being in the position to hold MR feet to the fire regarding illegal contracting methods, illegal incentives regarding patient referral, illegal interference with delivery of approved plans of treatment and illegal reimbursement processes meant to enrich the network rather than provide good care for injured workers. More on this in the coming weeks.
Please do not hesitate to contact me through CalChiro if you have any questions regarding the work comp aspects of your practice. I will be glad to do what I can to help you!