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James Cool
James Cool
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It’s the Network: How the Medical Provider Network is Changing Care for Injured Workers

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Based on reforms of a few years ago, California workers who are injured on the job are turning to physician networks. Both an insurance research group and the California Workers’ Compensation Institute show increased use of medical provider networks, or MPNs. An MPN is an entity specifically created by self-insured employers and insurers to treat injured workers. The use of MPNS was not allowed until January of 2005, but they are becoming more common in California. The reforms also marked a change for the duration of the employer’s involvement in a workers’ care. Before the reforms, employers typically controlled only the first month of injury. When a worker receives treatment under an MPN, employers can require injured workers to receive treatment through the MPN for the duration of their care.

Although some workers may feel that the MPN limits their choice of care, the goals of the MPN are fairly noble. Legislators allowed for the MPNs with the goal of containing costs, coordinating care, and improving efficiency. It seems that those goals may be reached, as MPNs continue to grow very popular among injured workers. A study by an insurance research group showed that “use of networks to treat injured workers rose from one in three first-year outpatient doctor visits for 2002 job injuries to nearly half of all visits for 2004 injuries — the first claims in which treatment in the initial 12 months could have shifted to MPNs. The rate rose to nearly 60 percent of doctor visits for 2005 injuries, and to 63 percent of the doctor visits for 2006 injuries.” The MPNs, like PPOs before them, have begun to play an increasing role in the medical services provided to those with worker compensation claims.

Some unions and workers have begun to formulate physician and medical networks as part of employment agreements and employment negotiations. When an MPN becomes competitive, it is the workers that may reap the benefits. When Liberty Mutual’s MPN was modified just last year, it was touted as a boon to employees. The modifications and increase of the MPN’s size was thought to create additional opportunities for local care. Some also argue that wider networks foster experience for doctors in treating occupational injury. While this may be the case, the Institute has yet to study just how satisfied workers are with the various networks at play in the state.

A year after the MPN was permitted in California, the use of doctor network doubled in size. However, the Institute has not included any data about whether or not the practice of permitting MPNs is encouraging doctors to stay in the state to practice.

Employers may provide an employee with an MPN Employees Manual or MPN Employee Letter at the time of hire, at the time of injury on the job, or at both times. It is suggested that even if you have not sustained an on-the-job injury, you may want to request this documentation from your employer and evaluate the MPN. If you work for an employer that offers group health insurance, you may be required to receive treatment from an MPN for the duration of your medical compensation claim. If you do not wish to be treated by the MPN, you can designate your own personal doctor to provide treatment. However, this has to be done in advance.