Doctors who treat workers injured on the job may be in for fee raise

Friday, June 28, 2002 | 9:52 a.m.

CARSON CITY -- While physicians have been hit with big increases in medical malpractice insurance premiums, doctors who treat workers injured on the job may be in for a fee raise.

A new study, presented this month to the state Division of Industrial Relations, suggests an average increase of 15 percent to medical personnel and others who handle industrial accident cases.

The state division sets the ceiling on what insurance companies and HMOs can pay their providers. Division Administrator Roger Bremner has scheduled July 12 for a televised hearing between Carson City and Las Vegas to gather comments from those affected by the proposed increase.

After the hearing, Bremner said, the staff will discuss the testimony and make a decision on how much the fees should be changed and the effective date.

Arthur L. Baldwin III, an actuary for the Milliman USA of Seattle said there has been an increase in the last three years in the medical component of the Consumer Price Index of 13.9 percent.

In making its recommendation, Baldwin said the company looked at rates paid by private insurance companies, other state workers' compensation systems, Medicare and on reimbursement levels in Nevada.

Bremner said there are about 250 to 300 insurance companies licensed in Nevada to write workers compensation policies but he estimates there may be only 180 actually conducting business.

John Wiles, general counsel for the division, said the law says insurance companies, MCOs and others can't exceed the rates set by the state agency. Wiles and Bremner said most companies negotiate lower rates for doctors, hospitals, care centers and others who care for the injured worker.

The last rate adjustment, Wiles said, was about two years ago. Bremner said the 2001 Legislature authorized a rate study and the Milliman USA report is the outcome of that. Once the rates are set now, Bremner said they could be adjusted every year based on the medical component of the CPI.

Although the average increase is 15 percent for all medical providers, the average raise for physicians is 12 percent. Baldwin said, "This should be considered the midpoint of a range of reasonable results."

And the raise in the ceiling for reimbursement would not be the same for all physicians. Milliman USA suggests there be no increase in the cap for anesthesiologists but a 25 percent raise in the maximum for doctors in general medicine and in the evaluation and management of cases.

The report suggests a 5 percent increase for those doctors in surgery, radiology, pathology and physical medicine.

Wiles said the division hopes to gather information at the hearing on such things as how much will the increase mean when treating an injured worker for something, like a broken leg or an arm.

There will be increases to hospitals based on formulas and rural hospitals should receive per diems reimbursement that is 10 percent greater than those hospitals in the city.

The study recommends a "significant increase" in the rates charged by emergency rooms -- nearly 200 percent. But the values are still lower than commercial emergency services, based on a five-hour stay in the emergency room, according to Milliman USA.

Bremner said the law allowing the division to set the ceiling on the medical provider rates dates back to the days when the state ran the only workers compensation system.

But the state system has been converted to a private company, Employers Insurance Company of Nevada. Private employers are also allowed to set up their own system of workers compensation and there are others writing these policies.