Fewer doctors treating Nevada workers

Chris Jones

Friday, May 17, 2002 | 11 a.m.

A controversy over cost-cutting by Nevada's largest provider of workers' compensation insurance has sparked a heated debate over the quality of health care available to injured workers.

While critics contend that the insurers' actions will jeopardize the health of injured workers and could lead to new malpractice claims against Nevada doctors, an executive of Employers Insurance Co. of Nevada denied those allegations and said people hurt on the job will be adequately cared for.

On April 1 Care Network Inc., a managed-care subsidiary of Reno-based EICON, canceled contracts with an undisclosed number of Nevada health care professionals after the parties failed to agree on a new, lower fee schedule.

Health care providers who balked at what they considered below-market payment offers from Care Network said they were dropped from its list of authorized providers, upsetting some prominent Nevada doctors, attorneys and labor leaders.

"If it weren't overshadowed by the medical liability crisis, I think this would have been a very contentious and public issue over the last couple of months," said Larry Matheis, Nevada State Medical Association executive director. "Are there enough doctors, hospitals and health care providers that are going to be available to those that are covered (through Care Network)?"

Nevada AFL-CIO Executive Secretary-Treasurer Danny Thompson also thinks Care Network's reductions will hurt the quality of care for Nevada's workers. Care Network and its parent have placed financial gain ahead of the health of the state's laborers, he said.

"EICON is trying to make more money off the backs of injured workers, and in exchange for that they're going to sacrifice the care of (Nevada) employees," said Thompson, whose organization represents 165,000 union members in the state. "By getting rid of so many doctors, these people are going to be raping these injured workers ... by providing untimely care, which is going to result in further complications and possibly new malpractice claims at a time when the state can least afford that to happen."

Care Network President Laurie England disputed those accusations. While some providers were dropped to contain employers' rising insurance costs, she said more than 400 health care providers who remain on the network statewide are more than sufficient to handle the needs of injured workers.

"We have selected specific providers that work to the best interests of our employer shareholders and their most precious resource, their workers," England said. "There's no truth to statements that claim quality of care is impacted by the rates our reimbursement offers."

EICON is the largest provider of workers' compensation insurance in Nevada. Last year it wrote more than $112 million in direct premiums -- a figure that surpassed the totals of the state's next nine insurance companies combined.

Like other workers' compensation insurers, EICON's premiums are based on a scale issued periodically by the state Department of Industrial Relations, which limits the maximum amount a workers' compensation care provider can charge for specific medical procedures.

There are currently no laws that limit how low an insurer can set reimbursement payments, said Chuck Verre, chief administrator for the state Industrial Insurance Regulation section.

England declined to discuss contract rates, but representatives from several medical companies said they typically agreed to accept payments that were about 10 percent less than state's suggested rates to attract an insurer's business in a competitive market.

Problems arose when providers said EICON recently attempted to cut its payments anywhere from 20 percent to 35 percent below suggested rates.

"A lot of doctors aren't signing up with them because they just can't afford to," said Matheis, who added those who remain with Care Network could be overburdened soon treating patients displaced by other providers. Quality of care will likely suffer, which could increase new malpractice claims, he said.

Matheis and Thompson said they are also troubled by EICON's decision to sever ties with 26 urgent care operators in Southern Nevada.

Representatives of Fremont Medical Centers, Rainbow Medical Centers and University Medical Center said they were dropped from EICON's provider network effective April 1.

"(EICON) was seeking a 20 percent discount from the Division of Industrial Relations' standard rates, and that was more than we were willing to give," said Ernest Barela, Fremont Medical chief operating officer. "They're good people, but their negotiating was a little more hardball than we anticipated."

Routine services such as pre-employment or post-accident drug tests or physical examinations are available to employees of EICON policyholders at Harmon Medical Group, Industrial Medical Group and St. Rose Urgent Care. Those companies operate five urgent care sites in the Las Vegas Valley, but none in outlying areas such as Laughlin, Mesquite or Pahrump.

England said seriously injured workers can still seek treatment at any urgent care center or hospital emergency room.

Attorney Virginia L. Hunt -- who was once an appeals officer and later chief counsel for EICON when it was a state-run monopoly -- said she worries that the insurer is not providing workers with sufficient options for specialized needs.

Hunt cited EICON's new list of approved orthopaedic surgeons -- which includes only two doctors in the Las Vegas Valley who are not affiliated with Desert Orthopaedic Center -- as an example of the problem.

"If you've got a provider list that's so narrow it eliminates an injured worker's right to choose a physician without working with someone else in their (current physician's) firm, there's a problem," Hunt said. "And if you've got a doctor who is seeing 40 patients a day already, imagine how long it's going to take (a patient) to get in now?"

Dr. James Vahey, who specializes in the treatment of hand injuries, is upset that only two of the eight licensed hand surgeons in Southern Nevada are on EICON's provider panel.

"Our goal is to have all panels open to all surgeons," said Vahey, who added he and his partner were dropped from EICON's provider panel despite their willingness to work at below-market rates. "Quality of care, outcomes and patient satisfaction (should) drive the selection of a physician, rather than economic pressures."

Injured workers are also speaking out against Care Network and EICON. Pahrump resident Dennis Newcomb has been unable to work since he ruptured a disk in his back while working at a North Las Vegas auto repair shop in 1989.

Newcomb has a long-running dispute with the insurer over his inability to seek treatment from his physician, Dr. James Thomas, because Thomas is not included on the insurer's provider list.

"Dr. Thomas knows my body better than any other doctor, but I'm told by EICON I must go to another doctor," said Newcomb, 55, whose injury has required eight operations, five performed by Thomas. "All I see is an insurance company that's trying to save money."

Regardless of its recent fee reductions, England said Care Network's reimbursements are in-line with market averages.

"We did an in-depth study of the rates we reimburse our providers and found that we were well within what the market dictates we should be paying," England said. "We also found that this market as whole pays higher than the suggested national benchmarks.

"The providers who are not on our network are upset because it impacts their own interests, but those who have remained on our network are concerned about providing good quality of care while helping the state's employers maintain their costs of doing business."