Workers compensation

[Smokeydoc]

I am currently an employed physician (interventional pain medicine ) at a hospital setting in California.

A friend of mine (is a lawyer) does a lot of workers compensation. He sees the patients and sends them out to the doctors he knows.

He told me if I started my own practice he could easily refer 75 (if not closer to 100) patients a month.

I am trying to understand the sort of compensation I will get from just 75 workers comp patients a month till the rest of the practice picks up and if it will be worth my while. would love people's feed back that deal with these patients. I could be the primary and also do all the interventional procedures that are needed.


Thank you!

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[MitchLevi]

It pays a lot, and 75 WC pts right off the bat is a lot of wine when you get home from work.

There are ethics here BTW. He will want your opinion to be favorable to his side, and at some point may begin pressuring you to make decisions you're uncomfortable making.

75 WC pts is a lot of ancillary money too.

I'd do it, but let him know you're ethical and objective above all else.

This could be very lucrative.

 

[Agast]

It’s very paperwork driven. You need to have your staff trained down to a T to make sure you’re paid for the work you are doing. That means compensatory diagnoses clearly marked and everything follows ODG, although I think California may have their own set of guidelines for msk stuff.

 

[Smokeydoc]

It pays a lot, and 75 WC pts right off the bat is a lot of wine when you get home from work.

There are ethics here BTW. He will want your opinion to be favorable to his side, and at some point may begin pressuring you to make decisions you're uncomfortable making.

75 WC pts is a lot of ancillary money too.

I'd do it, but let him know you're ethical and objective above all else.

This could be very lucrative.

when you say a lot, what would you say the gross income could be from that?
just trying to understand how my income will change.

Thank you!

 

[Laryngospasm]

In theory the income from 100 wc patients per month with procedures could go well into the six figure range possibly if rfa etc were done. There will be tons of depositions and trials will happen as well.

 

[BobBarker]

I have not made any more money with WC than anything else. Got paid less on some things.

 

[MitchLevi]

I have not made any more money with WC than anything else. Got paid less on some things.

Unusual.

We make a lot from WC.

 

[Sig123]

I have not made any more money with WC than anything else. Got paid less on some things.

Its all state dependent as WC fee schedules are state specific. Some states have fantastic fee schedules, others not so much.

 

[SSdoc33]

i feel like i need to take a shower after I see a comp patient. pretty much ANY comp patient.

 

[bedrock]

Its all state dependent as WC fee schedules are state specific. Some states have fantastic fee schedules, others not so much.

Unusual.

We make a lot from WC.

California used to be great for WC. Now nobody wants to do WC in California because CA WC pays crap and you have way more regulations to deal with than other states.

 

[Agast]

i feel like i need to take a shower after I see a comp patient. pretty much ANY comp patient.

I had a patient with severe numbness and weakness who was cured with a therapeutic EMG - once the EMG came back normal, his symptoms got better!

 

[bedrock]

I had a patient with severe numbness and weakness who was cured with a therapeutic EMG - once the EMG came back normal, his symptoms got better!

90% of my EMGs are either confirm that a patient has carpal/cubital , and not a radic or to prove that a WC patient is FOS.

 

[CleanUp]

WC in California is crap. Terrible pay terrible patients.

Patients get angry with you when it’s not approved.

They’re basically Medi-Cal patients.

They want you to “appeal and fight” for that mobic.

Their adjustor will send you 400 page documents.

A PR4 pays peanuts while the QME doc is getting 1k for 20 mins.

Good luck getting a cervical epidural approved.

 

[callmeanesthesia]

CA WC pays Medicare rates but with onerous paperwork. Have to fill out a request for authorization if you want to do a trigger point injection or prescribe flexeril, and it will probably be denied.

I still do WC, about 10% of my volume, because there’s no one else around me to do it.

Don’t agree to be primary treating, only secondary, or you’ll be bogged down in even more paperwork. Only good thing is you can bill a PR2 code with every office visit. Pays about an extra $10. Helps offset extra admin paperwork.

 

[Espn123]

This sounds like a terrible idea if you want an enjoyable day to day experience

 

[thiswonthurtabit]

I'm in CA and my group does a lot of WC. More acute cases tend to be reasonable but unfortunately we have a lot of dates of injury that are 10+ years out and patients feel that any and all problems in that region are due to their comp injury. I don't find these patients rewarding to treat and, generally, are a significant energy drain.

 

[callmeanesthesia]

I'm in CA and my group does a lot of WC. More acute cases tend to be reasonable but unfortunately we have a lot of dates of injury that are 10+ years out and patients feel that any and all problems in that region are due to their comp injury. I don't find these patients rewarding to treat and, generally, are a significant energy drain.

I’m in CA too but I’ll take the old settled claims over the acute ones almost all the time. But I inherited a bunch of people from a retiring guy who just come in 1-4 times a year for an RF or an epidural, and he already weaned them off meds.

 

[drrosenrosen]

I have a pt who is CA WC, retired cop, moved to Texas. His work related injury was from getting out of his squad car without taking his seatbelt off and "wrenching his back". He now has like 15 diagnoses related to his injury and it's a huge PITA to get anything paid for. Meanwhile, I discovered severe stenosis with myelomalacia on a cervical MRI, WC won't approve him to see a surgeon, and he refuses to treat it through insurance bc he insists it's related to his injury.

I try to avoid WC

 

[RoloTomassi]

WC is a PITA that is marginally worth the headache in a state that pays well. I'm sure
you can get your state's fee schedule. Personally, I would not trust any one referral source that much to take such a leap, especially if you're not well seasoned in WC nuances

 

[Espn123]

I have a pt who is CA WC, retired cop, moved to Texas. His work related injury was from getting out of his squad car without taking his seatbelt off and "wrenching his back". He now has like 15 diagnoses related to his injury and it's a huge PITA to get anything paid for. Meanwhile, I discovered severe stenosis with myelomalacia on a cervical MRI, WC won't approve him to see a surgeon, and he refuses to treat it through insurance bc he insists it's related to his injury.

I try to avoid WC

This sounds about right

 

[Agast]

I have a pt who is CA WC, retired cop, moved to Texas. His work related injury was from getting out of his squad car without taking his seatbelt off and "wrenching his back". He now has like 15 diagnoses related to his injury and it's a huge PITA to get anything paid for. Meanwhile, I discovered severe stenosis with myelomalacia on a cervical MRI, WC won't approve him to see a surgeon, and he refuses to treat it through insurance bc he insists it's related to his injury.

I try to avoid WC

I was under the impression that you couldn’t qualify for WC if you were injured doing something in a way you weren’t supposed to…are you sure he wasn’t attacked by the seatbelt

 

[thiswonthurtabit]

One of the challenges in CA is that if 1% of the injury can be attributed to work then it is a comp claim. This is good for truly injured workers but it creates an environment for people looking for a free ride and the number of claims is insanely high so the default position for any carrier seems to be to deny everything and force physicians to have to do lots of extra paper work or give up.

 

[Smokeydoc]

for those that responded, would that net at least 600k a year?

 

[Agast]

WC makes big bucks if you’re also billing the ancillaries. I suspect your lawyer friend has a hand in those and would not be interested in sharing MRI, Utox and PT fees.

 

[MitchLevi]

for those that responded, would that net at least 600k a year?

What are you asking?

If you start your own practice, there are expenses that go with that.

You're asking can you net 600k? Sure, but assuming you know the difference in gross and net, it's not easy unless you're busy as hell and your state has great WC laws.

Where did 600k come from as a number?

 

[nvrsumr]

I don’t think you are listening to the docs that worked in CA. 75 patients/month at Medicare rates will get u150k net. Your atty friend will make much more than you

 

[CleanUp]

for those that responded, would that net at least 600k a year?

No it won’t.

 

[bedrock]

CA WC pays Medicare rates but with onerous paperwork.

I still do WC, about 10% of my volume, because there’s no one else around me to do it.

Your practice should just opt out of WC …to force WC to come to the table. I know of two orthopedic groups in two rural areas who stopped taking WC due to the rates. These were rural orthopedic practice, and the sole ortho group in those areas.

In both cases, WC came to them hat in hand and dramatically increased their rates, and then they resumed taking WC.

This only works in a rural situation like yours as the only ortho group around.

You might to discuss it with your partners.

 

[DoYouEvenLiftBro]

CA WC sucks. Deny everything. Pt has 10% leg 90% back they deny facets due to leg symptoms..

 

[callmeanesthesia]

Your practice should just opt out of WC …to force WC to come to the table. I know of two orthopedic groups in two rural areas who stopped taking WC due to the rates. These were rural orthopedic practice, and the sole ortho group in those areas.

In both cases, WC came to them hat in hand and dramatically increased their rates, and then they resumed taking WC.

This only works in a rural situation like yours as the only ortho group around.

You might to discuss it with your partners.

Was this CA? And if so can you put me in touch with the groups? My understanding was that CA WC fee schedule was basically fixed in state law.

 

[MitchLevi]

Correct me if I'm wrong, but isn't CA great for PI?

 

[Agast]

CA WC pays Medicare rates but with onerous paperwork. Have to fill out a request for authorization if you want to do a trigger point injection or prescribe flexeril, and it will probably be denied.

I still do WC, about 10% of my volume, because there’s no one else around me to do it.

Don’t agree to be primary treating, only secondary, or you’ll be bogged down in even more paperwork. Only good thing is you can bill a PR2 code with every office visit. Pays about an extra $10. Helps offset extra admin paperwork.

Google tells me California WC pays 140% of Medicare rates. This is from an acupuncture group so they may be wrong but I would do some digging and see if you guys are getting screwed over.

California Workers' Compensation Fees Increasing - AAC Info Network

For 2023 the fees related to workers’ compensation will be increased. This increase should be updated and effective by March 1, 2023. This includes acupuncture as well as evaluation & management, and physical medicine and Read more…

www.aacinfonetwork.com

 

[bedrock]

Was this CA? And if so can you put me in touch with the groups? My understanding was that CA WC fee schedule was basically fixed in state law.

Was not in CA. But I still think you should consider this move. There are exceptions in medicine that do benefit rural docs at times.

 

[callmeanesthesia]

Was not in CA. But I still think you should consider this move. There are exceptions in medicine that do benefit rural docs at times.

DWC Answers to frequently asked questions about the workers' compensation Physician and Non-Physician Practitioner Fee Schedule

www.dir.ca.gov

Statewide fee schedule. Similar to Medicare. Opt in or out but no individual negotiations as far as I can tell.

 

[Smokeydoc]

I don’t think you are listening to the docs that worked in CA. 75 patients/month at Medicare rates will get u150k net. Your atty friend will make much more than you

150k net a year? yikes!

 

[Smokeydoc]

What are you asking?

If you start your own practice, there are expenses that go with that.

You're asking can you net 600k? Sure, but assuming you know the difference in gross and net, it's not easy unless you're busy as hell and your state has great WC laws.

Where did 600k come from as a number?

600k would be a number to consider the move. 600k Net after all expenses into my pocket.

 

[BobBarker]

You will have more than just these WC patients. So yes, if you use your friends referrals to get started with and develop a practice you should make more than $600k after a couple years.

 

[CleanUp]

Do you know how to rate MMI and P&S?
Do you know the difference between exacerbation and aggravation?
What about assigning apportionment?
Will you have time to schedule depositions?
Who will pick up the phone when the adjuster calls?
There’s a deadline on appeals.
Do you know much a PR4 pays?

 

[swamprat]

How does one get on WC panels? I have a few WC patients but they all are excpetions that got attorneys that had me added.

 

[RoloTomassi]

To be on panels you have to essentially be defense friendly. A lot of networking in that niche. Sounds like plaintiff attorneys got their clients away from a panel doc to you, which probably means you don't practice in a defense friendly way.

 

[TIVAndy]

there's a reason i don't pick up california WC who move to our state. everything gets denied.