“So if it's not price, that means it's utilization,” he said. “There's been issues about high levels of use of chiropractic care, high levels of utilization across the board — more office visits, more MRIs, more pain management.”
Overuse of the workers' comp system in Oklahoma is a primary reason for the proposed changes, said Nathan Atkins, spokesman for Senate President Pro Tem Brian Bingman, who authored the bill.
There were over 28,000 trials and contested case hearings in the state workers' comp court in 2011 compared to about 4,000 each in Texas and Arkansas, Atkins said.
But critics of the proposal, including Democratic lawmakers and the lawyers who take workers' comp cases, said serious system reforms should address medical costs.
Bob Burke, who represents claimants at the comp court, said he believes the proposed legislation is driven not by a genuine push for reform but for political reasons.
“It is a power grab for some really big businesses in the state to control the workers' comp system and for them, rather than a court, to decide what workers get,” Burke said.
A leading physician at the hospital which does the most workers' comp spinal procedures in the state is a close friend and former fraternity brother of Bingman's. But both Dr. Robert Remondino of Oklahoma Spine Hospital and Bingman, R-Sapulpa, denied collaborating on the legislation.
Oklahoma Spine Hospital filed claims reimbursements for 973 inpatient treatment procedures under the workers' comp system in 2010, according to discharge data.
The hospital, its doctors and its associated companies together donated more than $340,000 to elected officials, political parties, political action committees and other entities in recent years, according to reports filed at the Oklahoma Ethics Commission.
“Our only conversation was he and I had the understanding that we're friends and that however the legislation came out we would remain friends,” Bingman said.
Remondino, who developed a carve out for spinal surgeries in the court's treatment guidelines in 2011 — guidelines that recommend against spinal fusions — said adjustments to the fee schedule in 2011 reduced physician reimbursements by $40 million.
Reimbursements under the comp system are necessarily higher than under Medicare because of ancillary work involved in the treatment, he said.
“The bureaucracy and just the paperwork that's involved, and the fact you may recommend something that someone may disagree with and there may be deposition — it's much more involved,” he said.
Most physicians and hospitals are paid less than what the fee schedule prescribes anyway due to discounts taken by managed care companies, Remondino said.
And states that have capped workers' comp reimbursements have ultimately pushed physicians away from providing those services, he said.
“They did that in Texas and many of the physicians got out of the work comp system, and then I think they went back up to 180 (percent) or higher to try and get physicians back in the system because they couldn't get an injured worker treated or seen,” he said.