SB-537 Signed Into Law by Gov; PTP vs. UR Stats to be Available?
Happy Friday, dear readers! Guess what? I’m going to tell you two really cool facts about Sacramento. Are you ready?
Fact number one – your humble blogger’s favorite place to get breakfast is in Sacramento. In fact, whenever I’m in Sacramento and the hours of breakfast are unclaimed by an appearance or a meeting or anything else, few things would make me happier than darkening this place’s doorstep. I can’t name it here of course, because it’s not entirely clear if the owners would welcome or scorn the association with this most humble of defense blogs. But if I ever hear someone say “hey, Sacramento is 100% bad” I can always retort, with confidence and sincerity, “well, what about that breakfast place?”
Now on to fact number two: In Sacramento is a man named Gavin Newsom who serves as Governor of California. A few days ago, he signed into law SB-537, which is set to take effect on July 1, 2021. Aside from requiring every MPN to provide a list of participating physicians, and provide that website to the administrative director, SB-573 would also codify the recent decision in Puni Pa’u, to wit, that Saturdays are not counted towards the working days allowed to make a UR determination.
But the biggie is the new section 138.8. Therein, SB-573 directs the administrative director, prior to January 1, 2024, and every year thereafter, publish utilization review data. For every physician who treated 10 or more injured workers in the year prior to July 1 of the last year, the AD will list the physicians first and last name, specialty, number of injured workers treated, diagnoses codes used, the number of Utilization Review reports denying or modifying his request for treatment, and the number of IMR reversals of UR.
The idea is that for each doctor treating injured workers, we are going to see how frequently a diagnosis is made and how frequently UR and IMR denied the recommended course of treatment.
Reader K.C. had previously advised your humble blogger that in some states, data on the prescription of opioids, along with the frequency and amounts per patient is collected and doctors see where they fall as compared to their colleagues – the idea being to share the over-prescribing doctors to tone it down with the zombie pills.
Perhaps we’ll see the same effect here? Perhaps SB-573 will help us tone down those doctors who say “if you don’t pay for this wacky treatment, I’ll keep your injured worker on TD for the full 104 weeks.”
What do you think, dear readers? Is there more to SB-573 that we can anticipate besides data collection?
See you on Monday folks!