Language access for all
Every patient deserves effective communication. If you decide that an interpreter is needed, you may use any of the three following interpretation options for face-to-face appointments with the worker:
- Video, or
- Face-to-face interpretation
For more information on interpretive services see:
- Billing and payment for Interpretive Services
- How providers arrange interpretive services
- Interpreter Lookup Service
- What modality of interpretation should the provider choose?
- IMIA Guide on Working with Medical Interpreters
The History and Physical
It's different for workers' compensation
In today’s fast-paced health care world, providers are squeezed for time, so every minute counts. Yet there are additional factors you need to address when taking a history and physical for an injured worker. The immediate medical needs come first, but you also must consider if and how the worker’s condition is related to his or her job. If it is not an industrial injury or occupational disease, it won’t qualify as a workers’ compensation claim. If it is, L&I or the self-insured employer relies on you to provide your opinion on the Report of Accident or an occupational work history form and consider all possible contributing factors (e.g. environmental, military service, recreational sports or hobbies etc.).
When a second or specialty opinion is needed
You may obtain a consultation with a specialist without prior authorization, except for mental health consultations, which do require prior authorization (WAC 296-20-051). In some instances, the claim manager will request that you obtain a consultation to provide assistance with diagnosis, treatment planning, medication appropriateness, and other medical aspects of a claim (WAC 296-20-045). If, after you have recently obtained a consultation, you learn that your patient’s claim manager is arranging an Independent Medical Exam (IME), please inform the claim manager of the consultation as soon as possible.
Identifying Risk Factors
An opportunity for prevention
Long-term disability is a major problem in workers’ compensation. When someone has been on time-loss for three months, there is a 50 percent probability that he/she will still be on time-loss at one year. You can help prevent this when you address the patient’s medical and return-to-work needs within the first month after injury. A number of screening, assessment, and patient tools are available to help identify key risk factors. Several of them, including a Functional Recovery Questionnaire and the 2015 Interagency Guideline on Prescribing Opioids for Pain are on the Agency Medical Directors’ Group website. Also available is the practice resource: Reducing Disability: Psychosocial Determinants Influencing Recovery (PDIR).
Drugs and Prescriptions
Know what drugs are covered
Save time for you and your patients by reviewing L&I’s drug policies and using the Drug Lookup tool to see which ones are covered on L&I’s formulary. If a drug is non-preferred or requires prior authorization, you can also view formulary alternative(s). This will be especially helpful in decreasing calls from pharmacies asking you to change to formulary drugs and decreasing workers’ wait time to receive their medication.
Of particular importance is opioids. Opioids are not effective for the most common injuries of sprains and strains. Although opioids may be appropriate for some acute phases of serious work-related injuries, more than one prescription increases the risk of disability. You can improve the care of injured workers and help save lives by using the best practices described in L&I’s Guideline for Prescribing Opioids to Treat Pain in Injured Workers.
Catastrophic Injuries and Care
Nurse case management can help
L&I has a dedicated Catastrophic Management Unit for workers who have extended hospitalization, and one or more of the following injury types: serious burns, spinal cord injuries, significant amputations, severe traumatic brain injuries, or multiple orthopedic trauma injuries. These injuries comprise less than 1% of claims, but have a profound and often sustained impact on a person’s life. This multidisciplinary team meets regularly to discuss the best ways to meet these workers’ needs. 2019 Report to the Legislature: Comprehensive Catastrophic Care Management Project
Centers of Excellence (CoE)
Highly Specialized Care
In an effort to improve access to quality care for patients with catastrophic injuries, L&I has partnered with trauma and rehabilitative services in Washington to be Centers of Excellence (CoE) for certain catastrophic injuries. The aim is to assure continuity of care, especially long-term care, when coordination is needed between a specialist and a community provider. To date, two CoEs have been established at Harborview Medical Center: One for amputations and one for burn patients. Standard referral criteria and processes are in place at these Centers for both new patients and those who already have claims.
Evidence-based Guidelines and Resources
To tell the truth
L&I produces surgical guidelines that L&I’s Utilization Review team applies when certain surgeries are requested. If you are a surgeon, these guidelines are especially relevant for you. L&I also produces non-surgical guidelines and conservative care best practice resources. Both are based on a systematic review of the best available medical evidence, combined with expert clinical opinions from practicing physicians. They are publicly vetted and approved by L&I’s Industrial Insurance Medical Advisory Committee and/or the Industrial Insurance Chiropractic Advisory Committee (IICAC). Providers in L&I’s Medical Provider Network are required by law (RCW51.36.010) to follow these guidelines.
Medical Coverage Decisions
Do we or don't we?
Generally, medical coverage decisions (defined in WAC 296-20-02700 through WAC 296-20-02850), are policy statements describing whether a specific health care service or supply is a covered benefit. Services/supplies may be for the purpose of diagnosis, treatment, or determining prognosis. L&I reviews and weighs the highest quality evidence on the services’ effectiveness, safety and cost-effectiveness to ensure high quality, value based care is delivered to injured workers. Medical coverage decisions may include criteria that must be met for the service or supply to be paid. Many of them are listed in our Condition and Treatment lookup tool. Check it out and note those that are relevant to your practice.
Mental Health and the Injured Worker
The whole person matters
A physical workplace injury can have many repercussions affecting the worker’s mental health without the worker having a psychiatric diagnosis. In these cases, the attending provider may provide short-term Health and Behavior Assessment/Intervention services (as described in the CPT™*) without prior authorization to help the worker through this tough time. However, if you believe the worker would benefit from an evaluation and/or treatment for a possible or contended psychiatric condition, this must be done by a mental health specialist and prior authorization is required. L&I’s mental health guidance and a practice resource for Psychosocial Determinants Influencing Recovery (PDIR) have more information.
* CPT™ is a registered trademark of the American Medical Association.
Where providers advise L&I
L&I has a long and successful track record of engaging with its partners in business, labor, and the health care community when it comes to major programs and decisions. Depending on your practice and patient population, you may be interested in knowing about these, and even participating when a topic interests you. Meeting agendas, materials, and minutes are always available online.