"Physicians are the most critical component to a successful health care experience," said Dr. Teresa Bartlett, Troy, Michigan-based senior vice president and medical director of Sedgwick Claims Management Services Inc.
Payers also dislike when physicians engage in aggressive or unnecessary medical testing, and when they render medical care outside evidence-based guidelines without clearly documenting why, Dr. Bartlett
Meanwhile, submitting untimely utilization review responses or not conveying the covered conditions within a claim are examples of payer behaviors that can lead to contentious relationships with physicians, she
, Ms. Wagner and other experts in attendance at the 2015 California Workers' Compensation
& Risk Conference in Dana Point, California, earlier this month stressed that effective communication requires participation from both parties.
Having physicians tour the worksite provides a greater understanding of workers' functional requirements, Dr. Bartlett
said, adding that supplying pictures, videos and job descriptions is also helpful.
At Sedgwick, "there is a higher degree of scrutiny and UR" with physicians who don't obtain good claim and medical outcomes, Dr. Bartlett
"Doctors definitely need to know they are being watched and held accountable."
It is the workers comp industry's responsibility to drive the use of evidence-based care, which is "based on the latest research and ensures physicians are staying current with new technology and medical practice," she