Extreme discount networks rely on heavily discounting one aspect of care such as physical therapy or diagnostics. In doing so, such networks have no impact on the medical decision making of physicians. Only a decision from a physician can return an injured employee to work or end a case. Furthermore, such networks simply do not have the ability to communicate complete medical information to adjustors or employer professionals as they are only addressing discounts on one aspect of care. Discounting is almost always done after the services have been rendered so unnecessary treatments cannot be prevented.
In reality, discount networks encourage overutilization of the services they discount. If a provider is paid less for treating a patient and gains nothing of value then the temptation is to provide additional treatment that may be unnecessary. In fact, because of how splinter discount networks unnecessary care that has been discounted appears to save you more money when in fact you have paid for treatments that should have never happened in the first place. Therefore the promised savings by such networks are negligible when the total cost of care is calculated.
The outcomes of most cases are decided in the acute phase of the case. Without intervening in this phase many cases can become chronic, and very expensive. The traditional nurse case management system has not been designed to intervene acutely in cases. As a result of the significant hourly or per diem fees associated with nurse case management their acute intervention is simply not an option. In most cases, their intervention in the acute phase could easily double or triple the cost of a case. Why wait for a case to become a problem before you intervene; stop them before they become a problem.
Work related injuries are not always at the top of the list for employer professionals. Sometimes it is easier to let a case run and hope that it does not become a problem. This approach can work provided that no cases become chronic. Statistically it is inevitable that eventually a case will become a problem. It only takes one bad case to affect your insurance rates dramatically. Once the case has become a problem the task of unwinding it is enormous. The wait-and-see approach is a gigantic risk that has far-reaching implications for your organization.
In some cases it seems reasonable to let the employee choose the physician they want to see, usually their primary care physician or perhaps just go to the ER. The downside of this approach is that the emergency room is extraordinarily expensive for treatments that can be rendered in a physician's office. In fact emergency room treatments are 6 to 7 times the cost of treatment in a physician's office. This is not to mentioned the hours of wasted time waiting in the emergency room. So why not let the employee see their primary care physician? Most primary care physicians are not trained in the treatment of work-related injuries, they treat them just like the other injuries they see on a daily basis. However if you have an employee interested in manipulating the system going to a primary care physician is an easy method to manipulate the system. In addition that physician is not prepared to provide adequate information to you for effective decision-making.
