Medical Provider Network

You may hear about a new Medical Provider Network, or MPN, being created by the Department of Labor & Industries. Legislation was recently signed by the Governor giving the Department the authority to create a network of medical providers to provide treatment to injured workers. This was a Legislative proposal which Business and Labor groups worked on together and ultimately both supported.

There are a lot of details to be ironed out, and the new Network will be rolled out slowly to limit unanticipated problems and preserve access to care. The most important thing for injured workers to know is they still have the choice to determine who will provide treatment for their industrial injury.

Workers’ choice of treating medical provider has been a cornerstone of our system, and nothing in the creation of a new MPN will alter that free choice. Currently, the worker may receive treatment from any provider who has an L&I provider number for billing purposes. In the new MPN the worker may choose to treat with any provider in the network.

The Network itself will be very broad, and will include virtually every medical provider who currently has a Provider number for billing purposes. The Network allows the Department to review the credentials of medical providers. Providers will be accepted into the Network if they are already credentialed by another health care system, for instance Blue Cross, Uniform Medical, or Group Health. There will be incentives for Providers who meet some additional standards in Occupational Medicine best practices,  encouraging quality care for injured workers.

One of the basic tenets of our workers compensation system is better medical care improves return to work and overall outcomes for injured workers. The Network will provide the Department with additional tools to meet this goal, while preserving access to care, choice of provider and improving medical treatment.

4 thoughts on “Medical Provider Network

  1. so you wont have a choice of physician and if you go to emergency room there suppose to refer you to a mpn dr only,
    and if you go to a non mpn dr you can go one time only, and there suppose to refer you to a mpn dr only

    correct me if im wrong

    • Yes – and no. You may be seen in the ER, then you will need to follow up with a provider in the network. But you do still have an absolute choice of physician, within the network. The sticky question is how broad or narrow will the network be?

      We don’t know the answer to that yet. The intent at the time the MPN was being negotiated was that the network would be very broad. Essentially, all medical providers who currently treat injured workers would be eligible to join the Network. The credentialing requirements should really only serve to weed out a handful of not very qualified providers. The primary concern was to improve the care injured workers receive and not restrict access to quality medical care.

      Unfortunately, the Department has a Medical Director who, in my opinion, has a very different agenda. Some of the Rules regarding the credentialing process seem designed to frustrate providers, thereby limiting the pool of those willing to jump through the hoops to become part of (and stay a part of) the MPN. Is the intent to limit the Network to only those Providers who follow and agree with a certain point of view when it comes to treating injured workers? I suppose only time will tell.

      So, you still have a choice of provider, within the Network. We need to make sure all the providers who treat injured workers currently, take the necessary steps to become part of the network. What each of you should do is ask your primary care provider, and any specialist you are referred to, to become part of the MPN so they can continue treating injured workers without interruption. If the physicians don’t become part of the network, access to quality care will become an even bigger problem.

  2. Can treatment or diagnosis by a physician NOT part of the network be admitted to the worker’s case file? I am not familiar with the appeals process, but it seems the opinion of a qualified doc should count for something.

    • That’s a good question – the Network is a creature which controls who can treat an injured worker, by controlling who will get paid to provide that treatment. If the provider is not in the network, they will not get paid. Because an injured worker has to have an attending medical provider who is treating the work injury, the worker will have to have a provider in the network.
      An appeal will be different situation. If there is an appeal a party can call whomever they wish as an expert witness. The expert will be paid by the party, not the department, for testifying, so no requirement that they be in the medical provider network. I suppose on cross examination the provider will be asked if he is in the network, and if not why not. It would be a line of questioning which would go to the providers qualifications and credibility.

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