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Q&A
for the 2007 (HB2756, HB2943 and SB504) and 2009 (HB2045) legislative changes
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The
2007 legislative session made changes that expanded treatment authority of some health
care providers to treat injured workers and authorize time loss from work. House Bill
2756 requires chiropractors, naturopathic physicians, podiatrists, and physician assistants
to certify to the director before providing any services to an Oregon injured worker.
Additionally, House Bill 2756 allows chiropractors, naturopathic physicians, podiatrists,
and physician assistants to be attending physicians for a limited time period. ORS
656.005(12)(b)(B). These four health care provider types will be referred to as type
B attending physicians. Medical doctors, doctors of osteopathy, or oral or maxillo-facial
surgeons who qualify as attending physicians under ORS
656.005(12)(b)(A) will be referred to as type A attending physicians.
The 2009 legislative session (HB 2045) expanded the authority of chiropractors to make
impairment findings. |
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When
do type B attending physicians have to certify? |
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Since
Jan. 2, 2008, every chiropractor, naturopathic physician, podiatrist, and physician assistant
must have certified to the director of the Department of Consumer & Business Services
that they have read informational materials about the workers' compensation system before
treating any patient with an Oregon workers' compensation claim, whether they assume
the role of attending physician or not. This certification requirement also applies to
similarly licensed providers outside of Oregon that treat any patient with an Oregon
workers' compensation claim. |
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When
can type B attending physicians be attending physicians? |
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House
Bill 2756 allows chiropractors, naturopathic physicians, podiatrists,
and physician assistants to be attending physicians on the initial
claim for up to 60 days or 18 visits, whichever occurs first, from
the first visit to any of these attending physicians. |
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What
can type B attending physicians do (as attending physicians)? |
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House
Bill 2756 allows chiropractors, naturopathic physicians, podiatrists,
and physician assistants to authorize time loss for up to 30 days
from the first visit to any chiropractor, naturopathic physician,
podiatrist, or physician assistant on the initial claim. |
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What
can't type B attending physicians do? |
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Type
B attending physicians are only granted attending physician status
on the initial claim. The initial claim refers to the time period
of the claim, starting from the date the worker files the claim until
the worker becomes medically stationary. If a worker sees a type B
attending physician after he or she has been declared medically stationary,
or the claim has been closed, the type B attending physician must
refer the worker to a type A attending physician.
The time period the type B attending physician is allowed to be an
attending physician is a cumulative amount of time. Once the worker
has reached the 60 days or 18 visits, from the date of first visit
with the type B attending physician, the worker may not see another
type B attending physician. At the end of the 60 days or 18 visits,
the worker must be referred to a type A attending physician or authorized
nurse practitioner. The 60 days or 18 visits starts even if that first
provider (type B attending physician) has failed to certify to the
director.
Except Chiropractors, type B attending physicians are not allowed to make impairment
findings. |
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Example:
Jan. 10, 2008
The worker sustains a compensable injury and starts treating
with a medical doctor who assumes the role of the attending
physician.
April 1, 2008
The worker selects a naturopathic physician to assume the role
of attending physician. The naturopathic physician was the worker's
attending physician for 30 days and authorized time-loss benefits
from April 1 through April 15.
May 1, 2008
The worker goes to a chiropractor that becomes the worker's
attending physician. Because it has now been 30 days since the
worker first saw the naturopathic physician, the chiropractor
is not allowed to authorize any further time-loss benefits.
Additionally, remember that podiatrists, chiropractors, naturopathic
physicians, and physician assistants are only allowed to serve
as the attending physician for up to 60 calendar days or 18
visits from the first visit to any of these providers. Since
the worker saw a naturopathic physician for the first time on
April 1, the chiropractor is now only allowed to serve as the
attending physician until May 30 (60 days from April 1). |
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Can
type B attending physicians make impairment findings? |
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Except Chiropractors,
type B attending physicians may not make impairment findings. If the worker appears to
have any impairment, a podiatrist, naturopathic physician, or a physician assistant must
refer the worker to a type A attending physician for a closing exam. A podiatrist, naturopathic
physician, or physician assistant may determine that the worker is medically stationary
with no impairment. However, if podiatrists, naturopathic physicians, or physician assistants
suspect there may be some residuals due to the injury, they must refer the worker to
a type A attending physician or a chiropractor. |
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When
does House Bill 2756 not apply? |
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House
Bill 2756 does not apply to managed care organization (MCO) enrolled
workers. MCOs are not required to allow chiropractors, naturopathic
physicians, podiatrists, or physician assistants as attending physicians;
however, an MCO may do so if it chooses. |
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When
first visit is before Jan. 2, 2008, the following applies: |
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If
the worker's first visit to a chiropractor, naturopathic physician,
podiatrist, or physician assistant on the initial claim is before
Jan. 2, 2008, the attending physician authority introduced by House
Bill 2756 does not apply. However, the requirement that providers
certify to the director after Jan. 2, 2008, remains, even if the worker's
first visit was before Jan. 2, 2008. |
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Example:
Dec. 15, 2007
A worker is injured, and he sees a podiatrist the same day he
is injured. The podiatrist can treat the worker for 30 days
from the date of injury without assuming the role of attending
physician and without the authorization from an attending physician.
Jan. 14, 2008
The worker must now choose an attending physician or an authorized
nurse practitioner.
In this example, the worker's visit to the podiatrist triggered
the application of the old law, because that visit was before
Jan. 2, 2008. Under the old law, a naturopathic physician, podiatrist,
or physician assistant is allowed to treat a worker for 30 days
or 12 visits from the date of injury without the authorization
from an attending physician but is not allowed to assume the
role of attending physician. Under the old law, a chiropractor
may assume the role of attending physician for 30 days or 12
visits from the date of the first visit, any time during the
initial claim. |
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| Senate
Bill 504: Emergency room physicians |
| Senate
Bill 504 affects attending physician status of emergency room physicians
and how long they can authorize time loss. |
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Background: |
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Emergency
room physicians frequently treat injured workers, authorize time loss,
and instruct workers to follow-up with a primary care physician. However,
workers often fail to follow-up with a primary care physician. In
these cases, workers end up having open-ended time-loss authorization.
Senate Bill 504 attempts to change that. |
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Attending
physician status and time-loss authorization: |
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Under
Senate Bill 504, an emergency room physician who refers the worker
to a primary care physician may not act as the attending physician
and is limited to authorize time loss for a maximum of 14 days. Senate
Bill 504 does not apply if the emergency room physician continues
to see the worker in his or her private practice for follow up. |
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Example
1:
When the emergency room physician is considered an attending
physician
The worker goes to the emergency room and receives treatment
and time-loss authorization from an emergency room physician
who is also a general practitioner. Rather than referring the
worker to another physician, the emergency room physician sees
the worker in his private practice for follow-up care. In this
example, because Senate Bill 504 only affects an emergency room
physician who refers the worker to another primary care physician,
the emergency room physician can be the attending physician
and authorize additional time-loss beyond 14 days.
Example
2:
When the emergency room physician is not considered an attending
physician
The worker goes to the emergency room and receives treatment
and time-loss authorization from an emergency room physician
who refers the worker to another physician for follow-up care.
In this example, the emergency room physician is not considered
the attending physician and time-loss authorization is limited
to 14 days, even if the emergency room physician does not
note an end date of the time-loss authorization.
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| House
Bill 2943: Independent Medical Examination (IME) standards of professional
conduct |
| House
Bill 2943 requires the Workers' Compensation Division to adopt standards
of professional conduct for health care providers who perform independent
medical examinations if the provider's professional regulatory board
has not adopted such standards. The Workers' Compensation Division
adopted standards from the Independent Medical Examination Association.
These standards can be found in OAR
436-010-0265. |
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