The Office of the Medical Director is a part of the Research and Information Services division of L&I, whose function is policy development, research, and problem-solving relative to the needs of workers and employers in Washington state. Other divisions include Insurance Services, which provides claims administration, and Consultation and Compliance Services, which oversees the state's occupational health and safety programs.
Dr. Mootz explained:
"The Office of the Medical Director has set precedents by having health care providers in policy-setting positions as well as input from claims administrators. Since about one-third of all injured workers with back pain end up seeing chiropractors, they felt it was appropriate to hire a chiropractor in one of their associate medical director positions."According to Dr. Mootz, Medical Director Gary Franklin, MD, was instrumental in establishing the new chiropractic position. Dr. Franklin worked with the Washington State Chiropractic Association to resolve a number of problems in provider relations. The new position was one of the results of this effort. To the best of our knowledge, it is the first policy-level position in any state or federal agency. L&I currently employs two chiropractic consultants who serve in the role of claims' review.
Dr. Mootz will be working under the commission of Medical Director Franklin. His role is primarily three-fold: research, communication, and an advisory capacity. There are a variety of potential research projects including review of past utilization data and patterns of chiropractic services in the occupational arena.
In many states, such as California, a number of private insurance carriers may provide workers' compensation coverage in addition to state funds. In Washington, coverage is provided by one of two mechanisms: the state fund or self-insurance, both administered by L&I. Approximately half the state's employers are insured through L&I.
Dr. Mootz's position will allow access to a great amount of data regarding care of injured workers in a number of large companies. This will facilitate interesting actuarial research on the extent and nature of chiropractic utilization, with an eye towards outcome information.
As Dr. Mootz puts it:
"Having that much access should be unique because we work with all of the records. That's part of my research agenda. Another priority is to get more grassroots involvement of chiropractic perspectives in development of any guidelines, policies on reimbursement, health care purchasing, etc. That will be one of my charges, to develop mechanisms whereby whatever policies are implemented, chiropractic viewpoints will have some grassroots involvement. The may allow for a variety of consensus-building procedures to be used."This position would also allow Dr. Mootz the opportunity to conduct collaborative research on outcomes studies. L&I funds some research at the University of Washington in the Occupational Health Department at the School of Public Health. There is a great opportunity for interdisciplinary collaboration on outcome studies and perhaps even clinical trials.
This position will allow Dr. Mootz to communicate what chiropractic is:
"Many carriers and government administrators do not understand chiropractic terminology and just what chiropractors do. Chiropractors, many times, don't understand the needs of either employers or insurance carriers. You tend to see a lot of misunderstanding of the various sides' perspectives that leads to difficult communications and resultant policies that are made based on inadequate communication. This position was created partly by the Department of Labor and Industries to help alleviate some of those communication problems.Currently, there is a chiropractic advisory committee comprised of individuals appointed by the Washington State Chiropractic Association. Dr. Mootz said that he believes this committee should have a greater role for input and involvement in policy development, similar to other medical advisory committees that exist. He said he also sees this committee facilitating dialogue between representatives of the chiropractic profession through their association and other provider groups, as well as employers and insurers. This communication will allow an opportunity for greater understanding of the perspectives of workers, providers, employers, and insurers by all concerned.
The creation of this new position provides several potential benefits for the chiropractic profession at large. It allows a chiropractic perspective to be included from the inside during policy-making, an important precedent for other agencies around the country and certainly within the state of Washington.
Dr. Mootz concluded:
"There is a tremendous opportunity for collaboration that's going to occur. It also permits the right questions to be asked in the policy/decision-making process. For the state of Washington, it essentially creates a clean slate for the chiropractic association working with the Department of Labor and Industries because it modifies the whole dynamic between the chiropractic providers and payers."What this position doesn't do for chiropractic is guarantee the profession's whole agenda. It certainly doesn't eliminate the need for any involvement of chiropractors being active in politics or in policy-making. It certainly doesn't insure a blank check for practitioners in the work comp. arena. The position is not a mediator, a claims adjuster, a judge or a czar of any kind. It's a policy and research position."
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