Nebraska big business and big insurance has introduced a bill to impose evidence-based medicine and utilization review (EBM/UR) on Nebraska workers. The proposal, LB 584, designates a California corporation to review what kind and how much medical care our injured workers are to receive. I have many criticisms of the bill that will be discussed from time to time. One of my fundamental problems is who reviews the care proposed by Nebraska doctors for our injured workers.
Most EBM/UR systems involve reviews by doctors, many of whom are retired, from other states. These doctors aren’t familiar with the high-quality doctors who practice within the state. Illinois has a form of EBM/UR, and my Illinois colleagues informed me that some of the utilization review had been outsourced to India. The Illinois Department of Insurance has recently dealt with these out-of-state reviews by requiring that Illinois doctors must be reviewed by other Illinois doctors. Peer review of care ought to done by peers, not some stranger half a planet away.
Would the business and insurance interests pushing EBM/UR want their treatment recommendations for a loved one second-guessed by a retired physician in another state or an offshore physician? Especially when that treatment recommendation was made by a trusted Nebraska physician who knows the loved one’s individual circumstances? I understand that business is always concerned about costs, but the worker must be protected. Workers should be treated as businesses would like their loved ones be treated. Sadly, big business and big insurance doesn’t seem to think the Golden Rule applies to injured workers and their families.