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Physicians' opinions in comp statements correlate with who pays



Physicians 'views on workers' claims for black lung disease largely correlate with who pays for their time, experts say, and demand independent review programs and mandatory disclosures of medical disputes.

"It's quite surprising to see an expert not adapt to the parties who hired them," said Michael Duff, a professor at the University of Wyoming College of Law. "How structured our controversial system is, we almost assume the views offered of partisan experts will be weighed against the party that retained these experts. "

In a study conducted by the University of Illinois at Chicago, researchers found that physicians' diagnoses of black lung cases were often correlated with those who employed them.

Employers hired by employers were significantly less likely to find evidence of black lung disease on an X-ray, while doctors hired by miners were more likely to identify the worker with the disease, says Lee S. Friedman, associate professor at UIC's School of Public Health and leading researcher

Using data from the U.S. Department of Labor-administered Federal Black Lung Program, Mr. Friedman and his team evaluated nearly 8,000 court decisions between 2002 and 201

9 to evaluate conflicts of interest for each physician. In one-fifth of the black lung claims examined, doctors made the same decision for all patients 95% of the time – either discovering that almost all patients had black lung or not. The majority of physicians who believe these claims were employed by mines and reported the absence of pneumoconiosis.

"I do not think there is any question that there is bias … because of the financial incentives but also because you say at some level, & # 39; It's my team, I work for that team & "And the subtle pressure exerted on the human mind," Duff said.

"People perceive this as a broader issue … but I think the vast majority of physicians really only care about doing what's in the patient's best interests," said David Langham, assistant chief judge at the Florida Office of Judges of Compensation. Claims in Tallahassee. "The other 2% or less are people who are motivated by a poor adaptation of the ideology." Langham said. Another is the lack of choice of doctors, which can reduce a worker's sense of helplessness by giving each

For example, in California's independent medical evaluation system, each party eliminates one physician from a panel of three, with the last one imprinted to carry out the evaluation of the injured worker.

"If you To establish a neutral structure, you must be vigilant with the actual ties of the so-called neutral parties, says Mr Duff.

Requiring doctors in the workers' compensation system to publish information about their conditions – similar to the mandate under the Affordable Care Act for doctors to disclose conditions to medical providers and pharmaceutical companies – could be another way to address the problem, Friedman said.

"There is so much discretion when it comes to behavior at the insurance level, insurance management level, clinic level and even doctor level," he said. "We know it is an unbalanced system but do not know what the right solutions are."

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