The recognition of the efficacy of psychological evaluation and treatment of patients with medical conditions has increased over the years with the acknowledgment of the impact of the emotional state on the patient’s physical functioning and response to treatment.
Actually, psychologists’ involvement in the treatment of patients with medical conditions has been a noted component of mental health care for years; it is just that it is now being recognized more extensively by other health care providers.
The acknowledgement by insurance carriers, physicians and case managers of the effectiveness of psychologists’ work with patients who have experienced a work-related injury has likewise increased. Many are now recognizing that there are conditions that require the integration of psychological care with traditional medical treatment, especially as it relates to chronic conditions.
Although there are challenges for psychologists who choose to work within the workers’ compensation system, it can be a viable complement to one’s practice. The practicing psychologist must examine the advantages and disadvantages when deciding whether to make this a part of practice. Although I practice in the state of Georgia and am familiar with the workers’ compensation system in my state, much of the information presented in this article likely applies to others states and can provide useful information to consider in deciding to work with this population.
It has been estimated that 35 percent, or 105 million people in the general population of the United States, suffer from chronic pain. The costs in terms of medical care, lost time from work, disability and reduced productivity are estimated at more than $150 billion annually. It has been further estimated that the lost productive time because of common pain conditions among injured workers is approximately $61.2 billion annually. (Stewart, et al 2003; Harstall, 2003; U.S. Census Bureau 1996).
Psychologists working with injured employees need to have training and experience in health psychology and must feel comfortable with the team approach to patient care. In addition, they will need to have training in the causes and effective treatments of chronic pain.
The workers’ compensation patient who comes for treatment has experienced some form of an on-the-job injury. Most of the time there are physical manifestations, although there are occasions when there are only emotional consequences. An example is an employee who was a victim of a robbery while at work and developed PTSD.
The patient referred for care will typically have problems managing with the medical condition. There may be depression or anxiety, which are usually secondary to the medical condition, lack of understanding of how to manage with the condition on a long-term basis or compliance-related issues.
The psychologist may be called upon to conduct a psychological evaluation that includes objective testing to determine the patients’ current level of psychological functioning, address the impact of the injury to the current condition, determine appropriateness for medical procedures, evaluate barriers to success and provide recommendations for psychological care.
It needs to be clarified with the patient at the onset of services who the psychologist is working for – the patient, physician or the insurance carrier. Once potential patients have access to this information, they will be able to make informed decisions about whether to continue treatment.
The reimbursement rate is usually an attractive feature in working with this population. However, one must recognize that the workers compensation market, as with many industries, is economically driven. As businesses are experiencing more financial stress, there is more difficulty in obtaining authorization to provide care, especially mental health care.
Once authorization is obtained, however, there usually is minimal difficulty in obtaining the payment for services. Again, the challenge can be in obtaining authorization for services. The authorization is not usually for unlimited services, and the psychologist must be aware that it is possible that once treatment begins the insurance carrier may decide that they no longer want to authorize treatment. This is especially a concern for patients with more severe and chronic conditions.
The provider needs to have provisions for continued psychological care, as the injured worker likely will not have the financial resources to cover these services. There may be premature terminations of services and psychologists will need to deal with their feelings that they have abandoned their patients.
In working with patients in the workers’ compensation system confidentiality issues may pose a challenge to providing patient care. In Georgia, the medical records must accompany the claim form in order to obtain payment for services rendered.
The patient must be aware of these limits on confidentiality and the fact that once the records leave the office the provider has no control over who has access to them. That lack of confidentiality may impact the patient’s openness to therapy, which is a requirement for progress to be made.
It is highly likely that the injured worker will be involved in some form of litigation. Psychologists working with this population will need to have experience and comfort in working within the legal system, including the release of information to attorneys, preparation of reports for attorneys and participation in depositions or court. Providers are typically paid generously for their efforts, but they must have comfort in working within this system.
In summary, there are clearly some challenges in working within the workers’ compensation system; however, for many psychologists the advantages far outweigh the challenges. They include the reimbursement rate and, most importantly, being able to provide much needed care to an under served population.
References available from author
Jennifer F. Kelly, Ph.D., ABPP, is board certified in clinical health psychology and works at the Atlanta Center for Behavioral Medicine. She is also a member of the board of directors of the American Psychological Association. She may be reached at email@example.com or through her website.
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