How to gain speedier access to a specialist

Issue: BCMJ, vol. 55, No. 1, January February 2013, Page 17 WorkSafeBC
By: Janice Mason, MD, BSc, Dipl Sport Med (CASEM),

If you’re looking for expedited referrals for patients with accepted WorkSafeBC claims, the following process should ensure a timely response. Keep in mind that such appointments—for surgery or another form of consultation—are available only for elective cases.

Referral to community specialists 
Open WorkSafeBC claims with specific areas of injury require no prior authorization for referral to community specialists. To ensure a patient’s claim is open for health care benefits for a specific area of injury, go to WorkSafeBC.com, “Claims,” then “View claim information” under “Managing claims.”

In accordance with an agreement between WorkSafeBC and the BC Medical Association, specialists can be reimbursed for these visits, providing they see the patient and submit a consultation report to the referring physician, along with a copy to WorkSafeBC, within the designated timeframe. 

If you’re referring a WorkSafeBC patient to a community specialist, ensure the specialist is aware of your request for an expedited consultation. Send a referral letter as usual, and fax a copy to WorkSafeBC toll free at 1 888 922-8807, or in the Lower Mainland at 604 233-9777. 

Referral to the Visiting Specialists’ Clinic
If the community specialist is unable to expedite the appointment, or if you prefer a specialist’s opinion from WorkSafeBC’s Visiting Specialists’ Clinic (VSC) in Richmond, you can speak with a WorkSafeBC medical advisor about facilitating this referral for you. A WorkSafeBC medical advisor is required to write the referral note, based on internal authorization procedures. However, this referral is on your behalf, and you remain the responsible referring physician. 

The benefit of referral through the clinic is that VSC specialists can expedite elective surgery cases through access to specialized surgical facilities. While other community specialists might share similar access, the primary role of the VSC is to protect injured workers from needless disability caused by long waits for surgery.

At present, the following specialists provide care through the VSC: orthopaedic surgeons, neurosurgeons, a neurologist who can provide EMGs (or the VSC can expedite EMGs), physiatrists with expertise in spinal cord injury/amputation, a plastic surgeon for burn/wound patients, a urologist, and a general surgeon. 

If you refer your patient to a community specialist who works at the VSC, that specialist might ask the referral to be re-routed through the VSC. In this instance, you will need to contact a medical advisor at WorkSafeBC by phone or through request on a form F8/F11. The medical advisor can prepare a referral package on your behalf.

If your patient requires a referral to be re-routed to a psychiatrist for a non-urgent, claim-related psychiatric condition, you may be able to get help from a WorkSafeBC medical advisor.

At this time, the VSC is not accepting referrals for expedited consultations by sport medicine physicians. However, access to sport medicine physician examinations is available through WorkSafeBC’s Medical and Return-to-Work Planning (MARP) program. For patients who require diagnostic clarification and who are unlikely to require surgery, the MARP program might be a good option. Physicians who are part of the MARP program can also initiate referrals to the VSC.

Urgent or emergency situations
It’s important to note that the preceding referral scenarios are intended only for elective cases. If you have a patient with a clinically urgent or time-sensitive case, you would still need to personally contact the appropriate specialist and follow the same steps you would for any patient without a WorkSafeBC claim. 

Questions?
If you have any questions about expedited referrals for injured workers requiring elective surgery or specialist consultation, please contact a medical advisor in your local WorkSafeBC office through Medical Services at 604 244-6224, or visit WorkSafeBC.com.
—Janice Mason, MD, BSc, Dipl Sport Med (CASEM)
WorkSafeBC Medical Advisor, Victoria Office

This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.

Janice Mason, MD, BSc, Dipl Sport Med (CASEM),. How to gain speedier access to a specialist. BCMJ, Vol. 55, No. 1, January, February, 2013, Page(s) 17 - WorkSafeBC.


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