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Medical Services Contributes to Higher Workers Compensation Costs

In December 2003, the American College of Occupational and Environmental Medicine (ACOEM) developed a set of medical protocols, backed by scientific findings, for the treatment of workers compensation.

Occupational medicine physicians and other specialists involved in the medical care of workers developed these guidelines to provide practitioners with:

  • A step-by-step outline to assess the patient’s condition, and to educate the patient about that condition.
  • Specific guidelines about what physical findings and/or test results are required to establish a diagnosis.
  • A methodology for identifying the role psycho/social factors plays in a worker’s response to treatment.

The effectiveness of the workers compensation guidelines was documented in a study titled Acceptance and Self-Reported Use of National Occupational Medicine Practice Guidelines, published in the April 2000 issue of Journal of Occupational & Environmental Medicine.

Ninety-five percent of those polled reported that the workers compensation guidelines improved their practice in some manner. Fifty-two percent of physicians thought that guideline use decreased medical costs. Seventy-one percent reported that their care complied with the guidelines in 70 percent or more of their cases. The researchers concluded from their study that physicians’ attitudes toward the guidelines were positive and that reported compliance was high.

However, a 2006 study conducted by the National Commission of Compensation Insurance (NCCI) titled Workers’ Compensation vs. Group Health: A Comparison of Utilization, showed that compliance with ACOEM protocols had dropped considerably since 2000.

In fact, the researchers uncovered significant growth in the number and mix of medical treatments practitioners provided workers compensation to patients. The study, which compared 2001-2002 to 1996-1997, found that the number of treatments for all diagnoses increased 45 percent, except for injuries such as knee and leg sprains, which had increased as much as 80 percent.

But increased levels of treatment and unnecessary testing are just the tip of the iceberg. There are some other serious outcomes resulting from over utilization:

  • The barrage of doctor’s visits, tests, prescriptions, therapy sessions, etc., convinces the employee that they are getting all of this treatment because they are seriously injured. The employee begins making emotional decisions, and overlooks their economic well being. This kind of response often results in lawsuits and the loss of a valuable employee.
  • More narcotics are being prescribed as part of the treatment program, resulting in addiction among some employees.

Given these outcomes, it is incumbent upon employers to select a doctor who will follow evidence-based workers compensation treatment protocols.

The doctor should be in agreement with the ACOEM philosophy that it is important to return the injured employee to the workplace in the appropriate time, whether to their own job, or to a modified position.

The best way to find the right doctor is to talk to other local companies, asking if they use physicians who are specifically trained in occupational medicine.

After you have found the right doctor, establish a line of communication. Be sure your doctor knows that their workers compensation recommendations and restrictions will be respected. They should also be fully aware of the return-to-work possibilities that exist within your company so that they can make the appropriate decision for their patients.