Is there Unnecessary Medical Care in Workers' Comp?

Friday, August 24, 2012 | 0

That's defined as care that does not improve patient outcomes, and it was the subject of Dr Rick Victor's concluding remarks at the Workers' Compensation Institute's conference. And the answer is, well, let's consider the data first.

First, who cares? Not my problem, right? Consider that other research indicates the average household is working four weeks just to pay for the estimated total amount of dollars spent on unnecessary care.

When you put it in that perspective, it becomes very, very real. Dr Victor went on to discuss various indicators of wide variations in medical practices in comp. For example, docs in Massachusetts are ten times more likely to prescribe schedule II narcotics when prescribing narcotics than physicians in texas.

If you are prescribed narcotics in Louisiana you are four times more likely to become a long-term user of narcotics than in the lowest-ranked state.

If you have a disc problem, you are almost three times more likely to get back surgery if you are in Tennessee than if you live in California.

Why?

Well, perhaps there are financial motivations at play. Victor reported their research indicates surgeons that own a surgery center do 76 more surgeries each year than non-owners.

And yes financial ownership is a driver, but owned ASCs are more efficient so they can do more, and owners were usually operating more often before they became owners.

But with all that, there are still 20% more surgeries done by docs who own ASCs when you account for these confounding factors.

Are they unnecessary? Well, Medicaid patients weren't getting more surgeries, work comp patients were. And by the way, the same 20% increase was seen in colonoscopies.

And that's not even getting into the huge differences in prescribing patterns exhibited by docs who begin to dispense drugs out of their own offices.

What does this mean for you?

Returning to the headline question, I'd suggest there is ample evidence that suggests there is indeed a lot of unnecessary medical care.

And every year you work until Jan. 29 just to pay for that unnecessary care.

<i>Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers, and owner of Health Strategy Associates, a Connecticut employer consulting firm. This column was reprinted with his permission from his Managed Care Matters blog.</i>