Paduda: Workers' Comp Superior to All Other Health Care Payers

Thursday, February 16, 2023 | 0

And here’s why.

Joe Paduda

Work comp payers actually care about the patient's recovery, return to functionality, ability and productivity. Work comp must care because screwing up recovery equals huge financial penalties in the form of claims that last forever, really costly settlements and migraine-level headaches for all involved.

Whereas in group/individual health, Medicare and Medicaid (mostly), functionality is — at best, and then only rarely — an afterthought.

Side note: If you think about it, how dumb is it that 99% of health care payers don’t really care whether the $4.2 trillion they spend on health care actually improves lives, helps patients stay active, supports functionality and helps us live the lives we want to live?

Answer: dumb as a box of rocks.

The Workers Compensation Research Institute's latest in a never-ending stream of excellent research brought me back to this. Researchers examined patient-reported functional outcomes after low-back pain, a far-too-common and sometimes really problematic diagnosis. (The report is free to WCRI members and available at a nominal cost to nonmembers.)

The research compared comp outcomes to those of other payers and:

• Included patients covered by all types of payers.
• Totaled some 2.4 million patients.
• Covered almost 1.3 million PT/OT episodes of care.
• Used patient-reported functional status specific to the low back pain issues (as captured by Focus on Therapeutic Outcomes).

The researchers obviously put a lot of thought into selecting the measure. They describe the process and rationale in detail in the report.

While it is important indeed to consider that workers’ comp patients’ reported functional improvements were not as high as some other payers — and we need to understand why — that’s secondary to the fact that work comp’s primary focus (return to functionality) is way different from other payers’.

With extremely rare exceptions, no other payers focus on functionality, and almost none do across all patients with all conditions.

Kudos to Sebastian Negrusa, Vennela Thumula, Randall Lea and Te-Chun Liu for their excellent work.

What does this mean for you?

Work comp gets beaten up a lot. This is why. In one extremely important way, workers’ comp is superior to all other payers. 

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.