Work Comp and the ER Doctor

Sunday, September 15, 2002 | 0

In our past articles we looked at Industrial Medical Council Guidelines relative to treatment, and the impact those guidelines may have on reimbursement. Though we stray just a bit here from the topical integrity of that series, the following discussion is of equal importance to those who typically are the ones to have first contact with an injured worker, the Emergency Room Doctor.

Workers' compensation claimants often first present to emergency departments of their local hospitals or urgent care centers. The initial care they receive, as well as the all-important initial documentation that follows, clearly impacts medical outcomes and long-term disability as well as whether such patients even have access to the comp system, provider reimbursement, and litigation.

First, a look at the statistics is in order to fully appreciate the impact emergency department treatment has on workers' compensation. There are 147 million working adults and adolescents in this country. Most adults spend a quarter or more of their lives either at work or commuting. There are 7 million new workplace injuries or illnesses reported annually and emergency departments treat more than 3 million of them each year.

Nevertheless, there are many studies that suggest that occupational injuries and illnesses are grossly underreported and that the actual number of such cases are in fact as much as 10 million and almost 20,000 work related deaths. Nearly 2 million workers per year report some period of work-related disability and another 400,000 are diagnosed with disabling work-related illnesses (mostly pulmonary).

Statistics show that most patients reporting a work-related injury or illness are young and healthy at baseline. Disability has an enormous impact on this demographic with some estimates declaring that total combined cost to individuals, employers, the health care system, and society exceeding $140 billion annually. Direct medical costs, including emergency services, account for $17 billion of the total.

Beyond the basic statistics, the demographics of workers' compensation cases are indicative of larger trends that impact emergency room treatment.

In most industrialized nations women comprise a growing percentage of the working population, approaching 50% in the United States. While men account for most of the costs and deaths in work-related accidents, reflecting their disproportionate participation in more hazardous occupations such as mining, transportation, and construction, women have higher workplace homicide rates.

Women present more with certain injury syndromes, such as repetitive strain injuries related to keyboarding, and blood-borne pathogen exposure from needle sticks.

While white Americans report more occupational injuries than blacks, the mortality rate related to occupational injury is higher for blacks than whites.

The median age for the majority of work comp trauma cases presenting to the emergency room for treatment seems to be the early 40s/ early in the fourth decade of life for populations with reported injuries. In contrast, the median age for work comp illness cases is significantly older, since many occupational illnesses do not become clinically apparent for years to decades after initial hazardous exposures. Most of these cases do present initially to emergency providers.

The averages don't tell all of the story though. There are millions of children who work in the United States that are exposed to hazardous work conditions despite federal and state laws. Studies of teenagers with work-related injuries reflect that this group suffers up to 44.7 occupational injuries per 1000 per year, largely due to the use of machinery for which they have not been properly trained. Many of these injuries first present to the emergency room.

At the opposite end of the spectrum, almost 140,000 workers aged 55 years or older are seen in emergency departments for work-related injuries annually. Two thirds of these patients are male, and according to at least one study, report more major orthopedic injuries, more injuries from falls on the same level, and more injuries requiring hospital admission.

What these statistics mean is that there is great diversity in injury types and their causations among the various working populations that an emergency room physician should be aware of. There is also great diversity in just who, and what, is reported in ER. Local patterns are important to understanding your patient base, and understanding the patient base is critical to ensuring appropriate treatment, proper reporting, and ultimately proper care for your patient.

Next, we'll look at how work comp systems differ from other systems, and what the ER physician needs to do in order to improve patient and provider satisfaction.

Authored by Denyse Shaw of Comp Pro Insurance Services, matching vendors to the specific needs of administrators and carriers. She can be reached at 916-944-7870, or by e-mail at denysekshaw@earthlink.net.