How State Policies Affect Low Back Pain Costs

December 2, 2015

Public policies on the treatment and benefits for injured workers explain some of the state-level variation in costs and outcomes of claims for low back pain, according to a new medical study.

The study in the December Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM), found that state-level factors explain about five percent of the total variation in medical costs and disability time, after adjusting for differences in worker characteristics.

Dr. Glenn Pransky of Liberty Mutual Research Institute for Safety, Hopkinton Mass., and colleagues analyzed data on more than 59,000 low back pain (LBP) claims from 49 states.

Of the five percent variation, 43 to 50 percent was explained by differences in state workers’ compensation policies. Medical costs and disability times were both increased in states that had a longer retroactive period—that is, a longer disability time before the injured worker starts receiving benefits for lost work time.

Costs and disability were also higher in states that allowed injured workers to choose the treating provider, rather than employers.

States that had a schedule of fees reimbursed for specific medical services had longer disability times, as did states that limited the option to change providers. However, policies allowing a one-time change in the treating provider were linked to lower medical costs as well as shorter disability times.

Low back pain is a major cause of disability and workers’ compensation costs. The authors say it’s unclear how differing state policies affect the costs and outcomes of workers’ compensation claims.

While the policy-related differences may seem small—about half of the original five percent variance between states—they suggest opportunities for lowering workers’ compensation costs and improving outcomes, according to the authors.

“A shorter retroactive period and early referral of injured workers to health care providers familiar with occupational health issues may reduce medical costs and duration of work disability due to LBP,” Pransky and colleagues write.

But allowing workers who are not satisfied with their treatment the chance to switch to an alternative provider may improve both outcomes, they said.

The ACOEM authors say further studies are needed to determine whether these policies have a similar impact on other important causes of workers’ compensation claims.

According to a 2014 Workers Compensation Research Institute (WCRI) study, “Why Surgery Rates Vary,” approximately one-fifth of the injuries covered by workers’ compensation are back injuries.

Although back pain is common, how to best treat the injury, including if and when surgery is clinically appropriate, is controversial and lacks clinical consensus. Moreover, the frequency of surgery among workers with back injuries varies widely from state to state, according to WCRI. For example, nearly 20 percent of injured workers with back pain had surgery in Oklahoma and Tennessee. By contrast, less than 10 percent of workers in California and Florida with the same diagnoses had surgery.

The WCRI study found that certain conditions are associated with higher likelihood that back surgery is undertaken. These include more surgery-intensive local practice norms, higher reimbursement rates for surgery, and more surgeons in an area.

By contrast, WCRI found, these factors explain little of the variation in knee surgery rates.

ACOEM is an international society of 4,500 occupational physicians and other health care professionals. Liberty Mutual is a major worker’s compensation insurer. WCRI is a not-for-profit organization of public officials, employers, insurers, injured workers, organized labor and others involved in workers’ compensation.

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