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Drugs dispensed by doctors rise sharply in Workers' Comp

The volume of prescription drugs dispensed by doctors to injured employees is rising sharply nationwide, driving up Workers' Compensation costs, according to a recent NCCI study.

NCCI's "Workers Compensation Prescription Drug Study, 2010 Update" found a "dramatic increase in the portion of drug dollars associated with drugs dispensed by physicians."

The study, which covered the period 1994 – 2008, found that "Workers' Comp drug costs have always included some cost for physician-dispensed drugs," but "recently, we have seen a sharp increase in these costs in almost every state." The percentage of Workers' Comp prescription dollars dispensed by physicians increased to more than 20% in 2008, up from more than 15% the prior year, according to the study. This increase occurs in older as well as newer claims.

The study also notes that OXYCONTIN® has become the top prescribed (in terms of paid dollars) WC Rx. The exploding growth of opioid usage in narcotics in Workers' Comp has been well documented by NCCI and California Workers' Comp Institute (CWCI). It behooves employers to know how medical providers are managing narcotic opioid scripts and claimants on those scripts.

Medical treatment is key to Return-to-Work

Rising medical costs are the leading driver of Workers' Compensation costs. While employers have a huge stake in helping to manage claims since they ultimately pay for them, many believe they have little ability to control medical costs.

Yet, establishing trusted relationships with medical providers skilled in occupational medicine and understanding the different treatment options for common injuries can go a long way in controlling costs.

A major new study by Work Loss Data Institute, publisher of ODG Treatment, including the Official Disability Guidelines, concludes that the number one predictor of return-to-work is medical treatment. While other factors such as severity, job, age and co-morbidities affect return-to-work, the study finds that the type of medical treatment far exceeds these factors as a determinate of disability duration.

The table below shows the findings from the study:

Disability Duration Determinates
Predictor of RTW Low Impact High Impact Average Impact
Medical Treatment 0.1 100+ 7.8
Psychosocial Factors 1.1 2.8 1.7
Other Co morbidities 1.1 2.1 1.6
Severity 0.5 3.2 1.5
Age 0.4 2.7 1.4
Geography 0.8 5.0 1.2
Type of Job 0.7 1.7 1.1
DOL Job Class only 0.9 1.2 1.0
Gender 0.7 1.6 1.0

As an example, the study cites spinal infusion for low back pain. This treatment is not recommended in ODG and return-to-work is 100 times as long as exercise that is recommended by ODG. For low back pain, the study concludes that DOL job class (sedentary, light, heavy, etc.) makes almost no difference in disability duration.

In a recent study in the journal, Spine, researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers' Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that caused weaknesses of the limbs. Half of the patients had surgery to fuse two or more vertebrae and the other half did not have surgery. After two years, 67% of those who did not have surgery returned to work, yet only 26% of those who had surgery returned to work. There also was a significant increase in opiate use by those who had the surgery.

According to Pat Whelan, Publisher of ODG and Director of Work Loss Data Institute, the findings of the ODG study "supports what we identified years ago as we drilled down into our reported data. Different return-to-work pathways evolve within the same diagnosis, depending on the type of treatment administered. Return-to-work (RTW) durations are not self-defined but directly impacted by treatment; the above study quantifies that impact. RTW guidelines must be integrated with evidence-based medical treatment guidelines (EBM) in order to be a fair, accurate and effective RTW management tool. Further, true EBM must link to and mirror today's science. Treatment recommendations should not vary based on the preferences of different jurisdictions, political influences, or economic agendas. These two elements are what make ODG unique."

The takeaway is that employers need to work closely with medical providers and insurance companies in monitoring the treatment that is provided to employees.