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Finding the right Rx for your Workers’ Compensation program

Those who oversee safety in the workplace have every right to be proud. There is no doubt that today’s workplace is safer than ever. Since 1991, the frequency of workplace injuries is down approximately 50%, thanks to the hard work of safety professionals and engineers, the advent of OSHA in the 1970s, safe workplace practices, cordless tools, modular construction, even robotics, which has lessened human interaction with potentially dangerous machinery.

So if this increased attention to safety has led to a decline in the number of workplace accidents
which has resulted in fewer claims and lower rates—then why has the cost of claims risen dramatically over the years? Why have some workers fallen through this safety net? The answer is simple: higher medical costs are the direct result of alarming increases in utilization of medical services.

According to a recent study by the NCCI, the factor driving medical severity is the growth in the number of medical treatments and the different mix of treatments. The study took a look at the years 2001-2002 as compared to 1996-1997, and found that the number of treatments for all diagnosis increased 45%, while with such injuries as knee and leg sprains, the increase was as high as 80%.

Through negotiations, doctors have been cajoled into accepting lower fees, and to counteract these losses, medical treatments have increased. Think of it like squeezing a balloon; when you pinch in on one end, it expands on the other. Doctors are for the most part not following evidence-based treatment protocols as set forth by the American College of Occupational and Environmental Medicine (often referred to as the ACOEM Guidelines). And by not doing so, we are witnessing medical treatment plans that are misdirected and unnecessary, coupled with increased levels of treatment, additional testing, and the high cost of doctors to run the tests.

What we aren’t seeing is anyone challenging these recommendations. The reason is quite simple; no claims adjuster has ever been fired for agreeing with a doctor’s recommendation. And nobody wants to be the first. The bottom line is that the only thing more costly than a good doctor is a bad doctor.

Another major danger with over-utilization is that the steady stream of doctor’s visits, MRIs, prescriptions, therapy sessions, etc., creates in the employee a mindset that says, “If I’m undergoing all this treatment, I must really be hurt.” The injured employee then slips into a deep mental chasm referred to as “secondary gain behavior,” where his decisions are driven more by his emotions than his economic well being, often resulting in litigation and the loss of a valuable employee.

Another negative by-product of over-utilization has been the recent introduction into the Workers’ Compensation system of narcotics, once solely prescribed for individuals in their last months or weeks of life. Where years ago an employee might be given a couple of Advils for a backache, today it is not uncommon for doctors to prescribe drugs such as Oxycontin for the same ailment.

The overuse of narcotics in the workplace causes bad things to happen. New problems are created. But if the injured worker doesn’t get the prescription from one doctor, they may simply find another. It’s not a stretch to say you can easily pick up a magazine and find an advertisement for a doctor willing to prescribe narcotics.

If over-utilization is wreaking havoc on the medical costs associated with the Workers’ Comp system, then why would an overwhelmingly high percentage of doctors suggest treatment that is not evidence-based? Simply put, doctors have been trained this way throughout their professional lives. Since the day they picked up their first medical book, it’s been ingrained in them that their judgment is what’s best. That thinking is not going to change anytime soon.

The key to solving this problem is to be sure every effort is made to select the right doctor, one who will follow evidence-based treatment protocols and work towards returning the injured employee to the workplace in the appropriate time, even if in a modified position. And evidence supports the view that workers get better quicker when they are back on the job.

To find the right doctor, engage in dialogue with other companies and businesses in your area, looking specifically for those trained in occupational medicine. And once you find the right physician, remember —communication is key. Doctors shouldn’t have any doubt that their recommendations and restrictions will be respected. Furthermore, they need to fully understand the return to work possibilities that exist. The steady flow of information between the doctor, the employer, and the claims adjuster is the first step in changing a system that is severely eroding the good work being done by safety officials.