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The best way to cut workers' comp costs may be evidence-based medicine.

The workers' compensation field, generally speaking, has been slow to take up evidence-based medicine guidelines--in other words, medical treatments that are proven to work. But now that EBM guidelines have arrived, said Phil Denniston, president and founder of the Work Loss Data Institute, employers and their insurers can expect lower costs and fewer employee lost days.

Statistics bear this out. The Integrated Benefits Research Institute reported in 2004 that employer claims cost 3.67 times more when physicians failed to comply with such guidelines. In California, where EBM guidelines from the American College of Occupational and Environmental Medicine were adopted in September 2003, the pure premium rate has decreased a cumulative 46.2 percent since, according to a November report from the California Department of Insurance.

Charles Kennedy Jr., a treating orthopedic physician in the Texas workers' comp system, suggested during the NWCDC session that evidence-based medicine can be so successful in comparison to current workers' comp practices because nonevidence-based medicine tends, well, not to work. Kennedy rattled off several practices common today that just don't do it for treating low-back pain, repetitive motion disorders, and knee and shoulder conditions.

Pharmaceuticals, for instance, are not the answer according to Kennedy. Nonsteroidal anti-inflammatory drugs, like aspirin, ibuprofen and cox-2 inhibitors, kill more people than automobile accidents every year. Yet just as much money is spent on medications like these in the United States as is on gasoline.

Particularly troubling to Kennedy are narcotics. "It's absolutely incredible now what is happening with the proliferation of narcotics," he said. "People are taking them like there's no tomorrow."

On the overreliance on imaging devices as a "solution" to lower back pain, Kennedy quipped: "If X-rays and MRIs could cure back injuries, there'd be no more back pain in the United States. I guarantee it."

Evidence-based medicine guidelines can help employers avoid such ineffectual "treatments"--as well as get up to speed with the current workers' comp legal environment. Major Supreme Court cases in the 1990s, along with amendments to the Federal Rules of Evidence, have created a courtroom climate in which a physician's medical opinion may not constitute adequate expert testimony, explained Patricia Whelan, director of the Work Loss Data Institute and publisher of its Official Disability Guidelines, which are a workers' comp-specific EBM set.

States have responded to these legal changes. Besides California, policymakers in Florida, Ohio, Texas and Nevada have adopted national evidence-based disability guidelines. In following suit, other states could face political wrangling between labor and business interests. But for stakeholders in workers' comp, there should be no debate, said Denniston.

"Guidelines should not be a threat to people supporting an injured worker," he said.

January 1, 2006

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