Study Analyzes Practice Patterns of Doctors to Curb Costs

Analyzing practice patterns of physicians participating in a workers' compensation system may hold valuable clues about how to curb the nation's health care costs, according to a recent study.

According to the report, published in the Journal of Occupational and Environmental Medicine, researchers from the Johns Hopkins University School of Medicine found that such an examination of practice patterns had a profound impact on the ultimate cost of claims. After analyzing five years of claims data from the Louisiana Workers' Compensation Corp. from 1998 to 2002, the researchers found that a small group of physicians -- only 3.7 percent -- accounted for more than 72 percent of the workers' comp costs. The physicians in this group were termed cost-intensive providers.

"Across the board, we've found that most physicians practice prudently," said Edward J. Bernacki, director of the Johns Hopkins University School of Medicine's Division of Occupational Medicine and principal investigator of the study. "But there are physicians who engage in cost-intensive practices. As we continue to debate the nation's health care system, it makes sense to analyze how practice patterns drive costs before instituting sweeping reform."

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In 2003, researchers from Johns Hopkins began working with the LWCC -- a private, nonprofit, mutual insurance company -- to provide quality and cost control. For the study, researchers analyzed individual LWCC claims and a database of health care providers -- doctors, physicians, clinical practices and facilities -- during the same period. Bernacki said this research is the culmination of several years of investigation into workers' comp costs that have yielded similar results.

While some differences between physician groups were related to injury severity, researchers said the analysis controlled for International Classification of Disease group, claim duration and other potential surrogates for severity. The study concluded that cost-intensive provider status had a significant cost impact that was independent of severity.

"We have demonstrated that it is possible to objectively identify a group of physicians who are associated with high-cost claims and quantify their effect on a system of health care," said Xuguang "Grant" Tao, a member of the study's research team. "Our major finding was that the workers' comp costs of claims associated with this group of physicians are much higher than those claims associated with other physicians."

Earlier research support. Researchers noted that previous studies by the Hopkins team reinforce the findings of the current study. For example, a 2005 study was the first to find that a small network of physicians could have significant impact on overall costs. In this study, a statewide group of 2,000 medical providers -- the OMNET Gold Network -- showed significant cost-savings by treating patients effectively and closing claims quickly.

In addition, a 2007 study found that certain claim attributes -- specifically the involvement of an attorney and the duration of the claims -- greatly impacted overall claim cost. After analyzing 36,329 claims over five years, researchers found that 2 percent of these claims accounted for 32 percent of the claim costs.

A third study in 2008 found that attorney involvement was associated with consistently higher medical, indemnity and claim handling costs. Of nearly 7,000 claims examined in that study, 738 involved attorneys. By the study's closure, 97.7 percent of claims without attorneys had been resolved. Of those with attorney involvement, only 57.5 percent had been closed. Researchers found that attorney presence on a claim correlated with duration, and the duration correlated with higher cost.

Read more at the WORKERSCOMP Forum^TM homepage.

February 8, 2010

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