AN ERROR OF OMISSION?
I was fascinated by your coverage of chronic pain as viewed by Dr. David Deitz at the Annual National Workers' Compensation and Disability ConferenceŽ & Expo in Las Vegas, Nov. 10-12. (See "The Promise of Chronic Pain Programs.")
Of all the steps he listed for the workers comp industry to meet this challenge, he omitted the first, which is establishing that the patient's pain is valid.
A recent start-up company by a group of Johns Hopkins University-trained doctors in the Baltimore area has made progress in this area. The doctors pooled their research to put together a program that could improve the accuracy of assessing a patient's self-descriptions of pain, and then send that patient along to a better-informed diagnostic and treatment process. And the best part was convenience: the pain validation test could be taken on the Internet, in English or Spanish, in any of thousands of proctored settings.
The way we understand it, the scientifically constructed questionnaire is nearly impossible to fool (they told us it would work at 85 percent or greater accuracy). The way answers correlated with one another would illuminate the patient as (a) not actually in pain, (b) experiencing imaginary pain that still requires treatment, but a different kind of treatment, or (c) experiencing objective pain but, depending on the duration, may have been misdiagnosed and needs alternative treatment.
A transportation company thought the pain validity approach sounded too good to be true, as those things usually are. So they called the little company's bluff and sent them 260 active workers' comp cases. All were over six months old. Curiously, 48 percent were identified as sprains or strains, which was already suspicious or misdiagnosed because sprains/strains usually heal in seven to 10 days.
The only consistent element of those comp files was the continual increase in costs for both medical care and disability income. The oldest 15 cases carried a current average cost of $248,925. Stunning!
Each of the 260 claimants was scheduled to take the pain validity test at a proctored examination site. Then, if appropriate, they were scheduled for follow-up diagnostic and treatment protocols. The good news was that 30 people were able to get back to work immediately--there was nothing wrong with them except they had fallen through the cracks. Other cases were redirected to new diagnoses and treatment plans. In a large way, this company had stopped the bleeding.
The transportation company figured out that if the pain validity test worked that well on old cases, it would begin sending all its claimants through the system. It operates through several thousand health provider settings around the country, is easy to access and inexpensive at $300 per individual.
The Taft Companies
December 1, 2010
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