Outcomes for injured workers may differ from non-occupational patients

Reimbursement for medical procedures is often dependant on predictable outcomes. However, the results of spinal fusions for injured workers are causing some insurers to question whether the procedures should be authorized.

"We know there are certain indications that have predictably good results, but when you do procedures for degenerative disk disease and low back pain, the success rate is not as good and definitely not as good in the workers' comp population," said Dr. Marjorie Eskay-Auerbach, president of Spine Care and Forensic Medicine in Tucson, Ariz.

Eskay-Auerbach said she's heard of at least one insurer in North Carolina that has stopped reimbursing for spinal fusions for degenerative disk disease. "You have to show there is a tumor or fracture where we can predict improved outcomes," she said. "With degenerative disk disease, especially in the workers' comp population, we've not been able to predict. Nobody knows the reason."

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She says there's been much attention lately on why the success rates are much less predictable among injured workers compared to the same operation in the non-occ population. "That's been a bugaboo for a very long time," she said. "Many say it's a psycho-social issue. Nobody has really proven it yet, but that's something to be aware of."

February 17, 2011

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