WCRI: Texas treatment guidelines change amount, mix of medical care

Fewer medical services were provided to workers with low back injuries after the implementation of medical treatment guidelines in Texas in 2007. The Workers Compensation Research Institute also reports evidence of increases and decreases in medical utilization for injured workers with neck and upper back, shoulder, and knee injuries.

Those are among the findings from research on the effect of medical treatment guidelines in Texas. WCRI compared the experience of workers injured and receiving medical care prior to the guidelines becoming effective with workers injured after the guidelines became effective.

Evidence-based treatment guidelines are one method used to control medical costs in the workers' comp system.The Texas Department of Insurance announced that, as of May 2007, use of the Official Disability Guidelines - Treatment in Workers' Compensation was required for the treatment of all injured workers not covered by a certified health care network.

CWCI: Medical provider networks effective, but reforms raise questions (04/08/13)
WC systems increasingly eye treatment guidelines (12/10/12)
State considers treatment guidelines through rule change (12/10/12)
Executive Summit speakers weigh in on comp challenges, solutions (11/03/11)
CMS proposal could add layer of complexity to comp cases (08/02/12)

The researchers looked at how the use of the guidelines affected the medical care received by injured workers and disability duration. They analyzed the medical and compensable lost time experiences for injured workers with loss dates during the first two months after the guidelines, and analyzed the medical and compensable lost time experiences that occurred during the first nine months after the loss date.

"In sum, we found evidence of a decrease in the amount of medical services administered to workers with a low back injury, mixed results for workers with a neck or upper back or shoulder injury, and a general absence of statistical significance findings for workers with a knee injury," the report says. Specifically, the authors reported:

Low back injuries -- decreases for the likelihood of surgery, physical medicine, chiropractic manipulation, other radiology, or an injection; a decrease in the number of visits for physical medicine, chiropractic manipulation, other radiology or injections; an increase in the number of services per visit for physical medicine; and a decrease in the number of services per visit for chiropractic manipulation.
Neck and upper back injuries -- an increase in the likelihood an injured worker received physical medicine, and a decrease in the likelihood of an injection or experiencing more than 12 physical medicine visits; a decrease in the number of visits for physical medicine and injections; a decrease in the number of services per visit for chiropractic manipulation; and increase in the number of services per visit for other radiology.
Knee injuries -- a decrease in the likelihood of receiving an MRI/CT scan.
Shoulder injuries -- a decrease in the likelihood of receiving surgery and an increase in the likelihood of receiving an MRI/CT scan; an increase in the likelihood of receiving a physical medicine treatment; a decrease in the number of visits for physical medicine; and a decrease in the likelihood of experiencing more than 12 visits for physical medicine.

Read more at the WorkersComp Forum homepage.

September 27, 2012

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