NCCI researchers analyzed data and identified changes in cost trends for late-term claims.
"The Drugs category shows the greatest difference between early and late-term care, increasing by almost 30 percentage points late-term," the study says. "Pain medication accounts for the largest portion of prescription costs to treat injuries more than 20 years old."
The researchers used information from NCCI's Medical Data Call, which captures transaction level detail on the medical bills processed on or after July 1, 2010. Data from NCCI's 35 jurisdictions and seven others were included.
Overall, the report estimates that more than 10 percent of workers' comp medical costs are being spent on claims that are more than 20 years old, identified in the study as late-term claims. That percentage, they say, may continue to grow.
Where prescription drugs showed the biggest increase in services for late-term claims, surgery showed the biggest decline, dropping by 15 percentage points. That was followed by a 10 point drop for physical medicine.
"Because drugs account for a large proportion of late-term care costs, prescription data can suggest the nature of late-term care," the study says. It compares the share of medication costs for several specific drugs and compares late-term care experience with all workers' comp medication costs in 2009, and it includes the top 10 workers' comp drugs, either overall or within late-term care.
"The top drug, OxyContin, accounts for 6 percent of workers' comp medication costs in 2009 and that share rises another five percentage points to 11 percent for late-term care," the research states. "The shares for opioid chronic pain medications, such as Oxycodone (OxyContin, Percocet) and Fentanyl (Duragesic), are generally higher within late-term care than within all medication costs for 2009."
The increased use of the pain medications comes in the midst of arguments for and against them. "While few advocate the long-term use of opiates, Exhibit 6 shows a high reliance on controlled substances in late-term care," the study says.
Pain management also uses drugs that target the central nervous system and were initially developed to treat psychiatric and neurological conditions, such as Cymbalta.
Along with medications, home health services comprise a substantial portion of the costs for late-term claims, growing to 9 percent. The authors note that the growth in home health services may continue well beyond 20 years.
"If so, home health services may account for more than 10 percent of the cost of workers' comp medical coverage delivered decades post injury," the study says. "Since home health services have seen less upward pressure on prices than medical care generally, home-based treatment of chronic conditions may help contain worker's comp costs."
Medications and home health services, along with implants, orthotics, prosthetics, and other supplies, make up over half the outlay for late-term care but less than one-sixth the cost for cases under 20 years old.
Additional findings include:
- Disease cases and cases with complications from a medical procedure account for more than three-fourths of late-term payments. By contrast, treatments for traumatic conditions account for less than one-fifth of the cost of late-term care.
- Men were 71 percent of the claimants treated late term despite the lower corresponding percentage for men in the workforce -- which dropped from 57 percent in 1980 to 55 percent in 1990. "Male patients accounted for an even greater 76 percent of the late-term payments," the study says. "It follows that the average cost per year to care for a male patient was about 30 percent higher than for a female patient."
- Patients younger than 60 account for more than half the cost of late-term care but less than half of the number of services. "The younger claimants -- roughly those younger than age 60 -- cost about 55 percent more per year to care for than do older claimants."
Read more at the WorkersComp Forum homepage.
February 25, 2013
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