WC payers losing billions in unnecessary medical costs, expert says
In a presentation for the annual Workers' Compensation Education Conference, the executive director of the Workers Compensation Research Institute said unnecessary care and unnecessarily high -- or low -- costs were among the main culprits leading to wasted spending in the workers' comp system.
Unnecessary care. Examples of unnecessary care that drives up costs in the workers' comp system include some opioids and surgeries. One particular study undertaken by WCRI shows the variation in the prescribing patterns of opioids among states. While "most injured workers with pain medications received opioids," a study of 21 states showed marked differences.
On the lower end was Connecticut, where just under 60 percent of injured workers with pain medications received opioids. On the high end was Arkansas, where about 80 percent received opioids.
The longer term use of opioids also varied widely among states. The same study showed the percent of nonsurgical claims with opioids that were identified as longer term users of opioids.
On the lower end was Arizona with less than 5 percent while Louisiana was on the high end with roughly 17 percent. One out of six injured workers in Louisiana was identified as a longer term user of opioids, and one out of seven injured workers in New York.
"The longer term use of opioids has been persistent in all study states except Massachusetts," Victor said. That state previously took steps to address opioid prescribing patterns, resulting in a decrease.
There are opportunities to curb opioid use among injured workers. Victor pointed to studies showing low percentages of states that conduct drug testing of injured workers on longer term opioids and even lower rates of those injured workers receiving psychological evaluations and/or treatment.
A study of the prices paid for nonhospital services rendered in the first half of 2012 showed wide differences among states. "The medical prices in Wisconsin, Indiana, and New Jersey were about double the prices in California, Florida, and North Carolina," Victor said.
While prices that are too high drive up costs unnecessarily, those that are too low may reduce the number of providers willing to treat injured workers.
Victor will present relevant WCRI study findings during a panel discussion at the National Workers' Compensation and Disability ConferenceŽ & Expo, produced by LRP Publications.
By Nancy Grover
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September 30, 2013
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