Low workers' comp rates bad for care, return to work

Evidence-based care reduces costs

Workers' compensation fee schedules do not properly recognize and reimburse physicians who restore injured workers to optimal function and promote rapid return to work, says a new position statement from the American College of Occupational and Environmental Medicine (ACOEM).

In fact, workers' compensation payments often are so low that they make it almost impossible for occupational health clinics to be financially successful, says William Patterson, MD, MPH, assistant vice president of Concentra Health Services in Londonderry, NH, and member of ACOEM's board of directors.

Use of evidence-based guidelines to guide the treatment of work-related medical conditions and injuries reduces costs, says Patterson. "Unnecessary treatment is avoided, and administrative hassle is reduced," he says. "The research shows that if you deliver high quality occupational health care to injured workers, you will have better outcomes, quicker return to full duty, and lower medical costs."

Although the ACOEM guidelines are in use throughout the country, few states currently mandate the use of treatment guidelines by statute or regulation. The guidelines have been adopted by law in the states of California, Nevada, and Tennessee, and they may be used by networks in Texas. Several other states are considering adoption of the guidelines by regulation, including Kentucky, Michigan, and Utah. "In addition, the ACOEM Low Back Guideline has been recommended for adoption in New York by the New York Department of Insurance," says Patterson.

In California, adoption of the guidelines resulted in fewer visits to physical therapists and chiropractors. "There is no evidence that three times a week, six months out, is helpful or cost effective. That's an example of how they have been applied," Patterson says.

The guidelines also define limitations of diagnostic testing such as magnetic resonance imaging (MRI). "There are frequent false positives in the use of MRIs. Research shows that by a certain age, a high percentage of the normal population will have an abnormal MRI," notes Patterson.

Fees vary by state

In some states, fee schedules for workers' compensation are so low that it inhibits the ability of an occupational health provider to run a functioning business, says Patterson.

One of the most egregious examples is New York, where workers' compensation rates for routine office visits are below those of Medicare, even though delivering workers' compensation services is more complicated than regular medical care because it requires more communication, says Patterson. "You have to call the employer, fill out paperwork, get preapproval for the MRI, write up restricted duty forms, and so forth. With an injury from skiing, there is none of that."

Workers' compensation fee schedules should be 125% to 150% of Medicare rates as a minimum, says Patterson. "Otherwise, the development of qualified occupational health programs is inhibited, which rebounds negatively on people returning to work and the economic health of state employers," he adds. "It is a question of fairness as well. We should have an appropriate fee schedule."


For more information, contact:

  • William Patterson, MD, MPH, Assistant Vice President, Medical Operations, Northeast Zone, Concentra Health Services, Londonderry, NH. Phone: (603) 644-5987. E-mail: William_Patterson@Concentra.com.

The American College of Occupational and Environmental Medicine (ACOEM)'s Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers, 2nd Edition costs $175 for ACOEM members and $199 for non-members. To order a copy, call (847) 818-1800. To access the position statement on workers' compensation fees, go to the ACOEM web site (www.acoem.org). Under "Policies & Position Statements," click on "Position Statements," "Ensuring Quality of Care in Workers' Compensation Programs: Fair Fee Schedules and Evidence-Based Guidelines."