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Employer control over medical providers can lower costs for spinal injuries

Employer control over medical providers can lower costs for spinal injuries

The subjective nature of spinal injuries can cause the greatest disparity in medical and indemnity costs between states that allow injured workers to choose their own providers and those that give employers more control, according to the lead researcher of a study comparing overall costs.

However, those overall costs showed little difference between states, leading the researchers to take a closer look at individual injury trends.

The study, released in late April by the Workers Compensation Research Institute, found that average workers compensation indemnity and medical costs vary little between states with opposite approaches to provider choice.

“What (we) found was that the relationship between provider choice seems to raise costs for the most expensive back injuries,” said John Ruser, president and CEO of the Cambridge, Massachusetts-based institute.

Back injuries often fall outside of measureable outcomes, according to Dr. Bogdan Savych, study author and public policy analyst at the institute. This means some injuries — unlike broken bones or lacerations — won’t show up on a medical imaging scan, he said. 

The overall outcome of the research — that average cost difference was near zero for all injuries combined — caused researchers to dig deeper into the data, he added. “When we started looking at the analyses, we started looking at all injuries — and when you look at all injuries, you didn’t see differences in costs. We were not satisfied with just looking at aggregates.” 

That dissatisfaction drove Dr. Savych and his team to take a closer look at types of injuries.

“What we found, consistently, was when we looked at back and neck sprains, you typically find higher medical costs and higher indemnity costs,” he said. “When you are thinking of back and neck injuries, there is more subjectivity in nature of care. There’s probably more subjectivity in whether a worker is ready to go back to work and (whether) they still have pain. They probably have more time off work and higher costs.” 

The study examined injuries in 25 states that occurred between 2007 and 2010, evaluated at an average maturity of 36 months. States where workers can choose a provider within their employers’ established network were excluded from the study.

The study suggested that “policy changes that restrict worker choice across the board may do little to reduce costs on average,” a research note associated with the report said. “Rather, policymakers in states where policies give workers control of the choice of provider might focus on how to reduce the incidence of high-cost cases for a narrow set of injuries.”

Also, the institute noted that actual provider choice may not adhere to policy guidelines, which makes it difficult to establish a direct causal relationship between provider choice policies and costs.