Reimbursements, proximity of surgeons affect likelihood of back surgery

A study released on Thursday by the Cambridge, Massachusetts-based Workers Compensation Research Institute found that a variety of factors including reimbursement rates for doctors and local practice norms account for the wide variance in back surgery rates for injured workers according to location.

Using workers compensation claims and payment data in addition to other sources of information related to the health care and economy of geographic areas, the study, “Why Surgery Rates Vary,” found that a worker's probability of getting surgery for their back pain depends largely on the area of the country in which they seek treatment. For example, while 19.6% of injured workers in Oklahoma with back pain went under the knife, only 6.9% of workers in California with the same diagnoses had surgery.

The study found that more surgery-intensive local practice norms, higher reimbursement rates for surgery, and more surgeons in an area each independently were associated with higher likelihoods that an injured worker had back surgery. Noting that approximately 20% of the injuries covered by workers' compensation are back injuries, the authors of the study say the findings can be used to shape discussions about second opinions, treatment guidelines, and fee schedules.

“Some of the factors are within the control of workers' compensation policymakers,” Christine Yee, WCRI economist and one of the authors of the report, said in a statement. “Other factors result from the dynamics and practices of the larger health care system.”