Costs, recovery from joint injuries vary by state

There's a wide variation among states in the utilization of services to treat workers with joint injuries involving knees, shoulders, elbows and ankles, according to a new study by the National Council on Compensation Insurance Inc.

Joint injuries are among the most common workers compensation claims, the Boca Raton, Florida-based workers comp ratings and research organization said in a study released Monday about state differences in the diagnosis and treatment of such injuries.

While some can be catastrophic, joint injuries usually require less time to heal than many back injuries, according to the study. However, treatment can range from conservative options to costly and invasive surgical procedures.

Using medical bills processed on or after July 1, 2010, NCCI studied medical services provided within the first two years after the date of injury, and found a wide variation among states in the utilization of services to treat joint cases, the study says.

NCCI measures utilization by the cost at common fees, which is what the cost of treatment would be if all services were reimbursed at a common fee rather than using state fee schedules. (The cost at common fee is determined by taking the median amount paid for a service within each state and then averaging the state medians, according to the study.)

In most states, the average cost at common fees is greatest for ankle injuries, followed by shoulder, knee, and elbow injuries, the study says.

For each of the four joints studied, NCCI selected three states with a comparatively low average cost at common fees per case and three states with a comparatively high average cost at common fees.

While the findings depend on the six states selected, “restricting to a few states simplifies the comparisons, while still including enough state-specific detail to show how utilization can vary by state,” NCCI said.

For example, for knee injuries in low utilization states (Indiana, Maryland and Missouri), surgery accounted for 23% of treatment utilization and physical medicine, such as physical therapy, accounted for 26%. Meanwhile, for knee injuries in high utilization states (Colorado, Illinois and Kentucky), surgery accounted for 35% of treatment utilization and physical medicine accounted for 25%.

Higher cost at common fees for surgery and physical medicine “reflect some combination of a greater average number of services per claim and a shift toward more costly treatments,” NCCI said in the study. And although states showed differences in the diagnoses of knee injuries — including strains/sprains, contusions and meniscus tears — their cost at common fees per case for diagnostics are similar.

“The difference in the itemized average (cost at common fees) per case between the low and high states for surgery and physical medicine is about $2,400; this is more than five times the difference for drugs and diagnostics, which is about $460,” according to the study.

NCCI said “future research is needed to better understand the drivers of the differences in diagnosis and treatment among states and to evaluate the effectiveness of approaches for regulating utilization.”

Jurisdictions included in the study are Alaska, Alabama, Arkansas, Arizona, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Maine, Minnesota, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Virginia, Vermont, Washington, D.C., Wisconsin, and West Virginia.