Mandatory treatment guidelines may lower back surgery rates: WCRI

States with mandatory use of medical treatment guidelines in utilization review, reimbursement and dispute resolution may lead to lower rates of lumbar decompression surgery among workers with low back pain, according to a new report released Thursday by the Workers Compensation Research Institute.

Researchers from Cambridge, Massachusetts-based WCRI looked at the impact of treatment guidelines in combination with utilization management policies for the treatment of low back pain in 27 states between Oct. 1, 2015, and March 31, 2017. The study revealed that states that had both medical treatment guidelines in place and utilization management and reimbursement policies were more likely to see lower rates of surgeries for the treatment of low back pain that those with medical treatment guidelines alone, suggesting that the combination “may help encourage greater adherence with guidelines,” WCRI said in a news release.

The researchers noted that frequent use of MRI early in a claim is not consistent with most medical treatment guidelines, yet in most of the states studied, early MRIs were ordered and performed within six weeks of injury. However, for low back claims with nerve involvement that had more than seven days of lost time, the percentage of claims with early MRI ranged from 18% in Massachusetts to 55% in Florida, and the number of injured workers fitting into this category who received lumbar decompression surgery within the first year of treatment ranged from 3.2% in Delaware to 21.5% in Kansas.

States that had more extensive use of medical treatment guidelines in UR and dispute resolution tended to have lower rates of surgery. New York and California, which both have restrictive and mandatory medical treatment guidelines for UR and dispute resolution, reported that less than 5% of patients received lumbar decompression surgery within the first year, while Kansas, which has guidelines for educational purposes, and Missouri, which has no guidelines, reported surgery rates of 21% and nearly 18%, respectively. 

However, the researchers noted some outliers that suggest that other factors may explain variations. For instance, Tennessee reported the third highest rate of surgery despite the fact that it has restrictive and mandatory medical treatment guidelines for UR and dispute resolution, and Florida and Maryland, which were among the top five states with the lowest lumbar decompression surgery rates, have no state-adopted medical treatment guidelines in place.

The 27 states in the study include Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and Wisconsin.