The California Workers' Compensation Institute and Axiomedics Research revisited and updated a 2008 study on the relationship between the number of opioid prescriptions and other claims characteristics titled, "Pain Management and the Use of Opioids in the Treatment of Back Conditions in the California Workers’ Compensation System."
According to report co-author Dr. Laura Gardner 40% of applicants with one opioid prescription during their first post-injury year filed indemnity claims.
67% of injured workers with three opioid prescriptions during their first post-injury year had filed indemnity claims. Claimants with six or more opioid prescriptions during their first post-injury year had the highest rate of indemnity claims, with 85% to 92% of their claims resulting in indemnity claims.
Likewise, that there is a link between higher opioid prescriptions and attorney involvement isn't surprising - data already shows that increased potential for indemnity is related to increased attorney participation.
Because applicants with more opioid prescriptions are more likely to file an indemnity claim, they could also be more likely to hire an attorney to represent them.
The data also revealed a strong correlation between the amount of medical benefits paid on a claim, and the number of opioid prescriptions an applicant received, the study finds.
And of course these cases are harder to settle or get closed.
If there's only one opioid prescription the claims closure rate averaged 87%. Applicants with three opioid prescriptions had a closure rate of 76%, workers with six opioid prescriptions had a closure rate of 67% and applicants with nine opioid prescriptions had a closure rate of 62%.
What IS surprising to me is that, 5 years after that original study, we are still working towards some "solution" to this issue.
The overall majority of all claims presented involve back sprains and strains.
A 2012 CWCI study concluded that workers with these types of injuries accounted for 10.6% of California's job injury claims, but only 1 in 7 of these injuries involved a permanent disability payment, they had a relatively low attorney involvement rate, and those that resulted in lost-time closed more quickly than other types of claims, so they accounted for only 7.8% of California workers' compensation benefit payments.
This means that opioids disproportionately affect a small percentage of claims.
The American College of Occupational and Environmental Medicine guidelines do not recommend opioids for patients with simple back sprains and strains. So it would seem that if utilization review (now backed up by independent medical review) were effective then we should see some declination in these numbers over time.
I'm not sure that's happening - such cases are not increasing based on the statistics I've recently seen, but they are not decreasing either.
Which brings me to the point that I was making yesterday: we have lots of numbers that paint a big picture. But those numbers don't do us any good unless we get to the number "one" - the individual that is the tree in the forest.
How do we use this information to make sure that "one" doesn't end up in the high percentage cohort? The only way that happens is with focused attention.
We make grand policy changes through legal and regulatory mandates. These are all well intentioned, but unless we take the time to deal with "one" then the claim is lost to the big statistical group.
This is not an easy task in our current, process oriented, managed benefit system. The efficiencies realized with systematic treatment of claims masks the difficulty each "one" presents - every claim, despite similarities, is different.
I think that most of us in this business want to do the very best we can for claimants whose files come across our desks, but it takes a lot of stamina and fortitude.
For those professionals who are able to sustain the incredible energy day in and day out paying attention to "one," hats off to you! May the rest of us learn from your hard work and dedication. By dealing with "one" we can over time make these studies more joyous reading.
Which brings me to the point that I was making yesterday: we have lots of numbers that paint a big picture. But those numbers don't do us any good unless we get to the number "one" - the individual that is the tree in the forest.
How do we use this information to make sure that "one" doesn't end up in the high percentage cohort? The only way that happens is with focused attention.
We make grand policy changes through legal and regulatory mandates. These are all well intentioned, but unless we take the time to deal with "one" then the claim is lost to the big statistical group.
This is not an easy task in our current, process oriented, managed benefit system. The efficiencies realized with systematic treatment of claims masks the difficulty each "one" presents - every claim, despite similarities, is different.
I think that most of us in this business want to do the very best we can for claimants whose files come across our desks, but it takes a lot of stamina and fortitude.
For those professionals who are able to sustain the incredible energy day in and day out paying attention to "one," hats off to you! May the rest of us learn from your hard work and dedication. By dealing with "one" we can over time make these studies more joyous reading.
No comments:
Post a Comment