According to a survey conducted for the Center for DiseaseControl, 51.5 percent of adults reported a chronic musculoskeletalcondition in 2009, twice the rate of chronic heart or respiratoryconditions. This issue is so pervasive it is the third most commonreason that Americans seek medical attention.

A U.S. Department of Health study showed that from 1996 to 2004managing musculoskeletal disease, including lost wages, cost anaverage $850 billion annually, making it the largest workers'compensation expense. For employers paying workers' compensationclaims, the economic strain has reached a tipping point. Howsignificant is this specific category of injuries? Consider:

• 80 percent of all claims under workers' compensation aremusculoskeletal sprain/strain injuries, with lower back injuryconsuming more than 33 percent of every workers' compensationdollar.
• Back pain causes more than 314 million bed days and 187 millionlost work days yearly (data from the U.S. Department of Labor, 1998to 2005).
• Employers lose 5.9 hours of productivity per week from thosesuffering from musculoskeletal pain who continue to be on the job(referred to as presenteeism).

The statistics surrounding musculoskeletal injury clearly defineit as the primary threat to employers' risk programs. The magnitudeof this problem is related to three principal problems with thedelivery of efficient, effective care: 1) Lack of reliable orprecise diagnoses; 2) Ongoing use of ineffective treatment methods;3) Poor application or emphasis of self-care and preventivestrategies.

Patients, employers and insurance providers assume that thecurrent model of care is driven by evidence-based standards thatdictate treatment methods. However, the reality is thatdetermination of treatment protocol is rarely based on a precise orreliable diagnosis as supported by the medical literature. Instead,most clinicians assign treatment based on the specific trainingwithin their medical discipline:

• Pain management physicians apply injection therapy
• Chiropractors manipulate most patients with joint pain
• Physical therapists apply general exercise and modalities
• Surgeons recommend surgery.

These inherent biases towards delivering care based upontraining result in over-utilization of services, inefficienttreatments, and regular recurrence of pain due to the lack ofemphasis on prevention. It is the “I seek what I know, therefore Ifind what I seek” mentality that creates these clinical biases. Inshort, employers are funding an outdated system of treatment thatis ineffective and costly.

Saving Billions

Effective wellness management programs that align allstakeholders and centralize care methods can reduce workers'compensation claims by more than 50 percent, saving billions ofdollars annually.

With more than 80 percent of all workers'compensation dollars allocated to musculoskeletal injuries, astrategy specific to these injuries is necessary to successfullymanage costs. The best musculoskeletal care strategies combineupdated scientific studies regarding diagnosis and treatment withclinical outcome data and robust self-care prevention. Whenimplemented properly, these practices are clinically proven toresolve painful joint dysfunction in a timely manner throughconservative care, virtually eliminating the need for imagingstudies, lengthy physical therapy, surgery, and other protracted,expensive treatments. Employers who direct their injured workersinto these outcome-driven practices immediately experiencesignificant decreases in the duration of claims and are back on thejob more quickly, reducing employers' exposure for lost time. Casedata compiled by Integrated Mechanical Care show that theseimprovements in medical management also come with significantdecreases in recurrence of injury and very high patientsatisfaction with care ratings.

Presenteeism, the function of ailing workers remaining on thejob with pain, poses another dilemma for employers. Fortunately,the same treatment methods used to dramatically reduce time lostfor injuries have revealed effective preventive workplace solutionsthat resolve these conditions quickly, resulting in moreproductive, healthier workers.

A National Business Group on Health survey found that nearly 75percent of employees rely on their employers for medical and healthinformation in 2010. This was a significant increase from 2007,which showed 54 percent of employees using the option. Thisreliance dictates that employers understand what the scientificevidence states as it pertains to effective treatment andprevention programs and how to locate “best-care” practices fortheir injured workers.

What Is Evidence-Based Treatment?

Most clinicians believe they are delivering a high standard ofcare. However, due to the convoluted nature of our current workers'compensation system, most patients are not tracked over a longperiod. The most successful wellness programs rely on trackingpatient outcomes using scientifically validated disabilitymeasurement tools. Through this process, it becomes clear that themajority of diagnostic tools and treatment protocols formusculoskeletal pain and injury are based on tradition and painreduction rather than a long-term cure. The result is inappropriateutilization of services (i.e. chiropractic, pain management, andthe like), lengthened duration of claim, elevated direct medicalcosts, increased time away from work, and eventuallydisability.

The clinical outcomes achieved through evidence-based practicesshould be constantly monitored, allowing for evolution of treatmentand application of treatment specific to each patient's injury ordisease. Additionally, the treatment protocol should bestandardized among all providers, clinicians and stakeholders,allowing reproducibility of the outcomes from region to region.This results in a consistently implemented program, limiting thepossibility an injured worker will receive unnecessary care or bedenied optimal care.

Efficient care or treatment includes a precise and accuratediagnosis and effective and conservative treatment along withself-care strategies for prevention. A reliable diagnosis is thefirst step toward resolution of injury. Clinicians should betrained to diagnose and treat all injuries based on current casestudies and scientifically supported interventions. Once anaccurate diagnosis has been determined, the most effective carestrategies can be implemented by delivering the patient to thecorrect provider of services. This outcome-driven process reducesthe need for imaging, medication, specialist consults, and surgicalprocedures. The clinical outcome data produced from these types ofprograms prove it is possible to attain excellent results withlimited medical system exposure.

The last piece in the program is a valid, self-care strategyspecific to the patient's injury. Properly implemented and guided,the self-care piece guarantees a reduction in recurrence of injuryand pain. The result for the payer and the employer is a largedecrease in the upfront cost of medical care, and reductions ofclaim duration and lost time, indemnity, medico-legal fees andexpenses associated with disability related to the claim. Theemployer also retains a healthier, more productive worker.

Workers' compensation payers, employers and insurance carriersreact to the market in predictable ways. Their data shows medicalcosts, indemnity and disability claims costs rising, and leadingworkers ' compensation entities struggling to remain profitable.The recent trends of negotiating discounted rates for providers anddeveloping networks based upon who will take the lowestreimbursement does nothing to solve the problem associated withineffective treatment methods and poor diagnostic skills. Thisstrategy further perpetuates unnecessary, aggressive and expensivetreatments.

All workers' compensation stakeholders must use theirconsiderable influence to demand proven, evidence-based clinicaloutcomes for treatment. Providers must earn the right to managepatient care through the demonstration of excellent clinicalresults. By driving the market toward treatment protocols withproven outcomes, stakeholders can fundamentally change thesystem.

Benefits for All

Effective programs featuring evidence-based practices have asignificantly positive impact on patients, employers, and workers'compensation programs. There are entire regions of Florida thathave experienced an over 50 percent reduction in claims and losttime/indemnity costs while maintaining a 98 percent satisfactionrating from patients participating in these programs. These resultshave caused more employers, brokers and insurance groups to demandcomprehensive, evidence-based care to provide improved outcomes fortheir workers and clients.

When evidence-based practices are implemented, all stakeholdersbenefit. The injured worker resolves his condition expediently andeffectively without aggressive or confusing medical interventionand returns to work faster, armed with a prophylactic programproven to reduce future recurrence of his condition. The employermaintains a healthier, more productive workforce at a reduced cost.The workers' compensation plan insurance carrier maintains a strongrelationship with its client, while reducing risk andcosts.

The result is a happier, healthier workforce and employers ableto capitalize on the fact that good clinical outcomes improve thebottom line.