According to a survey conducted for the Center for Disease Control, 51.5 percent of adults reported a chronic musculoskeletal condition in 2009, twice the rate of chronic heart or respiratory conditions. This issue is so pervasive it is the third most common reason that Americans seek medical attention.

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

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

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

Patients, employers and insurance providers assume that the current model of care is driven by evidence-based standards that dictate treatment methods. However, the reality is that determination of treatment protocol is rarely based on a precise or reliable diagnosis as supported by the medical literature. Instead, most clinicians assign treatment based on the specific training within 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 upon training result in over-utilization of services, inefficient treatments, and regular recurrence of pain due to the lack of emphasis on prevention. It is the “I seek what I know, therefore I find what I seek” mentality that creates these clinical biases. In short, employers are funding an outdated system of treatment that is ineffective and costly.

Saving Billions

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

With more than 80 percent of all workers' compensation dollars allocated to musculoskeletal injuries, a strategy specific to these injuries is necessary to successfully manage costs. The best musculoskeletal care strategies combine updated scientific studies regarding diagnosis and treatment with clinical outcome data and robust self-care prevention. When implemented properly, these practices are clinically proven to resolve painful joint dysfunction in a timely manner through conservative care, virtually eliminating the need for imaging studies, lengthy physical therapy, surgery, and other protracted, expensive treatments. Employers who direct their injured workers into these outcome-driven practices immediately experience significant decreases in the duration of claims and are back on the job more quickly, reducing employers' exposure for lost time. Case data compiled by Integrated Mechanical Care show that these improvements in medical management also come with significant decreases in recurrence of injury and very high patient satisfaction with care ratings.

Presenteeism, the function of ailing workers remaining on the job with pain, poses another dilemma for employers. Fortunately, the same treatment methods used to dramatically reduce time lost for injuries have revealed effective preventive workplace solutions that resolve these conditions quickly, resulting in more productive, healthier workers.

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

What Is Evidence-Based Treatment?

Most clinicians believe they are delivering a high standard of care. However, due to the convoluted nature of our current workers' compensation system, most patients are not tracked over a long period. The most successful wellness programs rely on tracking patient outcomes using scientifically validated disability measurement tools. Through this process, it becomes clear that the majority of diagnostic tools and treatment protocols for musculoskeletal pain and injury are based on tradition and pain reduction rather than a long-term cure. The result is inappropriate utilization of services (i.e. chiropractic, pain management, and the like), lengthened duration of claim, elevated direct medical costs, increased time away from work, and eventually disability.

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

Efficient care or treatment includes a precise and accurate diagnosis and effective and conservative treatment along with self-care strategies for prevention. A reliable diagnosis is the first step toward resolution of injury. Clinicians should be trained to diagnose and treat all injuries based on current case studies and scientifically supported interventions. Once an accurate diagnosis has been determined, the most effective care strategies can be implemented by delivering the patient to the correct provider of services. This outcome-driven process reduces the need for imaging, medication, specialist consults, and surgical procedures. The clinical outcome data produced from these types of programs prove it is possible to attain excellent results with limited medical system exposure.

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

Workers' compensation payers, employers and insurance carriers react to the market in predictable ways. Their data shows medical costs, indemnity and disability claims costs rising, and leading workers ' compensation entities struggling to remain profitable. The recent trends of negotiating discounted rates for providers and developing networks based upon who will take the lowest reimbursement does nothing to solve the problem associated with ineffective treatment methods and poor diagnostic skills. This strategy further perpetuates unnecessary, aggressive and expensive treatments.

All workers' compensation stakeholders must use their considerable influence to demand proven, evidence-based clinical outcomes for treatment. Providers must earn the right to manage patient care through the demonstration of excellent clinical results. By driving the market toward treatment protocols with proven outcomes, stakeholders can fundamentally change the system.

Benefits for All

Effective programs featuring evidence-based practices have a significantly positive impact on patients, employers, and workers' compensation programs. There are entire regions of Florida that have experienced an over 50 percent reduction in claims and lost time/indemnity costs while maintaining a 98 percent satisfaction rating from patients participating in these programs. These results have caused more employers, brokers and insurance groups to demand comprehensive, evidence-based care to provide improved outcomes for their workers and clients.

When evidence-based practices are implemented, all stakeholders benefit. The injured worker resolves his condition expediently and effectively without aggressive or confusing medical intervention and returns to work faster, armed with a prophylactic program proven to reduce future recurrence of his condition. The employer maintains a healthier, more productive workforce at a reduced cost. The workers' compensation plan insurance carrier maintains a strong relationship with its client, while reducing risk and costs.

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

Special Reports /

Musculoskeletal Disease Is Major Pain in Work Comp

Related Stories

Recommended For You