Once again the fall is here, which means it is time for the Workers Compensation Research Institute’s annual meeting (today and tomorrow in Boston) and the National Workers Comp and Disability meeting (next week in Las Vegas).
Today’s kickoff began with a review of how the system has evolved since the WCRI’s inception in 1983. Peter Barth PhD began with the historical perspective.
A presentation on worker outcomes and variation in medical treatment patterns by Dr Sharon Belton indicated there were significant variations in the treatment patterns for back injuries across states. Dr Belton suggested that the design of the work comp system may be what is affecting both treatment patterns and outcomes. That sparked a question from your author regarding the potential impact of external factors unrelated to workers comp, such as practice pattern variation that have been documented in the Dartmouth Atlas. With workers comp accounting for less than 2% of national medical costs in a system dominated by Medicare, Medicaid, and private payers, the other, larger payers are likely to have more impact on treatment patterns than work comp.
Responding to my question and a similar one from Peter Rousmaniere, Dr Rick Victor, Executive Director of WCRI, said the Institute has looked into this. Although they are not ready to publish the results, Dr Victor said words to the effect that, when looking at state level data, there is almost no correlation between practice pattern variation as documented in the Dartmouth Atlas and workers comp back surgery rates. The (possible) implication is that reimbursement and other workers comp system idiosyncrasies are causing physicians to vary their treatment patterns.
My sense Is the degree of interstate variation is a result of the aggregate of local medical treatment patterns. What I’d really like to know is does the back surgery rate for workers comp mirror that reported in the Dartmouth Atlas. One example of this variation is this: The back surgery rate in Miami is less than one-fifth the rate in southwest Florida.
Historically there is solid evidence illustrating the impact of compensation and reimbursement on practice patterns; the treatment of insured v uninsured patients at hospitals is but one example. The real question is this: “is the variation among/between states as important or significant as the intrastate variation?”
Nov
14
