A comment by David Deitz MD on last week’s post is well worth your read. Referring to ProPublica, Dr Deitz said:
describing the use of guidelines and other evidence-based tools as a cut in benefits is not just misleading, it gets to the root of one of the central problems with much WC care
As Dr Deitz notes, what PP doesn’t grasp is this; evidence-based guidelines promote better medical care, and when work comp patients get sub-standard care, everyone suffers. .
Not just a few patients highlighted in a couple of headline-grabbing stories, but thousands victimized by lousy medical treatment. Today, many states do not allow or support the use of evidence-based clinical guidelines (which PP describes as a “cut in benefits”), and as a result many patients get crappy medical care.
Want evidence?
- Workers’ comp accounts for 1.25% of total US medical spend, but 13% of opioid spend. Opioid prescribing and dispensing is a major contributor to death, extended disability, ruined families, and ruined lives.
- The Drobots and their ilk – carving up workers’ comp patients to implant faulty devices to generate huge profits for a select few doctors.
- Physician dispensing of drugs extends disability, runs up medical costs, and keeps patients from returning to work.
- Physician-owned toxicology labs.
Data and the analysis thereof identifies these issues.
Outcomes data such as return to work, disability duration, functionality, sustained re-employment, re-injury rates differentiates good medical care, and providers who deliver that care, from providers who don’t.
Alerts based on potentially problematic treatment such as prescription of opioids without trauma or surgery, high incidence of surgery for patients with soft-tissue injury diagnoses, physical therapy scripts for patients without musculoskeletal injuries are based on data collection and analysis.
Dull stuff, huh?
Anecdotes are easy to grasp, get lots of attention, generate excitement, start politicians squawking. Data is, well, boring. Thinking based on data requires focus, concentration, effort, and a desire to understand. Anecdote is quick, easy, and triggers emotions that often lead to simplistic and misguided conclusions.
That’s the briefest explanation I could come up with as to why work comp reform efforts are far too often sidetracked by issues/stories that, while concerning or even troubling, do NOT represent what happens the vast majority of the time.
What does this mean for you?
Make decisions based on data, not on anecdote.
Thank you for commenting on this. One of the dangers of stories where individuals claim mistreatment or even abuse is that there is significant information asymmetry. By this I refer to the ability of an individual to allege anything they like regarding their medical care, injury, condition and the like. At the same time, those involved in their care as physicians or claims management are precluded from responding with any specificity absent written release to do so.
On more than one occasion over the years, I have seen or heard individuals attack employers, carriers and/or doctors in one sided attacks. My advice to anyone being asked to respond to such allegations is that they are unable to respond in a meaningful way unless the complainant is willing to provide consent to access their entire file. A journalist inquiring about such matters should be advised that they would be smart to take with a grain of salt any allegations by anyone who is unwilling to release their file, and consider qualifying anything claimed as just an allegation that has not been substantiated.
Unfortunately, too many reporters publish as fact that which is far from proven, and which in many cases has strong and compelling evidence in the files to the contrary that is protected by medical confidentiality protocols. I have not read the Propublica report referenced, but suspect from Joe’s comments, that some of its’ content falls in the latter category.
A reliance on anecdotes betrays the absence of a rational, logical and persuasive argument.
My perspective from two decades of operating a company that schedules independent medical examinations: in twenty years, I’ve received a complaint in writing from an examinee approximately 75 times. These complaints alleged injury & misrepresentation among other things. Each time, a reply from the medical expert was offered which was rational and factual. Not one of those allegations was substantiated. Each one requires investigation, but it seems in each case that the design was to stir the pot versus report a factual complaint.