Reducing Patient and Workers’ Comp Pain
Unnecessary surgery is bad for almost all parties involved. It results in more pain and more hospital time for the patient, greater susceptibility for pain medication abuse, larger claims for workers’ comp carriers, and a poorer level of overall health care quality.
Dr. Frank Tomecek, a neurosurgeon with the Oklahoma Spine & Brain Institute, saw a way to lessen that basket of troubles.
By using electrodiagnostic functional assessments (EFA) to collect more data on muscle and nerve function, he could determine if a patient complaining of pain from hardware in the neck or back really needed to have it removed.
“The EFA determines if muscles are functioning properly, or if there are other nerves or muscles away from the hardware that may be causing the pain,” Tomecek said.
That’s relevant, he said, because in a workers’ compensation case, a patient could attempt to cheat the system by lobbying for a second surgery to increase the size of the settlement.
By attaching electrodes to a patient’s body and then asking him to perform activities like standing, bending and lifting, Tomecek can see whether the muscles in question are contracting and relaxing as they should, or if the patient is purposely giving no effort in order to exaggerate their pain and strengthen their case for hardware removal.
Other than through EFA, in conjunction with X-rays and other tests, “there’s no true way to diagnose if hardware really needs to be removed,” said MaryRose Reaston, founder of Emerge Diagnostics, who developed the technology — and won a 2012 Risk Innovator™ award for it.
“He took EFA to a new level and developed a procedure to see if it could objectively assess whether removal was necessary and what alternative treatments could help.”
Working on this new application of EFA for just under a year, Tomecek has used it for only about 20 patients, but the results, Reaston said, have been “phenomenal.”
“In the realm of workers’ compensation,” said Sheila Harless, workers’ compensation manager at the Spine & Brain Institute, “I know that Dr. Tomecek has been able to eliminate the need for many hardware removal surgeries.”
“This has protected the patient from the risks of a surgery that may not even help them, and has saved money for the insurance company in the cost of the surgery and in permanent impairment rewards related to additional surgery.”
Hardware removal has posed a particular problem because its criteria are subjective; all it took was a complaint of pain to justify an invasive surgery to extract hardware.
Favorable outcomes were achieved in only 50 percent to 60 percent of patients, according to Reaston.
With the help of EFA, Tomecek has been able to reduce these surgeries and recommend site-specific physical therapies to treat the root cause of pain, which in turn decreases dependency on high-strength painkillers.
“We’re one of the highest states for prescription drug-related deaths,” Tomecek said. “We’re trying to prevent those events.”
Reaston called Tomecek a “big patient advocate.”
Workers’ comp carriers are likely happy to have him on their side as well.
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