Experts: Over-Imaging Leads to More Disability
Physical rehabilitation or cognitive behavioral therapy may lead to better outcomes for injured workers in pain and lower costs for payers, according to several experts. They say diagnosis and treatment based solely on imaging and/or physicians’ expert opinions is creating more disability.
In a white paper written for insurance brokerage Lockton, the experts say research indicates a 300 percent increase in spinal imaging among Medicare patients between 1994 and 2004 with a corresponding increase in expensive, aggressive treatment. They say a similar expense among injured workers is leading to more large loss claims.
“While these are the latest identified data comparing imaging to spinal fusion and injections rates, we know that the frequency of MRI/CT imaging of the spine has substantially increased since 2004,” they wrote. “The results are greatly disappointing because outcomes for workers have not improved. … Disability rates among working age Americans are higher than at any time in our country’s history, and the problem is getting worse.”
The paper, Red Herrings and Medical Overdiagnosis Drive Large-Loss Workers’ Compensation Claims, was written by Keith Rosenblum, senior strategies for Workers’ Compensation Risk Control at Lockton; Dr. David B Ross, diplomat at the Board of Psychiatry and Neurology; and Dr. Jennifer Christian, president of Webility Corporation and a fellow at the American College of Occupational & Environmental Medicine.
Low back injuries are the most costly musculoskeletal conditions. The report noted that Lockton’s claims database indicates these injuries represent 20 percent of all loss dollars and 25 percent of dollars in claims over $250,000.
“Employers are paying an ever larger percentage of their workers’ compensation dollars on physicians’ less than effective efforts to relieve pain and distress by focusing treatment on the spine,” they wrote. “This is all a direct consequence of false medical certainty about the cause of (and cure for) workers’ pain and distress being created by these images of visible changes in the spine.”
Disability rates among working age Americans are higher than at any time in our country’s history, and the problem is getting worse.
The problem, they say, is that imaging is being used and relied upon way too much. They noted that the American College of Physicians identifies just two conditions appropriate for imaging: severe neurological conditions and serious spinal instability. “Otherwise, routine use of imaging is ‘strongly’ discouraged and is considered in and of itself invalid,” they wrote.
“Far too often today, aggressive medical intervention is undertaken because physicians’ expert opinions are based solely on patients’ subjective pain complaints or imaging studies, neither of which reliably assess the actual source or extent of pain and distress.”
The writers said they are following the integration of new innovative models in diagnosis technology that address potential chronic pain cases as they develop. They said some insurers and third-party administrators are looking into these new technologies early in the life of a claim.
“In one TPA model for non-subscriber programs in Texas and Oklahoma, they will integrate several promising innovations including the NeuroPAS NPI and NP3 assessments into their medical management process,” the report said. “The goal is to improve outcomes for workers suffering from chronic pain and nip potential high cost claims in the bud.”