Here are five points for spine surgeons on treating workers' compensation patients.
1. Cases may be beneficial in an ASC. Workers' compensation cases traditionally reimburse well for spine in the ASC setting, so physician-owners should consider performing these cases in the ASC, when appropriate. Kamshad Raiszadeh, MD, medical director of the Advanced Spine Institute of Alvarado Hospital in San Diego and a physician-owner of the recently-opened Physicians Surgery Center in San Diego, says many of his workers' compensation cases, including most anterior cervical and lumbar discectomies and some fusions, can be performed in the outpatient setting. These cases bring additional revenue to an ASC, and building relationships with workers' compensation representatives can be beneficial.
2. Psychological indications for workers' compensation patients. It's important to indicate the appropriate patients for surgery to achieve the best possible outcomes. However, appropriately indicating patients for surgery goes beyond examining their physical characteristics. Surgeons must also assess the patient's psychological health and motivation to recover. In many cases, workers' compensation patients can be problematic because they often have psychological instabilities and little motivation to return to work, says Sumeer Sathi, MD, a neurosurgeon with Long Island Neurosciences in East Patchogue, N.Y. "We try to minimize exposure to workers' compensation patients unless there is a motivation from the patient to get better," he says. These patients have also often been on pain medication for an extended period of time, which can cause further complications.
3. Recovery expectations affect outcomes. Recovery expectations among workers' compensation patients with back pain can predict their recovery, according to an article published in the Journal of Spinal Disorders & Techniques. Researchers reviewed 1,040 workers' compensation claimants receiving time-loss benefits for a musculoskeletal condition and undergoing return-to-work assessments. Outcomes during a one-year follow-up found that negative work-related recovery expectations were consistently associated with slower suspension of time-loss benefits and slower claim closure in patients with back pain.
4. Conservative treatment may be better than fusion. Trang H. Nguyen, MD, of University of Cincinnati College of Medicine, recently led a study that showed that spinal fusions led to worst long-term outcomes in workers' compensation patients, according to an article published in Spine. Dr. Nguyen and co-authors identified 235 workers who underwent spinal fusion for low back pain from Ohio workers' compensation data. Most of the patients had degenerative disc disease, herniated discs or nerve root disease. The workers' compensation patient results were compared with the results of 725 patients who underwent nonsurgical treatment for back pain.
The research found that 11 percent of the spinal fusion patients had permanent disability, compared to the 2 percent of patients treated without surgery. The spinal fusion patients were more likely to continue using opioid drugs for pain management. Slightly more than 25 percent of the patients receiving spinal fusions returned to work, compared to the two-thirds of patients who received conservative treatment. Additionally, 27 percent of the spinal fusion patients received repeat surgeries and 36 percent experienced some type of complication.
5. Predictions for outcomes and recovery time. Predicting outcomes and recovery time is important because the company is required by law to set aside money for the employee's medical care until the injury is healed. This requirement annoys many physicians who believe that an inaccurate predication will lead to being sued. However, if the prediction is off, the company simply asks the physician to revise it.
1. Cases may be beneficial in an ASC. Workers' compensation cases traditionally reimburse well for spine in the ASC setting, so physician-owners should consider performing these cases in the ASC, when appropriate. Kamshad Raiszadeh, MD, medical director of the Advanced Spine Institute of Alvarado Hospital in San Diego and a physician-owner of the recently-opened Physicians Surgery Center in San Diego, says many of his workers' compensation cases, including most anterior cervical and lumbar discectomies and some fusions, can be performed in the outpatient setting. These cases bring additional revenue to an ASC, and building relationships with workers' compensation representatives can be beneficial.
2. Psychological indications for workers' compensation patients. It's important to indicate the appropriate patients for surgery to achieve the best possible outcomes. However, appropriately indicating patients for surgery goes beyond examining their physical characteristics. Surgeons must also assess the patient's psychological health and motivation to recover. In many cases, workers' compensation patients can be problematic because they often have psychological instabilities and little motivation to return to work, says Sumeer Sathi, MD, a neurosurgeon with Long Island Neurosciences in East Patchogue, N.Y. "We try to minimize exposure to workers' compensation patients unless there is a motivation from the patient to get better," he says. These patients have also often been on pain medication for an extended period of time, which can cause further complications.
3. Recovery expectations affect outcomes. Recovery expectations among workers' compensation patients with back pain can predict their recovery, according to an article published in the Journal of Spinal Disorders & Techniques. Researchers reviewed 1,040 workers' compensation claimants receiving time-loss benefits for a musculoskeletal condition and undergoing return-to-work assessments. Outcomes during a one-year follow-up found that negative work-related recovery expectations were consistently associated with slower suspension of time-loss benefits and slower claim closure in patients with back pain.
4. Conservative treatment may be better than fusion. Trang H. Nguyen, MD, of University of Cincinnati College of Medicine, recently led a study that showed that spinal fusions led to worst long-term outcomes in workers' compensation patients, according to an article published in Spine. Dr. Nguyen and co-authors identified 235 workers who underwent spinal fusion for low back pain from Ohio workers' compensation data. Most of the patients had degenerative disc disease, herniated discs or nerve root disease. The workers' compensation patient results were compared with the results of 725 patients who underwent nonsurgical treatment for back pain.
The research found that 11 percent of the spinal fusion patients had permanent disability, compared to the 2 percent of patients treated without surgery. The spinal fusion patients were more likely to continue using opioid drugs for pain management. Slightly more than 25 percent of the patients receiving spinal fusions returned to work, compared to the two-thirds of patients who received conservative treatment. Additionally, 27 percent of the spinal fusion patients received repeat surgeries and 36 percent experienced some type of complication.
5. Predictions for outcomes and recovery time. Predicting outcomes and recovery time is important because the company is required by law to set aside money for the employee's medical care until the injury is healed. This requirement annoys many physicians who believe that an inaccurate predication will lead to being sued. However, if the prediction is off, the company simply asks the physician to revise it.