The Workers’ Compensation Research Institute (WCRI) published a new report on the prevalence of extended use of physical medicine (PM) services among 28 states for nonsurgical low-back pain (LBP) claims.
Reviewing their database, WCRI analyzed approximately 119,664 LBP claims that met study criteria and which did not include certain extenuating factors, such as cancer, significant comorbidities, etc. The data was taken across 28 states from October 1, 2015, through September 20, 2017. WCRI’s data represented 38-77% of all workers’ comp claims within each state. This analysis included LBP claims with radiating leg pain and/or neurological findings, and LBP only claims.
WCRI studied two groups of LBP claims; the first group was composed of claims with regular PM use, where treatment was initiated within six weeks of injury and had all PM services completed within three months. The second group included extended PM use claims, where PM services were initiated within six weeks of injury and continued after three months.
WCRI found that extended PM use was relatively frequent in most states. In 18 of 28 study states, the percent of LBP claims with extended PM use ranged from 15-28%. In 11 study states, one in five LBP claims with PM had extended PM use.
Extended PM use was associated with longer durations of temporary disability at 6 weeks compared to 2.7 weeks for claims with regular PM use, as well as higher overall medical costs. LBP claims with extended PM averaged $6,554, 162% greater than claims with regular PM use, which averaged $2,930 per claim.
However, the metric of medical costs must be properly weighted. The cost of physical medicine services per unit did not fluctuate greatly between these study groups. Costs per PM unit averaged between $32-$62 across all PM claims, but the total number of PM visits was the main cost driver for higher medical spend in the extended PM group.
The report identified several important factors associated with an increased likelihood of having extended PM use. The most important factor associated with extended PM use was the presence of multiple providers in PM care.
Other factors that were at least twice as likely to evolve into extended PM claims include:
- Neuro back diagnosis
- Injections for radicular pain
- Lumbar facet injections
- 15+ PM visits during the initial six weeks
- Attorney involvement
