Magazine article Risk Management

Diagnosis: Reduced Disability Costs

Magazine article Risk Management

Diagnosis: Reduced Disability Costs

Article excerpt

For some employees, chronic pain -- backaches, stiff necks, muscle strains and tightness -- is a way of life that presents problems they are generally able to cope with.

For others, this kind of pain is disabling, restricting employees' ability to function and requiring extensive medical treatment. In this latter instance, chronic pain is an enormously expensive problem for businesses. Consider these facts:

* An estimated 160 million workdays are lost in the United States each year due to back pain and headaches alone, at an annual cost to business of $55 billion.

* More than $60 billion is spent annually to diagnose and treat chronic pain.

* The average benefit liability claim for long-term chronic pain exceeds $200,000.

* The most alarming fact of all: the typical return-to-work rate (RTW) for the most difficult long-term cases is only 1 percent.

Overall, pain-related claims represent a huge expense for businesses, but there's also lost worker productivity and insurance premium increases that result.

The enormity of this problem is compounded by the fact that the rate of workers' compensation and long-term disability claims is rising. Claims for lower back and disk injury have climbed by 215 percent in just the past year, and one estimate places the average cost per case at nearly $7,000.

Pain of this sort can be unlike other illnesses for which there are established treatment protocols. In the past, chronic pain sufferers trooped from doctor to doctor seeking relief that was often temporary or, in some instances, ineffective. With an emphasis on evaluating and diagnosing chronic pain accurately in the earliest stages, more effective treatment options can offer promising solutions to reducing claims costs and increasing RTW rates.

Diagnosing Savings

Employers have traditionally concentrated resources on worker education and accident prevention programs to reduce the number of claims that are filed. Managed care has introduced protocols to evaluate treatment and recovery, which has helped. But the accurate diagnosis of chronic pain through more proactive case management techniques has largely been unexplored as an avenue for cost reduction and increased RTW rates. Preliminary research indicates that improving diagnoses can be an important factor in achieving these goals.

We have found that misdiagnosis is particularly common in cases of back, neck and limb pain, which constitute 60 percent of all chronic pain cases. Inaccurate diagnoses can be a significant obstacle that not only delays a patient's return to work but also increases the cost ultimately paid by the employer. Although just 30 percent of all workplace injury claims become chronic pain cases, they account for an astonishing 75 percent of claims costs.

Our research indicates that 40 to 67 percent of chronic pain patients involved in litigation have been misdiagnosed by their treating doctors. This is not surprising when you consider that even sophisticated diagnostic procedures are often inaccurate. Magnetic resonance imaging (MRI), often ordered early in the evaluation process, can produce false positive readings 25 percent of the time and false negative readings another 25 percent of the time. In all, at an average cost of $800 per procedure, they are only 50 percent accurate. Furthermore, there are valid physiological causes of chronic back pain that may not show up on MRIs or CT scans. For example, a disk that appears normal using these tools may be diseased or riddled with stress fractures.

Other common diagnostic tests such as X-rays can be ineffective in producing accurate diagnoses for chronic pain patients. Ordered routinely, most likely because they are relatively inexpensive, static X-rays are not particularly effective in detailing soft tissue injuries and cannot provide a picture of what happens when the patient moves. …

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