WCRI: Extended Physical Medicine Treatment Drives Up Cost of Low Back Claims

PHOENIX — Low back pain is one of the most common workplace injuries. Most cases can be resolved through physical medicine. Treatment guidelines call for two to three visits a week for four to six weeks and then an evaluation to determine if more therapy is needed.

But in 16% of workers’ compensation cases, physical medicine treatment continues for more than three months and in some states the share of extended treatment cases is much higher, according to research findings presented Tuesday during the Workers’ Compensation Research Institute’s annual conference.

Treatment costs for those longer-lasting back pain claims cost two to three times as much as claims that are resolved after the initial treatment and are more likely to include opioids and MRIs. Indemnity costs are three times as much and 59% of injured workers with extended physical medicine treatment were off work for more than seven days, the research shows.

WCRI economist Dongchun Wang presented the results of the research she conducted along with Dr. Kathryn Mueller, a professor at the University of Colorado School of Medicine, before an audience of more than 300 workers’ compensation professionals. The researchers studied the characteristics of nonsurgical back pain claims filed in 28 states from 2015 to 2019.

While the 28-state median was 16%, the research found that the incidence of “extended physical medicine use,” defined as lasting longer than three months, was 38% in New York and exceeded 20% of claims in 11 states, including California, Pennsylvania and Illinois. The rate of chronic back pain ranged from 3.9% to 10.2% of the US population of age 18 and older, according to several studies.

The researchers found that workers who had extended physical medicine treatment for low back pain had a higher percentage of neurological back conditions — 48% compared to 18% for workers whose pain was resolved within six weeks. Also, 8.4% of the extended treatment workers had at least one comorbidity, compared to 2.5% of workers whose back pain was more quickly resolved.

The finding suggest that a lack of coordinated care may play a role in the extended treatment cases. Multiple health care organizations were involved in 27% of cases with extended care, but only 12% of cases with “regular” physical medicine use. Both chiropractors and other types of medical providers were involved in 30% of extended care cases, versus 8% or regular cases.

Attorney involvement may also play a role. Attorneys were involved in 23% of cases with extended treatment, compared to 5% of cases that were resolved within six weeks.

Wang said care that was initiated by a nonchiropractor but later involved a chiropractor was the most important factor in predicting whether there would be extended care. Such combined care cases were eight times more likely to have extended physical medicine use. Cases initiated by chiropractors that later involved nonchiropractors were four times more likely to have extended care.

Factors such as attorney involvement, neurological conditions and comorbidities also increased the likelihood of extended care, but to a lesser extent.

The WCRI conference concludes today at the Renaissance Phoenix Downtown Hotel in Phoenix.