Why would anyone want to keep injured workers from receiving the best care?

I was recently asked by a highly esteemed colleague, “Why would anyone want to keep injured workers from receiving the best care?”

After almost a decade of working with stakeholders and shareholders in and around Workers’ Compensation systems around the country, I’m still somewhat surprised each time I hear arguments opposing the implementation of standards that will encourage consistent care. The term “cookie-cutter” is almost always injected into the discussion attempting to peg consistent patient-centric care as inflexible and a “one size fits all” approach.

The truth of the matter is, obvious and significant variations in medical care for similar health conditions have been identified as signs of quality concerns in the medical process. I’ve yet to come across evidence, or even slightly compelling information, suggesting that this variability leads to improved patient care and better health outcomes. Variations in diagnostic considerations/interpretations and treatment approaches/methods occur in every medical specialty.

The State of Pennsylvania’s House Labor and Industry Committee will hear testimony today (March 17th, 2016) from various stakeholders on HB1800 that proposes the adoption of nationally recognized evidence-based medicine (EBM) treatment guidelines. WorkCompCentral published comments from the Pennsylvania Bar Association on March 9th stating, “The Pennsylvania Bar Association intends to just say no to proposed medical treatment guidelines it claims will shoehorn injured workers on workers’ compensation into a “one size fits all” treatment plan.”(1)

The original definitions of EBM focused on the care of individual patients, using scientific evidence to improve outcomes. Sackett defined EBM as “…the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” in a 1996 editorial in the British Medical Journal.(2) It was further noted that the practice “…means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”(2) In other words, the sum of both individual (clinical) expertise combined with the best available (clinical) evidence equals EBM.

The California Workers’ Compensation Institute (CWCI) published a report on March 3rd, 2016 stating that California experienced a decrease in Workers’ Compensation inpatient hospitalizations by 22.8% from 2008 to 2014. The report also referenced that the number of Workers’ Compensation implant-eligible spinal surgeries declined by 8.4% in 2013 and 13.6% in 2014. CWCI cited that the decline “coincided with the continued development of evidence-based medicine…”(3)

The use of EBM treatment guidelines has been positively correlated with improved quality and patient safety and decreased costs in general medicine.(4) The same can be expected when properly applied in an occupational medicine scenario.

It is difficult to imagine the number of injured workers being subject to surgical intervention without the use of scientific evidence to confirm their eligibility for the procedure; or consulting the evidence to verify the procedure’s effectiveness.

Why would anyone want to keep injured workers from receiving the best/most effective care?

The inquiry left me without words…

References:

  1. “Bar Association Blasts Treatment Guidelines As ‘One Size Fits All’”. n.p. WorkCompCentral. March 9th, 2016. Web.
  2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996;312(7023):71-2.
  3. Goldberg, Stephanie. “Spinal surgery drop leads to fewer workers comp hospitalizations”. Business Insurance. March 4th, 2016. Web.
  4. Gochnour G, Ratcliffe S, Stone MB. The UTAH VBAC Study. Matern Child Health J. 2005;9(2):181-8.

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