Role of Workers’ Compensation Data in Spinal Disability
Highlight from the 2nd Annual Spine 10 x 25 Summit: Technology Update
At the 2nd Annual Spine 10 x 25 Summit: Technology Update, Keith Rosenblum spoke about the unique role workers’ compensation data may play stemming from the rising tide of spinal disability costs worldwide. Mr. Rosenblum is a senior strategist with a large private insurance broker and risk consulting company. He advises industry and individual companies on strategic safety and workers’ compensation managed care practices. “My exposure to massive amounts of workers’ compensation data places me in a unique position to assess what’s working and what’s not working in the treatment of injured workers,” Mr. Rosenblum said.
Workers’ Comp is Data-Rich
Unlike disability claims for the general population, workers’ compensation claims are followed and tracked by teams of people—claims' adjudicators, nurse case managers, physicians, and claims consultants. Large amounts of data are collected in an effort to reduce risks and costs.
Spinal disability makes up an estimated $35 billion of the $100 billion spent annually in workers’ compensation. Workers’ compensation claims for spinal disability represent 5-6% of the $600 billion spent nationally on spinal disability each year. So although it’s a small slice of the disability pie, treatment and cost containment successes in the workers’ compensation arena have the potential to make a big impact worldwide. From his vantage point, and with 40 years of experience scrutinizing the data, Mr. Rosenblum asserts that we can achieve this turnaround, “simply by integrating effective assessments.”
The Cost of Delayed Recovery
About 2%-4% of workers’ compensation claims account for approximately 50% of the dollars spent. “The majority of this subset is spinal disability, “Mr. Rosenblum said, “and a sizeable majority of these patients are suffering from delayed recovery, which is synonymous with unresolved chronic pain.” Mr. Rosenblum reported that he recently had the opportunity to examine the top 30 open workers’ compensation disability claims at a large transportation company. The claims included some individuals who have been disabled and in treatment since the 1970s and 1980s. “Not one of them had any assessments performed to identify if there were emotional, cognitive or behavioral issues underlying the root cause of their chronic pain,” he said.
Mr. Rosenblum asserted that the data supports making early referrals for health and behavioral workups—within the first two to six weeks—for emerging spinal disability claimants. Currently, if those referrals are ever made, it is typically three to six months into the recovery timeline. “If you’re not managing those losses within the first couple of weeks, the results are going to be negative,” he states.
The growing awareness of pain as multifactorial in origin means that while current imaging and diagnostic technology can identify most cancers, tumors, fractures and infections, “these technologies do not offer reliable diagnostic information about nociceptive and neuropathic pain mechanisms in most individuals,” Mr. Rosenblum said.
Using tools that pinpoint tissue dysfunction to diagnose the source of chronic pain is a flawed model. We have developed a healthcare system that puts specialists trained to diagnose and treat anatomical problems in the position of managing patients in chronic pain. “This is a huge dilemma,” Mr. Rosenblum said. “We seldom see a behavioral workup before a patient gets to a neurosurgeon or an orthopaedic surgeon. This leaves the specialists to make diagnoses for which they are poorly equipped. It’s a profoundly poor use of available talent.”
Big shifts in thinking and practice habits are needed to reach the goal of better patient outcomes and fewer workers sidelined by pain and disability. Keeping physician authorizations for diagnostic and treatment protocols in line with evidence-based medicine is an ongoing insurance industry challenge, Mr. Rosenblum acknowledged. However, he indicated, “as the healthcare, risk management, and insurance industries increasingly accept the emotional and cognitive aspects of chronic pain, medical assessment and treatment will become more effective for injured workers.”