Medical technology, treatments, delivery and even payment mechanisms are evolving. In this session at NCCI’s AIS Virtual Conference, Raji Chadarevian, Director of Medical Regulation and Informatics, highlighted new developments and offered insight into what the near future may hold for workers’ compensation.
Who Is Delivering Medical Services?
In 2012, nonphysicians made up 47 percent of all professional services. In 2018, that share has jumped to 59 percent. Nonphysicians are composed of professions like physical therapists, physician assistants and nurse anesthetists.
Nonphysician employment is growing rapidly. From 2012-2018, nurse practitioners saw a 63 percent increase, physician assistants saw a 32 percent increase and physical therapists saw a 15 percent increase in employment rates. In comparison, physicians only saw a six percent rise in employment rates. Nonphysician employment rates are projected to increase further through 2028, while physician employment rates are not.
How Are Services Delivered?
Medical services are currently being delivered through an office setting or through telemedicine and remote patient monitoring. However, with the current coronavirus crisis, there is a massive increase in the use of telemedicine.
Potential Cost Savings through Telemedicine
There is a potential two to six percent medical cost savings in workers’ compensation from:
- Remotely triaging less serious injuries to reduce emergency room visits.
- Improved at-home monitoring resulting in fewer hospital readmissions.
- Lower physical therapy costs from sessions conducted in patients’ homes.
Where Are Surgeries Performed?
Surgeries are performed either at hospitals and traditional inpatient facilities, or ambulatory surgical centers (ASCs) and outpatient facilities. Outpatient surgeries are shifting from hospitals to ASCs, with ASCs seeing a 13 percent increase in surgeries from 2012-2018.
Overall opioid use is on the decline, with the share of all prescription claims receiving opioids decreasing 38 percent from 2012-2018. 60 percent of all claims receiving medical services after 90 days are chronic pain claims, and 70 percent of these claims receive opioids. However, chronic pain, lasting longer than three months, saw a drop in prescribed opioids from 2012-2018.
Alternative Treatments for Chronic Pain
- One out of every 105 chronic pain claims received massage services in 2018.
- 131 percent increase since 2012.
- One out of every two chronic pain claims received an orthotic in 2018.
- 26 percent increase since 2012.
- 23 visits per chronic pain claim during the first year of injury in 2018.
- 15 increase since 2012.
- One out of every 42 chronic pain claims received mental health services in 2018.
- 20 percent increase since 2012.
- One out of every 257 chronic pain claims received a platelet-rich plasma treatment in 2018.
- 518 percent increase since 2012.
Neck Injuries and Treatments
Most neck injuries occur from strain, injury or motor vehicle accidents, making up almost 60 percent of all cases. Fall or slip injuries and injuries caused by others make up most of the remaining causes.
Neck pain accounts for less than one percent of all major surgeries. Cervical disc disorders, cervical spine degeneration and cervical radiculopathy/myelopathy account for 24 percent of all active neck claims and 85 percent of all major neck surgeries. Anterior cervical discectomy and fusion, and cervical artificial disc replacement are providing alternatives to traditional neck surgery.
In 2018, disc replacements made up nine percent of all major neck surgeries, a six percent increase from 2012. When compared to fusion surgery, disc replacements:
- Cost an average of $36k per surgical visit, 3 percent higher than fusion.
- See a 9 percent lower incurred medical cost.
- See a 19 percent lower incurred indemnity.
- Have a quicker recovery time for patients.
- Have a lower rate of reoperation.
- Allow patients a faster return to work.
Spinal Cord Injuries
Severe spinal cord injuries often require long-term care. 60 percent of medical and indemnity costs going unpaid. Of the $2 million in unpaid medical costs, home healthcare services account for $0.8 million.
Stem cell research has made incredible advances for spinal cord injuries. In one Mayo Clinic case study, stem cells were taken from a person’s body fat, given time to multiply in a lab and then injected into the patient’s lumbar spine. The patient later regained his ability to walk.
Cell therapy, known as autologous chondrocyte implantation (ACI), is advancing knee surgery techniques with its ability to repair and regrow knee cartilage. Matrix-induced ACI consists of cultured cells on a collagen membrane and costs $42k on average. Introduced in 2016, the matrix-induced ACI technique is growing to contribute to the majority of ACI patient visits.
Robotic Surgical Assistance
Robotic surgery offers a minimally-invasive type of surgery. It can use multiple robotic “arms,” including a camera arm. While more expensive, it can provide greater reach and precision while reducing surgeon fatigue in the operating room.
Of all robotic-assisted workers’ compensation surgeries:
- 65 percent are inguinal hernias
- 19 percent are other hernias
- 7 percent are knee/hip/thigh/degenerative/overuse
- 9 percent are other diagnoses
90 percent of inguinal hernias requiring surgery are caused by strain. These outpatient surgeries are the fourth most paid and thirteenth most frequent in workers’ compensation claims.
Value-based programs must balance the value of patient care with the quality of care the patient receives.
Value-Based Payment Mechanisms
- Capitation – Amount paid is determined by the number of patients.
- Bundled Payments – Single payment covers all the services included in a defined treatment of care.
- Patient-Centered Medical Homes – Treatment coordinated through primary care physician.
With bundling in workers’ compensation, hospital inpatient stays have always existed, but hospital outpatient surgeries have been recently adopted.
Find the full statistical analysis PDF from NCCI, here.