At the WCRI Annual Issues & Research Conference, Dr Olesya Formenko from WCRI talked about a study into why there are variations in surgery rates for patients with back injuries.
In the WCRI study, spinal surgery rates on back injury claims varied from a low of 7% in California, to a high of 19% in Oklahoma.
While case mix and clinical aspects of the back injury will have an impact on surgical rates, they study looked at three areas:
- Local Practice Norms – By looking at group health surgery rates, they found that higher group health surgical rates was also correlated by higher workers’ compensation surgical rates.
- How Much are Physicians Reimbursed – There is significant variation among states for back surgery reimbursement rates. The rate in Illinois (the highest state) is over four times higher than in Florida (the lowest state). In the states where workers’ compensation reimbursement rates were significantly higher than group health (OK, IL), there were corresponding higher rates in back surgery.
- Number of Surgeons in the Local Area vs Conservative Care Options – The median number of spinal surgeons per 100,000 people in the study was 6.6/100,000. They also found a median of 79 physical therapists and chiropractors per 100,000. An increase of 1 physican per 100,000 over the median resulted in a corresponding increase in surgical rates. However, an increase of 9 non-surgical providers per 100,000 people offset the impact of the higher number of surgeons.