Networks in workers' compensation medical delivery

Medical networks offer discounted fees, control of the workers' compensation case, quality monitoring, and managed care services. As channeling of workers' compensation cases to networks increases, credentialed physicians will benefit.     

Regulatory trends in workers' compensation managed care

The authors discuss various managed care arrangements in workers' compensation and present a valuable chart that summarizes the managed care policies of each state and the district of Columbia and links the policies to their regulatory environments.     

Uses of workers' compensation data in epidemiology research

Contrary to general opinion, workers' compensation data can be helpful in epidemiologic research. Dr. Goldsmith assesses several studies based on data culled from workers' compensation or disability programs and explains how valuable information was derived.     

Recognition of psychologists in workers' compensation law.

Reviews the workers' compensation laws with reference to the recognition of psychologists as diagnosticians of mental injuries and treatment providers for workers with work-related mental injuries. It is shown that with the exception of California, Florida, Hawaii, and the federal system, psychological services are not explicitly recognized as available to, nor are psychologists explicitly recognized as diagnosticians or treatment providers for, the mentally injured worker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance measurement in workers' compensation managed care organizations

In 1997, 29 states were applying managed care programs to workers' compensation. Several major initiatives to develop standard performance measures are underway.     

Analysis of workers' compensation claims associated with manual materials handling

In eukaryotes, from fly to human, nine aminoacyl-tRNA synthetases contribute a multienzyme complex of defined and conserved structural organization. This ubiquitous multiprotein assemblage comprises a unique bifunctional aminoacyl-tRNA synthetase, glutamyl-prolyl-tRNA synthetase, as well as the monospecific isoleucyl, leucyl, glutaminyl, methionyl, lysyl, arginyl, and aspartyl-tRNA synthetases. Three auxiliary proteins of apparent molecular masses of 18, 38 and 43 kDa are invariably associated with the nine tRNA synthetase components of the complex. As part of an inquiry into the molecular and functional organization of this macromolecular assembly, we isolated the cDNA encoding the p38 non-synthetase component and determined its function. The 320 amino acid residue encoded protein has been shown to have no homolog in yeast, bacteria and archaea, according to the examination of the complete genomic sequences available. The p38 protein is a moderately hydrophobic protein, displays a putative leucine-zipper motif, and shares a sequence pattern with protein domains that are involved in protein-protein interactions. We used the yeast two-hybrid system to register protein connections between components of the complex. We performed an exhaustive search of interactive proteins, involving 10 of the 11 components of the complex. Twenty-one protein pairs have been unambiguously identified, leading to a global view of the topological arrangement of the subunits of the multisynthetase complex. In particular, p38 was found to associate with itself to form a dimer, but also with p43, with the class I tRNA synthetases ArgRS and GlnRS, with the class II synthetases AspRS and LysRS, and with the bifunctional GluProRS. We generated a series of deletion mutants to localize the regions of p38 mediating the identified interactions. Mapping the interactive domains in p38 showed the specific association of p38 with its different protein partners. These findings suggest that p38, for which no homologous protein has been identified to date in organisms devoid of multisynthetase complexes, plays a pivotal role for the assembly of the subunits of the eukaryotic tRNA synthetase complex.     

The role of prevention in workers' compensation managed care arrangements

Managed care's emphasis on restricting costs may interfere with its ability to assume a prevention orientation. The authors present models, derived from group health and workers' compensation, of successful incorporation of prevention into managed care arrangements.     

Preserving workers' compensation benefits in a managed health care environment

Managed care techniques are increasingly being applied in the workers' compensation setting. Many workers, labor representatives and public health advocates fear that the introduction of managed care into workers' compensation may reflect a broader employer-driven campaign to erode benefits, tighten eligibility criteria, and weaken employees' control over health care and compensation issues. The potential threats to workers can be mitigated by involving them in the design of the workers' compensation health plan and selection of provider organization, assuring access to appropriate specialists and diagnostic testing, minimizing delays, increasing accountability through contract provisions and government oversight, and enhancing communications through the use of ombudsmen and alternative dispute resolution approaches. Additional outcomes studies assessing the long-term impact of managed care in workers' compensation are needed.     

Carpal tunnel surgery outcomes in workers: effect of workers' compensation status

One hundred thirteen workers' compensation and 53 non-workers' compensation patients who had undergone open carpal tunnel release were queried about job status and the presence or absence of residual symptoms of numbness, pain, or nocturnal awakening an average of 42 months postoperatively. Thirty-nine non-workers' compensation subjects were at their original jobs as compared to only 53 workers' compensation subjects. Seventeen of the workers' compensation subjects were unemployed versus two non-workers' compensation subjects. These differences were significant. Of patients changing jobs, 39 workers' compensation subjects and 2 non-workers' compensation subjects attributed their job change to symptoms of carpal tunnel syndrome. Residual symptoms were significantly more common in workers' compensation compared to non-workers' compensation subjects, with 92 of the former and 26 of the latter subjects reporting some residual symptoms.     

How independent are independent psychological examinations? A workers' compensation dilemma.

In recent years there has been an increasing demand for clinicians to conduct independent psychological examinations (IPEs) of persons involved in work-related injuries, with referrals coming from insurance carriers and attorneys. This article discusses the role of the psychologist in the workers' compensation system, specifically focusing on the challenges facing psychologists who accept the IPE assignment. Potential abuses of the workers' compensation process by psychologists and ethical considerations are also discussed. Several recommendations for improving the system are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care in workers' compensation: analysis of cost drivers and vendor selection

1. Managed care for employee benefits provides a model of cost containment for workers' compensation; however, significant differences must be understood. 2. Purchasers of managed care services must perform an internal assessment to determine the cost drivers for workers' compensation. Managed care does not address all cost drivers. 3. A model for evaluating managed care vendors places them on a continuum of risk, similar to insurance risk, where a variety of cost containment strategies may be used together. 4. By reviewing seven key aspects of a managed care vendor, a purchaser can rate the vendor's ability to meet their needs.     

Managed care workers' compensation outcome measurements: how can a clinic compete?

Clear guidelines and standards established for physicians by managed care organizations are not similarly applied to clinics. Generally, measures of quality of care and service for clinics are ill-defined. Dr. Mueller details six steps to creating a meaningful, achievable set of outcome measures so that clinic organizations can improve and promote their care.     

Control of workers' compensation claims and costs in the U.S. Army

The Army Medical Department has been implementing initiatives to reduce workers' compensation claims and costs since 1983. After years of an upward trend, reductions in both costs and claims were reported for 1995 and 1996. To assess efforts at managing workers' medical care and compensation in the Army, we reviewed Department of Defense and Department of the Army documents and studied data on claims and costs. We found several programs that were launched to control claims and associated costs. None of these programs adequately addressed the absence of real-time financial incentives for reducing compensation costs, a lack of acceptable workers' compensation data collection and data management systems, and a lack of emphasis on medical case management. To sustain this trend of decreased costs and claims, the Army must focus on (1) incentives, (2) data management systems, and (3) a comprehensive plan for medically managing workers' compensation claims and costs.     

Comparison of disability behavior after different sites and types of injury in a workers' compensation population

In this study, an extensive data set from a regional workers' compensation system was analyzed to determine whether particular sites or types of injury were associated with prolonged disability. This data shows a similar pattern of vocational disability for almost all sites and types of injury. A workers' compensation carrier collects data for financial purposes related to insurance, and such data therefore has several serious potential deficiencies when used for clinical research. However, published data on disablement after nonoccupational trauma shows similar patterns of vocational and nonvocational disability, and also shows dependence on severity of injury. In both settings, head injury is associated with greater occupational disability. Because treatment, policy, and medicolegal decisions are based on the impression of "typical disability" for particular sites and types of injury, there is a need for better documentation of post-traumatic disablement in compensation settings and in noncompensation settings. This should include better classification of the cause, type, and severity of the injury, and of the functional outcome in terms of both the resumption of occupational and nonoccupational roles, and of persistence in these roles.     

Health insurance and workers' compensation: the delivery of medical and rehabilitation services for construction workers

The construction industry has one of the highest proportions of workers without health insurance. The authors review the two types of insurance systems that are generally used to cover the cost of health care for construction workers in the U.S.: health and welfare funds and workers' compensation. Recent developments in health care delivery in the U.S. are discussed, as are the more comprehensive occupational medicine services offered in France, Germany, The Netherlands, and Sweden.     

Trends in disability duration and cost of workers' compensation low back pain claims (1988-1996)

Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.     

Occupational skin diseases in Washington State, 1989 through 1993: using workers' compensation data to identify cutaneous hazards

OBJECTIVES: This study sought to characterize occupational dermatoses and cutaneous hazards. METHODS: Workers' compensation claims filed for skin disease in the Washington State Fund were analyzed for 1989 through 1993; incidence rates for industries and employers were calculated, and cutaneous hazards associated with the highest rates were identified. RESULTS: A total of 7445 claims were filed for skin disorders, principally contact dermatitis; 675 (9.1%) involved more than 3 missed work-days. The rate of accepted skin disorder claims was 1.0 per 1000 full-time employee-years. The highest incidence rates (4.6 to 30.7 accepted claims per 1000 full-time employee-years) were in certain manufacturing industries (plastics related, concrete products, aircraft parts, sporting goods, and boat building), wholesale farm product raw materials, automotive glass replacement, and beauty shops. Seven of the 10 employers with the highest incidence rates (19.6 to 85.5 accepted claims per 1000 full-time employee-years) used fiber-reinforced plastics (composites) and exposed workers to epoxy and other resin systems associated with contact dermatitis. CONCLUSIONS: Workers' compensation data identify known and emerging workplace cutaneous hazards and show promise for targeting prevention efforts.     

Healthcare utilization and referral patterns in the initial management of new-onset, uncomplicated, low back workers' compensation disability claims

Most episodes of low back pain are considered non-specific in nature, with the vast majority resolving within 2 weeks and almost all resolving within 6 weeks regardless of the medical intervention. Recently published clinical guidelines have clearly delineated a limited set of circumstances that would indicate the need for specialist referral. The purpose of this study was to describe the healthcare utilization and physician referral patterns for new-onset, uncomplicated, low back workers' compensation disability cases randomly selected from a large insurance carrier data source. The provision of care in urgent care centers and emergency departments for both initial and main sources of care occurred more frequently than was probably indicated. For this selected group of uncomplicated low back pain cases, specialist care was provided more commonly than would be expected or indicated (36% of the sample was seen by a surgeon, while only 2% received surgery). In addition, referral to specialists (other than occupational medicine specialists) was often made sooner than would be expected or indicated, with a median of 13 days for such referrals. Such overutilization of resources can reasonably be expected to increase overall medical costs.