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Objective: This study analyzed Ohio workers' compensation data to identify potential prevention strategies for common oil and gas extraction industry claims., Methods: Claim rates for 2001-2018 were calculated per full-time equivalent employee. Descriptive analyses on free-text descriptions of lost-time (LT) claims (>7 days away from work) identified common characteristics among claims and injured workers., Results: Among 3134 claims, 860 (27%) were LT. The industry group, drilling contractors, experienced the highest LT claims rate, whereas the cost from servicing contractors was the highest. Contact with objects and equipment caused the highest LT claims rate. The most frequent LT occupation was roustabout, and the most frequent LT work activity was material handling. Transportation incidents caused most fatalities and hospitalizations. Over half of LT claims were from short-tenured workers., Conclusions: Both proven and innovative approaches are needed to reduce severe workers' compensation claims in this industry., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Abstract: Clinical practices that provide workers' compensation care and other services related to managing work-related illnesses and injuries have long been challenged in receiving appropriate payment for their professional work. The American College of Occupational and Environmental Medicine (ACOEM) has provided excellent guidelines for coding and billing via its various documents that have been provided over the years. However, despite these guidelines, payors have been slow to adopt occupational specific coding guidelines to justify higher professional payment. With the move to a Centers for Medicare & Medicaid Services (CMS)-sponsored time-based coding option in 2011, the occupational and environmental medicine (OEM) clinics have been able to finally not only document but recoup the value of those services that go beyond the simple patient interface, being able to capture those activities that truly provide high value in the management of workers' medical issues., Competing Interests: Conflict of interest: None declared., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Abstract: Workers' compensation outpatient care requires attention to causation, functional assessment, work disability prevention, and return-to-work planning, elements not usually addressed in other types of outpatient encounters. Because these elements of care deviate from the usual pattern of ambulatory services, providers of workers' compensation care have faced challenges in billing and auditing practices resulting in underpayment when providing high-value care based on evidence-based guidelines. Recent changes in Centers for Medicare & Medicaid Services rules on documentation requirements for coding outpatient evaluation and management encounters offer an opportunity for occupational health clinicians to be paid appropriately for care that follows occupational medicine practice guidelines. There remains a need to define the elements of documentation that should be expected in delivering high-value workers' compensation care. This article provides guidance for documenting high-value workers' compensation care., Competing Interests: Conflicts of interest: None declared., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Objective: This study summarized the frequency and cost of mining-related injuries., Methods: Mining-related workers' compensation (WC) claims data from 35 states were summarized to report counts, claim rates, and costs for 2012-2019. These data were compared with Mine Safety and Health Administration injury and employment data for the same period., Results: Despite system differences, both WC and Mine Safety and Health Administration counts and rates declined over time and injury patterns were similar. Total WC costs were approximately $2.325B. Medical-only claims represented 59.4% of the claims by count, but only 3.3% of costs. Lost-time nonfatal claims represented 40.2% of the claims by count, but 90.2% of costs. Claims frequency and costs varied greatly by injury event/exposure, part of body, and nature., Conclusions: Injury frequency has declined but costs remain high. The most costly and disabling cases were identified., Competing Interests: Conflict of interest: None declared., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Objective: To assess the effect of morphine equivalent dose-days (MED-D) on the total cost for acute low back pain (LBP) workers' compensation claims., Methods: Simple random samples of 123 opioid and 141 nonopioid acute LBP claims were obtained. Opioid claims were divided into low, medium, and high subgroups for MED-D, MED, and prescription duration. Subgroup mean total costs were compared to the nonopioid group using multivariate regression analyses., Results: MED-D and prescription duration were each, respectively, associated with significantly increased total costs at both medium and high levels. Increasing MED had a negative association with total cost, though stratification by duration abrogated this perceived trend. Interaction testing indicated MED and duration together better explained cost than MED alone., Conclusion: MED-D is a better predictor of total cost in acute LBP claims than MED alone.

Objective: To quantify the association between physical therapy (PT) visits and workers' compensation costs and lost time., Method: A total of 40,203 lost-time claims (1998 to 2018) were analyzed., Results: The odds ratio of total paid claim costs more than or equal to $100,000 increased with the number of PT visits from 1.91 with 1 to 3 PT visits (95% confidence interval [CI]: 1.62 to 2.26) to 5.56 (95% CI: 4.86 to 6.37) for workers with a surgical procedure and more than or equal to 50 PT visits versus those without PT visits, when controlling for confounding factors. The risk of remaining at an off work status is greatest among claims involving surgery, escalating among claims with 15 or more PT visits (hazard ratio more than or equal to 3.76)., Conclusions: PT visits may be used as a marker for high workers' compensation cost and delayed return-to-work.

In 1966, about 1,600 US military men-mostly Air Force-participated in a cleanup of plutonium dispersed from two nuclear bombs in Palomares, Spain. As a base for future analyses, we provide a history of the Palomares incident, including the dosimetry and risk analyses carried out to date and the compensation assessments made for veterans. By law, compensation for illnesses attributed to ionizing radiation is based on maximum estimated doses and standard risk coefficients, with considerable benefit of the doubt given to claimants when there is uncertainty. In the Palomares case, alpha activity in urine fell far faster than predicted by plutonium biokinetic excretion models used at the time. Most of the measurements were taken on-site but were disqualified on the grounds that they were "unreasonably high" and because there was a possibility of environmental contamination. Until the end of 2013, the Air Force used low dose estimates derived from environmental measurements carried out well after the cleanup. After these estimates were questioned by Congress, the Air Force adopted higher dose estimates based on plutonium concentration measurements in urine samples collected from 26 veterans after they left Palomares. The Air Force assumed that all other cleanup veterans received lower doses and therefore assigned to them maximum organ doses based on the individual among the 26 with the lowest urine measurements. These resulting maximum organ doses appear to be sufficient to justify compensation to all Palomares veterans with lung and bone cancer and early-onset liver cancer and leukemia but not other radiogenic cancers.

Objective: To evaluate obesity-related costs and body mass index (BMI) as a cost predictor among privately insured employees by industry., Methods: Individuals with/without obesity were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Direct/indirect costs were reported per-patient-per-year (PPPY). Multivariate models were used to estimate the association between obesity and high costs (more than or equal to 80th percentile) by industry., Results: Overall (N = 86,221), direct and absenteeism/disability cost differences between class I obesity (BMI 30.0 to 34.9) and reference were $1,775 and $617 PPPY, respectively (P < 0.05). Among employees with obesity (BMI more than or equal to 30), highest total costs were observed in the government/education/religious services, food/entertainment services, and technology industries. Class I obesity increased the odds of high costs (more than or equal to 80th percentile) within each industry (odds ratios vs reference = 1.09-5.17)., Conclusions: Obesity (BMI more than or equal to 30) was associated with high costs among employees of major US industries.

Introduction: Heat stress is an occupational hazard. Exposed workers may suffer heat-related illness, disease exacerbation, increased injuries, and reduced productivity. Response strategies include mitigation policies and preparedness., Methods: Frequency of heat-related illness and workers' compensation costs before and after implementation of a voluntary Heat Stress Awareness Program were evaluated retrospectively in outdoor workers from 2009 to 2017. The program consisted of training, acclimatization, and medical monitoring as outlined in NIOSH's Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments., Results: Of the 604 workers assessed, those with two or more risk factors reported a heat-related illness at greater frequency, which decreased after program implementation. Median workers' compensation costs decreased by 50%., Discussion: Heat-related illness prevention programs can be effective in reducing the frequency and severity of these occupational injuries as well as associated costs.

: Physical therapy (PT) is perceived as a cost driver in the US workers' compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers' compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers' compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]: 5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI: 3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.

Objective: The purpose of this paper is to describe and evaluate a web-based, educational Health Risk Calculator that communicates the value of investing in employee health and well-being for the prevention of work-related injuries, illnesses, and fatalities., Methods: We developed and evaluated the calculator following the RE-AIM framework. We assessed effectiveness via focus groups (n = 15) and a post-use survey (n = 33) and reach via website analytics., Results: We observed evidence for the calculator's usability, educational benefit, and encouragement of action to improve worker health and safety. Website analytics data demonstrated that we reached over 300 users equally in urban and rural areas within 3 months after launch., Conclusion: We urge researchers to consider the ways in which they can communicate their empirical research findings to their key stakeholders and to evaluate their communication efforts.

Objective: Workers' compensation (WC) processes do not lead to maximal return-to-work or cost savings. The aim of this study is to assess barriers and facilitators to reporting and managing injuries and illnesses among civilian employees in the US Army., Methods: We triangulated a review of policy and practice documents, stakeholder interviews, a descriptive analysis of WC data, and a literature review to inform recommendations of best practices for improving return-to-work and lowering WC costs., Results: Federal WC costs are trending downward for civilian employees in the US Army; however, the approaches are not uniform or optimized, especially at the installation level., Conclusions: This mixed methods evaluation of the Department of Defense WC elucidates areas for improvement and potential best practices within the Federal WC system.

Objective: American College of Occupational and Environmental Medicine's (ACOEM's) evidence-based guidelines for acute low back pain (LBP) were used to assess relationships between guideline adherence and worker's compensation costs., Methods: Treatments at first appointments were abstracted. Two scoring tools were utilized to assess each patient's treatment plan. One score assessed ACOEM Guideline compliance while the second utilized mean expert scores of the perceived value of each treatment. Claim costs were log-transformed and compared with scores., Results: There is a significant trend between increased compliance and decreasing costs. Medical and total costs trended lower by an average $352.90 and $586.20 per unit of compliance score respectively. No outlier cost claims were in the best guidelines compliance groups., Conclusion: This study shows a statistically significant trend in the relationship between adherence to ACOEM guidelines for initial management of work-related LBP and decreasing claim costs.

Background: Antidepressants, benzodiazapines, and opioid medications are used to manage the pain, anxiety, or depression associated with workplace injuries., Objective: To evaluate the impact of these medications on workers' compensation costs and time lost from work., Methods: A cohort of 22,383 indemnity claims from 2008 to 2013 were evaluated for the association of prescribed medications on claim cost and delayed claim closure controlling for confounders., Results: Claims with anti-depressant, opioid, or benzodiazepine prescriptions were 2.24 (95% CI: 2.00 to 2.51), 1.14 (95% CI: 1.02 to 1.27), and 1.38 (95% CI: 1.23 to 1.54) times more likely to remain open at the end of the study., Conclusion: The concurrent treatment of pain, depression or anxiety, and occupational injuries are associated with large increases in claim cost and delayed return to work.

Objective: Assess the effect of chronic comorbidities on hours and earnings recovery following a carpal tunnel syndrome (CTS) claim., Methods: The hours and earnings profiles of Washington State workers' compensation claimants with CTS and controls, upper extremity fractures (UEF) claimants, were collected by linking to unemployment insurance data during 2007 to 2014. Chronic comorbidity status was determined from workers' compensation bills., Results: More (43%) CTS claimants had diagnosed chronic comorbidities than UEF (24%). CTS claimants and claimants with multiple chronic comorbidities had significantly higher odds of not working post injury and poorer hours and earnings recovery compared with UEF claimants and those with no chronic comorbidities., Conclusions: This research suggests that chronic conditions should be considered as barriers to return to work among injured workers.

Background: Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants., Objectives: To assess the impact of a state policy implemented in June 2010 that required prospective utilization review (UR) for early MRI among workers' compensation claimants with LBP., Research Design: Interrupted time series., Subjects: In total, 76,119 Washington State workers' compensation claimants with LBP between 2006 and 2014., Measures: Proportion of workers receiving imaging per month (MRI, computed tomography, radiographs) and lumbosacral injections and surgery; mean total health care costs per worker; mean duration of disability per worker. Measures were aggregated monthly and attributed to injury month., Results: After accounting for secular trends, decreases in early MRI [level change: -5.27 (95% confidence interval, -4.22 to -6.31); trend change: -0.06 (-0.01 to -0.12)], any MRI [-4.34 (-3.01 to -5.67); -0.10 (-0.04 to -0.17)], and injection [trend change: -0.12 (-0.06 to -0.18)] utilization were associated with the policy. Radiograph utilization increased in parallel [level change: 2.46 (1.24-3.67)]. In addition, the policy resulted in significant decreasing changes in mean costs per claim, mean disability duration, and proportion of workers who received disability benefits. The policy had no effect on computed tomography or surgery utilization., Conclusions: The UR policy had discernable effects on health care utilization, costs, and disability. Integrating evidence-based guidelines with UR can improve quality of care and patient outcomes, while reducing use of low-value health services.

Background: The financial impact regarding choice of physician within the workers' compensation domain has not been well studied., Objective: The aim of this study was to assess the difference in claim cost between employee- and employer-directed choice of treating physician after injury., Methods: Thirty-five thousand six hundred forty indemnity lost time claims from a 13-year period at a nationwide company were analyzed with multivariate logistic regression to determine the association of medical direction with risk of high-cost claims., Results: States that have employer-directed physician choice were associated with a lower risk of having high-cost claims (≥$50,000) but higher attorney involvement than employee direction. The net effect of this enhanced presence of attorneys offsets the benefits of employer choice of treating physician., Conclusion: States that permit employer selection of treating physician have slightly higher cost due to the higher prevalence of attorney involvement in the claims process.

Study Design: A retrospective cohort., Objective: The aim of this study was to determine the impact of preoperative opioid use in workers' compensation (WC) patients undergoing lumbar diskectomy (LD)., Summary of Background Data: The prevalence of back pain among opioid users approached 60%. Long-term opioid dependence in spine surgery patients is roughly 20%. Despite pervasive use, there is no evidence to support long-term opioid analgesic use for back pain., Methods: Ten thousand five hundred ninety-two patients received compensation from the Ohio Bureau of Workers' Compensation for a lumbar disc herniation between 2005 and 2012. Patients with spine comorbidities, smoking history, or multilevel surgery were excluded. Preoperatively, 566 patients had no opioid use, 126 had short-term opioid use (STO), 315 had moderate opioid use (MTO), and 279 had long-term opioid use (LTO). The primary outcome was whether subjects returned to work (RTW)., Results: Seven hundred twelve (55.4%) patients met our RTW criteria. There was a significant difference in RTW rates among the no opioid (64.1%), MTO (52.7%), and LTO (36.9%) populations. Multivariate logistic regression analysis found several covariates to be independent negative predictors of RTW status: preoperative opioid use [P < 0.01; odds ratio (OR) = 0.54], time to surgery (P < 0.01; OR = 0.98 per month), legal representation (P < 0.01; OR = 0.57), and psychiatric comorbidity (P = 0.02; OR = 0.36). Patients in the LTO group had higher medical costs (P < 0.01), rates of psychiatric comorbidity (P < 0.01), incidence of failed back surgery syndrome (FBSS) (P < 0.01), and postoperative opioid use (P < 0.01) compared with the STO and no opioid groups., Conclusion: Preoperative opioid use was determined to be a negative predictor of RTW rates after LD in WC patients. In addition, long-term preoperative opioid use was associated with higher medical costs, psychiatric illness, FBSS, and postoperative opioid use. Even a short or moderate course of preoperative opioids was associated with worse outcomes compared with no use. For WC patients undergoing LD, judicious use of preoperative opioid analgesics may improve clinical outcomes and reduce the opioid burden., Level of Evidence: 3.

Objective: To evaluate the efficacy of an injury prevention and monitoring program implemented by athletic trainers to reduce workers compensation costs in a hospital system with multiple centers and locations., Methods: A retrospective analysis of workers compensation claims (ie, lost days, light days, and incurred costs) was performed to compare injury data from 2 years before to 2 years after the start of the program., Results: The program significantly reduced the organization's incurred costs by 46.7% (P = 0.031) and light days by 44% (P = 0.022). Lost days were found to decrease by 37%, however, this decrease was not statistically significant (P = 0.078)., Conclusions: Athletic trainers, using their knowledge of anatomy, biomechanics, ergonomics, injury management, and rehabilitation, can effectively prevent and reduce workers compensation costs in a multicenter hospital system.

Study Design: This study was a retrospective-cohort design involving a review of patient medical and cost records and a 2-year postsurgery follow-up outcome survey., Objective: To evaluate the functional and cost outcomes associated with recent lumbar fusion surgeries in Utah workers and compare these outcomes with a comparable prior study cohort., Summary of Background Data: Lumbar fusion performed on injured workers has dramatically increased over the past 2 decades and this likely coincided with the increased use of more advanced surgical instrumentation. Considering the recent changes in lumbar fusion surgery, there is a need to identify how patient outcomes have changed among injured workers., Materials and Methods: Retrospective chart review and 2-year postsurgery follow-up survey of patient outcomes were performed. Postsurgical outcomes for this sample were compared with established norms for back pain patients and a previous cohort of compensated lumbar fusion patients obtained from Workers' Compensation Fund of Utah., Results: The current cohort evidenced a solid fusion rate of 89% and significant increase in the use of surgical instrumentation, particularly titanium fusion cages. Despite increased solid fusion rates, injured workers who have undergone lumbar fusion in Utah demonstrated equivalent and in some cases worse outcomes than those documented a decade ago. Specifically, there were significant increases in back pain dysfunction and narcotic medication usage in the current versus the past cohort. Medical and compensation costs for compensated lumbar fusion patients in Utah also significantly increased since the mid-1990s., Conclusion: Over the past decade, injured workers who have undergone lumbar fusion in Utah showed an increase in solid fusion rates and costs without a corresponding improvement in patient outcomes., Level of Evidence: 3.

Objectives: The objective of the project was to identify trends in emergency department visits and inpatient admissions for occupational injury and disease frequency and describe the financial impact from specific clinical groups known to have occupational risk factors., Methods: Workers compensation cases among 19 million records in the Arizona statewide hospital discharge database (HDD) were assessed for seven clinical groups from 2008 to 2014, including back, cardiac, carpal tunnel syndrome, heat-related, psychiatric, pulmonary, and trauma., Results: Cases with cardiac, psychiatric, and pulmonary diagnoses were both frequent and expensive. Although incidence was generally stable, charges per case rose significantly over the time period., Implications: Inpatient and emergency department records provide valuable data that complement other surveillance approaches for both occupational illnesses and injuries. Tracking charge as well as incidence data is useful.

Objective: The aim of this study was to investigate the effect of very early access to physical therapy and specialty care management in a workers' compensation population., Methods: A prospective pilot (n = 75) was conducted from 2012 to 2013 in which injured workers with musculoskeletal complaints received physical therapy and started care management during their initial occupational medicine clinic visit. Two retrospective comparator groups with workers' compensation claims from 2009 and 2012 were included in this study., Results: When comparing 2009 data with the 2012 to 2013 prospective pilot study, statistically significant differences were noted in favor of the prospective pilot for total costs per claim, cost of indemnity, number of therapy visits, and time to access physical therapy. When compared with the 2012 nonpilot cohort, differences were not statistically significant., Conclusions: Expedited access to physical therapy and care management can reduce duration of care, cost of claims, and therapy visits.

Study Design: Retrospective comparative cohort study., Objective: Examine the effect of prolonged preoperative opioid use on return to work (RTW) status after single-level cervical fusion for radiculopathy., Summary of Background Data: The use of opioids has a dramatic effect in a workers' compensation population. The costs of claims that involved opioids in the management plan are catastrophic particularly for those undergoing spinal surgical procedure., Materials: Data of patients who underwent single-level cervical fusion for radiculopathy and had received opioid prescriptions before surgery were retrospectively collected from Ohio Bureau of Workers' Compensation between 1993 and 2011 after work-related injury. Then, based on opioid use duration, short-term use (STO) group (<3 mo), intermediate-term use (ITO) group (3-6 mo), and long-term use (LTO) group (>6 mo) were constructed. A multivariate logistic regression analysis was used to determine whether successful RTW status was achieved. Chi-square and analysis of variance tests were used to compare other secondary outcomes after surgery., Results: Prolonged preoperative opioid use was a negative predictor of successful RTW status (odds ratio = 0.73; 95% confidence interval: 0.55-0.98; P value: 0.04). Prolonged preoperative opioid use was associated with increasingly lower rates of achieving stable RTW status (P < 0.05) and RTW within 1 year after surgery (P < 0.05). The odds of achieving successful RTW status were 0.49 (0.25-0.94) for ITO, and 0.40 (0.24-0.68) for LTO compared with STO group. The odds of RTW less than 1 year after surgery were 0.43 (0.21-0.88) for ITO and 0.36 (0.21-0.62) for LTO compared with STO group. Prolonged preoperative opioid use was also associated with increasingly higher net medical costs (P < 0.01), and disability benefits awarded after surgery (P < 0.01)., Conclusion: Prolonged preoperative opioid use was associated with poor functional outcomes after cervical fusion. STO and earlier inclusion of the surgical approach in the management plan may offer better surgical and functional outcomes after cervical fusion., Level of Evidence: 3.

Study Design: Retrospective comparative cohort study., Objective: Examine the impact of multilevel fusion on return to work (RTW) status and compare RTW status after multi- versus single-level cervical fusion for patients with work-related injury., Summary of Background Data: Patients with work-related injuries in the workers' compensation systems have less favorable surgical outcomes. Cervical fusion provides a greater than 90% likelihood of relieving radiculopathy and stabilizing or improving myelopathy. However, more levels fused at index surgery are reportedly associated with poorer surgical outcomes than single-level fusion., Methods: Data was collected from the Ohio Bureau of Workers' Compensation (BWC) between 1993 and 2011. The study population included patients who underwent cervical fusion for radiculopathy. Two groups were constructed (multilevel fusion [MLF] vs. single-level fusion [SLF]). Outcomes measures evaluated were: RTW criteria, RTW <1year, reoperation, surgical complication, disability, and legal litigation after surgery., Results: After accounting for a number of independent variables in the regression model, multilevel fusion was a negative predictor of successful RTW status within 3-year follow-up after surgery (OR = 0.82, 95% CI: 0.70-0.95, P <0.05).RTW criteria were met 62.9% of SLF group compared with 54.8% of MLF group. The odds of having a stable RTW for MLF patients were 0.71% compared with the SLF patients (95% CI: 0.61-0.83; P: 0.0001).At 1 year after surgery, RTW rate was 53.1% for the SLF group compared with 43.7% for the MLF group. The odds of RTW within 1 year after surgery for the MLF group were 0.69% compared with SLF patients (95% CI: 0.59-0.80; P: 0.0001).Higher rate of disability after surgery was observed in the MLF group compared with the SLF group (P: 0.0001) CONCLUSION.: Multilevel cervical fusion for radiculopathy was associated with poor return to work profile after surgery. Multilevel cervical fusion was associated with lower RTW rates, less likelihood of achieving stable return to work, and higher rate of disability after surgery., Level of Evidence: 3.

Objectives: The aim of this study was to compare the association between insurance premium incentives and claim outcomes in two different workers' compensation programs., Methods: Regression models were run for claim outcomes using data from two Canadian jurisdictions with different experience-rating programs-one with prospective (British Columbia) and another with retrospective (Ontario) adjustment of premiums. Key explanatory variables were past premium adjustments., Results: For both programs, past premium adjustments were significantly associated with claim outcomes, suggesting adjustments provided incentives for claims reduction. The magnitudes of effects in the prospective program were smaller than the retrospective one, though relative persistence of effects over time was larger., Conclusion: Having large and immediate employer responses to incentives may appear desirable, but insurers should consider the time required for employers to improve and sustain good practices, and create incentives that parallel such time lines.

Objective: The aim of this study was to assess the relationship between timing and duration of opioid prescriptions, disability duration, and claims costs for work-related injuries., Method: A retrospective cohort study using lost time compensation claimant data to examine the relationship between opioid prescription patterns and claim duration and cost. Logistic regression adjusted for sex, marital status, initial reserve, attorney involvement, and spinal surgeries., Results: Odds ratios for claim cost at least $100,000 and duration at least 3 years were not statistically different between groups prescribed opioids less than 30 days and those not prescribed opioids. Claims with short-acting opioids continued after 180 days; the odds ratios for claim cost at least $100,000 and duration at least 3 years were 6.21 (95% confidence interval 5.30 to 7.28) and 3.32 (95% confidence interval 2.94 to 3.74)., Conclusion: Claim cost and lost time are related to when and how long opioids are prescribed for work-related injuries.

Objective: The aim of the study was to examine the impact of state workers' compensation (WC) policies regarding wage replacement and medical benefits on medical costs and length of disability (LOD) in workers with low back pain (LBP)., Methods: Retrospective cohort analysis of LBP claims from 49 states (n = 59,360) filed between 2002 and 2008, extracted from a large WC administrative database., Results: Longer retroactive periods and state WC laws allowing treating provider choice were associated with higher medical costs and longer LOD. Limiting the option to change providers and having a fee schedule were associated with longer LOD, except that allowing a one-time treating provider change was associated with lower medical costs and shorter LOD., Conclusions: WC policies about wage replacement and medical treatment appear to be associated with WC LBP outcomes, and might represent opportunities to improve LOD and reduce medical costs in occupational LBP.

Objective: To explore the association between the initial 60 days of prescriptions for psychotropic medications and final workers' compensation claim outcomes., Methods: A cohort of 11,394 claimants involved in lost time injuries between 1999 and 2002 were followed through December 31, 2009. Logistic regressions and Cox Proportional Hazard Models were used in the analysis., Results: The initial 60 days of prescriptions for psychotropic medications were significantly associated with a final claim cost at least $100,000. Odds ratios were 1.88 for short-acting opioids, 2.14 for hypnotics, antianxiety agents, or antidepressants, and 3.91 for long-acting opioids, respectively. Significant associations were also found between decreased time lost from work and decreased claim closures during the study period., Conclusions: Early prescription of opioids and other psychotropic drugs may be useful predictors of high claim costs and time lost from work.

Study Design: Retrospective cohort study and systematic literature review., Objective: To examine the influence of "universal no-fault compensation" upon return-to-work rates in patients undergoing lumbar spinal fusion, and then to make comparison with workers' compensation (WC) and non-workers' compensation (non-WC) claimants., Summary of Background Data: Compensation has an adverse influence upon outcomes and return to work in lumbar spinal fusion. It is unclear whether this is due to the compensation per se, or due to the features of WC including its adversarial environment, delayed resolution of claims, and need for disability enhancement to promote compensation. The New Zealand Accident Compensation Corporation (ACC) is a universal no-fault system offering early treatment and salary reimbursement. Given the differing features of these compensation systems, comparison of return-to-work rates may give insight into the differing outcomes for the two compensation systems., Methods: From a cohort of 428 patients undergoing lumbar spinal fusion, 178 patients covered by ACC system underwent a structured interview to determine pre-injury, pre-surgical, and post-surgical work status. A systematic literature review was performed relating to lumbar spine fusion, return to work, and WC., Results: The return-to-work rate for the ACC patients in work at the time of their injury was 81%. The systematic review of 21 studies including 2519 subjects revealed a return-to-work rate of 40% for WC patients, and 74% for non-WC patients (P < 0.001). There was a significantly greater return-to-work rate for ACC patients than WC patients (P < 0.001), but no difference between ACC and non-WC patients., Conclusion: The return-to-work rates for a universal no-fault compensation system are higher than those under WC cover, and are compatible with non-WC cases. This suggests that the features of WC may contribute to the inferior return-to-work rates.

Objective: To determine whether a relationship exists between elevated levels of body mass index (BMI) and workers' compensation measures., Methods: This was a retrospective analysis of 3951 workers' compensation claimants between 1981 and 2009 representing municipal workplaces. A BMI scale composed of seven levels, including two overweight tiers, was used., Results: Higher BMI levels were related to more lost workdays, indemnity costs, and total costs. Medical care costs were virtually the same in overweight and obese claimants and moderately higher than claimants with recommended BMIs. Males were more likely to incur workers' compensation claims than females across all BMI tiers; yet, obese females incurred twice as many lost workdays and indemnity costs, and nearly 50% higher medical costs and total costs than obese men., Conclusions: Elevated levels of BMI negatively influence several workers' compensation outcome measures.

Study Design: Prospective cohort study and systematic literature review., Objective: To compare the functional outcomes for lumbar spinal fusion in both compensation and noncompensation patients in an environment of universal no fault compensation and then to compare these outcomes with those in worker's compensation and nonworkers compensation cohorts from other countries., Summary of Background Data: Compensation has an adverse effect on outcomes in spine fusion possibly based on adversarial environment, delayed resolution of claims and care, and increased compensation associated with prolonged disability. It is unclear whether a universal no fault compensation system would provide different outcomes for these patients. New Zealand's Accident Compensation Corporation (ACC) provides universal no fault compensation for personal injury secondary to accident and offers an opportunity to compare results with differing provision of compensation., Methods: A total of 169 patients undergoing lumbar spinal fusion were assessed preoperatively, at 1 year, and at long-term follow-up out to 14 years, using functional outcome measures and health-related quality-of-life measures. Comparison was made between those covered and not covered by ACC for 3 distinct diagnostic categories. A systematic literature review comparing outcomes in Worker's Compensation and non-Compensation cohorts was also performed., Results: The functional outcomes for both ACC and non-ACC cohorts were similar, with significant and comparable improvements over the first year that were then sustained out to long-term follow-up for both cohorts. At long-term follow-up, the health-related quality-of-life measures were the same between the 2 cohorts.The literature review revealed a marked difference in outcomes between worker's compensation and non-worker's compensation cohorts with a near universal inferior outcome for the compensation group., Conclusion: The similarities in outcomes of patients undergoing lumbar spine fusion under New Zealand's universal no fault compensation system, when compared with the dramatically inferior outcomes for these patients under other worker's compensation systems, suggest that the system of compensation has a major influence on patient outcomes, and that change of compensation to a universal no fault system is beneficial for patients undergoing lumbar fusion surgery., Level of Evidence: 2.

Background: Obesity is associated with an increased risk for many chronic illnesses and disability., Objective: To assess the relationship between obesity and delayed return to work and workers' compensation claim costs for both minor and significant injuries., Method: There were 1107 workers who filed a workers' compensation claim with the Louisiana Workers' Compensation Corporation in 2011 that were followed up to the end of the first quarter of 2014., Result: Adjusting for sex, age, marital status, and attorney involvement, the odds ratio of an obese versus normal weight claimant returning to work after a severe injury was 3.58 (95% confidence interval, 1.26 to 10.14) and claim expenses $100,000 or more, 3.19 (95% confidence interval, 1.18 to 8.62)., Conclusions: Obesity was associated with increased time lost from work and costs among workers' compensation claimants sustaining severe, but not minor injuries.

Study Design: Retrospective matched pair cohort analysis using a prospectively maintained registry., Objective: To describe the findings associated with workers' compensation (WC) claimants in regard to surgical outcomes, costs, and reimbursement after a 1- or 2- level anterior cervical discectomy and fusion., Summary of Background Data: WC patients are perceived to demonstrate poor surgical outcomes and greater health care expenditure than more traditional patients. This study aims to evaluate the perceived differences in financial costs between patients with and without WC insurance., Methods: A retrospective analysis of 352 patients who underwent a primary 1- or 2- level anterior cervical discectomy and fusion for degenerative spinal etiologies between 2007 and 2013 by a single surgeon was performed. Patients were stratified on the basis of the payer status (WC vs. non-WC). Demographics, Charlson Comorbidity Index scores, smoking status, pre- and postoperative Visual Analogue Scale (VAS) scores, procedural time, estimated blood loss, hospital length of stay, complications, and revisions/reoperations were assessed between cohorts. The 1-year arthrodesis rate was also evaluated via computed tomography. Two cohorts of 30 patients were then matched for the number of fusion levels, smoking, and Charlson Comorbidity Index scores to compare hospital costs and reimbursements. All financial data were reported as a ratio of non-WC to WC payment/charges to protect hospital-sensitive financial data. Statistical analysis was performed using the independent sample t test for continuous variables and χ analysis for categorical data. An α level of less than 0.05 denoted statistical significance., Results: A total of 352 patients were included in this study of which 132 (37.5%) carried WC as the primary payer. The WC cohort was significantly younger (45.2 ± 8.5 vs. 52.9 ± 11.9, P < 0.001) and demonstrated a reduced comorbidity burden (2.3 ± 1.2 vs. 3.4 ± 1.7, P < 0.001) compared with non-WC patients. In addition, the WC cohort consisted of a significantly greater proportion of males, non-Caucasians, and active tobacco users. The preoperative VAS score, number of fusion levels, procedural time, and hospital length of stay did not significantly vary between cohorts. The 6-month VAS scores (3.2 ± 2.9 vs. 2.3 ± 2.4, P < 0.05), pseudarthrosis rates (7.6% vs. 0.9%, P < 0.001), revision/reoperations (12.9% vs. 2.7%, P < 0.001), and smoking rates (29.8% vs. 20.5%, P < 0.05) were significantly increased among WC payers. The difference in the total charges for anterior cervical discectomy and fusion between the WC cohort and the non-WC cohort was not statistically significant. The costs associated with implants, anesthesia, operating room, and in-hospital therapy were comparable between cohorts. The WC cohort was associated with a 282% higher reimbursement rate than the non-WC cohort (P < 0.001)., Conclusion: The WC cohort demonstrated lower clinical improvement, reduced 1-year arthrodesis rate, and an increased incidence of revision/reoperations when compared with non-WC patients. The greater proportion of smokers and increased occupational demands within the WC cohort may help explain these findings. Reimbursement rates were significantly higher in the WC patients. However, costs to the health care system during the acute hospitalization period (implants, operating room resources, postoperative care, and therapy) were similar between cohorts., Level of Evidence: 3.

Objective: Primary health care providers may not be familiar with the Federal Employees' Compensation Act (FECA) and Department of Defense regulations that govern injured workers' rights, benefits, and procedures to follow when an injured employee is seen in the military medical treatment facility., Methods: The FECA program was examined and each section reviewed to facilitate provider involvement from time of injury to final disposition of a claim and employee return to work. The best practices in case management are highlighted as well., Results: Several areas of the FECA program require coordination between members of the installation Federal Worker's Compensation team. Areas requiring extensive communication by all team members were emphasized., Conclusions: Successful installation FECA programs engage all members of the FECA team in a collaborative fashion to share information, prevent injuries, and keep costs low.

Background: Federal Employees' Compensation Act injury rates and claim costs benefit from injury prevention and case management efforts. The Department of Labor Protecting Our Workers and Ensuring Reemployment data on lost time injuries and illnesses do support injury prevention and case management activities., Methods: The management efforts of the Department of Defense, Veterans Administration, and Department of Labor were examined to determine whether more is needed to support injury prevention and case management efforts., Results: Data on Protecting Our Workers and Ensuring Reemployment goal 3 metrics should be provided to safety and occupational health (SOH) personnel to support injury prevention and case management efforts., Discussion: Injury prevention and case management data need to be made available to SOH team members to prevent injuries and lower claims costs., Conclusion: Actionable information must be provided to SOH that will facilitate case management and injury prevention programs and lower costs.

Objective: This study of Department of Defense (DoD) civilian employees Workers' Compensation (WC) claims for chargeback year 2000 through 2012 aimed to analyze the frequency, rates, and costs of WC claims representing 5% of the DoD annual personnel budget., Methods: A multiyear cross-sectional study of WC claims data identified the top five most frequent causes, natures, and anatomical sites; changes in frequency, worker age, costs, and time were evaluated for trends., Results: The annual frequency and rate of new DoD WC claims decreased over time, whereas costs per new claim have increased. New claim frequencies, rates, and costs aggregated in older age groups., Conclusions: The increasing trend in costs of each claim and the overall program costs presents a need for case management. Analysis of WC claims data is necessary to help target injury prevention efforts and reduce program costs.

Objective: The objective of this article is to introduce the reader to this special supplement to the Journal of Occupational and Environmental Medicine regarding Federal Workers' Compensation Programs., Methods: The short history of both the VHA and DoD Federal Workers' Compensation Programs are provided and a short synopsis of each author's article is provided., Results: The lessons learned from the articles in the supplement are summarized in this article and 6 key findings are highlighted., Conclusions: Cooperation between human resources workers' compensation personnel, safety and occupational health personnel is a must for successful management of the WC program. Information and data sharing are critical for root cause and injury prevention, case management, and cost containment efforts. Enhancing efforts in these areas will save an estimated $100 million through cost avoidance efforts.

Objective: This is the first study of workers' compensation injuries and costs in Department of Defense workers that examined whether any demographic factors including age, sex, occupation, and nature of injury altered the risks or costs of an injury or illness over time., Methods: Department of Defense Workers' Compensation claims for period 2000 to 2008 were analyzed (n = 142,115) using Defense Portal Analysis and Defense Manpower Data Center to calculate injury rates and costs. Regression analysis was done using SPSS to examine the change in the risk of injury or illness over time from 2000 to 2008., Results: The age group of 30 to 34 years had the lowest costs per claim and highest claims rate, 332 per 10,000. The age group of 65 to 70 years had the lowest claims rate of 188 per 10,000 but the highest costs per claim. Claims cost increased $69 for each 5-year group, and older workers had a threefold increase in costs per claim., Conclusion: Younger workers get hurt more often, but older workers tend to have more expensive claims.

Objective: To study the relationship between the use of psychotropic and opioid medications with workers' compensation disability and costs., Methods: The study population included lost time claimants injured between 1999 and 2002 followed to closing in December 31, 2009., Results: Controlling for age, sex, marital status, attorney involvement, and spinal surgeries, multivariate logistic regression revealed that odds ratios (95% confidence interval) of claim costs ≥$100,000 compared with claimants who were never prescribed opioids were 4.3 for short-acting opioids only; 8.6 for any use of long-acting opioids; 2.8 for any use of hypnotics; 2.6 for any use of antipsychotics; 1.6 for any use of anti-anxiety agents; and 2.9 for any use of antidepressants., Conclusions: The use of psychotropic and opioid medications was associated with high workers' compensation costs and prolonged disability.

Objective: Study the use patterns and claim cost impact of prescription opioids and benzodiazepines in workers' compensation., Methods: A cohort of 11,394 lost time claims filed with the Louisiana Workers' Compensation Corporation from 1999 to 2002 was observed for 7 years post injuries., Results: We found that benzodiazepines are almost always prescribed in combination with opioids. The odds ratios of benzodiazepines used alone, with short-acting opioids and with long-acting opioids for claims ≥$100,000, were 2.74, 4.69, and 14.24, respectively (after controlling for gender, low back pain, marital status, attorney involvement, and each other). Average benzodiazepine daily dose increased to year 3 postinjury and plateaued thereafter, whereas the average opioid dose escalated each year postinjury., Conclusions: The addition of benzodiazepines to an opioid treatment regimen significantly increases workers' compensation costs.

Study Design: Retrospective cohort study., Objective: To compare type, timing, and longitudinal medical costs incurred after adherent versus nonadherent magnetic resonance imaging (MRI) for work-related low back pain., Summary of Background Data: Guidelines advise against MRI for acute uncomplicated low back pain, but is an option for persistent radicular pain after a trial of conservative care. Yet, MRI has become frequent and often nonadherent. Few studies have documented the nature and impact of medical services (including type and timing) initiated by nonadherent MRI., Methods: A longitudinal, workers' compensation administrative data source was accessed to select low back pain claims filed between January 1, 2006 and December 31, 2006. Cases were grouped by MRI timing (early, timely, no MRI) and subgrouped by severity ("less severe," "more severe") (final cohort = 3022). Health care utilization for each subgroup was evaluated at 3, 6, 9, and 12 months post-MRI. Multivariate logistic regression models examined risk of receiving subsequent diagnostic studies and/or treatments, adjusting for pain indicators and demographic covariates., Results: The adjusted relative risks for MRI group cases to receive electromyography, nerve conduction testing, advanced imaging, injections, and surgery within 6 months post-MRI risks in the range from 6.5 (95% CI: 2.20-19.09) to 54.9 (95% CI: 22.12-136.21) times the rate for the referent group (no MRI less severe). The timely and early MRI less severe subgroups had similar adjusted relative risks to receive most services. The early MRI more severe subgroup cases had generally higher adjusted relative risks than timely MRI more severe subgroup cases. Medical costs for both early MRI subgroups were highest and increased the most over time., Conclusion: The impact of nonadherent MRI includes a wide variety of expensive and potentially unnecessary services, and occurs relatively soon post-MRI. Study results provide evidence to promote provider and patient conversations to help patients choose care that is based on evidence, free from harm, less costly, and truly necessary., Level of Evidence: N/A.

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.

Objective: To determine the incidence of low back injuries and associated workers' compensation costs before and after the introduction of a standardized fitness-for-duty evaluation of commercial truck drivers who present for their comprehensive Department of Transportation (DOT) physical examination., Methods: Trained physical therapists administered questionnaires and performed functional testing of commercial truck drivers scheduled for their DOT examination. The results were communicated to providers performing DOT examinations. Incidence rates of low back injury and associated workers' compensation costs 3 years before and 3 years after the intervention (1999 to 2006) were determined., Results: There was a 54% reduction in the low back pain incidence rate and an associated 45% reduction in workers' compensation costs from 1999 to 2006., Conclusions: This intervention was associated with a reduced incidence of low back injuries and reduced associated workers' compensation costs in this population.

Objective: Quantify incremental employee medical, pharmacy, sick leave, short- and long-term disability, and workers' compensation costs, absence days, and turnover associated with urge urinary incontinence (UUI) in employees., Methods: This retrospective 2001-2011 database comparison of employees with UUI versus those without UUI (controls) included employees aged 18.5 to 64.0 years at index, with 6-month preindex and 12-month postindex health plan enrollment. Logistic and generalized linear models measured postindex costs, absences, and turnover., Results: The study included 1448 employees with UUI and 337,796 controls. Employees with UUI had statistically significantly higher medical (131% higher), pharmacy (52%), sick leave (30%), and short-term disability (74%) costs and more sick leave (22%) and short-term disability (99%) days than controls (all P < 0.02)., Conclusions: Employees with UUI had 117% greater medical and pharmacy costs, 47% greater total absence costs, and 63% more absence days than employees without UUI.

Objective: Assess the relationship between performing lumbar epidural steroid injections (ESIs) after lumbar surgery and workers' compensation claim duration and cost., Methods: A multivariate logistic regression was used to determine the association between performing ESI after the first lumbar surgery in 11,394 lost time injury claims filed from 1999 to 2002 followed for 7 years postinjury., Results: Odds ratio of costs more than $100,000 is 6.49 (95% confidence interval: 4.30 to 9.81) for ever having lumbar ESI after the first lumbar surgery, compared with no spinal procedures, controlling for sex, age, attorney involvement, opioid use, other spinal procedures, and claim duration. Odds ratio of having claim duration longer than 1000 days was 14.73 (95% confidence interval: 7.01 to 30.95)., Conclusion: Lumbar ESI after the first lumbar surgery was associated with high cost and longer claim duration.

Objective: Quantify the impact of employee overweight and obesity on costs, absence days, and self-reported productivity., Methods: Employees' retrospective body mass index (BMI) values (kg/m(2)) from 2003 to 2011 health appraisal data defined three cohorts: BMI < 27, 27 ≤ BMI < 30, BMI ≥ 30. Medical, pharmacy, sick leave, short-term disability, long-term disability, and workers' compensation costs and absence days, and Health Productivity Questionnaire responses were compared using regression modeling, controlling for demographics, salary, and index year., Results: Among 39,696 (BMI < 27), 14,281 (27 ≤ BMI < 30), and 18,801 (BMI ≥ 30) eligible employees, per-employee adjusted total annual costs were $4258, $4873, and $6313, respectively. Medical, pharmacy, sick leave, workers' compensation costs and days were higher for higher-BMI cohorts (P < 0.01). Employees with BMI ≥ 30 kg/m(2) had the most short-term disability costs and days and least productivity (P < 0.001)., Conclusions: Employees with higher BMI levels are associated with significantly more costs and absences and lower self-reported productivity.

Objective: Previous research suggests that non-workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs., Methods: Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments., Results: Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims., Conclusion: Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.

Objective: To estimate community-acquired pneumonia (CAP) incidence, turnover, episode length, inpatient length-of-stay, and cost burden., Methods: Using 2007 to 2010 employee demographic, payroll, and claims data, CAP episodes were identified in employees aged 18 to 64 years. Semiannual medical, drug, sick leave, short-term disability (STD), long-term disability, and workers' compensation costs and absence days were compared between employees with and without CAP (controls) using two-part regression modeling., Results: In a population of 250,000, the number of CAP episodes per 100,000 employees was 628. The incidence rate increased with age and comorbidity. CAP employees' turnover rate nearly doubled that of controls (P < 0.01). In every age and risk group, employees with CAP had significantly (P < 0.01) higher medical and drug costs than controls and double the STD costs and days (P < 0.05)., Conclusions: CAP and underlying comorbidity are associated with increased medical, pharmacy, and STD costs and employee turnover rates.