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Are California’s work comp claimants denied necessary care?

One study published in the Spine Journal says no.

In fact, the opposite may well be the case; compared to Washington State, workers’ comp back patients in California get way too much unnecessary surgery, leading to higher costs and worse outcomes – including more wound infections, life-threatening complications, and device complications.  

The study used a case-mix adjusted of patients undergoing an inpatient lumbar fusion for degenerative disease in 2008 – 09, and produced the following results:

  • the rate of lumbar fusions in CA was 47% higher than in WA.
  • the complexity of procedures was much higher in CA.
  • CA costs were more than 20% higher in CA than WA.
  • CA costs were influenced by the (since fixed) double payment for surgical devices and coverage for bone growth enhancers (which have decidedly mixed reviews)

So, we have too many and too complex procedures performed on too many patients at too high a cost, with worse outcomes.


Well, the limits on lumbar fusion in WA are pretty tight, for very good reason.  In contrast, CA only required a second opinion to approve the procedure.

The financial incentive inherent in CA’s high payments for the procedure may (!) have had something to do with it.

What does this mean for you?

More surgery is often not better care, and in many instances means worse care – and a pretty crappy life for the patient.


2 thoughts on “Are California’s work comp claimants denied necessary care?”

  1. It is clear that the United States needs more utilization of Chiropractic services for the MORE conservative care of the spine, pelvis and cervical spine immediately following an injury. Surgery has been proven to NOT be the answer and many times the surgery results in MORE complications and Much greater cost than Chiropractic intervention! Patient satisfaction surveys of their chiropractic care is VERY HIGH!!

  2. Dr Titze, I agree with you and many others that we need much less spinal surgery in this country. It is costly, ineffective and disabling. Conservative therapies are successful and underused. Most patients with low back pain need little-to-no treatment other than comfort measures; others need behavioral therapies to overcome fears and other psychosocial barriers; a few need spinal surgery in the context of a well-defined clinically accurate diagnosis of nerve root pain. Only those very few with severe injuries such as some fractures and dislocations may need spinal fusion.

    I agree that many patients view chiropractic as highly SATISFYING; it is also less expensive than surgery (although not less expensive than other conservative treatments). However, most well-conducted randomized controlled studies show that chiropractic is not CLINICALLY effective (see, for example, “Short-term usual chiropractic care for spinal pain: a randomized controlled trial. Spine (Phila Pa 1976). 2013” ). Let’s not jump from one ineffective and very expensive treatment (most spinal surgery) to another ineffective and expensive treatment (chiropractic).

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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