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.