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A work comp exec’s MUST read

The health care “system’s” problems are even worse for worker’s comp.

That’s the conclusion I reached after I finally got around to finishing “Overkill“, Atul Gawande’s latest piece on the clustermess that is the American health care system.

The top takeaway is this – there is huge over-diagnosis of medical “problems” due to an over-reliance on fancy diagnostic technology, technology that far-too-often identifies physical abnormalities that have little to no effect on one’s health or functionality.

An excerpt makes the point:

Studies of adults with no back pain find that half or more have degenerative disk disease on imaging. Disk disease is a turtle—an abnormality that generally causes no harm. It’s different when a diseased disk compresses the spinal cord or nerve root enough to cause specific symptoms, such as pain or weakness along the affected nerve’s territory, typically the leg or the arm. In those situations, surgery is proved to be more effective than nonsurgical treatment. For someone without such symptoms, though, there is no evidence that surgery helps to reduce pain or to prevent problems. One study found that between 1997 and 2005 national health-care expenditures for back-pain patients increased by nearly two-thirds, yet population surveys revealed no improvement in the level of back pain reported by patients. [emphasis added]

More specific to workers’ comp, the good folks at Liberty Mutual’s Institute for Research found claimants with back pain with:

early or non-indicated MRIs led to a cascade of medical services in the six-month period post-MRI that included electromyography, nerve conduction testing, advanced imaging, injections or surgery.

These procedures often occurred soon after the MRI and were 17 to nearly 55 times more likely to occur than in similar claims without MRI.

“Being a highly sensitive test, MRI will quite often reveal common age-related changes that have no correlation to the anatomical source of the lower back pain,” said one of the researchers, Glenn S. Pransky, MD, Center for Disability Research, which is part of the Liberty Mutual Research Institute for Safety, in a statement.

According to Pransky, evidence-based practice guidelines for lower back pain recommend against early MRI except for “red flag” indications such as severe trauma, infection or cancer.

Dr. William Gaines, associate national medical director, Liberty Mutual Commercial Insurance Claims, said that the National Committee for Quality Assurance and the American Board of Internal Medicine have emphasized for years that overuse of imaging does not represent good care for low back pain.

What does this mean for you?

Our health care system is very, very good at finding physiological and anatomical “problems”.  Unfortunately, it is also very good at assuming those findings actually indicate an underlying and significant pathology.


4 thoughts on “A work comp exec’s MUST read”

  1. Dr. Atul Gawande is a tremendous champion in intelligently and articulately highlighting the causes of the epidemic of overdiagnosis that patients are suffering. The MRI has now been proven to not be useful in determining the presence or absence of pain. Until now there is no other tool that can successfully and reliably determine the predominant factors (and their severity) which cause a patient’s pain experience. A tool that can do that, helps clarify and reassure (when sensory physical factors

  2. can be addressed with conservative care) that patient’s do no have to endure unnecessary and potentially damaging surgeries, epidurals and opioids. Supporting conservative care with evidential medical information will benefit patients and payers.

  3. This knowledge has been well published in the medical literature and is NOTHING NEW! Sadly, the medical community, insurers and patients are all too slow to adopt evidence and this is well known…coupled with the ability to use shiny new technology and the system does not have a chance. Again we all have a role to play and insurers demanding specific ICD-10 codes for billing purposes often perpetuate the problem esp. for diagnoses like LBP and FM. Giving a recent talk to Canadian MDs (suspect it’s worse in the US) one pointed out when I stated that LBP is not a diagnosis quickly interjected that I was wrong because it does exist as a billing code and therefore it must be a diagnosis! Until all stakeholders including insurers realize we cant suck and blow at the same time this insanity is likely to continue.

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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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