Workers' Comp - the answer to the spinal fusion question
Kudos to USAToday for publishing a pretty good article on variations in practice patterns related to back surgeries. In a front page story today, the paper that has been derided by some as "McNews" explores the issues surrounding the explosion in the number of spinal fusions.
The reporting is balanced, insightful, and thorough, a bit of a surprise coming from a paper that prides itself on short sentences, really short words, and lots of color, not depth and nuance.
Noted throughout the article is the primary problem - no one knows how many spinal fusions are the right number, and there is significant disagreement among stakeholders re when a patient should have surgery. (free registration required) That's all true, and that's where workers compensation comes in.
Back pain is one of the most common, and potentially most expensive, workers comp injuries. Unlike group health or Medicare, in workers comp the payer really cares about the end result of the medical treatment process - if the patient does not fully recover, the insurer has to pay a lot of money for future lost wages. And, in work comp the claim stays open until it is either settled, or the patient is fully recovered. Finally, work comp databases include both medical treatment information and indemnity, or lost wage, data.
That does not mean workers comp payers have figured out how best to handle back injuries - far from it.
That said, for researchers looking for a robust and comprehensive database for analysis to help determine when spinal fusion makes sense, work comp is the place to go.
Comments
Except that there is data (some of which is excellent anecdotal evidence) that condition for condition, people on workers' comp do worse with clinical outcomes than those not on workers' comp.
The big problem with outcomes is determining the 'denominator'-- how many people are actually comparable.
You are right to focus on practice variations as an issue, the Dartmouth group continues to do the 'Able Danger' work in US healthcare.
Posted by: Eric Novack | October 17, 2006 9:21 AM
1 million $$$$ a day - 2 years ago...
http://www.healthpointcapital.com/research/2004/04/12/fda_approves_second_growth_factor_for_the_spine/
This is expensive and perhaps at the same time quite profitable for Medtronic ?
Posted by: The other Joe | October 17, 2006 6:30 PM