Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier.

BACKGROUND: Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. OBJECTIVE: To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). METHOD: A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. RESULTS: The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. CONCLUSIONS: Undergoing an AM is associated with an increased risk of TKA in WC claimants.

Dose Escalations Among Workers' Compensation Claimants Using Opioid Medications-An 8 Year Postinjury Follow up Study.

OBJECTIVE: The aim of the study is to determine the morphine equivalent dose in milligrams (MED)/day escalation trend after initial utilization. METHODS: A total of 25,108 lost time claims filed between 1998 and 2007 were followed for 8 years from injury date. Claims were stratified by initial MED/day at 3 months after injury into four groups (0, 1 to < 15, 15 to < 30, and ≥30 MED/day). The slopes in MED/year of opioid dose escalation were determined for each initial MED/day group. RESULTS: The slopes of MED/day escalation by initial MED categories were similar ( P ≥ 0.05) ranging from 5.38 to 7.76 MED annually. On average, MED/day increased in a liner pattern with a slope at 6.28 MED/year ( P < 0.01). CONCLUSIONS: Opioid MED/day increased in a linear pattern, regardless of initial MED/day dose.

Marked Decreases in Time Lost From Work Among COVID-19 Claimants During the SARS-CoV-2 Pandemic: An Observational Study of Claims Filed at a Nationwide US Workers Compensation Insurance Carrier.

OBJECTIVE: To explore the long-term persistence of COVID-19-related impairment and the ability to work after the acute phase of the illness. METHOD: The 19,101 COVID-19 workers' compensation claims filed between January 1, 2020, and December 31, 2021, with follow-up to May 31, 2022, were analyzed. RESULTS: The average time lost from work decreased from 77 days in the first quarter of 2020 to 9.2 days in the fourth quarter of 2021, and the proportion of claims with 30 days or more of lost time decreased from 40.4% to 2.8 days in the same time frame. CONCLUSION: COVID-19 indemnity claims filed in later quarters of the SARS-CoV-2 pandemic have much lower average time lost from work and lower proportions of workers' compensation claims with more than 30, 60, and 150 days of lost time compared with earlier quarters.

Early Drug Prescription Patterns as Predictors of Final Workers Compensation Claim Costs and Closure: An Updated Analysis on an Expanded Cohort.

OBJECTIVE: The aim of the study is to determine the associations of workers' compensation claim costs and return to work with drugs prescribed for early symptom management. METHODS: Claims filed from 1998 to 2007 were followed for 10 years from the injury date. Drugs analyzed included gabapentin, pregabalin, antipsychotics, antidepressants, sedatives, benzodiazepines, carisoprodol, and opioids, controlling for initial reserve, sex, age, physical therapy, attorney involvement, and surgery. RESULTS: Gabapentin, antipsychotics, antidepressants, and sedatives used in the first 3 months after injury were significantly associated with higher claim cost (≥$100,000). All opioid morphine equivalent doses greater than or equal to 5 mg/d for the first 6 months was significantly associated with higher cost (≥$100,000) and not being released to work at end of third year after injury with dose-response relationships. CONCLUSIONS: Prescription patterns in the first 3 months or first 6 months of workers' compensation claim development may be used as predictors of claim outcomes.

Attributes of Long Duration COVID-19 Workers' Compensation Claims.

OBJECTIVE: To examine the attributes associated with long duration COVID- 19 workers' compensation (WC) claims. METHODS: A study was conducted on 13,153 COVID-19 WC claims accepted by a workers' compensation insurance carrier between January 1, 2020 and November 30, 2021. RESULTS: 1) Ninety-five percent of accepted WC claims were closed within the study period; 2) five percent of claims had 30 days or longer of lost time accounting for 65% of total paid WC costs; 3) medical costs increased 8-fold once paid days lost crossed the threshold of 60 days or greater; 4) age was the strongest risk factor associated with increased WC costs and prolonged impairment. CONCLUSION: Age at the time of infection was the major factor associated with prolonged impairment and high costs of COVID-19 related WC claims.

Trends in the Utilization and Dose of Gabapentinoids in Combination With Opioids in an Injured Worker Population Between 2008 and 2018.

OBJECTIVE: To determine long term (11 year) trends in gabapentin and pregabalin prescribing among workers' compensation claimants at various opioid dose combinations (low, medium, high, and very high) in Louisiana. METHOD: A longitudinal study of 18,737 claimants who filled any prescriptions between 2008 and 2018. RESULTS: The proportion of claimants prescribed opioids alone at all dose levels decreased dramatically. The proportion claimants prescribed the combination of low dose opioids and low dose gabapentinoids increased (7.7% to 10.9%). Prescribing higher daily doses of gabapentinoids was associated with higher daily doses of opioids. Gabapentinoid prescribing was associated with continued prescribing of medium and high dose opioids as claims matured. CONCLUSIONS: Overall opioid prescribing decreased over time, while prescribing low dose opioids with gabapentinoids, increased.

Prevention, Medical Management, and Adjudication of Workplace Injuries: A Thirty-Two Year Follow-up of an Integrated Workers' Compensation Program.

OBJECTIVE: To describe the cost outcomes of an integrated workers' compensation program. METHODS: We studied a population that increased from 20K to 59K, incurring 8807 lost-time claims between 1988 and 2020. RESULTS: Lost-time claims decreased from 22.15 to 4.32 per 1000 employees (1988 to 2020), and total closed lost-time claim costs per $100 payroll, decreased from $0.62 to $0.17 (1988 to 2017). The percent of claims resolved within 3 years of the accident increased from 10% to 89% (1988 to 2017). Adjusting for medical inflation and wage increases, total workers' compensation benefits paid per claim decreased $124 per year, medical benefits decreased $45 per year and indemnity benefits decreased $79 per year. CONCLUSION: On both a population (per employee) and on a per claim basis, workers' compensation costs decreased substantially, which is attributable to improvements in accident prevention and decreases in claim duration.

What Industrial Categories Are Workers at Excess Risk of Filing a COVID-19 Workers' Compensation Claim? A Study Conducted in 11 Midwestern US States.

OBJECTIVE: Determine the industries with the highest proportion of accepted COVID-19 related workers' compensation (WC) claims. METHODS: Study included 21,336 WC claims (1898 COVID-19 and 19,438 other claims) that were filed between January 1, 2020 and August 31, 2020 from 11 states in the Midwest United States. RESULT: The overwhelming proportion of all COVID-19 related WC claims submitted and accepted were from healthcare workers (83.77%). Healthcare was the only industrial classification that was at significantly higher COVID-19 WC claim submission risk (odds ratio [OR]: 4.00; 95% confidence intervals [CI]: 2.77 to 5.79) controlling for type of employment, sex, age, and presumption of COVID-19 work-relatedness. Within healthcare employment, WC claims submitted by workers in medical laboratories had the highest risk (crude rate ratio of 8.78). CONCLUSION: Healthcare employment is associated with an increased risk of developing COVID-19 infections and submitting a workers' compensation claim.

Gabapentinoid and Opioid Utilization and Cost Trends Among Injured Workers.

OBJECTIVE: To characterize changes in opioid, gabapentin, and pregabalin utilization patterns and cost trends between 2008 and 2018 in a Louisiana workers' compensation claims population and explore the role of gabapentinoids as alternative analgesics during the opioid epidemic. METHOD: Filled prescriptions for gabapentinoids and opioids were studied for 11 years in a cohort of 18,737 claimants. RESULTS: The proportion of claimants prescribed gabapentin increased 2-fold (8.9% to 18.9%) and average drug cost per claimant decreased 22% ($612 to $480). The proportion of claimants prescribed pregabalin decreased approximately 80% (11.7% to 2.5%) and average drug cost per claim increased 224% ($911 to $2952). Proportion of claimants prescribed opioids decreased 20% (80% to 64.2%) and average drug cost per claim decreased 46% ($691 to $371). CONCLUSIONS: Utilization increased substantially for gabapentin and decreased for pregabalin and opioids.

Increasing Physical Therapy Visits as a Marker for Time Lost From Work and High Workers' Compensation Claim Costs.

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.

Increased Spinal Cord Stimulator Use and Continued Opioid Treatment Among Injured Workers: A Regional Pilot Study.

OBJECTIVE: To determine the rate, characteristics, and costs of Spinal Cord Stimulator (SCS) placements among claimants at a Texas-based workers' compensation carrier. METHODS: Indemnity claims occurring between January 1, 2008 and December 31, 2018 were assessed longitudinally. RESULTS: While there was annual variability in rates of SCS placement, the rate of SCS placement increased from 0.21 to 1.56 per 1000 serviced claims. The average total paid claim cost of a trial and permanent placement was $141,288 and $197,813, respectively. Chronic opioid use (more than 3 months) following trial (73.0%) and permanent placement (63.8%) occurred frequently. Time between injury and trial placement decreased (2008 to 2010 = 3.1 years vs 2015 to 2018 = 2.5 years, P < 0.0001) over the study period. CONCLUSIONS: The rate of SCS placements significantly increased and duration between injury to placement decreased over time. Claimants undergoing SCS placement frequently continued to use opioids, indicating limited success in pain modulation.

Assessing Workplace Clinic Utilization and Performance: Lessons and Implications for Care Delivery.

: Many large employers utilize on-site medical clinics as a major component of their long-term healthcare cost management strategy. This study aims to quantify on-site clinic return on investment (ROI) associated with the avoidance of direct healthcare expenditures for preventive, urgent care and occupational medical services at an international beverage company. A multivariable linear regression model indicated there was a significant association between the ROI and increasing penetration rates, number of employees, and clinic age (P < 0.0001). Over a 10-year period, while the types of services delivered changed, onsite clinics continued to demonstrate significant and increasing cost savings for this employer.

Assessment of Ergonomic Strain and Positioning During Bronchoscopic Procedures: A Feasibility Study.

BACKGROUND: Poor ergonomics place health care workers at risk for work-related overuse injuries. Repetitive and prolonged hand maneuvers, such as those performed during endoscopic procedures, may lead to musculoskeletal complaints and work-related injuries. However, the prevalence of health care-related work injuries among physicians is thought to be underreported and there is a paucity of literature investigating the impact of ergonomic strain on bronchoscopy. We designed a feasibility study to explore the differences in ergonomic strain and muscle activity of bronchoscopists. MATERIALS AND METHODS: A prospective study of bronchoscopic procedures was performed in a simulated environment. Preselected target areas were identified and airway sampling was performed with real-time ergonomic assessment utilizing electromyogram (EMG), grip strength, and musculoskeletal use and motion analysis. RESULTS: Procedural data was obtained for all procedures (78 bronchoscopies by 13 subjects) for both ergonomic and EMG scores. Experienced bronchoscopists demonstrated less EMG burden (P=0.007) and improved ergonomic positioning (P=0.007) during bronchoscopy when compared with less experienced bronchoscopists. Procedures performed with rotational-head bronchoscopes trended toward improved ergonomics (P=0.15) and lower EMG scores (P=0.88). A significant improvement in ergonomic scores was seen with the rotational-head bronchoscope when targeting the left upper lobe (P=0.036). CONCLUSION: Poor ergonomic positioning and excessive muscle strain appear present within bronchoscopy procedures but may be improved in those with more bronchoscopy experience. Technological advances in bronchoscope design may also have the potential to improve procedural ergonomics. Additional prospective studies are warranted to define the long-term impact on bronchoscopic ergonomics.

Do Work-Related Lost-Time Injuries Sustained Early in Employment Predict Multiple Lost-Time Injuries Throughout Employment?

OBJECTIVE: The aim of this study was to identify a simple surrogate to predict the future risk of multiple lost-time injuries. METHOD: Employees of an academic medical center who sustained 5,906 injuries were followed from 1994 to 2017 or 1,046,218 person years. RESULTS: The odds ratio of having three or more lost-time injuries during their entire duration of employment was 2.12 (95% confidence interval: 1.60 to 2.79) for employees having their first lost-time injury within the first 6 months of employment versus those injured after that, controlling for demographics and employment duration. For each increasing year before the first lost-time injury, the probability of having three or more lost-time injuries decreased by 13%. CONCLUSIONS: Employment duration before the first lost-time injury may be used to predict future lost-time injuries without detailed information of underlying risk factors.

Significant Decreasing Trend in Low Back Injuries in a Beverage Company.

BACKGROUND: Work-related injuries in the U.S. have steadily declined over the past three decades. OBJECTIVE: The aim of this study was to compare trends of the most frequently injured body parts from a beverage company over an 8-year study period (2008 to 2015). METHOD: Work-related injury claims with more than 3 days of missed work (N = 20,203) were classified into body part groups, including low back, knee, shoulder, and all other(s). Descriptive statistics and linear models were used to evaluate trends over time. RESULTS: The total number of injuries decreased from 6.57 per 100 to 3.79 per 100 employees from 2008 to 2015. Proportion of low back injuries decreased from 22.0% to 15.4% (P < 0.001) over the study period. Proportionally, knee(s), shoulder(s), and all other injuries increased, but the changes did not reach statistical significance. CONCLUSION: Low back injuries decreased at a faster rate than knee, shoulder, and all other injuries.

Is Employer-Directed Medical Care Associated With Decreased Workers' Compensation Claim Costs?

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.

Work Enabling Opioid Management.

OBJECTIVE: This study describes the relationship between opioid prescribing and ability to work. METHODS: The opioid prescription patterns of 4994 claimants were studied. Three groups were constructed: 1) at least 3 consecutive months prescribed (chronic opioid therapy; COT); 2) less than 3 consecutive months prescribed (acute opioid therapy; AOT); and 3) no opioids prescribed. Variables included sex, age, daily morphine equivalent dose (MED), days opioids were prescribed, temporary total days (TTDs), and medical/indemnity/total costs. RESULTS: The COT versus AOT claimants had higher opioid costs ($8618 vs $94), longer TTD (636.2 vs 182.3), and average MED (66.8 vs 34.9). Only 2% of the COT cohort were not released to work. Fifty-seven percent of patients in the COT category (64 of 112) were released to work while still receiving opioids. CONCLUSION: COT does not preclude ability to work when prescribing within established guidelines.

Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates.

Hospital executives are under continual pressure to control spending and improve quality. While prior studies have focused on the relationship between overall hospital spending and quality, the relationship between spending on specific services and quality has received minimal attention. The literature thus provides executives limited guidance regarding how they should allocate scarce resources. Using Medicare claims and cost report data, we examined the association between hospital spending for specific services and 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction. We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmission if left unaddressed.

Is Obesity Associated With Adverse Workers' Compensation Claims Outcomes?

BACKGROUND: A pilot study indicated that obesity was associated with an increased time lost from work and higher costs among workers' compensation claimants sustaining severe, but not minor injuries. OBJECTIVE: The aim of this study was to further test the hypotheses by increasing sample size and controlling for additional confounding factors. METHOD: Cost and lost time outcomes were assessed for 2301 lost time workers' compensation claims filed in 2011 and 2012 followed to the end of the first quarter of the third postinjury year. RESULT: Adjusting for gender, age, marital status, attorney involvement, and spinal procedures, the odds ratios of incurring a claim expense at least $100,000 after a severe injury for an overweight or obese versus normal weight claimant was 2.11 [95% confidence interval (95% CI): 1.04 to 4.29] and 2.23 (95% CI:1.12-4.46), respectively. CONCLUSION: Obesity was associated with increased costs among workers' compensation claimants sustaining severe, but not minor injuries.