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Paying doctors more: use of musculoskeletal specialists and increased physician pay to decrease workers' compensation

S G Atcheson¹, R L Brunner, E J Greenwald

¹Arthritis Specialists of Northern Nevada, 93 Bell Street, Reno, NV 89503, USA.

Journal of Occupational and Environmental Medicine

|August 23, 2001

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A new specialist-direct workers' compensation (WC) care model significantly reduced overall claim costs by 63%. This innovative approach proved more cost-effective than traditional discounted-fee WC managed care.

Area of Science:

Occupational health
Healthcare management
Musculoskeletal care

Background:

Previous workers' compensation (WC) care system evaluations relied on retrospective controls.
Managed care in WC often involves discounted fees for primary care physicians.

Purpose of the Study:

To compare the effectiveness and costs of a novel specialist-direct WC system against a typical discounted-fee managed care system.
To evaluate the impact of direct specialist access on claim costs, medical expenses, and claim resolution times.

Main Methods:

A concurrent effectiveness study was conducted over two years, examining all employee claims from two hotels.
The study compared a specialist-direct system, where visiting musculoskeletal specialists assisted primary care physicians, with a standard discounted-fee WC managed care system.

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Patient self-selection determined their assigned care system, with total claim costs attributed accordingly.

Main Results:

The specialist-direct system demonstrated a 63% lower overall claim cost (P < 0.001).
Medical costs were reduced by 45% (P < 0.014) and indemnity costs by 85% (P < 0.001) in the specialist-direct system.
Claims were resolved approximately 6 months faster (P < 0.0001), with fewer indemnity claims (P < 0.0001) compared to the discounted-fee system.

Conclusions:

The specialist-direct care model is a highly cost-effective alternative to discounted WC managed care.
Direct physician payment models, rather than discounting primary care services, may lead to genuine cost savings in WC.
This model offers significant potential for improving efficiency and reducing expenditures in occupational injury management.