Access to Specialists May Reduce Workers' Compensation Costs

In contrast to managed care approaches, a program offering direct access to specialist doctors and increased physicians'' fees may reduce workers'' compensation costs, according to a study in the August Journal of Occupational and Environmental Medicine.

Dr. Stephen Atcheson of Reno, Nev., and colleagues evaluated a "specialist-direct" approach to workers'' compensation cases from two large hotel-casinos.

In the new approach, workers with on-the-job injuries had direct access to physicians specializing in the care of musculoskeletal injuries.

Over two years, the program reduced overall workers'' compensation costs by 63 percent.

Indemnity cost -- including compensation for missed work time and disability payments -- decreased by 85 percent.

Rapid access to specialists was a major factor in reducing indemnity costs, according to the study.

For minor injuries, the specialists were likely to recommend that the worker stay on the job with modified duties.

For more serious injuries, seeing a specialist early shortened the time until the patient received definitive care.

The specialist-direct approach also increased the fees paid to the primary care doctors treating the injured patients, but did not allow them to profit from "self-referral" for tests or treatments from which they might profit financially.

Under the new system, medical costs decreased by 45 percent -- even though the doctors received higher fees, the amount of services provided decreased.

Occupational injuries are an enormously expensive problem. In recent years, employers have considered managed care approaches, limiting limited access to specialists and discounted fees paid to physicians. However, these approaches have often failed to achieve expected cost reductions.

"Although more study of the specialist-direct approach is need, the preliminary results suggest it has the potential to achieve real cost reductions, rather than cost shifting, in the management of workers'' compensation cases," said Atcheson.

by Virginia Foran