As a percentage of total comp claims, medical costs rose from 46% in 1988 to 58% in 2009, the last year for which fully adjusted data is available. A workforce plagued by obesity, diabetes, and poor health habits coupled with demographic trends of an aging workforce that takes longer to heal, offer little relief to combat this disconcerting trend.

Action: All bills should be carefully checked as mistakes, inaccurate coding, duplication and fraud happen. Beyond checking the bills, it’s vital to ensure that employees receive the most appropriate, and most cost-effective, care.

Workers’ Comp hospital costs inflation high

A recent article in Risk and Insurance by Peter Rousmaniere, an expert on the Workers’ Compensation industry, notes that the rate of inflation for hospital costs appears to be among the highest for Workers’ Comp claims payers.

Action: Partnering with the right medical providers is key. Employees who are injured at work are entitled to the highest quality medical care, aimed at returning employees safely back to productive work. There are significant differences between occupational health delivery systems and the general medical community. Establishing relationships with physicians or clinics that use proper diagnostic evaluation and evidenced-based treatment guidelines will improve outcomes, reduce costs and help workers return to their jobs quickly and safely.

Emergency room wait times put safety at risk

In addition to having costs four or five times higher than clinic or office visits, emergency rooms are jeopardizing patient safety due to high wait times, the American College of Emergency Physicians (ACEP) warns. The increasing number of patients relying on ER for medical care because they do not have health care coverage caused the average wait time to rise to 4 hours, 7 minutes.

Action: Only life threatening emergencies should be treated at an Emergency Room. Having a clearly defined process for medical evaluations, treatment and care when an injury occurs is critical to controlling costs.

Misuse and abuse of prescription drugs on the rise

Prescription drugs play a significant role in Workers’ Compensation and while medications can replace expensive surgeries or other invasive procedures, they can also be abused or wrongly prescribed. The estimated number of emergency room visits related to nonmedical use of prescription painkillers increased 111% between 2004 and 2008, according to the Centers for Disease Control and Prevention.

Action: When prescriptions are suspicious and do not follow established prescription treatment guidelines, case managers reviewing claims should call doctors. Supervisors must be trained to act early, while protecting employees’ privacy, when they notice things such as unusual employee behavioral changes or an uncommon increase in absences that may be drug-related.

Injuries to older workers can have higher costs

While accident frequency among older workers is lower, the severity of a Workers’ Compensation claim for an older worker can be significant. The BLS estimates that it takes older workers approximately two to three times longer than a younger worker to recover from an injury, an average of 20 days away from work.

Action: Since shoulders, backs, and wrists injuries have the highest musculoskeletal claim severity in older workers, take steps to identify causes of strain and fatigue through an ergonomic evaluation of workstations and workspaces, and implement corrections. Consider task rotation. A highly responsive return to work effort can benefit the employer by enabling the worker to be productive while healing.

As the only Certified WorkComp Advisors in Nebraska UNICO Group can assist your company to lower your costs and increase your profits. We work with many great companies like Allied Insurance…a Nationwide company on your side.  If you ever have any insurance questions, do not hesitate to call us.

by Carl Zeutzius, CWCA
UNICO Group Inc

Carl Zeutzius has 18 years of experience in helping businesses address their risk management needs.
He is a Certified work comp advisor and UNICO is the only agency in the state with that designation.