Study Reports High Levels of Satisfaction With Healthcare Provided to Pennsylvania Injured Workers

Study suggests transparency in claims process produces favorable results

According to a study recently published in the Journal of Occupational and Environmental Medicine [See Joshi, Anand B., MD, MHA, et al., “Factors That Predict Satisfaction With Medical Care: Data From 27,212 Injured Workers Surveyed for 14 Years,” JOEM, Vol. 58, No. 1, January 2016], workers’ compensation claimants in Pennsylvania are generally satisfied with the medical care they are receiving. The study also suggests that the more transparent an employer is in explaining a worker’s rights, including the right to change health care providers if the worker is dissatisfied, the higher the satisfaction level reported by the worker. Industry experts have long posited that the greater the dissatisfaction level of an injured worker, the greater the chances that the worker will retain an attorney or file an appeal. The study further suggests that employers who erect barriers between their injured workers and appropriate medical care do so at their own peril.

Study Methodology

The study took advantage of the fact that since 1994, the Pennsylvania Workers’ Compensation Act has required the state’s Bureau of Labor and Industry (“the Bureau”) to report annually on the relative ease with which injured workers are able to access appropriate health care services regarding their work-related injuries. During the researcher’s 14-year study period—2000 through 2013—the Bureau selected 10,000 claims each year, sending identical surveys to the identified workers.

The surveys included questions not only related to the worker’s treatment at the time of injury, but also during any post-treatment period. Those questions that were related to worker satisfaction called for one of three possible responses: “Very satisfied,” “Satisfied,” and “Dissatisfied.” The researchers combined the “Satisfied” and “Very satisfied” responses. The surveys also collected relevant demographic information regarding the injured workers. The researchers collected and collated the data using standard methods to account for variations in the responses.

The researchers initially noted that during the study period more than 27,000 individuals responded to the surveys. Annual response rates ranged from a low of approximately 16 percent to a high of approximately 24 percent. Overall, almost 19.5 percent of the surveys were returned.

Study Results

The researchers observed that, among those claimants who responded, the overall proportion of satisfied workers was 83.97 percent. The study data suggested that there were several strong predictors of claimant satisfaction:

•   Clear disclosure of the worker’s rights under the state’s Workers’ Compensation Act. According to the study, injured workers who were so informed were four times more likely to report satisfaction than those who were not.
•   A correct initial diagnosis by the treating physician. The study indicated these claimants were 3.8 times more likely to be satisfied than those who were misdiagnosed.
•   Clarity of the treating physician’s explanation of the worker’s available treatment options. These claimants were 1.8 times more likely to be satisfied than claimants who received no such explanations from their doctor.

The researchers acknowledged, of course, that the diagnosis related to some injuries (e.g., lacerations or broken bones) is usually straightforward, whereas it is much more difficult to come to a particular diagnosis for a claimant with chronic low back pain. Moreover, where the injury is relatively difficult to diagnose, it is usually also more difficult to provide the injured worker with a clear explanation regarding his or her treatment options.

The researchers found some other factors to be positive, although weaker, predictors of satisfaction, included (a) whether the worker was more than 50 years of age and (b) whether the worker was male.

Variables that were associated with the lowest satisfaction rate included workers:

•   With female gender
•   Aged between 30 and 40 years
•   Who did not receive clear explanation of their workers’ compensation rights
•   Who were not provided with a panel of doctors and health care providers from which the injured worker could choose
•   Who were not told that they had the right to change physicians if dissatisfied with care
•   Who did not receive medical evaluation within 48 hours of injury
•   Who received an incorrect initial diagnosis

The researchers observed a particularly interesting pattern regarding “provider panels.” These are lists of physicians and other health care providers provided by the employer or the claims administrator, from which the injured worker must choose medical care. Such panel lists are ordinarily thought to be a type of managed care that reduces an injured worker’s available choices. One would assume, therefore, that the satisfaction of injured workers whose treatment had been provided by panel physicians would be low. According to the researchers, the data showed just the opposite. Those workers who had been provided with a panel list of doctors were 1.6 times as likely to be satisfied as those who indicated they had been provided with no such list.

Findings Are Consistent With Other State Studies

The researchers point out that the “regulatory impetus” for the study was the Bureau’s mandate to report annually on the accessibility of quality healthcare by the state’s injured workers. The researchers indicate such high quality care appears to be available in Pennsylvania, given the fact that the relatively high satisfaction rate (83 percent) has been maintained over a relatively long time frame.

The researchers noted that similar findings had been noted in studies involving other states. For example, a study of California data reported that almost 80 percent of workers were satisfied (or very satisfied) with the healthcare they had received in connection with their injuries [see Pourat, N., Kominski, G., et al, “Satisfaction with Care and Perceptions of Quality Among Injured Workers in California’s Workers Compensation System,” J Occup Environ Med., 2007: 49: 1249-1256].

Strengths and Weaknesses of the Study

The researchers indicate the primary strength of their study lies in the data itself, since it is a relatively large data set of prospective data collected over an extended time period. The data was systematically collected and the surveys were administered at the same time each year.

According to the researchers, a potential weakness in the study comes from the fact that the response rate of those surveyed was relatively low: less than 20 percent over the time period studied. Another weakness was the study’s reliance on patient reporting. The researchers said the study data was susceptible to recall bias, that is, a person who is unhappy with medical care may be more likely to respond than someone who had a positive experience. Although the researchers did not so indicate this point: one wonders whether recall bias might, therefore, actually understate satisfaction levels among the Pennsylvania injured workers.

Although the issue is not discussed by the researchers, one is left also wondering just how representative is Pennsylvania. Might there be unaccounted for factors that would not be repeated if similar studies were performed in other states?

One Thing Clear: Excellent Medical Care and Transparency Make for More Satisfied Claimants

For a number of years now, I have heard Rebecca Shafer, J.D., an Attorney/Risk Consultant at Amaxx Risk Solutions, Inc., Hartford, CT, a colleague and national expert in risk management and employer claims handling systems, repeat one of her helpful mantras to employer groups: “Provide the best quality medical care available. Yes, even if it’s more expensive” [See “7 Things Employers Should Do to Avoid a ProPublica Report”]. Shafer’s advice appears to be well supported by the Joshi study. Where the injured worker receives clear and correct medical treatment and advice early after the injury, his or her satisfaction levels with that healthcare, and the system itself, are predictably high. Other states should heed this finding.

Moreover, transparency in the claims process also produces favorable outcomes. The study posits that satisfaction levels are highest among injured workers where the steps to getting care and benefits are laid out clearly. If the employer and its carrier desire to increase dissatisfaction among injured workers, that can be accomplished, according to the study, by making the claims process a “cat and mouse” scenario. Why an employer would choose to be so shortsighted is beyond understanding. Some do so, however.

Michael D. Sherman, a partner in the Pittsburgh office of Chartwell Law Offices, who represents employers and insurers, says the Pennsylvania Bureau is endeavoring to improve its system, reduce bottlenecks, and provide timely and clear information to those filing petitions for benefits. Sherman thinks this effort on the part of the Bureau has also added to the general level of satisfaction among injured workers.

Sherman points out that in most claims the first hearing is scheduled within seven days of the petition’s filing. The Bureau has increased the efficiency of its toll-free telephone help-line. Sherman notes, “In the past, cases could drag on with numerous continuances and postponements; that scenario is rare today.”

Further study is needed to determine if Pennsylvania is a mere anomaly or if it represents the true current status of injured worker satisfaction with the delivery of healthcare.

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