WCRI Report Shows Wide State Variations in Time From Injury to Medical Treatment

Workers Compensation Research Institute (WCRI) recently released a report examining interstate differences in the time from work-related injury to first medical treatment by type of provider, type of service, and type of injury, and found wide variations across states for some medical services [see Carol A. Telles and William Monnin-Browder, “Time from Injury to Medical Treatment: How States Compare,” ISBN 978-1-61471-637-2, Workers’ Compensation Research Institute, FR-18-02, July 2018]. The authors suggest that while significant and appropriate attention has been given to the overall cost of medical care associated with work-related injuries and diseases, there has been much less focus on the time interval from injury to first medical treatment. Understanding such state variations in time from injury to initial treatment could be important in assessing steps that might return an injured worker to his or her job—a goal of virtually all stakeholders in the workers' compensation world.

Early Treatment Tends to Reduce Time Away from Work and Length of Disability Period

As noted by the WCRI researchers, earlier research has generally shown that the likelihood of returning to work is lower for workers who seek treatment 30 days or more after an injury, when compared to those who seek treatment within 30 days of injury. Earlier research has also shown that shortening the lag time between the report of injury and the delivery of medical treatment tends to shorten the length of disability of workers with low back injuries. Little attention has been given, however, to state variations in these injury to treatment time frames. That was the focus of this WCRI study.

Description of the Study

The WCRI researchers compared the time from injury to first medical treatment across 18 study states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin) for claims with more than seven days of lost time with injuries occurring from October 1, 2014, through September 30, 2015, evaluated as of March 31, 2016. The researchers examined the time from injury to first medical treatment by:

• Type of provider
• Type of service, and
• Type of injury

The researchers stressed that while they try to identify some factors that might impact the time to first medical treatment, including state-specific information about workers’ compensation policy choices, their study did not provide explanations for such differences in time to medical treatment.

The WCRI used data from a broad array of national and regional insurers, claims administration organizations, state funds, and self-insured employers. Approximately 75 million claims were represented across the 18 states studied. The data also represented nine medical service groups: emergency, evaluation and management (office visits), minor radiology, major radiology, neurological/neuromuscular testing, pain management injections, pathology (laboratory), physical medicine, and major surgery.

The data were categorized into 12 common injury classifications:

1. Spine (back and neck) sprains, strains, and non-specific pain;
2. Other sprains and strains;
3. Upper extremity neurologic;
4. Fractures, lower extremity;
5. Fractures, upper extremity;
6. Inflammations;
7. Lacerations and contusions;
8. Hand lacerations;
9. Knee derangements;
10. Neurologic spine pain;
11. Skin; and
12. Other injuries.

Key Findings

The study offered a number of key findings:

• Considerable variation was noted across state lines from the time of injury to first treatment for physical medicine and certain medical specialties—e.g., radiology and pain management injections—regardless of injury types.
• Possibly the result of state-specific workers’ compensation policies, some states tended to show a definite pattern of shorter or longer times to first treatment across a broad range of injuries.
• As might be expected, there was little variation in time to first treatment for emergency, office visits, and minor radiology.
• Also, as expected, the time for initial treatment was faster for objective injuries, such as bone fractures, than for subjective injuries, such as sprains and strains.
• There was wider variation in the timing of medical services in some types of injuries than in others.

State Variation: Which State Ranks High or Low?

Aggregating all injuries and medical providers, the researchers highlighted the states on the lower and higher ends, when it came to delay from injury to first treatment. Those states with the lowest number of days (shorter time) from injury to first medical treatment for many of the services included Arkansas, Pennsylvania, and Wisconsin. States with a higher number of days (longer time) typically included California, Louisiana, and North Carolina.

State Variation as to Specific Medical Services

The researchers performed similar examinations of data related to specific medical services. The state-by-state results were summarized for a number of medical services. From time of injury to provision of first medical service, they noted the following:

• Pain management injection services, times were generally shorter in Indiana, Minnesota, Pennsylvania, and Wisconsin and longer in California, Louisiana, Massachusetts, and Texas.
• Physical medicine services, the times were generally shorter in Illinois, Iowa, Pennsylvania, and Wisconsin, and longer in Louisiana, North Carolina, and Virginia.
• Major radiology services, the times were generally shorter in Arkansas, Florida, Michigan, Pennsylvania, and Wisconsin, and longer in California, Georgia, Louisiana, and North Carolina.
• Neurological/neuromuscular testing services, the times were shortest in Illinois, Kentucky, Michigan, and Wisconsin. The times were longest in California, Massachusetts, Texas, and Virginia.
• Major surgery, the times were shortest in Indiana, New Jersey, Pennsylvania, Virginia, and Wisconsin. They were longest in California, Georgia, Iowa, North Carolina, and Texas.

Many Factors Contribute to Higher or Lower Time Periods

The researchers stress that a number of factors can account for state variation. For example, in some states, reimbursements for medical services are more generous than in others. Some states have a penchant toward conservative management of some conditions, which could mean services for physical medicine were utilized early, with surgery delayed. That Is to say, there are circumstances in which one treatment program can be used as a partial or total substitute for another.

Wide Variation in Time Periods for Physical Therapy and Chiropractors

The researchers noted wide variation in the median number of days from injury to first medical treatment for physical/occupational therapists and chiropractors. For example, across the 18 states, the median ranged from 4 to 163 days. It was highest in California and Texas, states that have enacted policy changes geared toward reducing historically high utilization of chiropractic care.

Data Showed Consistency Across Some States

The researchers noted consistency in the data and findings across some states, suggesting that the patterns are not random. One could not discern, however, from the study whether the different patterns reflected underlying workers’ compensation policy choices or perhaps other factors. It is commonly observed, for example, that some states more strictly control the choice of medical provider than others. Some require use of medical treatment guidelines and utilization review.

Implications: Policy Decisions Are Never Made in a Vacuum

The study draws no earth-shaking conclusions. The study does appear to confirm that those states that place significant barriers between the injured worker and his or her medical treatment see the longest delays in the delivery of that medical care and, although the study does not speak to this specifically, slower overall recovery and return to work. State-specific policy decisions are never made in a vacuum. Treatment guidelines, expanded utilization review, restrictive rules as to choice of physicians and other caregivers—they may result in reduced medical claims costs. Yet do they also postpone recovery, increase indemnity payments, and reduce the changes of a return to the worker’s former position? Additional studies, with more granular data, are required to provide the workers’ compensation community with an accurate picture.

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