Why Delayed Recoveries are Driving Up Costs and What You Can Do About Them

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Workers’ compensation payers are spending more money per claim on average, despite the drop in frequency for most of the last several years. There are several factors driving these costs; such as medications, more procedures being done in hospitals or other medical facilities rather than outpatient, and overutilization. But the biggest cost drivers relate to comorbidities — especially mental health issues.

● Do you have many injured workers with delayed recovery?
● Have you calculated the costs of these claims?
● What interventions have been successful in treating these injured workers?

Stress and mental health conditions are the biggest drivers of overall healthcare costs in this country. More workers miss work because of stress and anxiety than physical illness or injury combined. Among injured workers, these and other psychosocial factors often result in delayed recoveries. Understanding what delayed recovery is all about and knowing ways to address it can have a tremendous impact on helping injured workers recover faster and protecting a company’s bottom line.

About Delayed Recovery
“Sometimes you have these claims that don’t progress and you don’t k now why.” That statement from Denise Gillen-Algire, director of Risk Initiatives for Albertsons Safeway is an excellent description of ‘delayed recovery’ claims. I had the pleasure of presenting a session with Denise at the RIMS annual conference in San Antonio.

Delayed recoveries comprise a small minority of claims — about 6- to 10-percent. But they consume an estimated 80 percent or more of medical and indemnity resources.

Often these claims are not readily apparent until someone happens to notice them. The low back strain, the stiff shoulder, or the broken wrist that should have healed long ago continue consuming money for surgeries, procedures and medications with no pain resolution for the injured worker. That is typically the time an organization begins to pay attention and focus on them. But proper screening and intervention can eliminate them much sooner.

These claims are not dependent on any particular injury or illness. They are diagnosis/injury agnostic. The underlying reasons for a seemingly simple claim to go south are varied and relate to multiple psychosocial factors.

Here is what it typically includes:

● Catastrophic thinking — or OMG! thoughts — is one of the main issues affecting injured workers with delayed recovery. Despite the injury or illness, the person believes he is beyond the ability to recover.
● Fear avoidance is another. The patient is so concerned he will further injure his body that he avoids doing anything that might exacerbate the pain; such as any movement.
● Anger and perceived injustice are often present. Regardless of how long the person has worked at his company, he feels a disservice has been done to him.
● External locus of control occurs, meaning the worker relies on his medical providers and others to fix him, rather than taking any responsibility for his own recovery.

Unfortunately, the medical system often legitimizes this thinking. The treating physician easily takes on the injured worker’s external locus of control and focuses only on the physical diagnosis and pain. Multiple MRIs and other tests, unnecessary surgeries and finally the prescribing of opioids is often the treatment, although mothering really alleviates the injured worker’s suffering. The injury has become medicalized. Delayed recovery and overutilization is driven by inadequate coping skills and lack of knowledge of the pain generator, with the final common pathway being chronic pain and poly pharmacy.

ID Early
Interventions, especially cognitive behavioral therapy (CBT) have been proven to successfully address claims with psychosocial factors present. Workers’ compensation payers can prevent weeks, months or even years of needless suffering and save their companies precious dollars through early identification of injured workers prone to delayed recovery.

One of the most effective tools to do this is the Pain Screening Questionnaire (PSQ). Developed initially by Steve Linton, he and I collaborated and last year were able to validate it on our data down to just 10 questions.

The test and answers provided are very telling and have been shown to be highly accurate in predicting whether an injured worker is likely to have a delayed recovery. It identifies the person’s pain attitudes, beliefs and perceptions. The statements and questions require the respondent to answer on a scale of 1 to 10 how true each question is.

Sample questions include:
1. How would you rate the pain you have had during the past week?
2. In your view, how large is the risk that your current pain may become permanent?
3. An increase in pain is an indication that I should stop what I’m doing until the pain decreases.

My favorite question is, ‘I should not do my normal work with this amount of pain.’ The answer to this identifies the person’s work attitudes, catastrophic thinking and fear-avoidance behavior.

We’ve used the test among injured workers at Albertsons Safeway beginning in 2013. Since 2015, all injured workers with indemnity claims were given the questionnaire two weeks post injury. Their answers determined their risk level of delayed recovery — from low risk to very high risk.

Recent analyses of the PSQ show the value of this simple tool. The average amount paid per claim rose exponentially with risk level. Looking at data from the 2013 – 2015 timeframe shows the following:

Risk Level # of Injured Workers Average Amount Paid
Low 1,031 $2,059
Low-Moderate 307 $10,759
Moderate 145 $21,783
High 192 $26,212
Vey High 148 $39,967

The value of identifying workers at risk of delayed recoveries early in the claims process cannot be underscored. The injured workers included in the Albertsons Safeway study who scored ‘high’ or ‘very high’ risk were offered the choice to undergo CBT intervention. In an upcoming blog, I’ll discuss the treatment and results.

We’d like to hear from you:
● Do you have many injured workers with delayed recovery?
● Have you calculated the costs of these claims?
● What interventions have been successful in treating these injured workers?

Please share your thoughts with us.

Integrated Medical Case Solutions (IMCS) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at https://theimcsgroup.com, or http://www.cope-with-pain.com. Please join our LinkedIn group, COPE with Pain at https://www.linkedin.com/groups/8540640 .



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