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An Investigation of the Effects of a Healthcare Provider Network on Costs and Lost Time in Workers Compensation

Bernacki, Edward J. MD, MPH; Tao, Xuguang (Grant) MD, PhD; Yuspeh, Larry

Journal of Occupational & Environmental Medicine: September 2006 - Volume 48 - Issue 9 - pp 873-882
doi: 10.1097/01.jom.0000232765.94327.e7
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Objective: The objective of this study was to evaluate the number of lost time days and cost of workers’ compensation claims at a median claim duration (maturity) of 25 months for individuals injured between August 1, 2003, and July 31, 2004, who chose a statewide (Louisiana) network (Omnet Gold) of healthcare providers not subject to utilization review.

Methods: We identified and contrasted 176 lost time claims (143 closed) managed by Omnet Gold (OG) healthcare providers and 1464 lost time claims managed by healthcare providers not participating in OG.

Results: The average frequency of lost workdays for a closed OG claim was 53 days versus 99 days for a closed non-OG claim and the average cost of a closed OG claim was $12,554, whereas the average cost of a closed non-OG claim was $20,400. Both days lost from work and costs were significantly lower among claims managed by OG healthcare providers. This outcome was consistent with the findings of a previous study performed on the same claims in which a significant difference was demonstrated analyzing primarily open (unresolved) claims with a median claim duration of 6 months. The ability of OG healthcare providers to return a higher proportion of injured workers to work early and shorten claims durations were the major factors influencing these outcomes.

Conclusions: In a state where claimants are permitted choice of medical provider, a network of healthcare providers can achieve superior lost time and cost outcomes than out of network healthcare providers.

From the Division of Occupational and Environmental Medicine, Department of Medicine (Dr Bernacki, Dr Tao), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Research and Development (Mr Yuspeh), Louisiana Workers’ Compensation Corporation, Baton Rouge, Louisiana.

CME Available for this Article at ACOEM.org

This work was funded in part by the Occupational and Environmental Health Foundation.

Edward Bernacki has no commercial interest related to this article.

Address correspondence to: Edward J. Bernacki, MD, MPH, Director, Division of Occupational and Environmental Medicine, Johns Hopkins University, School of Medicine, 600 North Wolfe Street, Billings Administration 129, Baltimore, MD 21287-1629; E-mail: bernacki@jhmi.edu.

©2006The American College of Occupational and Environmental Medicine