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Journal of Occupational & Environmental Medicine:
doi: 10.1097/01.jom.0000232765.94327.e7
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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

Continued Medical Education
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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.

©2006The American College of Occupational and Environmental Medicine


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