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The Impact of Cost Intensive Physicians on Workers' Compensation.

Bernacki, Edward J. MD, MPH; Tao, Xuguang MD, PhD; Yuspeh, Larry BA

Journal of Occupational & Environmental Medicine: January 2010 - Volume 52 - Issue 1 - pp 22-28
doi: 10.1097/JOM.0b013e3181c91105
Original Articles

Objective: To identify physicians linked to high-cost workers' compensation claims.

Methods: Contrast the cost and duration of claims associated with cost intensive physicians (CIPs) and other physicians (OPs) on 5 years of closed claims paid by the Louisiana Workers' Compensation Corporation.

Results: Identified 77 CIPs of 2034 physicians who treated Louisiana Workers' Compensation Corporation claimants. CIPs made up 3.8% of physicians but accounted for 72% of costs. CIP's treated 16 times more claimants, and their average claim cost was four times higher than the OPs ($46,239 vs $11,390, P < 0.01). CIP claims settled in 697 versus 278 days for OPs. Adjusted for age, sex, marital status, International Classification of Diseases, 9th revision group, and initial reserve, the odds ratio of CIP claims with a final cost of >$50,000 was 5.4.

Conclusion: A small group of physicians (<4%) have a profound effect on overall workers' compensation costs.

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

Address correspondence to: Edward J. Bernacki, MD, MPH, 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.

©2010The American College of Occupational and Environmental Medicine