The State of Ohio has imposed rules that require injured workers to try more conservative measures like Physical Therapy prior to receiving spinal fusion surgeries or prescription painkillers.
The Ohio Bureau of Worker’s Compensation rule effective Jan. 1, requires injured workers to undergo at least 60 days of “conservative” care, while avoiding opioids if possible, before they pursue spinal fusion surgery.
Studies have shown that fewer than half of patients are able to return to work after the spinal fusion surgery and that it is often ineffective or followed by complications. The Bureau of Workers Compensation sited frequent complications and poor track record with return to work as reasons for their decisions. They also stated patients that have this surgery frequently may require increased opioid utilization post-surgery.
Washington, Colorado and Minnesota already restrict injured-worker payments for the surgery, officials said, but the Ohio policy, goes further by embedding an opioid warning specifically into its surgical restriction.
Neurosurgeons are obviously fighting back and find the regulations overly broad and having the potential to hurt more than help some patients. This remains to be seen. In the meantime, it is encouraging that several state bureaus are taking the initiative to impact change and follow evidence-based practice to protect injured workers. Potentially reducing unnecessary surgeries and further regulating the prescription of opioids will hopefully reduce the effects of the opioid epidemic in Workers’ Compensation.
The Workers’ Compensation industry spends over $1.5 Billion annually on prescription painkillers, which in addition to the cost have brought with them significant problems of addiction and accidental overdose.
Conservative treatments such as Physical Therapy, can significantly reduce the need for future surgeries, injections, advanced imaging and the need for opioids. This is consistently demonstrated in the literature, perhaps most powerfully in the landmark Spine Journal study by Fritz et al. This study found that referral to Physical Therapy in under 14 days significantly reduced future health care costs. Patients in this study referred early to Physical Therapy had on average $2,736.23 lower health care costs compared to those that were not.