title: Paying doctors more: use of musculoskeletal specialists and increased physician pay to decrease workers' compensation costs.
abstract: Previous studies evaluating workers' compensation care systems used retrospective controls. We performed a concurrent effectiveness study comparing a WC system that used visiting musculoskeletal specialists to assist primary care physicians with a typical discounted-fee, WC, managed-care system. In the new specialist-direct system, physicians could not profit from self-referral, but were paid 35% to 69% more per patient visit than doctors in the discounted-fee clinics. All claims filed by all employees of two hotels for 2 years were examined. Patients had self-selected either a specialist-direct or a discounted-fee clinic, and the entire cost of the claim was assigned to either system of care. Claim costs were 63% lower in the specialist-direct system (P < 0.001). Medical costs were 45% less (P < 0.014), and indemnity 85% less (P < 0.001), in this system. Claims were closed nearly 6 months faster in the specialist-direct system (P < 0.0001). Indemnity claims were more common in the discounted-fee system (P < 0.0001). Claimant and injury characteristics were not significantly different between the systems. This new care model is a cost-effective alternative to discounted WC managed care. Discounting the services of the primary treating physician may result only in cost-shifting, not cost-saving.
authors.affiliation: Arthritis Specialists of Northern Nevada, 93 Bell Street, Reno, NV 89503, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Atcheson
authors.forename: R L
authors.initials: RL
authors.lastname: Brunner
authors.forename: E J
authors.initials: EJ
authors.lastname: Greenwald
authors.forename: V G
authors.initials: VG
authors.lastname: Rivera
authors.forename: J C
authors.initials: JC
authors.lastname: Cox
authors.forename: S J
authors.initials: SJ
authors.lastname: Bigos
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004470:Economics, Medical; D005251:Fees, Medical; D006801:Humans; D007344:Insurance Claim Reporting; D008329:Managed Care Programs; D009140:Musculoskeletal Diseases / Q000191:economics* / Q000628:therapy*; D016017:Odds Ratio; D011320:Primary Health Care; D013038:Specialization; D014481:United States; D014942:Workers' Compensation / Q000191:economics*