Physicians who are dispensing drugs to your injured workers may be charging more than a pharmacy would charge. A lot more.

That’s just one surprising statistic revealed in recent WCRI reports [citation 1]. The Workers’ Compensation Research Institute studies workers’ comp claims, processes and outcomes around the country. They produce detailed reports on their findings. Some of the statistics they uncover are more than surprising.  

1. Overcharging by Dispensing Physicians

Physicians rarely dispense drugs directly to patients, except when it comes to injured workers. This practice could significantly inflate your workers’ comp costs.

WCRI studied 24 states that represent 70% of all workers’ comp benefits paid in the United States. They examined millions of claims and prescriptions, focusing on two things:

• Drugs that physicians often dispense to injured workers
• Claims that resulted in more than a week of lost time

They found that many doctors who dispense drugs to injured workers bill insurers much more than pharmacies charge for the same medications. The extent of the problem depends on where you’re located. For instance, the WCRI study showed:

• Doctors in Wisconsin dispensed 10% of all the Oxycodone dispensed in the state to injured workers.
• Doctors in Michigan dispensed 27% of all the ibuprofen dispensed in the state to injured workers.

Many states are creating stricter guidelines for physician-dispensed medications. Some states don’t allow doctors to dispense drugs. But some physicians are getting around new rules by dispensing drugs in non-traditional dosages.

For instance, a muscle relaxant called cyclobenzaprine is often prescribed for injuries such as back strains. The dosage is either 5 or 10 milligrams per pill. In some states that now limit what physicians can charge for these pills, doctors have switched to prescribing a 7.5-mg dosage. This size pill is not regulated, so doctors can charge several times more. However, there is no indication that this dosage benefits patients. Yet the cost is higher for workers’ comp insurers.

WCRI says physicians are using this same overcharging tactic to dispense tramadol and hydrocodone. Both these drugs are commonly-prescribed painkillers.

2. Trust Speeds Return to Work

In another study, WCRI looked for factors that could be used to predict return-to-work outcomes for injured workers. They found that injury type and severity are both strong predictors. What may surprise you is that the third major factor they identified is trust. Workers who feared they would be terminated upon return to work were out on disability an average of four weeks longer.

Lessons Learned

These statistics may be surprising, but they also offer valuable insight. As a workers’ comp professional, you can use WCRI stats to lower costs and improve the claims experience.  At PhysNet, we believe one lesson from these two WCRI statistics is that communication is critical throughout the workers’ comp claims process. Clear communication among all parties involves builds trust.

Knowing the latest statistics helps you identify potential problems that drive up costs. You can discuss these issues with your insurance carrier, adjuster and physicians. Better communication will allow you to monitor your costs more accurately and eliminate unnecessary expenses.

You’ve always known in your “gut” that trust improves worker’s comp outcomes. Now you have statistical proof. You can take additional steps to build trusting relationships with your employees. A visible return-to-work program demonstrates to all employees that injured workers are not “pushed out.” They are supported and encouraged as they recover.

Every step you take to return more injured workers to their jobs – sooner – saves money and boosts employee job satisfaction. And those are positive statistics any company can appreciate.

Citation 1: The Prevalence and Costs of Physician-Dispensed Drugs. Dongchun Wang, Te-Chun Liu, and Vennela Thumula. September 2013. WC-13-39.