Saving money where you can on Illinois WC carpal tunnel and other repetitive trauma claims.
Editor’s comment: Following last week’s article on the topic, we received two great replies from our readers. The first reply was sent by a top-notch, veteran adjuster who is one of the more savvy people in our industry. We do want her to use better defense counsel and we will continue to keep trying to convince her to add KC&A to her list.
It was her goal to let us know the approximate amount one should properly reserve for a typical CTS claim. She would typically reserve for indemnity (temporary total disability and permanent partial disability)
- Four weeks of TTD at an expected cost between $800-4,000.
- PPD at a value of 25% LOU of the hand at an expected cost between $10-33,000.
Total indemnity would therefore range between about $11,000-37,000.
She would typically reserve for medical expense:
- Hospital 5,500.00
- Physician/surgeon 7,500.00
- Prescription 300.00
- Diagnostics 2,500.00
- Medical supplies 250.00
- Physical therapy 10,000.00
- Field case management 3,500.00
Total medical costs are expected to be just under $30,000.00. Combined claim costs are expected in the range between $40-67K. Keep reading.
We also got a reply from one of the top hand surgeons and researchers in the United States, Dr. Jay Pomerance. Dr. Pomerance offices in Arlington Heights, IL and all of his relevant information is on the web at
http://orthodoc.aaos.org/drjaypomerance/
In 2007, he published a research study titled Outcomes of Carpal Tunnel Surgery With and Without Supervised Postoperative Therapy, Jay Pomerance, MD, Ilene Fine, BA in the Journal of Hand Surgery / Vol. 32A No. 8 October 2007. The study and its revolutionary results have not reached many workers’ compensation brokers, insurers, utilization review analysts or hand surgeons. We think it is a great read. In his study, Dr. Pomerance notes:
Using current reimbursement rates, the cost of therapy approximately doubles the professional cost of treatment (therapy plus surgeon’s fee) for Medicare and commercial plans. For all carriers in this study except workers’ compensation in Illinois, the cost of therapy is equivalent to the surgeon’s fee despite there being no benefit in the parameters measured. This disparity would increase with greater amounts of therapy other than the 6 visits used currently. There is no dispute as to the benefit of a carpal tunnel release in patients with documented carpal tunnel syndrome. The additional expense of therapy was not justified in the current study.
Dr. Pomerance reaches the conclusion:
In summary, the routine use of postoperative hand therapy for patients having contemporary small open incisions in the treatment of carpal tunnel syndrome uncomplicated by coexisting conditions such as arthritis, endocrinopathies, or advanced disease was not supported by the current study.
In layman’s terms, we are all wasting money by approving and paying for expensive post-surgical physical or hand therapy following a typical carpal tunnel release. From a scientific perspective, the patient, in ordinary circumstances, doesn’t need it and will return to normal function without it.
Cutting workers’ comp indemnity and medical costs in CTS claims in Illinois
Let’s go at this cost-cutting target one by one.
First, make a preliminary legal determination of whether you owe anything under WC for the problem. As we advised last week, the Illinois Workers’ Compensation Commission has demonstrated a willingness to listen to the defense side where there aren’t clear indications of CTS-producing activities in the workplace. They are also reluctant to provide benefits to part-time or short-term workers. From a legal perspective, we have won a number of such claims and the legal fees may be worth the money and risk in the right case.
Contact a physician to consider ergonomic changes in your workplace
Second, from an ergonomic perspective, along with Dr. Pomerance who we mention above, another great source for worksite analysis is Dr. Michael Vender who is another solid hand surgeon that can bring detailed ergonomic analysts to your plant and each work station. His website is http://hsasc.com/. In central Illinois, Dr. David Fletcher at SafeWorks Illinois has done a number of onsite evaluations to ascertain when CTS is caused by the work and when it is not. Dr. Fletcher’s website is www.safeworksillinois.com.
Third, let’s go down the list of major expenses:
- Lost time–try like mad to get CTS repairs to be done on a no-lost-time basis. Try to set surgery on Thursdays or Fridays and have the employee back to one-hand or no-hand work on Monday. Transition them to full duty. You may save between $800-4,000 in TTD if you can do so.
- Permanency–always try to settle them cheap where you can. The Commission is now affirming pro se settlements as low as 12.5% of the hand and awarding 15% of the hand for typical, routine CTS repairs. Your organization can save $5,000-15,000 in this fashion. Keefe, Campell & Associates provides legal fees on a flat rate for pro se settlement approval at $250 in Cook County and $350 outside Cook County.
- Physican/Surgeon’s fees: We feel the combined cost of CTS repairs for both surgeon’s and hospital fees should be much less than $12,500. To the extent they feel it appropriate, we ask top-notch hand surgeons such as Dr. Pomerance, Dr. Vender and any other Illinois hand surgeons to publish their fees for routine short-incision CTS repairs. If possible, we would ask them what to expect from competitive hospital or outpatient surgical costs. We are confident there is a lot of money to be saved without compromising quality.
- Prescriptions: We note there are lots of new programs to dramatically cut generic prescription costs at Target® and other big box retailers. We strongly recommend the WC industry start to source low-cost prescriptions. To learn more about Target’s prescription drug program, go to: http://sites.target.com/site/en/health/page.jsp?contentId=PRD03-004033.
- Physical Therapy: Follow the research of Dr. Pomerance and cut this high cost out altogether. We suggest you find a UR provider who is aware of the updated research and will prospectively non-certify such care. Use such non-certifications in all CTS cases. When you rely on UR to deny care, there is a presumption you can’t be penalized. The savings would be dramatic.
A similar approach should cut costs in all repetitive trauma claims. If you have other thoughts, questions or comments about cutting lost time, medical and other costs in managing CTS and other repetitive trauma claims, please send a reply.
