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. Washington, Colorado, and Minnesota have imposed similar restrictions, but Ohio has taken it further by adding a limitation on opioids, with the exception being the most severe low back injuries.
The Ohio Bureau of Worker’s Compensation, which imposed this regulation, cites the surgery’s ineffectiveness, 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.
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, particularly hands on Manual Physical Therapy prescribed immediately following the injury, 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.
It will be interesting to see if other state bureaus respond in a similar fashion as the opioid crisis continue to be front and center in the Workers’ Compensation industry.
