Workers’ compensation systems in dozens of states did not experience the expected delays in access to medical care when the COVID-19 pandemic took off last spring, according to a new study from the National Council on Compensation Insurance.
In the second quarter of 2020, the average wait for initial treatment for evaluation and management and physical medicine increased modestly compared with the same period in 2019, while the average wait for surgery actually decreased slightly, according to the study.
“In all cases, our second-quarter data suggests there were only minimal delays, if any,” said Dr. Raji Chadarevian, NCCI’s director of medical regulation and informatics.
Wait times for evaluation and management rose from 5.3 days to 5.6, while physical medicine increased 21.8 days to 22. Surgery wait times dropped from 20 days in the second quarter of 2019 to 19.8, according to the study.
Chadarevian said he expected to see some delays in treatment, but with 500,000 to 700,000 active claims each quarter, he called the data “pretty reliable.”
“When it comes to surgeries, that was really more surprising,” he said.
Not only did surgery wait times hold relatively steady, the share of active claims with surgeries has remained stable since the beginning of 2018, dropping from 12.8% to 12.1% during that period, Chadarevian said.
Despite the surprising stability in time to initial treatment, fewer claims actually had a medical treatment or service in the second quarter versus prior periods.
The number of active claims fell 15% between the first two quarters of 2020, and new claims dropped 26%, according to NCCI.
“We know, of course, that many businesses were either closed or had a severely diminished risk exposure, and that would have contributed to the decline,” Chadarevian said.
Active claims with at least one telemedicine service, however, increased substantially between the first two quarters.
Prior to the pandemic, just 0.3% of claims included telemedicine services. Between April and June, that number jumped to approximately 14%, Chadarevian said.
Arkansas had the lowest percentage of claims with telemedicine at 5%, while Maine had the highest at 30%, he said.
While the data overall may seem like a pleasant surprise for workers’ comp, there is no “one-size-fits-all response” when it comes to COVID-19, said Malcolm Crosland, president of the Workers’ Injury Law & Advocacy Group and partner at the Steinberg Law Firm in South Carolina.
“I can only tell you that, at least in the second quarter of 2020, I had multiple claimants who either just gave up on receiving care that should have been ongoing care because facilities were either closed or telemedicine was being offered, which was essentially worthless in their view,” Crosland said.
Crosland called his clients’ experience “a very mixed bag.”
He did not see tremendous disruptions in initial care because those facilities “seem to have adjusted more rapidly and were able to see patients at least initially,” he said.
“But once you got past that initial treatment, by the second quarter most physical therapy facilities were shut down,” Crosland said. “People weren’t getting their physical therapy or were getting it through telemedicine. They just stopped participating.”
Despite the reported rise of telemedicine in comp claims, Crosland said he believes most injured workers respond better to treatment that is provided in a face-to-face setting.
“Everybody also would agree, or most people would agree, they’d rather participate in a live deposition than a Zoom deposition,” he said. “One is more effective than the other.”
Alan Pierce, a claimants’ attorney in Salem, Massachusetts, said the common methods for studying comp costs and trends were being tested by a “once-in-a-lifetime pandemic.”
In his experience, Pierce said some claimants who suffered work injuries before the pandemic stopped seeing their doctors and therapists in the second and third quarters last year, which delayed diagnostic studies such as MRIs and other non-emergency orthopedic surgeries.
“Combining less people working and already injured people not getting better due to treatment interruptions, it’s hard to compare pre-COVID costs to early-post-COVID costs,” he said.
Pierce also said he had not seen a significant increase in telemedicine visits for his disabled non-COVID clients. He said many of his clients are “not sufficiently computer savvy,” and the services don’t appear to be very valuable for typical orthopedic injuries.
In addition to analyses on treatment times, the study also provided statistical breakdowns of COVID-19 cases for NCCI states.
While most COVID-19 cases were relatively minor, hospitalizations and visits to intensive care units were significant cost drivers for comp systems, according to the study.
About 20% of claims included a hospital visit, and the average time spent there was 7.5 days. The average amount paid per stay was $38,500, according to the study.
More severe cases, where workers were transferred to an ICU, made up 19% of COVID-related hospitalizations. Those cases tended to last about 12 days and cost approximately $62,000, according to the study.
Chadarevian from NCCI, however, cautioned that data for the study did not include information from self-insured employers, which often include emergency first responders and the health care sector.
For COVID-19 claims with some paid medical services through the second quarter of 2020, almost 70% were from females, and most of the claims were for workers ages 55 and older, he said.
About 16% of all claims included comorbidities such as high blood pressure and chronic pulmonary disorders. For those who were hospitalized, that number jumped to 24%, Chadarevian said.
“It’s indeed a changed workers’ comp environment when it comes to medical treatment as well as the types of diseases the system is experiencing,” he said.