Medical advances improve injury survival but increase costs

Byline: Louise Esola
Publication: Business Insurance
Date: Wednesday May 23rd, 2018

ORLANDO, Fla. — Loss of limbs and major burns that used to kill people in workplace incidents are doing so less and less thanks to pricey medical advances.

This has helped coin a phrase and trend that can cost insurers millions of dollars: the so-called work comp megaloss, according to a medical expert in this area.

“Not only are patients surviving, but patients are surviving longer,” said Dr. Michael Choo,

chief medical officer with Walnut Creek, California-based Paradigm Management Services L.L.C., a medical management firm that does business as Paradigm Outcomes and helps employers and insurers navigate catastrophic injuries stemming from major industrial and automobile accidents – a major driver of workplace injuries. “It’s very, very good news for the seriously injured workers.”

Dr. Choo gave attendees at the National Council for Compensation Insurance Inc.’s Annual Issues Symposium on Thursday a history of major injuries now resulting in sustained care that average $3.2 million an incident in medical costs alone.

His presentation included data that showed vast improvements in mortality rates today over figures from 50 years ago.

The mortality rate for those who suffer multiple injuries has seen reductions since 2004 alone – the most severe incidents saw reductions in mortality by 18.4% between 2004 and 2016, according to the American College of Surgeons’ National Trauma Data Bank.

Advances such as clinical burn centers, which specialize in treating major burns to more than 60% of one’s body, and improvements in trauma care and coordination have helped people survive such catastrophes, he said.

“I truly believe that megacost claims exist because people are surviving longer,” he said.

Meanwhile, adverse events that follow an injury can add to the claim costs, including complications such as hospital infections, respiratory problems that follow spinal injuries, abscesses, gastrointestinal or bowel complications, and delayed wound healing such as skin breakdown and graft failure, he said.

“The most common kinds we see are infection – infections are a big problem in hospitals,” said co-presenter Scott Goll, senior vice president of operations for Paradigm Outcomes.

In spinal injuries, for example, 35% of re-hospitalizations occur because of infections, according to Paradigm’s data.

Comorbidities are another common complication that can stall healing, said Mr. Goll.

“We see a very high frequency of multi-comorbidities that come with the injury … Imagine someone who is diabetic and has circulation issues and now has a massive wound with healing issues,” he said.

Still, Dr. Choo said he is confident that improved care can lead to better outcomes and fewer complications.

“Most of the conditions that drive megaloss claims” can be mitigated, he said. “What you need to do is get expertise or you find someone who can act as experts for you … People with experience can tell you what works and what doesn’t.”