Therapy before surgery; new BWC rule gets first approval.

COLUMBUS – On June 23rd, the Ohio Bureau of Workers’ Compensation (BWC) board of directors approved a rule favoring conservative, non-surgical therapy as the initial treatment over spinal fusion surgery (opioids) for workers with lower back injuries.

​Under the BWC’s new spinal fusion rule, the agency requires those workers to first undergo at least 60 days of comprehensive conservative care before considering a surgical option. Conservative care includes physical therapy, chiropractic care and rest, anti-inflammatories, ice and other non-surgical treatments.

BWC Administrator/CEO Sarah Morrison states: “Our mission is to get injured workers back to work and back to life as soon as safely possible, and our research shows that rushing to surgery may not be the best path for workers with lower back injuries,”

Several data studies by BWC Chief Medical Officer Dr. Stephen T. Woods, researchers at Case Western University School of Medicine and others found that fusion patients suffered considerably worse outcomes than non-fusion patients. Those outcomes included chronic opioid dependence, increased disability and high rates of failed back syndrome, as well as additional surgery and new psychiatric co-morbidities. One study in the journal Orthopedics found nearly 77% of fusion patients did not return to work within 2 years.

“This is a look-before-you-leap rule,” said Dr. Woods, who specializes in physical medicine and rehabilitation. “We’re not saying injured workers can’t have surgery. We’re simply trying to educate patients and providers as much as possible about the risks involved and requiring other treatment options before choosing surgery. Our research, as well as research throughout the industry, suggests fusion surgery should be limited to patients only when it is clearly indicated.”

Lower back injuries continue to be among the top injury types among Ohio workers each year.  Following trends nationwide, the number of lumbar fusion surgeries performed on Ohio workers’ compensation claimants decreased from 1,375 in 2002 to 563 in 2015.

The fusion rule’s goals are to:

  • Ensure the incorporation of best current clinical practices in the utilization of lumbar fusion surgery in the treatment of injured workers;
  • Ensure injured workers’ awareness of treatment options for allowed lumbar conditions and increase their awareness of potential outcomes;
  • Promote, at minimum, a 60 day course of comprehensive conservative care for allowed lumbar conditions unless otherwise indicated, prior to consideration of lumbar fusion surgery;
  • Provide criteria for consideration of lumbar fusion surgery when the injured worker’s condition has remained unchanged or worsened despite utilization of conservative care.

Exceptions to the rule include:

  • Conditions that require more immediate intervention, such as spinal fractures, tumors and infections, as well as progressive functional neurological deficits.

The rule does not expressly prohibit opioid use for pain management, but calls for “avoidance when possible.” Under BWC’s new opioid rule passed last year, physicians must follow best practice guidelines when prescribing the drugs or risk sanctions.

The spinal fusion rule now moves to the Joint Committee on Agency Rule Review, a bipartisan panel of state lawmakers. If approved there, it would become effective Jan. 1, 2018.

Columbus Workers Comp attorney, Tom Marchese
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