Medical misdiagnoses happen. However, a recently released report shows a staggeringly-high incidence: As much as one-fifth of claims involve diagnosis errors that are extending the treatment of injured workers and costing the workers’ comp system billions.
The 10-year study, conducted by Boston medical consultation service, Best Doctors, uncovered in an estimated 250,000 workers’ comp injuries 21% involved misdiagnosis and/or inappropriate medical treatment. In the most expensive top 5% of claims, error rates were estimated to jump as high as 50%. Cumulatively, these errors can add up to as much as $15 billion of the estimated $65 billion in workers’ comp claims expenditures annually nationwide.
Language barriers and misunderstandings may increase complications. Treatments take a wrong turn, sometimes resulting in the prescription of dangerous opioids and unnecessary treatment plans, increasing subsequent costs. Managing Director of Best Doctor Occupational Health Institute, Michael Shor, indicated that such findings remain consistent among all areas of the medical profession.
It is irresponsible and simply wrong to place the blame on any one entity or component. It is critical to remember that medical professionals make every effort to ensure treatment is appropriate and that their patients receive the highest level of care available. But they are human, just like the injured workers, case managers, and insurance employees.
How to Improve
The first step in preventing the physical, emotional, and financial tolls of diagnoses errors that result in prolonged disability and jeopardized careers is simple: Collaboration. Essential to quality of care, particularly in complex cases, the collaborative effort of medical personal with employers, patients, carriers and workers’ comp case managers can provide improved quality assurance and help prevent these issues. Peer review of diagnoses and second opinions can likewise reduce issues at the pass, putting injured workers on a better path, circumnavigating unnecessary costs and extended recoveries.
About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.
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