Back injuries, back pain, back surgery….these are all big discussions around workers’ comp water coolers as almost one-fifth of workers’ comp injuries are back related. The Workers’ Compensation Research Institute put out a study earlier this year called “Why Surgery Rates Vary”, to try and identify why rates for work-injury related back surgeries around the country were so different. They looked at 13 different states (CA, FL, GA, IL, IN, IA, MD, MI, NC, OK, PA, TN, TX) to try and figure out where the discrepancies really were in having back surgery or not.

What they found in terms of how likely a patient was to get back surgery was interesting, because it had a lot to do with where they lived. The appropriateness of back surgeries is still a divisive issue, some think we’re doing too many surgeries and some think not enough and there’s not really a clear definition of how to best treat back injuries. Which can lead to the variation.

Almost a fifth of patients, 20%, in Tennessee and Oklahoma get back surgery, while that number is under 10% in states like California and Florida. In states where surgery is more likely, reimbursement rates for the surgeries are higher and there are more surgeons willing to perform those surgeries on their patients. The researchers controlled for case mix. They found these factors did not explain variation in things like knee surgeries.

What this means is that maybe policymakers or health systems need to talk about or look at fee schedules or treatment guidelines a little more closely. If it’s the same injury in Oklahoma as it is in Florida why is there such a discrepancy in how workers are being treated for it, and how payers are being billed for it?