A study from the Johns Hopkins University School of Medicine and Accident Fund shows that workers’ comp claims that follow evidence-based guidelines have significantly lower costs and close quicker than claims that do not follow such guidelines.

Many states have adopted guidelines like the Work Loss Data Institute’s Official Disability Guidelines (ODG), which are embedded within Acrometis’ CLAIMExpert platform and can be utilized by the adjuster while they are working on their claims. This study further reinforces the importance of using evidence-based medicine in claims because it not only saves on medical costs but it rehabilitates injured workers faster while returning to work sooner

The researchers measured compliance with ODG on claims and then compared the outcomes of those claims to see whether those that were more compliant with guidelines had better outcomes. The claims were put into 10 different categories based on medical complexity and scored based on compliance. As part of their methodology the researchers established a two-year cutoff period to categorize a claim as open or closed.

They relied on four color coded levels of compliance attached to procedures that were recommended or performed with each claim based on that claim’s diagnosis. Procedures that were coded with green flags meant they were recommended based on the guidelines. Yellow flags meant that the procedures were common for that diagnosis but should be monitored or restricted for number of times they could be performed. Red flags meant the procedures were rare in comp and not necessarily a recommended treatment. Black flags meant that procedures were inappropriate and might need to be denied.

The Hopkins and Accident Fund researchers then determined a claim’s adherence rate to the guidelines by looking at the amount of green, yellow, red or black flags attached to it to measure how well that claim complied with the guidelines.

Those claims that followed the guidelines with at least a 50 percent adherence rate had a claim duration that was 13.2 percent shorter than those that did not follow the guidelines as strictly. The claims that followed the evidence-based medical guidelines with at least a 50 percent adherence rate also saw 37.9 percent lower medical costs. As the medical complexity of claims increased, the differences between claim duration and costs between compliant and less compliant claims grew even wider.

The director of Innovation for the Accident Fund, Jeffrey Austin White, said that the way evidence-based medicine (EBM) is applied in workers’ comp is different than the way it is applied to group health because the guidelines are applied in a more intensive and inclusive way.

“When the diagnosis is made, the evidence-based medicine guidelines define how often a treatment is administered, along with the expected cost and time off from work,” he said. White said that in group health settings EBM is used more to control costs and limit reimbursements, while the guidelines in comp are used to provide or set expectations for injury outcomes.

The researchers said they set out to deliver evidence that these kinds of guidelines have a measurable impact, specifically when they are used in workers’ comp. White said that as more in the workers’ comp industry start to use EBM over time, he hopes they will be able to refine their methodology in employing the guidelines and be able to improve outcomes even more.