The Workers’ Compensation Research Institute (WCRI) released a study which looks at the treatment guidelines around MRI and lumbar decompression surgery in workers’ comp, and how that impacts those with lower back pain and their claims.

The study is titled “Do Treatment Guidelines Influence Early MRI And Decompression Surgery for Low Back Pain”. Researchers found that states with the mandatory use of medical guidelines in utilization review, reimbursement and dispute resolution also tended to have a lower rate of lumbar decompression surgeries for workers with lower back pain when compared to states who had medical guidelines not also tied to utilization management and reimbursement policies. They studied 27 states between October 1, 2015 and March 31, 2017.

In most of the states studied, an early MRI (within six weeks of the injury) was ordered and performed frequently. For low back claims with nerve involvement that had more than seven days of lost time, the percentage of claims with an early MRI ranged from 18 percent in Massachusetts to 55 percent in Florida. The median of the states studied was 36 percent. A more frequent use of early MRI is inconsistent with most medical treatment guidelines used in workers’ comp jurisdictions.

The percentage of claims that received lumbar decompression surgery during the first year of treatment ranged from 3.2 percent in Delaware to 21.5 percent in Kansas, among low back claims with nerve involvement and more than seven days of lost time.

A more extensive use of state-adopted medical treatment guidelines in utilization review and dispute resolution tended to be correlated with a lower rate of lumbar decompression surgery, and if treatment guidelines were referenced in reimbursement rules, they were also correlated to a lower rate of this surgery. For example, New York and California have restrictive and mandatory treatment guidelines for UR and dispute resolution, and both reported less than 5 percent of patients received this surgery within the first year. Missouri has no guidelines and reported 18 percent of patients received this surgery.

Higher rates of early MRI are associated with a higher rate of lumbar decompression surgery, which is mostly consistent with other studies. Some states did show different patterns so maybe other factors explain the variations in these services. For example, Tennessee reported the third highest rate of surgery though it has restrictive and mandatory guidelines for UR and dispute resolution.

Read the study here and read more here.