Medical Misdiagnoses Cost Workers’ Comp Systems Billions, Paper Says

07.05.2017


By Liz Carey

Boston, MA (WorkersCompensation.com) – As much as a fifth of medical diagnoses in workers’ compensation claims involve errors that cost workers’ compensation systems billions, a 10-year study from a medical consulting service found. 

Best Doctors, a leading medical consultation service in Boston, released a report Wednesday that found in an estimated 250,000 workers’ compensation injuries, 21 percent of those cases involve a misdiagnosis and/or inappropriate treatment. In the top five percent of the most expensive workers’ compensation claims, the error rates are estimated to be as high as 50 percent.

Those errors can add up to as much as $15 billion of the estimated $65 billion in workers’ compensation expenditures nationwide per year, the study showed.

“There is a devastating physical, emotional and financial toll caused by a misdiagnosis,” said Dr. Lewis Levy, chief Medical Officer at Best Doctors and a co-author of the report. “The impact can be even more overwhelming for an injured worker who may experience prolonged disability, household financial distress, and a career in jeopardy.”

Dr. Bruce Friedman, also one of the report’s authors, said the report showed that there is a need for medical personnel to work collaboratively to address the quality of care for those who are injured on the job.

“I think that collaboration is important to provide quality care, especially in these complex cases,” Friedman said in an interview with WorkersCompensation.com. “I’m not saying that everyone is out there doing everything wrong, but there are ways to improve medical care for patients.”

The study looked at workers’ compensation cases the group has seen over the past 10 years. The study also shows that in as much as 80 percent of the cases with misdiagnosis, in 80 percent of those cases, the treatment plan was changed. 

The study identified four different cases where misdiagnosis or other issues complicated treatment — from erroneous prescribing of opioids, to language barriers. Michael Shor, managing director of Best Doctor Occupational Health Institute, said that the study’s findings are consistent with findings for all areas of the medical profession.

“The thing that’s terribly important here is that the people who get hurt are the ones who are pushing, pulling and lifting,” Shor said. “And many of these people have a high school education level. That makes them very vulnerable when it comes to knowing what it means to get quality care. We need to find ways to assure quality outcomes for these patients.” 

Shor said that adding peer review to diagnoses, making second opinions mandatory and working on ways doctors and nurses can provide quality assurance would help prevent these kinds of issues. 

“When someone gets hurt, when someone gets sick, they assume the person with the stethoscope is going to do the right thing,” Shor said. “But things can go wrong.”

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This article was updated as of 06/30/17.

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