Alternative Therapies Gain Ground, But Still Have a Long Way to Go

Liz Carey

Asheville, NC (WorkersCompensation) – As state workers’ compensation commissions and insurance agencies look to combat the opioid crisis, many are more accepting of non-traditional therapies for pain.

But that doesn’t mean the industry is moving quickly to adopt some more radical treatments.

Since 1999, 29 states have accepted acupuncture as a treatment for pain. The number of treatment sessions are limited and varies from state to state. In California, a state law passed in 2007 approved between 1 and 3 sessions of acupuncture per week for up to 2 months as part of a workers’ compensation claim.

In Ohio, the state’s Bureau of Workers’ Compensation began covering the use of acupuncture in the late 2000s. The state-run program currently covers up to two hours of acupuncture for workplace injuries, with treatments billed in 15-minute increments.

And in 2016, Washington state launched a pilot program that will study how effective acupuncture is as a treatment, through a two-year trial period.

Yet, covering behavioral therapy, CBD or medical marijuana is something many workers’ compensation programs fail to accept. In 2014, a Maine worker who had developed an opioid addiction after a work-related back injury in 1989 was prescribed medical marijuana by his physician. When the Maine Workers’ Compensation Board ordered his employer and insurance co. to reimburse him for the cost, the mill and insurance company refused to pay for it because it is an illegal substance under federal law. As of June 2018, the Michigan State Supreme Court had ruled employers can’t be forced to pay for medical marijuana, per WorkersCompensation.com coverage here.

Insurance companies say that they will only pay for proven treatments.

The Hartford’s Chief Medical Officer Adam Seidner said the insurance company looks first for treatments that have been tested.

“When choosing treatment for claimants, the selection process should begin with consideration of FDA-approved treatments and properly conducted research studies published in peer reviewed journals,” he said. “The main consideration is effectiveness of the treatments. We follow evidence-based medicine guidelines. These help ensure both safety and effectiveness of the selected treatment. Effective treatment either ensures the employee safely stays on the job or returns to work safely as soon as possible.”

Seidner said the company covers physical medicine therapies like acupuncture, behavioral modification therapy and other soft tissue injury treatments. The company does not cover medical marijuana, as a rule, although it may be forced to by state law, he said.

What do you say to those employers who may have employees for which traditional medicine may not be working, and who are looking for help through non-traditional routes? Per Seidner, focus on the science and select treatments that have been studied and shown to be effective. Harm may come from unstudied treatments and result is even greater loss for an injured worker.

But Blake Fagan, Chief Education Officer and Assistant Medical Director for Mountain Area Health Education Center (MAHEC) in Asheville, NC, said accepting alternative pain treatments needs to be pushed on the workers’ compensation and insurance industries from multiple sources.

MAHEC uses behavior modification therapy to help patients change negative thoughts about pain into positive thoughts. Through the use of this therapy, the center has been able to reduce pain in patients by 2 percent without drugs. And eliminating those drugs can reduce costs.

“Some insurers won’t cover the cost of behavior therapy sessions, but will pay for years of opioid use,” Fagan said in an interview with WorkersCompensation.com. “A lot of insurance companies and workers’ compensation programs are behind the curve when it comes to new research in the area of pain management.”

Preventing patients from getting addicted to opioids is key to the solution to the opioid crisis, he said. Fagan likened the opioid crisis to a river.

“Think of it like a river that swiftly moving and there are people in the river drowning,” he said. “You reach in and you rescue as many people as you can. But at some point, you’ve got to stop whoever is pushing people into the river upstream.”

Using alternative therapies, like behavior modification, acupuncture and exercise like tai chi, can help patients and is safer than opioids, he said.

But widespread acceptance of those forms of therapy by insurance providers and workers’ compensation will take action from all sides of the issue.

“The VA now accepts physical therapy and acupuncture as treatments for pain,” he said. “But I think what it will take is for Medicaid and Medicare programs to accept alternate therapies for pain, and then you’ll see a broader move toward covering them.”