Centers of Excellence Expanding in WC, Expert Suggests

Nancy Grover

Sarasota, FL (WorkersCompensation.com) – Centers of Excellence offer unique opportunities for the workers’ compensation system. While they are wholly different from traditional care delivery models in workers’ compensation, they can address current gaps; namely, better communication among providers and stakeholders, a true patient-centric approach, and answers to as yet unanswered questions about certain medical conditions.

“It is likely that more and different types of Centers of Excellence (CsOE) will emerge in workers’ compensation, and you might be asked to be a part of [them], as a care provider or asked to regulate them,” said Dr. Randall Lea. An orthopedic surgeon by trade, Lea is a senior research fellow at the Workers Compensation Research Institute. In a webinar on CsOE he explained the emerging concept of these delivery care models in workers’ compensation, some of the drawbacks and why he believes that can bring significant value to the workers’ compensation industry.

Definition

While there is no standard, clear-cut definition, Lea referred to one developed by James K. Elrod and John L. Fortenberry:

‘A program within a healthcare institution which is assembled to supply an exceptionally high concentration of expertise and related resources centered on a particular area of medicine, delivering associated care in a comprehensive, interdisciplinary fashion to afford the best patient outcomes.’

“The primary aim is to foster a team spirit in the organization where all members are pulling in the same direction,” Lea explained. “You know they are, if they all work off the same playbook,”

Medical treatment guidelines, for example are one way to promote coordinated care in workers’ compensation. What is also vital, and where CsOE can be a benefit is the communication that is typically inherent.

Typically in workers’ compensation, an injured worker being treated by ‘Dr. A’ goes to another specialist, ‘Dr. B,’ “but they don’t talk,” Lea said. “They must be willing to work in collaboration and be a frequency and effective communicator.”

In addition to better communications among providers and other stakeholders, such as employers, physicians within the CsOE also have “robust communication” with one another. “The whole goal is quality care,” he said. That can result, for example in more accurate diagnoses, fewer repeat surgeries, shorter lengths of stay, fewer complications and, perhaps, shorter return-to-work days.

The elements of cost and, especially, a patient-centered mentality should also be included in any definition of CsOEs. “Everything should be patient centered,” Lea said, “with patient engagement and patient satisfaction” as key indicators.

Challenges

Employing CsOE in the workers’ compensation system, however, is no easy task. The excessive paperwork required can deter physicians from taking on workers’ compensation patients. The wait for approvals of treatment is another obstacle. And the licensing requirements for providers who may be treating injured workers from different jurisdictions is yet another barrier. “We’re still working on the regulations to make it easier,” Lea said. “I think you’ll see pressure to make that happen.”

Another issue is the dearth of research showing whether CsOE actually result in better outcomes. Lea cited a handful of studies that indicated somewhat better results, though not in terms of costs. One study, for example, illustrated that there were fewer complications for hip surgery at a CsOE but no difference for knee surgery, and no difference in cost. Another compared spine procedures at CsOE with those done outside a CsOE and found no difference in the type or rate of complications.

With no assured savings or improved quality are CsOE still viable, especially for workers’ compensation? “I’d say yes,” Lea said. “I believe CsOEs do have relevance.”

Finding Answers

One way CsOE can provide real value for workers’ compensation is that they “have all the assets and tools to provide the best care and they can collect robust data sets,” he said. That can lead to answers to questions that have so far been unanswered.

In “spine surgery, for example, there are many unanswered questions,” Lea said. “In spite of evidence based guidelines, we don’t have all the answers just yet. And we still experience a lack of consistency in outcomes and less favorable outcomes.”

Metrics from CsOE could also help determine the extent of pain relief a patient could expect from a specific treatment. “Maybe we could measure some outcomes like the likelihood of RTW, or the likelihood of chronic opioid [use],” he said. “Other questions we have difficulty answering such as problems with utilization of services; what is the right rate and timing for an MRI? For surgery? For injections? … when is the best time to administer physical therapy?”

CsOE are currently used mainly for catastrophic conditions, such as spinal injuries and pain. Lea said rehab services and physical therapy are two additional areas where he sees value in CsOE for the workers’ compensation system. Additionally, subgroups within CsOE could be studied, such as aging workers.

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