State Differences in the Diagnosis and Treatment of Joint Injuries

Posted Date: November 30, 2015

Joint injuries are among the more common workers compensation claims. While some can be catastrophic, most are straightforward to treat and require less time to heal than, for example, many back injuries. Differences between states in the diagnosis and treatment of joint cases can be observed earlier in the course of treatment than for more complicated cases.

This study looks at medical services provided within the first two years after the date of injury. Although the nature of a joint injury is often better understood and the care more standardized than for more complex injuries, the care provided for a joint injury can run the full gamut of specialized medical services—from physical therapy to diagnostic imaging to surgery.

Key Findings

Stakeholders are interested in differences in treatment patterns by state and how to ensure the best outcomes for injured workers. This study quantifies differences in treatment patterns by state for joint injuries. Some key findings are:

  • There is a wide variation among states in the utilization of services to treat joint cases as measured by the average Cost at Common Fees (CCF) per case.

  • For each cohort, we selected three lower and three higher utilization states from among the larger volume states. The average CCF per case is much higher for the higher-utilization states than the lower-utilization states, with elbow cases showing the greatest spread. The percentage differences in the average CCF among all states is at least as great as that between the highest and lowest of the six selected states:
    • Knee: 71%
    • Shoulder: 103%
    • Elbow: 182%
    • Ankle: 114%

  • For each joint cohort:
    • Surgery and physical medicine show the greatest variation in CCF across states
    • The CCF for diagnostics is comparatively consistent across states
    • Utilization differences across our selected states are driven more by differences in the treatment for given diagnoses than to the mix of diagnoses; this finding is strongest for shoulder and elbow cases