4113 Ohio Work Comp Clamps Down on Spine Surgery
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Dynamic Chiropractic – October 1, 2017, Vol. 35, Issue 10

Ohio Work Comp Clamps Down on Spine Surgery

By Editorial Staff

The Ohio Bureau of Workers' Compensation has issued a rule change regarding payment for lumbar fusion surgery,1 effective Jan. 1, 2018, that only authorizes surgery after the injured worker has received at least 60 days of conservative care for low back pain.

The care plan can include chiropractic treatment among the conservative options (rest, ice/heat, rehab, etc.), and the 60-day requirement can only be waived in cases of progressive neurological deficit, spinal fracture, tumor, infection, emergency / trauma care, or "other catastrophic spinal pathology causally related to the injured worker's allowed conditions."

While anti-inflammatories and spine injections are also listed as conservative care options, the bureau emphasizes both "avoidance of opioids, whenever possible" and "avoidance of provider catastrophizing the explanation of lumbar MRI findings."

Why the rule change? Per an article published on WorkCompWire,2 "The rule follows several studies of BWC data by BWC Chief Medical Officer Dr. Stephen T. Woods, researchers at Case Western University School of Medicine and others that found fusion patients suffered considerably worse outcomes than non-fusion patients. Those outcomes included chronic opioid dependence, increased disability and high rates of failed back syndrome, as well as additional surgery and new psychiatric co-morbidities. One study in the journal [Orthopedics] found nearly 77 percent of fusion patients did not return to work within two years."

spine surgery - Copyright – Stock Photo / Register Mark The bureau is taking the new requirements seriously: "A provider's failure to comply with the requirements of this rule may constitute endangerment to the health and safety of injured workers, and claims involving lumbar fusion surgery not in compliance with this rule may be subject to peer review by the bureau of workers' compensation stakeholders' health care quality assurance advisory committee (HCQAAC) pursuant to rule 4123-6-22 of the Administrative Code or other peer review committee established by the bureau."1

References

  1. Executive Summary: 4123-6-32 - Payment for lumbar fusion surgery. Ohio Bureau of Workers' Compensation.
  2. "Ohio BWC Announces New Rule: Rest and Rehab Before Lumbar Surgery." WorkCompWire, July 19, 2017.

Dynamic Chiropractic editorial staff members research, investigate and write articles for the publication on an ongoing basis. To contact the Editorial Department or submit an article of your own for consideration, email .

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