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Workers Compensation Research Institute Study Finds ER Use by Injured Workers Differs by State

According to an Article by Jim Sams of Claims Journal, the Workers Compensation Research Institute (WCRI) conducted a study to determine where injured workers seek medical care, with the types of injuries they sustain such as strains, sprains, and other types of injuries, and the differences vary widely by state.

For example, almost one third of injured workers in Massachusetts received treatment at an emergency room for strains/sprains, in comparison to California and Nevada, where only 10% of injured workers received treatment at an emergency room for the same injuries.

Sams writes, “Olesya Fomenko, the lead author of the study, said she is puzzled by the wide variation among the states. Fomekno said that Massachusetts has one of the highest percentage of residents with health insurance in the nation, in part because of a subsidized health insurance plan shepherded into law by former Gov. Mitt Romney. Generally, health insurance brings with it managed-care incentives that direct routine care away from hospital emergency rooms.”

Here are some of the study examinations and findings:

  • “The study examined ‘pre-COVID’ 2019 data from 28 states. The study found that 44% of all new workplace injuries in Massachusetts were treated initially in a hospital emergency room, 37% in Mississippi and 33% in New York. On the other end of the spectrum, only 17% of new workplace injuries in California were treated in an emergency room, 19% in Nevada and 20% in Arizona.”

  • “The data showed that some emergency room use was driven by medical necessity. For example, 58% of fractures that resulted in lost-time claims were initially treated in emergency rooms in the 28 study states. In contrast, only 17% of strains and sprains that did not result in lost time were.”

  • “However, several states exhibited a high use of emergency room use even for less urgent injuries. In New York, 25% of injured workers sought initial treatment for strains and sprains in an emergency room; Mississippi 23%, Louisiana 21% and New Mexico 20%.”

  • “Injured workers in states where employees control the place of care tended to use emergency rooms more than states where employers direct care. Louisiana, Mississippi, New York and Massachusetts are all employee-choice states. In California, by contrast, workers generally must choose treatment facilities from medical provider networks established by employers, while in Nevada employers decide where workers get care.”

If nothing else, this reaffirms including urgent care facilities in our hospital/medical canvasses in the event that injured workers/accident claimants seek alternative treatment.

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