Musculoskeletal Care: Where’s All That Money Going?

May 2, 2014

Health care resources are limited.  Squandering them on ineffective, unnecessary, even risky treatment is simply unacceptable.  Purchasers of care, especially self-insured employers, are challenged to determine where such waste occurs and find ways to avoid it.  But how does one determine what spending will be wasteful before spending the money?

In the care of musculoskeletal (MSk) disorders, avoiding these unnecessary costs is no longer merely an aspiration but a reality. That’s great news since MSk care is one of every employer’s most expensive health care domains.   An employer with 1,000 employees can spend close to $1 million on MSk care each year.  That means $25 M with 25,000 employees, etc.  

Two large payers’ unpublished claims data now show that utilizing one specific type of MSk evaluation results in a direct savings of nearly 50% of their MSk costs.  These data will be published in the near future. But that’s right – 50% of those costs prove to be not only unnecessary, but they’re identifiable before that money is spent. So that spending is preventable and the savings goes right to the company’s bottom line. And these findings appear to be generalizable to most employers.

But there’s more good news. Such rapid recoveries also proportionally reduce lost work-time and wage replacement costs. Patient satisfaction is naturally also very high since most would rather work than not work.

Some call the combination of improved quality care tied to cost savings the “holy grail” of health care.  Such real “value” supports the adage that high quality care is usually also less expensive.  When you then add high patient satisfaction, you have what I call “the health care trifecta”.

The key to producing these benefits is better diagnostics, specifically by reliably identifying valid subgroups for which there are standardized, predictably effective treatments.  Consider that one very large subgroup, if left unidentified, is routinely mis-treated and often worsens. Costs then significantly and unnecessarily mount due to imaging, extensive medications, injections, and even surgery.  Avoiding these interventions in this subgroup is all strongly supported in the scientific literature.

The challenge is that most care-givers don’t know about either these diagnostics or this reliability and validity literature.  For example, several studies confirm that a high percentage of patients undergoing expensive MRIs, injections, and even surgery actually have a very treatable condition using this form of inexpensive non-surgical care that so often results in rapid recoveries.  Again, the key for most employers is that these patients are identifiable before this unnecessary, ineffective care is undertaken.

Most physicians’ solution to the problem of an insufficient diagnosis to simply ignore it. They instead focus on providing the best, or their favorite, treatment while remaining largely ignorant to what is actually wrong with their patient.  But most stakeholders remain unaware of these diagnostics and instead continue their unfortunate focus on hundreds of studies that unsuccessfully attempt to determine the best treatment for various non-specific pains.

I’m intentionally omitting in this posting any description of the diagnostic procedures that have generated such savings.  The message of this posting is intended for employers and health plans as an alert to their opportunity to dramatically reduce their very high costs for MSk care.

As always, I welcome feedback and questions. Please click on “Like” if this was useful and enlightening, or “Leave a Comment” by clicking on “Comment” below.

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