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The Opioid Risk for Workers’ Compensation PatientsManaging pain is one of the immediate concerns after a workplace injury. The patient may have intense pain after suffering a traumatic injury or chronic pain from an injury that developed over several years. Physicians sometimes prescribe opioid painkillers as a means of immediate pain relief. However, the public is learning more about the dangers of opioid addiction. Workers’ compensation insurers are taking action against the pharmaceutical companies and physicians who have pushed opioid use, in part because opioid addiction can increase the cost of workers’ compensation. For instance, an Illinois workers’ compensation insurance organization has filed a lawsuit against the makers and distributors of opioids, alleging that they are responsible for an increase in opioid addictions amongst claimants. Injured workers must be careful when using opioids during their injury recovery and should consider alternative methods of pain relief.

Dangers of Opioids

Opioid painkillers are safest when used for a short period. Patients who take opioids for a prolonged period can develop a dependence or addiction to the drug. How quickly the dependence develops depends on the patient and whether they take more than is recommended. Studies suggest that some patients can become dependent in a matter of days. People with opioid addictions may crave increased doses of the drug as their bodies become resistant to it. This increases the risk of overdose and death.

Effect on Workers’ Compensation

According to the National Safety Council, workers who received opioids for more than a week or had more than one opioid prescription are more likely to be on disability a year later. Workers who become dependent on opioids also:

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How Would Value-Based Care Change Workers' Compensation?There is an ongoing debate in the workers’ compensation insurance industry about whether more insurers should adopt a value-based care model for paying claims. VBC proponents in the industry cite the potential to provide treatment that is more effective in cost and outcome for the patient. How would a VBC system change workers’ compensation for claimants? It may benefit them in theory, but there are still questions about how the system would actually work.

Value-Based Care vs. Fee for Service

Workers’ compensation insurers use a fee-for-service payment model, in which the insurer pays the healthcare provider for each visit or procedure that it performs. Critics of fee for service say that it puts a greater incentive on the number of visits than the quality of care provided. A VBC payment system compensates healthcare providers based on the nature of the injury and the recovery of the patient. There are several payment models for VBC, including:

  • Pay for performance;
  • Bundled payments; and
  • Outcomes-based payments.

VBC proponents call this a more holistic and patient-centered approach to workers’ compensation. The doctor’s financial incentive is to help a worker reach maximum recovery as soon as possible, which could result in injured employees returning to work more quickly. Of course, insurers could also benefit from more predictable pricing and shorter periods of disability payments.

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