Call or email us anytime
(805) 484-0333
Search Guide
Today is Friday, March 24, 2023 -

Industry Insights

Moore: Visiting ER a Touchy Subject

  • National
  • -  0 shares

This is my angle on workers' comp emergency rooms as initial medical treatment providers. I am not discouraging anyone to not go to an emergency room. What I am covering is minor injury treatment through emergency rooms. Read on to see how I discovered a massive cost-cutting method for workers' comp claims.

James Moore

James Moore

I have been admonished over the years for recommending a risk management technique that put injured employees’ lives in danger.   Bottom Line – if the injury needs emergency treatment, then go to the nearest hospital emergency room.

My own ER visit = idea

More than a few years ago, I was working a claims adjuster’s desk when I realized something amazing  A huge homebuilder (now defunct) was trying to figure out how to cut workers' comp costs to a minimum while providing proper care for its injured workers. I had just visited an emergency room the week before due to massive cuts to multiple fingers from a canned ham accident.

When the bill arrived, and then the health insurance carrier’s explanation of benefits, I was astounded at the charges. I was covered by an HMO, so the final amount I paid was much less than the original bill. Whew!

I did not have a primary care provider or a family physician. The only place to go that I could get in for an appointment was the emergency room at the nearest hospital. There were no urgent care providers/walk-in clinics in the area.

I then reviewed a loss run for the huge homebuilder to see what factors would help reduce its costs. I noticed that all the injured employees, even with a splinter, went to the nearest hospital emergency room. The light bulb came on that minor claims could be handled by the nearest walk-in clinic at a much-reduced cost. This was before the advent of workers' comp medical networks. Workers' comp emergency room visits were reduced by the builder. Its premiums for workers' comp dropped 30%.

That light bulb was the beginning of the Six Keys to Workers' Comp Savings.

1999 study

I was the director of risk management for the North Carolina School Boards Association when I noticed the cost for certain school districts was much higher per claim than some of the others. I decided to pen and paper analyze more than 7,000 claims to see if the four keys that I had discovered 10 years earlier would cut workers' comp costs (quick injury reporting, medical treatment network in place, return-to-work program, treatment of an injured employee by the school district post-injury).

The most significant cost factor was not having a medical treatment network in place or just telling the injured employee to go to the emergency room or family physician. Even more extreme costs were generated by a minor injury being treated by an emergency room.

New study on workers' comp ER use

A new study was performed by the Workers Compensation Research Institute that carries on the same question. According to the study and report:

Oftentimes workers resort to emergency departments (EDs) to receive their initial medical services after a work-related injury. For some injuries, workers may be more likely to use ED services rather than going to physician offices or urgent care clinics — which are less costly alternatives to ED services.

I have not read the report yet, only an abstract summary. I rarely make purchase recommendations, but in this instance, the $35 may be worth it. 

The other variable that I did not cover in this article is how COVID-19 affected medical treatment.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

No Comments

Log in to post a comment

Close


Do not post libelous remarks. You are solely responsible for the postings you input. By posting here you agree to hold harmless and indemnify WorkCompCentral for any damages and actions your post may cause.

Advertisements

Upcoming Events

  • Mar 23-24, 2023

    DWC Annual Educational Confere

    The California Division of Workers Compensation (DWC) is pleased to announce that registration fo …

  • Mar 24-26, 2023

    2023 WILG LONGSHORE CONFERENC

    Are you a claimant attorney trying to tread the treacherous waters of representing your clients un …

  • Mar 29 – Apr 1, 2023

    CLM Annual Conference

    Launch into 2023and beyondat our industry-leading event Are you ready to future-proof your care …

Workers' Compensation Events

Social Media Links


WorkCompCentral
c/o Business Insurance Holdings, Inc.
PO Box 1010
Greenwich, CT 06836
(805) 484-0333