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Will your doctor be consulting an algorithm on your workers' compensation claim?

On the job, injuries that result in workers' compensation claims often are painful. Back injuries, falls and broken bones typically leave workers with potentially long-lasting pain control needs. At the same time, insurers are becoming increasingly vigilant over claims that become what they consider as too expensive. While this is frequently couched in terms of concern over workers health and as a way of preventing prescription drug addictions from developing, it is as much a way of controlling the increasing costs of workers' compensation claims.

The Wall Street Journal reports on the growth of a number of companies that specialize in analyzing doctors and their patients and flagging those that are out of alignment with their proprietary actuarial programs that forecast the expected duration of a drug treatment. If a patient is receiving a longer treatment for their workers' compensation injury, the companies will contact the doctor and provide them with a treatment "roadmap" using evidence-based guidelines.

Of course, some doctors are worried that this "business model" is just one more way to cut corners on ligament patient needs. The problem is that you can often get to the answer you want by asking the "right" questions. Their "analytic" software can easily be designed to always opt for the shortest, least elaborate and therefore cheapest course of treatment as being "best."

Like any other mechanical tool, they can either assist doctors and help them see some issues they may have missed, like potential prescription drug addiction. More worryingly, they could also be a means for insurance companies to harass doctors and coerce them into providing their workers' compensation patients with less treatment and less help. With insurance companies, one always is concerned that less is less.

Source: The Wall Street Journal, "When Your M.D. Is an Algorithm," Timothy W. Martin, April 11, 2013

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