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ADIN Healthcare Identifies the Top Six Ways Employers Lose Money on Diagnostic Testing for Workplace Injuries

Wednesday, November 18, 2009 General News J E 4
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BRENTWOOD, Tenn., Nov. 18 With workers' compensation diagnostic imaging charges totaling billions of dollars a year, more employers are looking for ways to control the cost of on-the-job injuries while ensuring that employees return to work quickly and safely. ADIN Healthcare, Inc. offers solutions to employers with a national network of diagnostic providers, evidence-based guidelines and process oriented service delivery. In conjunction with one of its major payers, ADIN has analyzed workers' comp claims to identify the top six ways employers lose money when it comes to diagnostic testing for workplace injuries. The company announced its findings at the National Workers' Compensation and Disability Conference & Expo held November 18-20 in Chicago.

"We've found that workers' compensation plan sponsors are often at a loss as to how to control their increasing diagnostic-related costs," said Chris Moosher, Senior Vice President. "At ADIN, we believe one of the most important services we offer our clients is guidance to ensure that the most appropriate diagnostic tests are performed. Sharing these insights will help employers develop better programs for their employees and for their companies."

"In today's market, employers are demanding more accountability from their imaging vendors," adds Moosher. "We must be diligent and control inappropriate testing, which can lead to lost benefit dollars and poor outcomes. By following industry guidelines and offering consistent, high-quality service, we can help our clients provide the best possible programs for their employees."

About ADIN

Based in Brentwood, TN, ADIN Healthcare provides scheduling services and access to a national network of contracted providers. The company's service standards, coupled with a national network of high quality providers, can deliver significant savings of both time and medical costs. For more information on ADIN, visit www.adinhealthcare.com.

1. Ignoring the evidence. Guidance for employers on how and when to use diagnostic tests is becoming more prevalent thanks to Evidence-Based Medicine (EBM) and Comparative Effectiveness Research (CER). EBM relies on scientific studies from a number of sources to provide sound clinical guidance on the treatments and therapies that provide optimal guidelines. CER and EBM should become the foundations of all diagnostic imaging testing. When built into software review programs at the provider and third party administrator (TPA) level, they will provide the guidance necessary to ensure proper testing. 2. Conducting the wrong test at the wrong time. In an era of rising costs, it's understandable employers would want to use lower cost diagnostic tests. However, going with the lower cost option could end up costing considerably more in the long run by extending disability and increasing total medical costs. For example, while computed tomography (CT) scans are less costly for certain injuries (i.e., low back strains), beginning with a magnetic resonance imaging (MRI) exam may actually save money by giving the treating physicians a better opportunity to make an accurate diagnosis. Prompt, appropriate testing can help diagnose the injury early on and ensure recommended treatments are begun quickly. Waiting may mean an employer pays for the initial CT and a subsequent MRI if the treating physician is unable to accurately diagnose the injury the first time. 3. Poor oversight of diagnostic vendors. While diagnostic testing is a critical tool, it can be over-used resulting in wasted benefit dollars. Employers need to ensure their network providers and TPAs carefully monitor billing from diagnostic vendors. For example, some vendors routinely perform and bill for 3-D reconstructions. However, according to the American College of Radiology (ACR), 3-D codes should be reserved for situations where additional imaging is necessary for surgical planning or for a complete depiction of an abnormality from a two-dimensional study. In many instances, 3-D reconstructions are simply not necessary for CT scans and virtually never indicated with an MRI. Ensuring these codes are billed and paid only when appropriate can help payers manage their diagnostic costs. 4. Delaying necessary testing. Some employers and even providers take a 'wait and see' attitude when it comes to injuries, believing it may get better on its own. Others are forced to delay treatment because a recommended test is unavailable through network providers or there are delays in scheduling. Diagnostic scheduling providers, such as ADIN, can help ensure that the appropriate tests are scheduled promptly, helping to speed up the process and get injured workers back on the job more quickly. 5. Requesting unnecessary contrast studies. Many physicians will request contrast studies, which are diagnostic tests that introduce a contrast medium to enhance or highlight a specific injured area, because they believe it provides better imaging. While contrast is appropriate and beneficial for some patients and/or tests, unnecessary contrast studies can significantly increase the cost of testing and the risk of a patient reaction. Network providers and experienced TPAs using evidence-based guidelines can ensure the appropriate use of contrast studies. 6. Excessive use of Electromyography (EMG) testing or nerve conduction tests. EMGs are used to help diagnose nerve disorders, including carpal tunnel syndrome - one of the more prevalent work comp diagnoses. While an important diagnostic tool, more nerves and insertion points are often tested and billed than are necessary. Guidelines from the American Association of Neuromuscular & Electrodiagnostic Medicine and use of credentialed providers can help ensure appropriate use of this valuable tool.

SOURCE ADIN Healthcare
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