Following similar measures in Washington, Colorado and Minnesota, Ohio finalized restrictions on payments for injured-workers back surgeries. The new rule also imposes an opioid restriction, according to the Insurance Journal.
Here are six takeaways:
1. Effective Jan. 1, injured workers are required to undergo at least 60 days of alternate care while avoiding opioid use before the state will pay for a spinal fusion. There are a few exceptions for severe back injuries.
2. While Washington, Colorado and Minnesota already impose strict rules on spinal fusion payment coverage, Ohio is the first state to enforce an opioid restriction.
3. The Insurance Journal reported Ohio pays for approximately 600 spinal fusions each year. The surgeries are used to correct degenerative disc disease and severe chronic low back pain.
4. Neurosurgeon Daniel Resnick, MD, argues the rule is too broad and will create future hurdles for patients in need of spinal fusion surgery. He told the Insurance Journal, “[lumbar fusion] doesn’t work well for everything… but in those cases where it’s appropriate, this is an unsophisticated rule that’s going to add an
administrative burden – added time, added costs – for the patient.”
5. A CompPharma survey indicated insurers view opioids as the most pressing concern regarding workers compensation, with spending on opioids used by injured workers hitting $1.5 million in 2015 across the U.S.
6. The state of Ohio has seen a 44 percent decrease in injured workers receiving opioids over the past five years; however, this can also be related to the drop in injured workers from 81,000 in 2007 to 38,000 in 2016.