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It is likely that more than 10% of the cost of medical benefits for the workplace injuries that occur this year will be for services provided more than two decades into the future. That percentage has been growing and might continue to grow. A new study by NCCI looks at workers compensation medical services provided beyond 20 years after the injury, with a view toward anticipating: which medical service categories will account for the largest shares of costs and future treatment and utilization that will drive those costs.

NCCI first looks at the demographics of claimants who are still being treated for job-related injuries that were suffered more than two decades ago. The focus then shifts from patients to their medical care, looking at medical costs by service and diagnosis categories. Some key findings concerning services provided from 20 to 30 years following the date of injury are as follows:

  • Patients are predominantly male, more so than can be explained by historical gender differences in the workforce
  • Deteriorating medical conditions of the more elderly claimants is not a main cost driver; indeed, claimants younger than age 60 cost more per year, per claimant, to treat than those older than age 60
  • Relative to services within the first 20 years after injury, care provided later has a significantly greater portion of cost going for prescription medications, supplies, home health services, and the maintenance of implants, orthotics, and prosthetics.

Because drugs account for a large proportion of late-term-care costs, prescription data can suggest the nature of late-term care. The study compares the share of WC medication costs for several specific drugs. It compares late-term-care experience with all WC medication costs in 2009 and includes the top 10 WC drugs, either overall or within late-term care:

  • The top drug, OxyContin, accounts for 6% of WC medication costs in 2009 and that share rises another 5 percentage points to 11% for late-term care
  • The shares for opioid chronic pain medications, such as Oxycodone (OxyContin, Percocet) and Fentanyl (Duragesic), are generally higher within late-term care than within all medication costs for 2009
  • The shares within late-term care for muscle relaxants, such as Skelaxin and Cyclobenzaprine HCL are substantially lower than their overall shares for 2009

The specific medications given late-term provide a further indication for the shift in focus from treating the loss of function to relieving pain.