Ohio BWC Approves New Rule that Requires Conservative Care Before Back Surgery

The State of Ohio is modifying the way it addresses the needs of workers who have sustained lower back injuries on the job – such injuries are consistently among the most common types of injuries suffered by workers in the State. Some of these injured workers require the legal advocacy and support provided by Ohio workers’ compensation lawyers in order to help them obtain the compensation they deserve.

In light of the difficulties many injured workers have faced returning to work in the aftermath of lumbar fusion procedures, the Ohio Bureau of Workers Compensation (Ohio BWC) has issued a new rule intended to help remedy these problems.

The new rule institutes a 60-day waiting period that is intended to lessen the number of lumbar fusion surgeries performed for these lower back injuries and minimize the use of opioids such as Vicodin, OxyContin, and Percocet. The goal is to promote more conservative treatments and therapies for these injuries, including chiropractic care, rest, ice, physical therapy, anti-inflammatories, and other non-surgical/non-invasive treatments.

At Kademenos, Wisehart, Hines, Dolyk & Wright Co. LPA, we know that workers’ compensation laws can be complicated. Attorneys Adrienne Hines and Victor Kademenos from our team are certified workers’ compensation specialists. They can answer your questions and fight vigorously to help you recover the compensation to which you may be entitled.

Call us today at (419) 625-7770 to schedule a free consultation with one of our Ohio workers’ compensation lawyers.

Prior Research and Development of the New Rule

The decision to issue this rule was preceded by a number of different studies of Ohio BWC data performed by BWC Chief Medical Officer Dr. Stephen T. Woods, researchers at Case Western University School of Medicine, and other individuals who concluded that the majority of lumbar fusion surgery patients suffered significantly worse results than those patients not receiving fusion surgery. Some of the debilitating outcomes included increased disability, chronic dependence on opioids, increased rates of failed back syndrome, new psychiatric co-morbidities, and the need for additional surgery. A particular study in the Journal Orthopedics discovered that more than three-quarters of fusion surgery patients did not return to work within two years.

Dr. Woods, who operates a full-time practice and specializes in physical medicine and rehabilitation, described the new initiative of the Ohio BWC as a “look before you leap rule.” The intention, he said, is to “educate patients and providers as much as possible about the risks involved and [require] other treatment options before choosing surgery.” Woods pointed to the preponderance of research from the BWC as well as other sources indicating that “surgery should be limited to patients only when it is clearly indicated.”

Indicative of nationwide trends, there has been a significant decrease in the number of lumbar fusion surgeries performed on claimants within the Ohio workers compensation system – specifically, 1,375 fusions in 2002, and 563 in 2015.

Goals of the New Rule

The major goals of the new fusion rule are to:

  • Promote a minimum two-month course consisting of comprehensive conservative care for allowed lumbar conditions (unless indicated otherwise), before any consideration is made to move forward with lumbar fusion surgery
  • Maintain the awareness of injured workers regarding treatment options available for allowed lumbar conditions, as well as potential outcomes
  • Provide criteria to follow for the weighing of lumbar fusion surgery options when the condition of the injured worker has not improved or degraded, despite the implementation of conservative care strategies
  • Ensure that current best clinical practices are used with lumbar fusion surgery provided to injured workers

Sarah Morrison, Administrator/CEO of BWC described the mission of the new conservative care rule as one of returning injured workers “back to work and back to life as soon as safely possible.” She stated that the research demonstrates that “rushing to surgery may not be the best path for workers with lower back injuries.”

The State of Ohio’s opioid crisis began to develop in a significant way in 2011. Since that time the State has taken steps to reduce this crisis. About 8,000 injured workers in the Ohio were found to be dependent on opioids at that time. This number has been reduced in half, below the level recorded in 2002. This new rule by the BWC is the latest step in the overall strategy of reducing opioid dependence in the State.

Exceptions to the New Rule

There are some exceptions to the rule; in particular, conditions that necessitate immediate intervention, such as infections, tumors, spinal fractures, and progressive functional neurological deficits.

It should be noted that the BWC rule does not specifically exclude the use of opioids for pain management, but directs that opioid use for this purpose should be avoided when possible. Under a rule passed last year by the BWC, physicians are required to follow best practice guidelines when prescribing drugs for pain management. Physicians not following these guidelines risk incurring sanctions.

Next Step Toward Implementation

The new conservative care spinal fusion rule now proceeds to the Joint Committee on Agency Rule Review where it will be evaluated by a bipartisan panel of Ohio State lawmakers. If and when approved, the rule will take effect on January 1, 2018.

Get the Ohio Workers’ Compensation Representation You Need

Our Ohio workers’ compensation lawyers, Adrienne Hines and Victor Kademenos, are certified in workers’ compensation law – which means they are recognized as specialists. They can help you navigate through the claims process with the goal of helping you obtain the compensation you deserve.

Call our experienced legal team today at (419) 625-7770 to set up a free, no-obligation consultation.