Factors influencing the cost of chronic low back injuries: An analysis of data from independent medical examinations

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Abstract
Cost factors were examined in 157 patients with work- related spine injuries who were referred to a second opinion program between 1985 and 1991. The independent medical examination (IME) included a history, physical examination, and review of imaging and other studies. Data on demographic variables, litigation, work, injury history, physical examination, and imaging studies were recorded. A standard measure of psychological status (Low Back Pain Symptom Check List) was filled out. The instrument uses pain language as a clinical marker of psychological disturbance linked to a range of conflictual issues such as suppressed anger, burdensome feeling of inferiority, damaged self- esteem, role confusion, abnormal mentation, fear of responsibility or intimacy, gender issues, sexual concerns, disturbing arousal, and the like. Since it relies exclusively on pain language for diagnosis, it does not identify the specific nature of the psychological conflict. Data on treatment, final resolution, and cost were obtained from computerized files of the insurance company. The total cost incurred was $6,551,139. This averaged to $41,727 per case. More expensive cases were associated with a surgical intervention, psychological disturbance, litigation, motor weakness, and positive radiographs. These five variables accounted for 48% of the cost variance. Surgery accounted for 19.9% of the variance and contained the most expensive cases ($68,310 vs. $31,423). Psychological disturbance was detected in 27% of the sample and accounted for 10.5% of the cost variance. Litigation was present in 72% of the cases and accounted for 9.1% of the cost variance. Motor strength and radiographs taken together accounted for 8.4% of the variance. The usefulness of this information was explored from an actuarial and medical perspective.