Provider Pulse

The SPORT studies were designed as randomized, prospective, multicenter trials and were supported by a $15 million grant from the National Institutes of Health. All patients were surgical candidates who had failed to improve with initial non-surgical treatment within six weeks and who had neurologic compression evidenced by imaging studies, with corresponding neurologic symptoms.

There were two arms in the SPORT studies. Those patients who were willing to be randomized made up the randomized control (RCT) group. Those that were unwilling to be randomized made up the observational (OBS) group. The greatest limitation of SPORT would be the potential for a high rate of crossover from the non-surgical to surgical groups and vice versa. As such, both an intent-to-treat analysis and an as-treated analysis were performed.

Overall, both surgically and non-surgically treated groups showed strong improvement. Based on intent-to-treat analysis, the surgical group had a slightly greater improvement than did the non-surgical group. In the OBS group, most patients underwent surgery. All primary outcome measures significantly favored surgical treatment. The surgical “treatment effect” was noted as early as six weeks, was greatest at six months and was maintained for more than four years (See Figure 1.). Additionally, the degree of improvement in back pain among surgically treated patients was greater than in the non-surgical group. The reoperation rate was 8 percent after two years and 10 percent after four years. Approximately one-half of the surgeries were for herniation at the same level.

The collection of patient-generated outcomes, in combination with a careful accounting of all management methods provided, has generated cost-effectiveness data demonstrating that surgical treatment of disc herniations provides significant value to the patient over the long term. The costs to surgically treat of disc herniations were found to be approximately twice those of non-surgical management with most of the costs occurring during the first six weeks after surgery, including time spent away from work during recovery.

Although there are obvious limitations to the SPORT study, it seemed to provide convincing evidence that early surgical treatment of lumbar intervertebral disc herniations provides a benefit both to the patient — as evidenced by better immediate and long-term outcome scores — and to the workers’ compensation system, with significantly decreased costs to treat injured workers.

However, as with most studies, a subgroup analysis of injured workers showed that the surgical benefit of a microdecompression equalizes between the operative and non-operative group at two years after surgery.

The SPORT studies were a massive undertaking and the results have been very useful in predicting outcome. The evidence seems to suggest that a surgical decompression for an acute herniated intervertebral disc is superior to non-surgical management, but that those superior results are reduced significantly in the injured worker population.

If a nurse case manager believes that a physician review is appropriate for a particular clinical treatment plan, the nurse is able to schedule a clinical assessment by one of 26 physician advisers who are regularly on-site. In addition, physician advisers who have expertise in less frequently encountered types of clinical assessments are available off-site for nurse case managers. All clinical reviews are expected to conform to Colorado Division of Workers’ Compensation Medical Treatment Guidelines and Division Medical Rules.

As I have had the opportunity to meet with medical groups and physicians around Colorado who care for injured workers, I have received very positive feedback about the reviews and clinical appropriateness decisions which have been provided by physician advisers. Physicians have told me that they recognize the physician advisers who perform the clinical assessments as colleagues with whom they work in caring for Colorado injured workers.

I look forward to continuing to support this critical review process that is performed by independent physician advisers. Pinnacol looks to enhance the program to provide independent physician adviser review as new areas of clinical practice are identified to improve care for Colorado injured workers. Please feel free to contact me through the Pinnacol medical operations team's main line, 303.361.4945, if you see opportunities to further enhance or improve the Physician Adviser Program.

Results, obtained from the data set published on March 16, show that five SelectNet clinics — out of more than 200 PCP clinics participating in CPI — achieved the five-star rating. They are:

• Aviation & Occupational Medicine, Denver
• Exempla — Family & Occupational Medicine, Green Mountain
• Denver Health Center for Occupational Safety and Health, Denver
• Integrity Urgent Care, Colorado Springs
• Onsite Injury Care, Colorado Springs

Pinnacol congratulates each of these outstanding clinics, and we thank them for their hard work and commitment to provide excellent care and service to our mutual customers.

Our CPI achievements will allow injured workers to experience an improved service environment, our policyholders to make informed designated medical provider selections and our high-performing medical clinics to take advantage of performance rewards and marketing opportunities. For a complete list of PCP clinic ratings and performance information, visit the online SelectNet provider directory.

If you have any questions regarding the CPI, please contact Pinnacol’s medical operations team at 303.361.4945 and speak to the provider relations specialist assigned to your geographic region of Colorado.

Pinnacol is in the process of mailing formal, written notification to all providers about this change.

If you require a username and password to access the SelectNet website and view the revised manual, or if you have any questions regarding the upcoming notification process, please call 303.361.4945 and speak to the provider relations specialist assigned to your contract.

Speakers include Dr. Bart Goldman and Dr. Greg Reichhardt, Rehabilitation Associates of Colorado and Dr. Ron Carbaugh, PsyD. Panelists include:

• Division of Workers’ Compensation Administrative Law Judge Craig Eley
• Attorney Kerry Sullivan of Sullivan, Sullivan and McGuire
• Attorney Frank Cavanaugh of Ruegsegger, Simons, Smith and Stern, LLC

Save the date cards have been mailed and invitations will be sent via email when online registration begins on Aug. 1, 2012.