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Introduction/aims: In prior work, higher quality care for work‐associated carpal tunnel syndrome (CTS) was associated with improved symptoms, functional status, and overall health. We sought to examine whether quality of care is associated with healthcare expenditures or disability. Methods: Among 343 adults with workers' compensation claims for CTS, we created patient‐level aggregate quality scores for underuse (not receiving highly beneficial care) and overuse (receiving care for which risks exceed benefits). We assessed whether each aggregate quality score (0%–100%, 100% = better care) was associated with healthcare expenditures (18‐mo expenditures, any anticipated need for future expenditures) or disability (days on temporary disability, permanent impairment rating at 18 mo). Results: Mean aggregate quality scores were 77.8% (standard deviation [SD] 16.5%) for underuse and 89.2% (SD 11.0%) for overuse. An underuse score of 100% was associated with higher risk‐adjusted 18‐mo expenditures ($3672; 95% confidence interval [CI] $324 to $7021) but not with future expenditures (−0.07 percentage points; 95% CI −0.48 to 0.34), relative to a score of 0%. An overuse score of 100% was associated with lower 18‐mo expenditures (−$4549, 95% CI −$8792 to −$306) and a modestly lower likelihood of future expenditures (−0.62 percentage points, 95% CI −1.23 to −0.02). Quality of care was not associated with disability. Discussion: Improving quality of care could increase or lower short‐term healthcare expenditures, depending on how often care is currently underused or overused. Future research is needed on quality of care in varied workers' compensation contexts, as well as effective and economical strategies for improving quality. [ABSTRACT FROM AUTHOR]

Objective: The objective was to describe characteristics of civil monetary penalties levied by the Office of the Inspector General (OIG) related to violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies. Methods: Descriptions of EMTALA‐related civil monetary penalty settlements from 2002 to 2018 were obtained from the OIG. Cases related to psychiatric emergencies were identified by inclusion of key words in settlement descriptions. Characteristics of settlements involving EMTALA violations related to psychiatric emergencies including date, amount, and nature of the allegation were described and compared with settlements not involving psychiatric emergencies. Results: Of 230 civil monetary penalty settlements related to EMTALA during the study period, 44 (19%) were related to psychiatric emergencies. The average settlement for psychiatric‐related cases was $85,488, compared with $32,004 for non–psychiatric‐related cases (p < 0.001). Five (83%) of the six largest settlements during the study period were related to cases involving psychiatric emergencies. The most commonly cited deficiencies for settlements involving psychiatric patients were failure to provide appropriate medical screening examination (84%) or stabilizing treatment (68%) or arrange appropriate transfer (30%). Failure to provide stabilizing treatment was more common among cases involving psychiatric emergencies (68% vs. 51%, p = 0.041). Among psychiatric‐related settlements, 18 (41%) occurred in CMS Region IV (Southeast) and nine (20%) in Region VII (Central). Conclusions: Nearly one in five civil monetary penalty settlements related to EMTALA violations involved psychiatric emergencies. Settlements related to psychiatric emergencies were more costly and more often associated with failure to stabilize than for nonpsychiatric emergencies. Administrators should evaluate and strengthen policies and procedures related to psychiatric screening examinations, stabilizing care of psychiatric patients boarding in EDs, and transfer policies. Recent large, notable settlements related to EMTALA violations suggest that there is considerable room to improve access to and quality of care for patients with psychiatric emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Higher quality care for carpal tunnel syndrome (CTS) may be associated with better outcomes.Methods: This prospective observational study recruited adults diagnosed with CTS from 30 occupational health centers, evaluated physicians' adherence to recommended care processes, and assessed results of the Boston Carpal Tunnel Questionnaire (BCTQ) and Short Form Health Survey version 2 (SF-12v2) at recruitment and at 18 months.Results: Among 343 individuals, receiving better care (80th vs. 20th percentile for adherence) was associated with greater improvements in BCTQ Symptom Severity scores (-0.18, 95% confidence interval [CI] -0.32 to -0.05), BCTQ Functional Status scores (-0.21, 95% CI -0.34 to -0.08), and SF12-v2 Physical Component scores (1.75, 95% CI 0.33-3.16). Symptoms improved more when physicians assessed and managed activity, patients underwent necessary surgery, and employers adjusted job tasks.Discussion: Efforts should be made to ensure that patients with CTS receive essential care processes including necessary surgery and activity assessment and management. Muscle Nerve 57: 896-904, 2018. [ABSTRACT FROM AUTHOR]

Objective The objective was to describe characteristics of civil monetary penalty settlements levied by the Office of the Inspector General ( OIG) against individual physicians related to violation of the Emergency Medical Treatment and Labor Act ( EMTALA). Methods Descriptions of all civil monetary penalty settlements between 2002 and 2015 were obtained from the OIG. Characteristics of settlements against individual physicians related to EMTALA violations were described including settlement date, location, amount, whether there was an associated hospital settlement, the medical specialty of the physician involved, and the nature of the allegation. Results Of 196 OIG civil monetary penalty settlements related to EMTALA, eight (4%) were levied against individual physicians, and 188 (96%) against facilities. Seven of the eight penalties against individual physicians were imposed upon on-call specialists, including six who failed to respond to evaluate and treat a patient in the emergency department ( ED), and one who failed to accept appropriate transfer of a patient requiring higher level of care. The only penalty imposed on an emergency physician involved a case where a provider repeatedly failed to provide a medical screening examination to a pregnant teen based on the erroneous belief that a minor could not be evaluated or treated absent parental consent. Four of eight penalties against individual physicians were levied within the first 3 years of the 14-year study period. Half of all physician settlements were associated with a separate hospital civil monetary penalty settlement. Conclusions For emergency physicians, a civil monetary penalty is a feared consequence of EMTALA enforcement, as a physician can be held individually liable for fine of up to $50,000 not covered by malpractice insurance. Although EMTALA is an actively enforced law, and violation of the EMTALA statute often results in hospital citations and fines, and occasionally facility closure, we found that individual physicians are rarely penalized by the OIG following EMTALA violation. Individual physician penalties are far less common than hospital citations or fines related to EMTALA or malpractice claims or payments. The majority of penalties against individual physicians were levied upon on-call specialists who refused to evaluate and treat ED patients. Only one emergency physician was fined during the study period for a clear violation of the EMTALA statute. Physicians should be diligent to ensure appropriate patient care and that facilities are compliant with the EMTALA statute, but should be aware that settlements against individual physicians are a rare consequence of EMTALA enforcement. [ABSTRACT FROM AUTHOR]

Background We combined federal and state administrative data to study the long-term earnings losses associated with occupational injuries and assess the adequacy of workers' compensation benefits. Methods We linked state data on workers' compensation claims from New Mexico for claimants injured from 1994 to 2000 to federal earnings records from 1987 to 2007. We estimated earnings losses up to 10 years after injury and computed the fraction of losses replaced by benefits. Results Workers with lost-time injuries lost an average of 15% of their earnings over the 10 years after injury. On average, workers' compensation income benefits replaced 16% of these losses. Men and women had similar losses and replacement rates. Workers with minor injuries had lower losses but also had lower replacement rates. Conclusion Earnings losses after an injury are highly persistent, even for comparatively minor injuries. Income benefits replace a smaller fraction of those losses than previously believed. Am. J. Ind. Med. 57:1165-1173, 2014. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This paper studies whether newly created firms have higher injury rates than established firms. We use data on a large sample of single-establishment firms in Pennsylvania from 2001-2005 to examine the relationship between firm age and the risk of lost workday injuries. Using the full set of firms, there appears to be little overall correlation between firm age and risk. If anything, newer firms appear less likely to have lost workday injuries. When we condition on having at least one injury reported in 2000, however, we find that in later years the injury risk of firms declines with age. This pattern is consistent with systematic underreporting of injuries by new firms. [ABSTRACT FROM AUTHOR]

Workers' compensation systems are typically designed to assign higher permanent disability benefits to workers with more severe disabilities. However, little or no scientific work exists to guide the design of ratings systems to properly account for the amount of earnings power lost due to disability. In this article, we examine the effectiveness of disability ratings using matched administrative data on ratings and earnings for a large, representative sample of permanent disability claimants in California. We find that while workers with higher ratings do experience larger earnings losses on average, there are large and persistent differences in average earnings losses for similarly rated impairments in different parts of the body. We then explore how adjusting permanent disability ratings to reflect cross-impairment differences in earnings losses can affect the equity of permanent disability benefits. Adjusting disability ratings to account for typical earnings losses reduces cross-impairment differences substantially. The adjusted ratings result in a more equitable distribution of disability benefits across workers with different impairments. [ABSTRACT FROM AUTHOR]

About half of injured workers choose not to file workers' compensation claims. This is thought to result from their use of health insurance instead of workers' compensation. However, the data suggest that insured workers are actually less likely to file than their more vulnerable uninsured counterparts. We found that this relationship emerges as the result of employer characteristics and, in particular, that employers who offer health insurance to employees are more likely to have workers who file claims; this is much more important than the insurance status of workers themselves or fixed worker characteristics. [ABSTRACT FROM AUTHOR]

Physician evaluations of impairment severity have a significant impact on the size of permanent disability benefits awarded to injured workers in workers' compensation. This gives both parties in a disputed claim the incentive to “shop” for physicians who will provide them with sympathetic evaluations. In this article we use data from the California workers' compensation system on competing physician evaluations for the same injury to study the extent to which the ability to select a physician results in a more favorable disability rating. We find that disability ratings based on evaluations from physicians selected by the applicant are 23 percent higher than those based on a neutral evaluation, while ratings based on a defense physician's evaluation tend to be about 5 percent lower. Moreover, we match these data to earnings loss data and estimate the extent to which applicant, defense, or neutral ratings best predict the outcomes of injured workers. The neutral ratings appear to do the best job of predicting earnings losses overall, though not by a substantial margin. [ABSTRACT FROM AUTHOR]

Debate over civil justice reform in the United States frequently centers on the extent to which damage awards granted by juries have been escalating over time. However, past studies on civil juries have been hampered by lack of data on verdicts spanning a sufficiently long time period. Average jury awards tend to be highly variable from year to year, making it difficult to distinguish trends over relatively short periods of time. We use the longest time series of data on jury verdicts ever assembled: 40 years of data on tort cases in San Francisco County, CA and Cook County, IL collected by the RAND Institute for Civil Justice. We find that while there has been a substantial increase in the average award amount in real dollars, much of this trend is explained by changes in the mix of cases, particularly a decreasing fraction of automobile cases and an increase in medical malpractice. Claimed economic losses, in particular claimed medical losses, also explain a great deal of the increase. Although there appears to be some unexplained growth in awards for certain types of cases, this growth is cancelled out on average by declines in awards in other types of cases. [ABSTRACT FROM AUTHOR]