Burden of Medical Cost of Workplace Injuries among

Hospital Workers

Hyun Kim, Jonathan Dropkin, Francine Smith, and Jacqueline Moline

Hofstra North Shore-LIJ School of MedicineNorth Shore-LIJ Health System

Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Hyun Kim

No relationships to disclose

(2) My presentation will include discussion of “off-label” use of the following:

No relationships to disclose

U.S. Bureau of Labor Statistics report (2010)

• Musculoskeletal disorders (MSDs) accounted for 28% of all workplace injuries and illnesses requiring time away from work

• Among all occupations, psychiatric aides had the highest incidence rate of 226 MSDs per 10,000 full-time workers (FTW), followed by emergency medical technicians and paramedics (234 MSDs/10,000 FTW), with an average rate of 33 MSDs per 10,000 FTW

What about costs for MSDs among healthcare workers?

• Back injuries alone are estimated to be $20 billion annually (OSHA)

• Average $6,837 (median $428) per WC claim in Washington State (1990-1998)

• No study has directly evaluated burden of costs from MSDs among healthcare workers

Objective

• We investigated MSDs and its medical costs among 47,343 employees in the health system during 2003-2007

• North Shore-Long Island Jewish Health System consists of 15 community and tertiary hospitals in NYC, Staten Island, and Long Island in NYS

Methods

• Only claims accepted and reimbursed medical expenses from Institutional WC claims from 2003 to 2009 were included

• MSDs were identified using ICD-9 codes reported to health insurance (Dunning, 2010)

• Age, gender, occupation, union membership, scheduled shift, and employment status were obtained

Methods

• Index searching program for occupation was developed in Stata, and validated by manually reviewing with uncoded data

• To investigate potential determinants of medical cost expenses, multivariable zero truncated negative binomial regression model was used

Poisson with long tail and no zero0

2040

60

Cum

ulat

ive

# of

cla

ims

in x

-sca

le

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40Medical cost ($10,000)

Mean: $6229Median: $1313

Overdispersion parameter Alpha: 2.5

Results

• Among 47,343 workers, 3,452 (7.3%) WC cases had their medical expenses reimbursed

• Average medical cost reimbursed was $6,229 (median: $1,313)

• 76% of these WC cases were MSDs• Average cost for MSDs ($7560) was 3.7 times

more than non-MSDs claims ($2,037)• Median cost for MSDs ($1,960) was 4.4 times

more than non-MSDs claims ($443)

MSDs Medical Cost by Age

<30 30-40 41-50 51-60 >600

5000

10000

5328 5550

76818557

9271

1269 13092100 2261

3000

MeanMedian

Age (year old)

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by Gender

Male Female0

5000

10000

6782

7832

15262157

MeanMedian

Gender

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by Occupation

PT/OT

EMT/Paramedic

Physicia

n

mental healt

h

Other healt

h professional

Nurse

Non-healthcar

e

Nursing a

ide/assis

tant

medical te

chnici

an0

5000

10000

15000

2595

5052

2685

908910560

62377734

9580 8890

732 811 1046 1440 1766 1908 2060 2601 2811

MeanMedian

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by Union Membership

Non-union member Union member0

5000

10000

6640

8500

16592346

MeanMedian

Union Membership

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by Shift

Day Night Evening0

5000

10000

7051

8032

9281

17312310

2934

MeanMedian

Scheduled Shift

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by Job status

Per diem Fulltime Parttime0

5000

10000

5567

7698 7562

13622001 2207

MeanMedian

Job Status

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by Patient Handling MSDs or not

MSDs from Patient Handling MSDs from non-Patient Handling0

5000

10000

6719

8213

1940 2020

Mean

Median

Patient Handling

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by body region

Hand/Wrist/Elbow Back Other/Multiple Shoulder Knees0

5000

10000

4185

7529

8693

6737

8568

754

2096 2341 2450 2755

MeanMedian

Body Region Affected

Med

ical

Cos

t Rei

mbu

rsed

($)

MSDs Medical Cost by Cause of Injury

Twisting

Lifting

Other stra

in or abrad

ed

Holding or C

arryin

g

Pushing

Other non-M

SD re

lated

0

5000

10000

4626

65417669

5982

8508 8791

1349 1807 1940 2010 2063 2205

Mean

Median

Cause of Injury

Med

ical

Cos

t Rei

mbu

rsed

($)

Comparison determinants between MSDs and medical cost for MSDs

Medical Cost MSDs

RR 95% CI RR 95% CIAge <30 1 1 1 1 1 1

30-39 1.2 0.9 1.5 0.8 0.7 0.9

40-49 1.5 1.2 1.9 0.7 0.7 0.8

50-59 1.6 1.3 2.1 0.6 0.6 0.7

<60 1.8 1.4 2.3 0.6 0.6 0.7

Gender

Male 1 1

Female 0.7 0.6 0.8 0.9 0.9 1.0

Comparison determinants between MSDs and medical cost for MSDs

Occupation Medical Cost MSDs

RR 95% CI RR 95% CI

Nurse 1 1

Physician 0.5 0.2 1.2 0.6 0.4 1.0

PT/OT 0.5 0.3 1.0 0.9 0.7 1.1

Nursing aide 1.6 1.4 2.0 1.0 1.0 1.1

EMS worker 1.2 0.9 1.6 1.1 1.0 1.2

Med tech 1.5 1.2 1.9 1.0 0.9 1.1

Mental health 1.8 1.1 2.9 1.0 0.8 1.2

Other health prof. 1.6 1.2 2.2 1.0 0.9 1.1

Non-healthcare 1.3 1.1 1.5 1.0 1.0 1.1

Comparison determinants between MSDs and medical cost for MSDs

Medical Cost MSDs

RR 95% CI RR 95% CI

Union membership

Non-Union 1 1

Union 1.1 1.0 1.3 1.0 0.9 1.0

Shift

Day 1 1

Evening 1.2 1.0 1.5 1.0 1.0 1.1

Night 1.2 1.0 1.4 1.1 1.0 1.1

Comparison determinants between MSDs and medical cost for MSDs

Medical Cost MSDs

RR 95% CI RR 95% CI

Job status

Per-diem 1 1

Fulltime 1.3 1.0 1.7 0.8 0.7 0.9

Parttime 1.3 0.9 1.7 0.8 0.7 0.9

Patient handling

No 1 1

Yes 0.9 0.8 1.0 1.2 1.2 1.3

Discussion

• If you are over 60 yr old (median $3,000), female ($2,157), medical tech ($2,811), union member ($2,346), evening shift ($2,934), and part-time hospital worker, then watch out!

• Although the chance to get MSDs is lower than other workers (RR=0.6 for 60 or older, RR=0.9 for female, RR=1 for med tech, RR=1 for union, RR=1 for evening shift, RR=0.8 for part-time)

Discussion

• Aging was a unique, strong factor for increasing medical costs, while it was a strong factor for decreasing MSDs

• The increased association with age may be due to the increasing risk of developing more severe MSDs with age, resulting from cumulative exposure of dose or slower recovery time than younger group

Limitation

• WC is not designed for epidemiologic investigation

• Better understanding is required to explain why certain factors showed association with medical cost, such as union membership, job status, and occupation

• Few studies conducted an economic analysis with WC among hospital workers, so we lack a comparison group

Conclusion

• Prevention of MSDs should also consider factors that increase cost of medical treatment for MSDs

• Especially for the aging workforce