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Ohio BWC rules: Conservative Care (including Chiropractic) before Lumbar Surgery


A rule change was recently issued by the Ohio Bureau of Workers’ Compensation (BWC) regarding payment for lumbar fusion surgery. If approved by state lawmakers it would become effective January 1, 2018.​

Under BWC's new spinal fusion rule, the agency requires workers with low back injuries to first undergo at least 60 days of comprehensive conservative care before a surgical option will be considered.

Chiropractic treatment is among the conservative treatment options as well as rest, ice, physical therapy, anti-inflammatories and other non-surgical therapies.

According to the BWC, “The rule follows several studies of BWC data by BWC Chief Medical Officer Dr. Stephen T. Woods, researchers at Case Western University School of Medicine and others that found fusion patients suffered considerably worse outcomes than non-fusion patients. Those outcomes included chronic opioid dependence, increased disability and high rates of failed back syndrome, as well as additional surgery and new psychiatric co-morbidities. One study in the journal Orthopedics found nearly 77 percent of fusion patients did not return to work within two years.”

“The rule does not expressly prohibit opioid use for pain management, but calls for "avoidance when possible." Under BWC's new opioid rule passed last year, physicians must follow best practice guidelines when prescribing the drugs or risk sanctions.”

“The spinal fusion rule now moves to the Joint Committee on Agency Rule Review, a bipartisan panel of state lawmakers. If approved there, it would become effective Jan. 1, 2018.”

Sources: Ohio BWC

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