Cutting costs and lost work time.

A public utility saved more than $4,100,000 in workers' back and knee injury costs by establishing a quality care assurance program for its 5,300 employees. Workers at the Potomac Electric Power Co., Washington, D.C., returned to the job sooner, had less surgery, and the surgery success rate increased when the utility instituted this surveillance system, reports Sam Wiesel, an orthopedic surgeon at Georgetown University Medical Center, Washington, D.C.

Under the system, employees could choose their own private physicians, but were required to report any occupational accident within 24 hours and be examined at the utility's central medical facility as soon as possible, Each worker incurring a musculoskeletal injury that resulted in lost time from work was seen by a physician on the company's medical team and an orthopedic consultant within one week. An unbiased reviewer was responsible for quality care assurance and monitored the clinical course.

"The treatment plan of the employee's doctor was compared to the utility's standardized diagnostic and treatment protocols for musculoskeletal injuries," Wiesel explains. if there was a difference, the orthopedic consultant contacted the employee's physician. When there was disagreement, a...