A new California Workers’ Compensation Institute (CWCI) study shows a sharp reduction in the number of inpatient hospitalizations for California job injuries – including work-related back injuries — between 2002 and 2006, coinciding with implementation of workers’ comp reforms and reductions in the number of work injuries.
Using data on nearly 20 million 2002-06 hospital discharges from the state Office of Statewide Planning and Development, CWCI found that injured workers have consistently accounted for less than 1% of California inpatient hospital stays, but while the number of hospitalizations covered by group health, Medicare, MediCal, and other non-workers’ comp plans held steady, inpatient stays by injured workers fell more than 15%. The sharpest decline occurred in 2005, after workers’ comp medical care became subject to utilization controls, including treatment guidelines, mandatory utilization review, and second opinions for spinal surgery. The study notes that during this period, reported job injuries in California also fell sharply, with the number of work injury illness reports down 13% between 2002 and 2006, and the number of cases leading to days away from work down 26% – reductions that were undoubtedly reflected by the drop in workers’ comp hospitalizations as well.
Number of California Inpatient Hospitalization Discharges: WC vs. Non-WC Payors 2002-2006
|
2002 |
2003 |
2004 |
2005 |
2006 |
02-06 Total |
|
| Workers’ Comp |
31,348 |
30,736 |
29,247 |
27,542 |
26,552 |
145,425 |
| Non-Workers’ Comp |
3,885,015 |
3,948,889 |
3,928,393 |
3,962,713 |
3,970,630 |
19,695,640 |
| WC as % of Total |
0.81% |
0.78% |
0.74% |
0.70% |
0.67% |
0.74% |
A steady decline in the number of inpatient discharges for work-related back injuries, which fell 25% from 11,237 cases in 2002 to 8,385 cases in 2006 explains much of the overall decline in workers’ comp hospitalizations. In contrast, the number of hospital stays for back injuries covered by non-workers’ comp programs rose 4% over the same period. On the other hand, even with the reduction in the number of hospital stays for work-related back problems, back diagnoses still accounted for 1/3 of all California workers’ comp inpatient hospitalizations between 2002 and 2006, versus just 1.5 percent of non-workers’ comp hospitalizations.
Breaking down the data by specific diagnostic groups revealed significant differences between workers’ comp and other programs in the types of back conditions that result in inpatient care. For example, “medical back problems” (primarily back sprains) accounted for nearly 1/3 of non-workers’ comp back problems resulting in hospitalization — almost triple the proportion noted in workers’ comp. Focusing on just inpatient hospitalization cases that involved surgery, the study found 1/3 of the workers’ comp surgical discharges were spinal fusions except cervical (with and without complications) compared to 1/4 of non-workers’ comp surgical discharges. Conversely, just under half of the non-workers’ comp surgical discharges were back and neck procedures (with and without complications), while these diagnoses made up about 36 percent of the workers’ comp surgical back cases.
The study also noted that complications were far less prevalent in the workers’ compensation back surgeries, even though the average number of surgical procedures used in surgical back cases was similar to other systems, and for most diagnostic categories, the average number of surgical procedures in both workers’ compensation and non-workers’ compensation cases increased at about the same rate over the five-year span. After adjusting the surgical back data to control for differences in the mix of injuries between workers’ compensation and other systems, the Institute calculated and compared several variables associated with the intensity of service: average length of stay, average charge, average number of total procedures, and average number of surgical procedures.
Adjusted Service Intensity Indicators Associated w/02-06 Back Injury Inpatient Hospital Stays – Calif WC vs. Non-WC
|
2002 |
2003 |
2004 |
2005 |
2006 |
Total |
|
| Avg. Stay (days) | ||||||
| WC |
3.5 |
3.4 |
3.3 |
3.2 |
3.3 |
3.3 |
| Non-WC |
4.1 |
4.0 |
3.9 |
3.9 |
3.4 |
3.9 |
| Avg # of All Procedures | ||||||
| WC |
2.7 |
3.0 |
3.6 |
3.6 |
3.8 |
2.5 |
| Non-WC |
2.8 |
3.2 |
3.7 |
3.7 |
3.4 |
2.6 |
| Avg # of Surgical Procedures | ||||||
| WC |
2.2 |
2.3 |
2.7 |
2.7 |
2.7 |
3.3 |
| Non-WC |
2.3 |
2.4 |
2.8 |
2.7 |
2.5 |
3.5 |
| Avg Charge* | ||||||
| WC |
$56,363 |
$64,618 |
$69,832 |
$75,300 |
$83,964 |
$69,095 |
| Non-WC |
$56,109 |
$63,296 |
$69,191 |
$74,182 |
$72,925 |
$69,369 |
*Adjusted to 2002 dollars using BLS Medical price indices for Medical Care Services
The service intensity analysis, summarized above, found that on average, workers’ comp surgical back cases involved shorter hospital stays, fewer total procedures, and fewer surgical procedures for most of the study period, yet the average charge per hospital stay was similar to the average charged in other systems. This pattern reversed somewhat in 2006. Although the difference in length of stay between workers’ comp and non-workers’ comp surgical back inpatient hospitalizations fell by half a day in 2006, the difference in the average number of total procedures and the average number of surgical procedures increased, pushing the average charge for a workers’ comp surgical back hospitalizations up sharply, while average charges for non-workers’ comp surgical back hospital stays fell. It remains to be seen if this was a 1-year anomaly, or the beginning of a trend.
The Institute has published the complete results of the study in a CWCI Research Note, “Post Reform Changes in Inpatient Hospital Use and Back Surgery in the California Workers’ Compensation System,” which is available to Institute members and subscribers in the Research section of our website, www.cwci.org.