The number of inpatient hospitalizations in California workers’ compensation fell 22.8% between 2008 and 2014, exceeding the declines noted for California hospital stays paid under Medicare and private coverage, and in sharp contrast to the growth in Medi-Cal inpatient hospitalizations that followed the introduction of the Affordable Care Act and Medi-Cal’s absorption of the Healthy Families Program.
The new figures come from a California Workers’ Compensation Institute (CWCI) study that quantifies and compares the use of inpatient services and procedures in different systems using data compiled by the state on more than 24 million hospitalizations from 2008 through 2014. Workers’ compensation is by far the smallest program analyzed, accounting for just 151,545 (0.6 percent) of the inpatient stays over the 7-year study period. The number of hospital stays by discharge year and payer is shown in the table below.
Number of California Hospital Discharges (2008 – 2014) by Payer Group
| Discharge Year | Medicare | Medi-Cal | Private Coverage | Workers’ Comp |
| 2008 | 1,250,549 | 1,027,877 | 1,397,452 | 24,093 |
| 2009 | 1,256,097 | 1,036,376 | 1,351,040 | 22,410 |
| 2010 | 1,286,035 | 1,035,387 | 1,288,686 | 22,416 |
| 2011 | 1,285,300 | 1,022,199 | 1,257,356 | 22,165 |
| 2012 | 1,267,634 | 1,013,248 | 1,222,199 | 21,532 |
| 2013 | 1,257,843 | 1,000,269 | 1,163,669 | 20,336 |
| 2014 | 1,227,999 | 1,167,930 | 1,148,441 | 18,593 |
| 2008 – 2014 Net Change | -1.8% | -17.8% | -22.8% | |
| 2013 – 2014 Change | -2.4% | -1.3% | -8.6% |
In addition to quantifying reductions in workers’ compensation inpatient hospitalizations in 2014 and over the past 7 years, the study identifies the 10 most common inpatient diagnosis-related group codes (MS-DRGs) in workers’ comp for 2013 and 2014; calculates the average charged and paid amounts for the top 10 workers’ comp MS-DRGs; and measures changes in the volume of implant-eligible spinal surgeries and in the proportion of spinal fusion MS-DRG discharges to total discharges across time for each payer group. That analysis found a 21 percent reduction in the number of California workers’ compensatopm implant-eligible spinal surgeries between 2012 and 2014, which coincided with continued development of evidence-based medicine, utilization review, and independent medical review, fee schedule changes, and the phase out and ultimate repeal of duplicate “pass-through” payments for hardware used in workers’ compensation spinal surgeries.
CWCI members and subscribers can access the report and a summary Bulletin at www.cwci.org, while others can purchase a copy for $19 at www.cwci.org/shop.