A new study by the California Workers’ Compensation Institute (CWCI) shows that the percentage of injured worker doctor visits to physician networks nearly doubled after 2004 legislative reforms allowed the development of workers’ compensation Medical Provider Networks (MPNs), and links most of that increase to the MPNs’ expansion of employer medical control beyond the first 30 days following the injury.
Using first-year medical visit data from more than one million California workers’ compensation claims with 2002-2006 injury dates, CWCI measured the percentage of injured worker outpatient treatment visits to network providers before and after the MPNs began operations in January 2005. The study showed that the network utilization rate rose from one-third of first-year doctor visits for 2002 job injuries to nearly half of the visits for 2004 injuries–the first claims in which treatment in the initial 12 months could have shifted to MPNs. The trend continued the next year, with networks accounting for 62 percent of doctor visits for 2005 injuries. To gauge how much of the increase in first-year network utilization was linked to the expansion of employer medical control, the study measured changes in the proportion of visits to network providers within and beyond 30 days of injury. Before MPNs were introduced, networks accounted for about two-thirds of physician-based inpatient medical visits in the first 30 days post injury, and after the MPNs took effect, that rate edged up to more than 70 percent. On the other hand, the network utilization rate for visits beyond 30 days postinjury more than doubled from about 23 percent for AY 2002 claims to nearly 54 percent for AY 2005 claims, indicating that the expansion of medical control under MPNs has been the key factor leading to increased network utilization in California worker’s compensation.
The study found that overall, the increasing share of first-year treatment payments to networks tracked with the growth in network utilization. Overall, payments to network providers rose from about one-third of total reimbursements for first-year visits for 2002 injuries to 39 percent for 2004 injuries, then climbed to more than half of the payments for first-year visits for 2005 injuries. Again, that growth was primarily driven by a sharp increase in the proportion of payments to networks for treatment more than 30 days after the injury.
The Institute has published the results of the study, including data tables showing the 2002–2006 network utilization rates and the proportion of payments for physician-based treatment visits within and beyond 30 days of injury for six major treatment categories, in a CWCI Research Update report, “Analysis of California Workers’ Comp Reforms: Part 3: Medical Provider Networks and Medical Benefit Delivery. The report is posted in the research section of the Institute’s website www.cwci.org.