test research report

An Examination of Polypharmacy Claims

A study that uses 2016 – 2017 California workers’ compensation prescription data to determine the prevalence of polypharmacy in the system and to identify the types of drugs used in polypharmacy prescribing..

Integrating COVID-19 Presumptions into California Workers’ Compensation

A CWCI Report examines the historic role of WC presumptions, the current and proposed COVID-19 presumptions, and results of a survey detailing characteristics and outcomes of initial COVID-19 claims.

IMR Decisions, January 2014 Through March 2020

The number of IMR determination letters in California workers comp fell 11.3% in 2019, led by a sharp decline in prescription drug disputes, with initial data from 2020 showing the decline is continuing.

Trends in the Utilization and Reimbursement of Professional Medical Services in California Workers Compensation, 2013-2018

CWCI’s analysis of changes in the volume and reimbursement of California workers comp professional medical services from 2013-2018, which includes the 4-year transition to the RBRVS fee schedule that began in 2014. The study reviews data from nearly 36 million medical services rendered to injured workers during that period to measure shifts in the mix of services and payments across and within 9 major services categories, and discusses the underlying changes to the fee schedule that affected those moves.

The Impact of Declining Opioid Use on Lost-Time Claim Development and Outcomes in California WC

A 30-page CWCI Report to the Industry details CWCI research that quantifies the declining prevalence of opioids in workers comp lost-time claims, the impact on average benefit payments and average days away from work, and in light of the opioid trends, estimates projected costs for 2010-2017 claims at 10 years of development.

Post-Reform Medical Service Approval Rates in California WC

A new CWCI study on California workers comp medical care approval rates shows 94% of all treatment services performed or requested for injured workers in the first 10 months of 2018 were either approved or approved with modifications, though outcomes varied by type of service.

California Workers’ Compensation Inpatient Hospitalization Trends, 2010-2018

CWCI’s updated look at changes in the volume of inpatient hospitalizations in WC, Medicare, Medi-Cal and private plans from 2010-2018. The study shows the most common WC inpatient diagnosis-related group codes (MS-DRGs) and the top 5 Major Diagnostic Categories (MDCs); and provides detailed data on other workers compensation inpatient trends, including changes in the volume of implant-eligible spinal surgeries and a listing of the top 10 hospitals based on injured workers as a percent of their total inpatient discharges. CWCI members and subscribers can log in to view the summary Bulletin under the Communications tab, and the full report under the Research tab. Institute members can also log in to access the updated version of the Inpatient Hospital interactive tool from the Research section. CWCI members and subscribers who log in may read the full report, others may purchase a copy from the Store.

IMR Decisions: January 2014 Through December 2018

Independent Medical Review Volume and Outcomes Through Q4 2018. For further details, see the news release in the Communications section.

Calif WC Pharmaceutical Utilization and Reimbursement: Emerging Outcomes Under the Formulary

California WC Rx Drug Utilization & Reimbursement: Part 2 Emerging Outcomes Under the Formulary A CWCI Spotlight Report examines the impact that the Medical Treatment Utilization Schedule has had on the types of medications dispensed to injured workers and recent shifts in the total drug spend.

California Workers’ Compensation Prescription Drug Utilization & Payment Distributions, 2009-2018: Part 1

CWCI’s analysis of changes in the types of prescription drugs used in California workers’ compensation over the past decade. The report looks at the breakdown of prescriptions and payments by therapeutic drug group by service year, as well as the generic utilization rates for the different drug groups and how the average amounts paid for drugs within each group changed over the 10-year study period.

IMR Decisions, January 2014 Through June 2018

Independent Medical Review Volume and Outcomes Through Q2 2018. For further details see the news release in the Newsroom and CWCI members and subscribers may log in to view a summary Bulletin and the Research Update report.

Initial UR & IMR Rx Drug Outcomes Under the Formulary

Using data from 141,643 pharmaceutical requests and UR decisions from the first five months of 2017 and 2018, and 58,604 IMR decisions from the first four months of those same two years, CWCI takes a preliminary look at changes in pharmaceutical UR and IMR outcomes in the first few months after Californias WC Formulary took effect.

California Workers’ Compensation Inpatient Hospitalization Trends

CWCI research measures and compares changes in the volume of inpatient hospitalizations in WC, Medicare, Medi-Cal and private plans from 2008-2016, notes the most common WC inpatient diagnosis-related group codes (MS-DRGs) and the top 5 Major Diagnostic Categories (MDCs); and provides detailed data on other workers compensation inpatient trends, including average length of stay and changes in the volume of implant-eligible spinal surgeries.

CWCI Prescription Drug Interactive Tool

An online application that CWCI members can use to examine and compare industrywide prescription drug data derived from 12.5 million prescriptions dispensed to injured workers between January 2007 and June 2017.

Claims Monitoring: AY 2015-2016 Claims

From Bob

Opioids in California Workers’ Comp Claims With Mental Health Disorders

A CWCI analysis of the prevalence, volume and strength of opioid prescriptions in California work injury lost-time claims that involve a mental health component.

California WC Formulary – Part II: A Review of the July 2017 Proposed Formulary Drug List of Exempt and Non-Exempt Drugs

A CWCI Spotlight Report uses 2015 and 2016 workers’ comp prescription drug data to measure the potential impact of DWC’s proposed Formulary.

Injury Classification in California Workers’ Comp, Part 1: Medical Coding During the ICD-10 Transition

A new analysis on the use of ICD-10 codes in California workers comp during the transition from the ICD-9 system finds that 99 percent of submitted medical bills used ICD-10 codes and, as expected, a wider range of codes were provided than in the past, but many lacked the additional characters that better define the injury, identify the type of encounter and improve communication.

CWCI IRIS Regional Score Card: Sierra Claims

CWCI Study Examines the Impact of the California Workers Comp FormularyClaims filed by workers living in the Sierras represent just 1.7% of California workers’ comp claims, but over the past decade average loss payments in the region have grown faster than in other parts of the state. CWCI’s final Regional Score Card takes a close look at key aspects of Sierra claims and compares the results to those from other regions.

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