Research Reports

A new analysis examines the history, form and function of the ICD-10 classification system for healthcare delivery, which takes effect October 1 for all health care systems in the U.S. – including California workers’ comp.

Initial data on AY 2014 lost-time claims indicate that average medical payments at 3 and 6 months post injury declined following implementation of SB 863, though the 12- and 24-month data on claims from prior years still show average losses trending up, led by ongoing increases in payments for prescription drugs and DME.

An analysis of 2015 independent medical review (IMR) decisions from the first quarter of 2015 shows no significant decline in IMR volume in the first three months of this year, even though the independent medical reviewers continue to concur with the utilization review (UR) physicians denial or modification of treatment in about 90 percent of the cases.

A new CWCI study examines changes in the use of physician networks in California workers’ comp from AY 2000 – June AY 2011, measures their impact on medical costs and compares the changing nature and characteristics of claims where treatment is managed inside and outside of networks.

A CWCI analysis of 2014 IMR decisions suggests that the medical dispute resolution process mandated by SB 863 is working to assure that treatment provided to California injured workers meet evidence-based medicine standards and is providing a needed check against unnecessary and potentially harmful tests, surgeries, drugs and procedures.

A review of DWCs 2009-2013 UR audit results show claims administrators had an average performance rating of more than 97% over the 5-year period.

Average facility fee payments to ambulatory surgery centers have declined 27% per episode and 29% per procedure since ASC fee schedule changes mandated by SB 863 were adopted in 2013. Click here for the full report published jointly by CWCI and the WCIRB.

The average amount paid for all California WC physician reports fell 37% from $26.13 in the 1st quarter of 2013 to $16.53 in the 1st quarter of 2014 as the state began to transition to the new RBRVS Fee Schedule, but that decline was due to changes in the underlying E&M services in the schedule and not a decrease in the fee schedule amounts assigned to report codes.

CWCIs latest study tracks inpatient hospital utilization trends, monitors changes in the use of implant-eligible spinal surgeries and estimates the savings from eliminating pass-through payments for spinal surgery hardware.

A new CWCI study monitors the growth in California Workers’ Compensation medical and indemnity payments from accident year 2002 to accident year 2014.

A new CWCI study assesses the potential impact of a state-mandated drug formulary in California Workers’ Compensation.

A new CWCI study finds that the average number of medical reports per claim provided by California workers comp treating physicians to claims administrators rose steadily for more than a decade prior to the adoption of the RBRVS fee schedule, fueled in part by increases in the average number of E/M services per claim and in the number of physician reports per E/M service, but claims organizations note that reports still dont always meet regulatory requirements or include all of the information needed for effective claims management.

A CWCI Research Update finds the use and cost of Schedule II and Schedule III painkillers to treat California injured workers has remained at record levels since 2010 and takes a fresh look at the prescribing patterns of doctors who write Schedule II opioid prescriptions.

Preliminary data show average facility fee payments to ambulatory surgery centers have declined 26 percent per episode and 28 percent per procedure since fee schedule revisions took effect January 1, 2013.

A new CWCI study measures the level of attorney involvement in Calif WC indemnity claims, and provides regional data on average payments and claim closure rates for these claims.

Medical dispute resolution is a vital component of all healthcare delivery systems. This study examines the key linkages between utilization review (UR) and independent medical review (IMR).

CWCI’s latest study tracks the Calif WC medical and indemnity benefit growth trends from AY 2002 – 2012

A new CWCI report examines the implications of the AMA’s recent reclassification of obesity as a treatable disease, and identifies and measures key differences between claims with and without obesity as a co-morbidity.

The latest CWCI Injury Score Card provides detailed data on claims in which the diagnosis falls in the “Other Injury, Poisoning and Toxic Effect category, which comprise 1 out of every 13 California workers’ comp claims, but 1 out of every 10 loss dollars.”

California Public Self-Insureds Reported Fewer Claims in 2012, But Claim Costs Remained Near 10-Year High