A new CWCI study was conducted to assess the association between recent statutory and regulatory reforms and changes in pharmaceutical utilization and reimbursement patterns in the California workers’ compensation system. Some of the key findings include:
Research Reports
Schedule II Prescription & Payment Distributions in California WC: 2005 – 2008
California workers’ compensation law provides that injured workers are entitled to all reasonable and necessary medical care to cure or relieve the effects of a work-related injury or illness.
Analysis of California WC Reforms Part 4: Changes in Medical Payments, AY 2002 to 2007 Claims Experience
A new CWCI study shows significant increases in California workers’ comp medical payments since AY 2005, with amounts paid for treatment, pharmaceuticals and durable medical equipment, med-legal reports, and medical management all on the rise.
Calif. WC Reform Monitoring Series, Part 3: TD Outcomes AY 2002-07
Updated data on temporary disability claim outcomes under SB 899 finds that while the average TD paid on lost-time claims in California at 12 and 24 months remain less than pre-reform levels, average TD payouts for recent injury claims have increased and are nearing pre-SB 899 levels.
Medical Provider Networks and Medical Benefit Delivery AY 2002 – 2007 Experience
The latest CWCI Research Update on post-reform medical outcomes shows an ongoing shift toward the use of medical networks for the treatment of injured workers in California. The full report is in the Research section.
Post-Reform Changes in Inpatient Hospital Use and Back Surgery
A new CWCI study shows a sharp drop in the number of inpatient hospitalizations for California job injuries, including work-related back injuries, between 2002 and 2006, coinciding with the implementation of workers’ comp reforms and reductions in the number of reported work injuries.
Changes in Medical Cost Containment Payments AY 2002-2007
The first report in the CWCI’s latest 4-part research series on California workers’ comp reform outcomes finds that the average amount paid for medical cost containment (e.g. medical bill review, medical case management, UR and network fees) continue to increase, though preliminary data from accident years 2006 and 2007 show overall medical payments per claim, which declined sharply from 2002 to 2005, were up in AY 2006 and 2007. The full report on the study is posted in the Research section of the website, and CWCI members and subscribers may download a summary bulletin on the report from the Member section.
Pain Management and the Use of Opioids in the Treatment of Back Conditions in the California Workers’ Compensation System
The study analyzed more than 166,000 California work injury claims for back conditions with no spinal cord involvement and found an association between higher levels of opioid use with higher costs and a higher prevalence of other adverse outcomes such as increased likelihood of lost time from work, delayed recovery and more litigation. The study adds to scientific literature that suggests that at higher levels of use, opioids can have an adverse impact on both activity levels and on self-efficacy, and that prolonged administration of pain medication may impede rather than facilitate injured workers’ recovery from occupational back injuries.
Changes in Medical Cost Containment Payments
This analysis shows that recent California workers’ compensation reforms may be associated with higher medical cost containment payments. These preliminary findings indicate that increased utilization review resulting from the application of evidence-based medical treatment guidelines has contributed significantly to an observed increase in medical cost containment payment.
Medical Provider Networks and Medical Benefit Delivery; Accident Years 2002 – 2006 Claims Experience
This study analyzed medical provider network utilization rates, following the introduction of MPNs in January 2005. Using the Industry Claims Information System (ICIS) database, CWCI compiled first-year medical visit data for a large sample of pre- and post-MPN services and measured changes in the proportion of services rendered by network providers for accident years 2002 – 2006.
Temporary Disability Outcomes; Accident Years 2002 – 2006 Claims Experience
This study analyzed changes in temporary disability (TD) outcomes following implementation of SB 899 – the workers’ compensation reform legislation signed by Governor Schwarzenegger in 2004 which established a maximum of 104 weeks of paid TD within two years of the first TD payment for most injuries.
Medical Utilization & Reimbursement Outcomes for Accident Years 2002 – 2006 Claims
This study presents data on associations between the California workers’ compensation medical reforms implemented in 2004 – most notably, mandatory utilization review, the ACOEM guidelines, and the 24-visit cap on physical therapy and chiropractic care – and changes in the amount of treatment provided to injured workers, and the associated medical reimbursements.
Injury Scorecard – Other Non-Specific Diagnoses of Musculoskeletal Systems
The enclosed Score Card is the seventh and last in the ICIS injury series and provides detailed data and graphics on California work injury claims involving other non-specific diagnoses of musculoskeletal systems. Based on CWCI Industry Claims Information System (ICIS) data, these injuries are among the most common diagnoses in California workers’ compensation, and although many of these injuries appear relatively simple, they tend to be marked by high levels of physical therapy and chiropractic manipulation, delays in initial treatment and claim closure, a high rate of attorney involvement, and 1 out of every 7 results in a permanent disability.
Injury Scorecard – Other Nonspecific Diagnoses of Musculoskeletal Systems – Supplemental Reports
These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard injuries associated with other nonspecific diagnoses of musculoskeletal systems.
The Utilization of Physical Medicine in California Workers Comp Following Implementation of Mandatory UR and 24-Visit Caps
The goal of this physical therapy and chiropractic manipulation analysis was to determine any emerging correlations between the implementation of the utilization review program effective January 1, 2003, the 24-hour visit vap effective on January 1, 2004 and changes in the average utilization and cost of these services.
Post-Surgical Physical Medicine & Chiropractic Manipulation – Preliminary Results
The goal of this study was to advance the debate over the use of post-surgical physical therapy and chiropractic manipulation in the medical treatment of injured workers.
Injury Scorecard – Carpal Tunnel Syndrome
The enclosed Score Card is the sixth in the ICIS injury series and provides detailed data and graphics on California work injury claims involving Carpal Tunnel Syndrome. Based on CWCI Industry Claims Information System (ICIS) data, these injuries account for just over 1% of all California work injuries, but almost 3% of workers’ compensation benefit payments as these claims typically remain open much longer than claims for other injuries; involve more medicine section services, surgical procedures and physical therapy; and nearly a third of them result in a permanent disability – three times the rate noted for all injuries.
Injury Scorecard – Carpal Tunnel Syndrome – Supplemental Exhibits
These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with carpal tunnel syndrome.
Injury Scorecard – Degenerative, Infective or Metabolic Joint Disorders
The enclosed Score Card is the fifth in the ICIS injury series and provides detailed data and graphics on California work injury claims involving degenerative, infective or metabolic joint disorders . Based on CWCI Industry Claims Information System (ICIS) data, these injuries account for 3% of job injuries in California, but almost 6% of workers’ compensation payments, as treatment plans for these injuries rely heavily on radiology, physical therapy and surgery, and a quarter of these injuries result in a permanent disability – double the proportion noted for all work injuries.
Injury Scorecard – Degenerative, Infective or Metabolic Joint Disorders – Supplemental Exhibits
These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with degenerative, infective or metabolic joint disorders.