Research Reports

The goal of this analysis was to measure the average amounts paid and the percentage change in the average payment for common medical services by fee schedule section before and after the revision of the California Workers Compensation Physician Services Fee Schedule. Fee changes included in this study took affect on July 1, 2004, January 14, 2005, and May 14, 2005.

This analysis compared the average amounts paid under the revised outpatient surgery facility fee schedule effective on January 1, 2004 to the average payments for the same services prior to adoption of the schedule.

This study compares recovery and cost outcomes and the use of common medical procedures 1) not recommended by the ACOEM Guidelines and 2) those recommended with optimal targets (PT and chiro services). Results show that when treatment exceeded ACOEM-recommended levels, medical and indemnity payments, treatment durations, and the number of paid TD days were significantly higher for many medical service categories.

This study compares the evidence base and medical recommendations underlying different medical treatment guidelines for low back injury. The results show that different guidelines often have fundamentally different recommendations in regard to appropriate services and frequency of treatment for low back injuries — a lack of agreement that can produce conflict and debate within the workers compensation system.

This report established baseline medical utilization data to begin to track trends subsequent to the inception of AB749.

This analysis compares vocational rehabilitation payments prior to 2004 to the maximum voucher amounts allowed by the new Supplemental Job Displacement Benefit program that took effect for injuries on and after January 1, 2004.

In 2004, state lawmakers were considering a proposal to cap the payment of temporary disability beyond two years. To evaluate the potential impact of such a move, policymakers needed to know what proportion of claims involved more than two years of paid TD benefits and the proportion of TD paid after the two-year threshold. Results of this analysis hinged on the specific start and stop points state lawmakers used to define the two-year time frame.

This report traces the history and development of evidence-based medicine (EBM) and weighs the potential impact of the American College of Occupational and Environmental Medicine (ACOEM) guidelines by comparing ACOEM guideline recommendations to existing treatment and disability patterns among injured workers in California. The analysis modeled detailed medical and disability data from more than 1 million workplace injuries reflecting $8.6 billion in workers’ compensation benefit payments. The study found that applying the objective ACOEM guideline criteria could significantly increase quality of care, reduce unnecessary medical costs and facilitate return-to-work for the low-back injuries.

This study examines various characteristics of claims with injuries between 1993 and 2000 that involved attorneys. The research measures the level of attorney involvement, average legal and benefit costs of those claims, the timing of attorney involvement and the method of resolution.

This research explores the hypothesis that increasing chiropractic utilization from 1993 – 2000 was associated with the statutory and judicial expansion of the primary treating physician’s presumption of correctness. This study measures changes in the volume of services and the level of payments for chiropractic care in California workers compensation.

A substantial body of evidence from the group health sector indicates that there is a strong relationship between physician experience, measured by the volume of care provided, and the outcome of that care. This study explores the association between the experience level of the providers who treat and manage California’s injured workers and their outcomes as measured by claim costs (medical and indemnity) and other factors.

This Report to the Industry provides background on the issue of pharmaceutical benefit delivery, reimbursement, and management in California workers’ compensation. The analysis reviews past studies by CWCI and other research organizations that compare the California system to other programs, examines the current role and potential savings from PBMs, and outlines factors that are likely to affect the cost and delivery of pharmaceuticals to injured workers in the future.

This Research Abstract measures differences in inpatient admission characteristics, hospital resource use and clinical severity between California’s workers compensation, group health and Medicare systems. The results challenge the perception that workers compensation admissions are “more difficult” to treat than patients from other systems.

This study sets the parameters for potential medical savings that could result from a mandated expansion of group medical managed care into workers’ compensation.

This study documents the size and structure of health and disability benefit systems in the mid-1990s and projects the impact of mandating medical coverage for all California employees and their non-working dependents.