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.

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.

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.

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.

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.

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.

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.

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.

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.

These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard injuries associated with other nonspecific diagnoses of musculoskeletal systems.