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.