Initial Results: Sleep Disorder Testing Frequency

In response to recent inquiries regarding the perceived increase in sleep disorder diagnostic testing in the California workers’ compensation system ¹, CWCI has taken a snapshot of the number of services associated with sleep disorder testing. The Institute used the Industry Claims Information System

(1) ICIS is a voluntary database system with more than 2.5 million California workers’ compensation claims and over 200 million transaction level claims payments and medical procedures contributed by regional and national insurers and self-insureds for dates of injury between 1993 to 2007 (V9).

It is clear that a significant increase in services has occurred during calendar year 2007. All four diagnostic tests show a gradual increase in services from 2004 through 2006 and then a significant increase in 2007. Within the ICIS database, the count of these four tests increased 72% from 2004 to 2005, an additional 48% from 2005 to 2006 and 782% from 2006 to 2007.

Several additional findings are noteworthy.

• Of the total 1,078 tests counted between 2004 and 2007, 49% showed zero reimbursement.
• Of the 1,078 tests counted, 90% of the services were performed in Southern California.
• From a small sample of 2008 data, it appears that the rate of increase in sleep testing is continuing to increase but at a rate comparable to pre-2007 levels
The high rate of zero reimbursements may be associated with any number of factors including the utilization review decisions or challenges and overall maturity of data. The Institute has plans to look at this phenomenon in greater depth.

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