Q1, 2015 – April 28, 2015
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Research California Workers’ Compensation Claims Administrator UR Audit Results: 2009–2013. Results of 2009 to 2013 state audits of California workers’ comp utilization review (UR) programs, which check the timeliness, content and delivery of responses to requests for authorizations of treatment (RFAs) for injured workers, show that overall, claims administrators earned an average compliance score of 97.2%, well above the 85% benchmark set as a passing grade by the DWC. Executive Briefing (3/27/15) (members only) CWCI Spotlight Report (3/17/15) (members only) Bulletin (3/17/15) (members only) News Release (3/17/15) (public) Ambulatory Surgery Center Cost Outcomes Follow-Up Study: The Impact of SB 863 WC Reforms. A joint study by CWCI and WCIRB shows average facility fees paid to ambulatory surgery centers (ASCs) for treatment of injured workers in California have declined 27% per episode and 29% per procedure since fee schedule changes mandated by SB 863 were adopted in 2013. Executive Briefing (3/27/15) (members only) Joint CWCI/WCIRB Report (3/11/15) (members only) Bulletin (3/11/15) (members only) News Release (3/11/15) (public) Changes in WC Physician Reporting Under the RBRVS Fee Schedule: Initial Results. CWCI research shows the average payment for a California WC physician report fell 37% from $26.13 in the Q1 2013 to $16.53 in Q1 2014 as the state began to transition to the new RBRVS fee schedule that uses Medicare rules for reimbursing E/M services that had been associated with the priciest physician reports. The study compares medical report data for service dates in Q1 2014 – when the transition to the new schedule began – to Q1 report data from the 3 preceding years. Executive Briefing (1/29/15) (members only) Research Update (1/27/15) (members only) Bulletin (1/27/15) (members only) News Release (1/27/15) (public) Early Results on FY 2014 Public Self-Insured Claims Experience. A CWCI 10-year review of public S-I claims experience finds that while public S-I claim severity (avg loss/claim) fell briefly after the ‘04 reforms, it bottomed out in FY 05/06, then rose steadily for 5 years before peaking in FY 10/11. Since then, severity has leveled off, which combined with fewer claims, has reduced the total paid & incurred public S-I losses over the last 2 years. Executive Briefing (2/26/15) (members only) CWCI Announces New Interactive Analytic Tool as a Companion to the Inpatient Hospital Study. As a companion piece to the study, CWCI members can access a special interactive application to provide greater insight into three key areas through the use of comparative data on back surgery rates, average lengths of stay, and hospital charges for California Workers’ Compensation, Medicare, Medi-Cal and Private Coverage. Executive Memo (1/8/15) (members only)
Legal CWCI Announces 2015 Case Law Seminar. CWCI will conduct a one-day case law seminar in May in both Long Beach and San Francisco to examine how recent trends in decisional law are affecting California workers’ comp. The program will cover appropriate negotiation and defense strategies for attorneys, claims personnel, hearing reps, case managers, and others with negotiating authority. Executive Memo (3/6/15) (members only) News Release (3/6/15) (public) Seminar Flyer (3/6/15) (members only) Supreme Court to Hear Case on Lethal Rx Drug Cocktail. The Calif Supreme Court agreed to hear arguments in So.Coast Framing v. WCAB on whether the family of a 38-year old construction worker who OD’d on nerve pain & depression meds prescribed for a job injury, and insomnia & anti-anxiety drugs prescribed by his personal physician, is entitled to workers’ comp death benefits . Executive Briefing (2/26/15) (members only)
Statutory/Regulatory Heat Illness Regulation Changes. The Occupational Safety & Health Standards Board amended the state’s heat illness regulation and submitted it to OAL for approval, after which it will be filed with the Secretary of State. OSHSB asked for an accelerated effective date of May 1, so if OAL approves the changes, employers with outside workers will need to gear up quickly. Executive Briefing (3/27/15) (members only) DWC Sets Audit Standards for 2015. The DWC has announced updates to the RBRVS-based fee schedule, which will apply to services rendered by physicians and non-physicians on or after 3/1/15, including revised conversion factors, relative values and statewide geographic adjustment factors used to calculate maximum reasonable fees as well as minor clarifications. Executive Memo (2/23/15) (members only) Executive Briefing (2/26/15) (members only) OMFS Changes Effective 3/1/15. The DWC has announced updates to the RBRVS-based fee schedule, which will apply to services rendered by physicians and non-physicians on or after 3/1/15, including revised conversion factors, relative values and statewide geographic adjustment factors used to calculate maximum reasonable fees as well as minor clarifications. Executive Briefing (2/26/15) (members only) Annual Report of Inventory Due 4/1/15. The deadline for filing the Annual Report of Workers’ Compensation Claims Inventory (ARI) is Wednesday, April 1. Under CCR §10104, insurers, TPAs and self-administered, self-insured employers and JPAs must complete an annual report form for the preceding calendar year for each adjusting location and submit it to the DWC Audit Unit. Executive Memo (2/20/15) (members only) Executive Briefing (2/26/15) (members only) Copy Service Fee Schedule: CWCI comments to the DWC on proposed changes to the Copy Service Fee Schedule. 3rd 15-day Comments (2/13/15) (members only)
Other SSA Wants WC Benefit Reports. The Social Security Administration is seeking access to WC benefit data in order to calculate SSDI/WC offsets and cut SSDI payments to beneficiaries who also get WC. Executive Briefing (3/27/15) (members only) NSC Poll on Painkiller Use. A National Safety Council public opinion poll on Americans’ beliefs about opioid Rx painkiller use reveals a shockingly low level of public knowledge and awareness of opioids, underscoring why opioid use has become what the FDA has termed a “national epidemic.” Executive Briefing (3/27/15) (members only) CWCI Elects 2015 Chairman and Board. Vernon Steiner, President of the State Compensation Insurance Fund, was reelected Chairman of the Board of Directors of the California Workers’ Compensation Institute (CWCI) for 2015 at the Institute’s 51st annual meeting in Oakland. The membership also elected 18 other executives to one-year terms on the Institute’s Board. News Release (3/20/15) (public) CWCI In the News. A Risk and Insurance magazine feature article based on an interview with CWCI President Alex Swedlow spotlights the twin issues of questionable drug testing and opioid use in workers’ comp, and references CWCI data that will be released in an upcoming report and discussed at the 2015 Annual Meeting, noting the disconnect between the rapid growth in drug testing and the continued high rate of opioid use in workers’ comp claims. Executive Memo (2/4/15) (members only) Dept of Insurance Proposes Changes to Policy Filing and Approval Rules. The CDI has issued draft regulations governing the filing & approval of WC policy and endorsement forms. Executive Briefing (1/29/15) (members only) WCIRB Reports On California Workers’ Comp Cost Drivers. WCIRB reported that the uptrend in iinsured claim frequency that began in 2010 is continuing, driven by increases in cumulative injury claims and smaller non-cumulative injury claims that in the past may have been reported as med-only cases. At the same time, indemnity claims – including late reported cases, electronically reported claims, and med-only claims that become indemnity cases – all account for a growing share of California workers’ comp cases. Executive Briefing (1/29/15) (members only) CWCI Hotlinks Update. Quarterly listings of all CWCI publications, including publication dates, brief summaries of each topic and the various formats in which the information is available (e.g., research report, Bulletin, Executive Briefing, news release), so users can choose the level of detail they want to view. Listings include live links so users can click into the CWCI website to access specific documents quickly and easily. Hotlinks Q4/14 (1/8/15) (members only) |