Q3, 2017 – October 31, 2017
|
Research CWCI Claims Monitoring Report and Interactive Tool. CWCI developed an interactive application that allows members to access average paid indemnity and medical losses data on claims from AY 2005 through the end of AY 2016 at nine levels of development (with payments valued through December 2016). The report summarizes the data available and provides information on how to access and use the online tool, and provides details on the data and methods used for the research. Members who use the app have the ability to view results for indemnity claims or for all claims, subset the data by industry and region, and segment the medical payment data into medical treatment, pharmacy & DME, medical-legal services & medical cost containment expenses. Executive Memo (9/28/17) (members only) CWCI Interactive Research Report (9/29/17) (members only) Interactive Application Tool (9/29/17) (members only) IMR Outcomes: January 2014 Through June 2017. . An analysis of the volume and outcomes of Independent Medical Reviews based on determination letters issued from January 2014 through June 2017. The study found that in the first half of this year, more than 91% of all utilization review (UR) physicians’ modifications or denials of treatment that were reviewed by an IMR physician were upheld, and after increasing steadily since 2013, IMR volume appears to be leveling off. Spotlight Report (9/14/17) (members only) Bulletin (9/14/17) (members only) News Release (9/14/17) (public) Executive Briefing (7/20/17) (members only) Differential Use of Opioids in California Workers’ Compensation Claims with Mental Health Disorders. A CWCI analysis of the prevalence, volume and strength of opioid prescriptions in California work injury lost-time claims that involve a mental health component. Using data from 368,538 lost-time claims for work injuries that occurred during the 10-year span ending in December 2016, the authors calculated the percentage of claims with and without mental health disorders in which opioids were dispensed, then broke out the opioid data by accident year at 6 different development periods (3, 12, 24, 36, 48 and 60 months post injury). Spotlight Report (8/29/17) (members only) Bulletin (8/29/17) (members only) News Release (8/29/17) (public) Executive Briefing (7/20/17) (members only) California WC Formulary – Part II: A Review of the July 2017 Proposed Formulary Drug List of Exempt and Non-Exempt Drugs. A CWCI study used 2015 and 2016 California workers’ comp prescription drug data to show that more than 30 percent of the prescription drugs currently dispensed to injured workers in California will be classified as “Exempt Drugs” and will no longer require authorization prior to dispensing under conditions outlined in the Workers’ Compensation Prescription Drug Formulary regulations proposed by the state. Spotlight Report (8/1/17) (members only) Bulletin (8/1/17) (members only) News Release (8/1/17) (public) Executive Briefing (7/20/17) (members only) Regional Variations in Imaging and Diagnostic Testing in California Workers’ Comp. A CWCI analysis examined IRIS data on 93,451 claims from Calendar Years 2013-2015 in which MRIs and diagnostic tests were conducted between 2013 and 2015 and found a total of 163,724 MRIs and diagnostic tests on those claims. Using the injured workers’ home addresses to group the claims into 8 regions, the analysis found that rural and agricultural areas of the state have a disproportionate share of the claims w/MRIs and diagnostic tests – which likely reflects the high prevalence of musculoskeletal injuries in those areas. Executive Briefing (8/10/17) (members only) Brand-Name Meds Continue to Drive Rx Drug Costs. The high cost of Rx drugs remains a major medical cost driver in WC and other health systems. While the GAO reports that generic drug prices declined 59% for Medicare Part D drugs from 2010 to 2015, so far the increased availability of generics has failed to curb total Rx spending because the cost of brand drugs remains so high. As a result, Rx drugs have now grown to 10% of total U.S. healthcare costs. The impact of brand drug prices was underscored in a Health America Report published by Blue Cross/Blue Shield in May, which examined drug utilization and pricing and noted that while brand-name drugs accounted for 18% of all Rx drugs dispensed in the U.S. last year, consumed 78% of the costs. Executive Briefing (7/20/17) (members only) Topical Dermatologicals Account for Disproportionate Share of WC Drug Spend. CWCI Scorecard data based on WC prescriptions filled in 2014 show that topical dermatologicals represent 5% of Calif WC Rx Drugs, but 11% of Total Drug Spend. A closer look shows the key to this disproportionate spending on dermatologicals was the use of high-cost brand-name topical creams and patches such as Lidopro and Menthoderm, often dispensed for pain relief directly from physician offices, using unique formulas of active ingredients so they are not available as generics. In many cases insurers paid hundreds of dollars for a tube medicated cream or a supply of transdermal patches. Executive Briefing (7/20/17) (members only) Study Links Higher Initial Opioid Quantities to Long-Term Use. A new study, summarized in the CDC’s March 17 issue of the Morbidity and Mortality Weekly Report links the initial supply of opioids given to a patient to the duration of usage. The study suggests that that the larger the quantity of opioids initially prescribed to a patient, the higher the odds that they will still be taking them a year later, and found that about 1 out of 7 patients whose 1st-time opioid Rx exceeded a 1-week supply of the painkillers were still on the drugs a year later, while 3 out of 10 patients whose initial Rx exceeded a 1-month supply were still taking the opioids a year later. The study further supports limiting initial supplies of opioids prescribed to injured workers, as proposed in the current draft of the Calif WC Rx drug formulary. Executive Briefing (6/26/17) (members only)
Statutory/Regulatory TTD/PTD Rates to Increase 1/1/18. The Department of Labor announced California’s State Average Weekly Wage (SAWW) rose more than 3.6% for the 12 months ending 3/31/17, so temporary total disability (TTD) and permanent total disability (PTD) rates for injuries o/a 1/1/18 will increase as well because LC §4453(a)(10), a 2002 reform, tied minimum and maximum TTD and PTD rates to annual increases in the SAWW. The latest increase should boost maximum TTD and PTD to $1215.27/week for 2018 injuries, and bump the minimum to $182.29/week. 30-Day Public Comments (9/8/17) (members only) New Legislative Effort to Prohibit Apportionment to Genetics. The effort to prohibit apportionment based on genetic factors took a new turn when Senator Steve Bradford, chair of the Senate Committee on Labor and Industrial Relations, gutted and amended another workers’ comp bill (SB 617) in a move that would effectively overturn the Rice decision. The amended bill would add a new section to Labor Code §4665 specifying that “Notwithstanding any other law, including, but not limited to, Section 4663, heredity and genetics shall be excluded as bases of causation for purposes of determining the apportionment of permanent disability.” Because there was less than a month left in the legislative session, SB 617 will be carried forward into the 2018 session as a 2-year bill. Executive Memo (8/23/17) (members only) OSHA Delays Electronic Reporting of Injuries. Fed-OSHA delayed the compliance date for its new electronic-reporting rule from 7/1/17 until 12/1/17 to allow review into questions of law & policy and to give employers a 4-month window for submitting data. The final electronic reporting rule developed during the Obama Administration was published in May 2016. OSHA also announced plans to issue a separate proposal to reconsider, revise or remove other provisions in the final rule, which includes anti-retaliation provisions for reporting workplace injuries. Executive Briefing (8/10/17) (members only) WCIRB Recommends Pure Premium Rates for Policies Incepting On or After 1/1/18. WCIRB announced in early August that it planned to recommend advisory pure premium rates averaging $2.01 per $100 of payroll in its upcoming rate filing for WC policies with inception dates o/a 1/1/18. Executive Briefing (8/10/17) (members only) Bill Calls for All $120 Million in the RTWSP Fund to Be Distributed Annually. Applicants’ attorneys and Labor are supporting a bill SB 553 (Daly), which would require DIR to distribute the full $120M from DIR’s Return to Work fund each year. The proposal would require DIR to divide any money remaining in the fund at the end of each year among all claimants who received RTWSP benefits during the year, with the pro rata disbursement capped at $25K. Executive Briefing (7/20/17) (members only)
Legal Calif. Supreme Court Denies Request for Review of Genetic Apportionment Ruling. WC payors scored a win in the courts this week when the Calif Supreme Ct. denied a request to review the published Court of Appeal decision in the City of Jackson v. WCAB (Rice), which held that apportionment to causation may properly include apportionment to a combination of genetic and environmental factors. Significant Decision Summary (8/10/17) (members only) Executive Briefing (8/10/17) (members only) SCIF v. WCAB (Guzman). The 6th DCA granted a Writ of Review in a case involving an injured worker with less than six months of employment who is claiming a “sudden and extraordinary employment condition” exception to psychiatric injuries. The defense Petition for Writ contends that the WCJ erroneously placed the burden of proof on defendants to show that the injury was caused by an ordinary and routine work event. CWCI filed an amicus brief that was accepted by the Court. Amicus Brief (7/14/17) (members only)
Other Minutes from the Claims and Medical Care Committee Meeting. The meeting was held September 12 in Oakland. The agenda included reports on CWCI research projects including: updated UR data; opioids in claims with a mental health component; the impact of the MTUS Formulary; IMR decisions through mid-2017; the upcoming claim monitoring Interactive application; and a Report to the Industry on the use of opioids in WCMSAs’s, scheduled for release in October. Discussions also covered regulations (provider suspension rules; DWC updates to the MTUS.) Meeting Minutes (9/12/17) (members only) Minutes from the Legal Committee Meeting.The meeting was held Thursday, August 17 by conference call. The agenda included status reports on CWCI amicus activity (Ramirez; Baker; Zuniga; King; Berrios; Guzman) and cases under Amicus consideration (Stevens; McCartney; Black v. Corvel); updates on the status of 3 cases: Zhu; Hikida, City of Jackson (Rice); a report on Chamber of Commerce activity by Saul Allweiss; and an update on regulations (drug formulary; MTUS updates); and a status report on WC bills from the current session. Meeting Minutes (8/17/17) (members only) CWCI Schedules Free Webinar to Train Claims, Legal and Medical Professionals on the new MTUS Drug Formulary Debuts Redesigned Website. The Institute developed a 90-minute training session to be presented as a free webinar to educate our members on the MTUS Drug Formulary and the regulations that are about to be adopted by the state. The effective date for the Formulary is 1/1/18. Executive Briefing (8/10/17) (members only) Executive Memo (9/7/17) (members only) News Release (9/8/17) (public) California Poised to Become World’s 5th Largest Economy. Despite a host of problems – a lack of affordable housing, traffic, high taxes, heavy regulation — the Center for Continuing Study of the Calif Economy (CCSCE) reported this month that the Calif economy is continuing to prosper, growing so strongly that the state is on track to overtake the United Kingdom as the 5th largest economy in the world. Executive Briefing (7/20/17) (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 Q2/17 (7/24/17) (members only) |