Q3 – 2018 – October 3, 2018
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Research The Impact of the Copy Service Fee Schedule on Payments, Service Mix and Denial Rates. A white paper prepared for CWCI members that examines the impact that the copy service fee schedule has had on workers’ compensation copy service experience. The paper provides background on the issue and notes the changes in the average and median amounts paid for copy services per claim since the adoption of the schedule; the distribution of payments by copy service category for the top 10 providers; and the distribution of denials by copy service category for the top 10 providers. The paper also identifies billing practices and payment and denial patterns that may warrant additional analysis by claims organizations that have access to detailed bills, and points to areas where regulatory action in regard to copy services could be helpful. White Paper (9/20/18) (members only) Executive Briefing (9/25/18) (members only) Executive Memo (9/20/18) (members only) California Workers’ Compensation Prescription Drug Distributions and Opioid Trends. The Institute’s latest analysis of California workers’ compensation prescription drug trends, based on a review of nearly 10.7 million prescriptions dispensed to injured workers from 2007 through 2017, shows the decline in opioid use that began in 2015 is continuing, with the percentage of claims that involved opioids within 3, 12, and 24 months post injury all down sharply, as were the number of opioid prescriptions per user, and the morphine equivalents per user. Bulletin (9/25/18) (members only) Interactive Application Tool (9/25/18) (members only) Summary of Calif WC Q1 2018 Insured Experience. Q1 Insured Experience. CWCI notes highlights from WCIRB’s update on WC insured experience through Q1 2018, including total DWP, the decline in the average charged rate per $100 of payroll, and the increase in the combined ratio. Executive Briefing (9/25/18) (members only) IMR Decisions, January 2014 Through June 2018. CWCI’s review of IMR Data Through the 2nd Quarter of 2018 shows the number of determination letters increased 4.4 percent over the level noted in the first half of 2017. The report takes a detailed look at IMR volume, distribution by medical service and outcomes, including a breakdown of pharmaceutical IMRs. Research Update Report (9/07/18) (members only) Bulletin (9/07/18) (members only) Executive Briefing (9/25/18) (members only) News Release (9/07/18) (public) An Examination of Polypharmacy Claims. CWCI research examines the prevalence of multiple, concurrent prescription drugs in California workers’ comp claims, identifies characteristics of polypharmacy claims, and notes the most common drugs and drug combinations. Research Note (8/16/18) (members only) Bulletin (8/16/18) (members only) Executive Briefing (8/17/18) (members only) News Release (8/16/18) (public) Initial UR and IMR Prescription Drug Outcomes Under the Formulary. Using data from 141,643 pharmaceutical requests and UR decisions from the first 5 months of 2017 and 2018, and 58,604 IMR decisions from the first 4 months of those same years, CWCI takes a preliminary look at changes in pharmaceutical UR and IMR outcomes in the first few months after California’s WC Formulary took effect. Spotlight Report (7/20/18) (members only) News Release (7/20/18) (public)
Statutory/Regulatory Governor Vetoes Several High Profile WC Bills. With the deadline for the governor to sign or veto legislation fast approaching, Governor Brown vetoed four WC bills that had received a lot of attention: SB 899 (Pan), which would have explicitly excluded “race, gender and national origin” from apportionment calculations; AB 479 (Gonzalez Fletcher), which would have required doctors to consider the absence or presence of an organ, loss of function, skin disfigurement, pain, and other impairments when rating breast cancer claims; AB 553 (Daly), which would have required DIR to pay out the entire $120 million/year from the Return to Work Supplemental Program (RTWSP) each year to injured workers; AB 1697 (Daly), which would have required DIR to create a WC Anti-Fraud Unit within DWC by July 1, 2019 and develop data analytic processes to “identify the sources of previously unknown fraud and the magnitude of known or suspected fraud;” and AB 2496 (Gonzalez Fletcher), which would have created a presumption that people working for janitorial firms are employees and not contractors. Executive Briefing (9/25/18) (members only) RBRVS Physician Fee Schedule. CWCI’s testimony on revisions to the physician fee schedule submitted during the first 15-day comment period. First 15-Day Comments (9/14/18) (public) Indemnity Debit Cards. What began as a bill to allow the State Compensation Insurance Fund to run a pilot test to see if using debit cards to pay TD benefits was feasible has morphed into a proposal (SB 880, Pan) that would include all insurers and all indemnity payments. As currently drafted, the bill would authorize employers to make “disability indemnity payments” using a prepaid card through 1/1/23. Executive Briefing (8/17/18) (members only) MTUS Guideline Updates. CWCI’s 30-Day Comments on Proposed Updates to the Medical Treatment Utilization Schedule. 30-day Public Comments (7/18/18) (public)
Legal Dept. of Corrections v. WCAB (Fitzpatrick). The 3rd DCA reversed a longstanding practice of the Appeals Board, and held that WCAB exceeded its jurisdiction when it relied upon LC §4662(b) to find 100% permanent total disability, where the scheduled PD rating of 99% under LC §4660 was unrebutted. Thus, even in cases falling under LC §4662(b) “in accordance with the fact,” applicant must still provide substantial evidence rebutting the scheduled rating pursuant to LC §4660. Significant Decision Summary (9/25/18) (members only) King v. CompPartners. In a unanimous decision, the California Supreme Court held that allegations of medical negligence by a UR physician for failure to warn of the dangers of sudden cessation of a medication, or to provide a weaning plan, fall within the exclusive remedy protections of the Workers’ Compensation Act, which preempts the employee’s tort claims. The case reaffirms that injuries derivative of a compensable workplace injury fall within the scope of the workers’ compensation bargain and are therefore compensable within the workers’ compensation system. Significant Decision Summary (8/23/18) (members only) First Foursquare Church v. WCAB (Austin). The 2nd District Court of Appeal denied a defendant’s appeal of a ruling that applicant’s CT injury ended at the time applicant changed from one employer to the next. Because she had no disability during the first employment, that employer contended that a DOI cannot be applied unless there is both knowledge and disability under section 5412. In denying the writ, the COA refused to consider whether a change in employment alone constitutes a basis for the assignment of a CT DOI. CWCI filed an amicus brief in support of the employer. Amicus Brief (8/21/18) (members only) City of Petaluma v. WCAB (Lindh). The 1st DCA granted writ in a case involving a police officer who, prior to injury, had migraines that were not labor disabling. During a training exercise, he sustained repeated blows to his head and developed severe headaches. Weeks later he lost all vision in his left eye. The QME apportioned 85% of the PD to a pre-existing disease process (hypertension and vasovascular spasticity). Apportionment was denied on the basis that the QME apportioned to injury rather than to disability. The case is an important turning point in the continuing question of whether apportionment to pathology/congenital defect is valid. CWCI filed a joint amicus brief with CAJPA. Amicus Brief (7/07/18) (members only)
Other Calif Medical Board Sets Up Online Info for Doctors on CURES Requirements. As of 10/2/18, medical providers in Calif are required to consult the CURES Rx drug database and run a “patient activity report” the 1st time a patient is prescribed a Schedule II-IV drug and at least once every 4 months for as long as the drug remains part of the patient’s treatment plan. Doctors are not required to document that they consulted CURES, but the state Medical Board recommends that they do so, as the Board has access to audit data on the activity of CURES users that it can use to gauge compliance, and may also act on complaints from patients or other health professionals about non-compliance. Failure to consult CURES could result in a citation or disciplinary action, including license revocation. To help guide providers, the Board has posted an online CURES summary and FAQs page. Executive Briefing (9/25/18) (members only) WC Insurers Ordered to Report Federal Tax Savings. Insurance Commissioner Jones ordered WC insurers to report their federal income tax savings derived from the new federal tax law, noting, “Any savings to insurers should be passed along to California businesses, and this order will allow my department to examine workers’ compensation insurers’ savings and rates and provide transparency to the public.” Insurers must report the dollar amount of their tax savings by 12/31/18, and on a yearly basis through 2020, including details on how those savings impact their rates; and if they determine there is no rate impact, a detailed explanation of why the tax cut does not affect their rates. Executive Briefing (8/17/18) (members only) WCIRB Calls for 4.5% Cut in Advisory Pure Premium Rates Effective 1/1/19. On Aug. 8 the WCIRB approved a recommendation calling for an avg 4.5% reduction in WC advisory pure premium rates for new and renewal WC policies effective 1/1/19. This was the 8th consecutive rate cut WCIRB has recommended. If approved, it would result in a cumulative 40% reduction in the advisory rate since 2015. Executive Briefing (8/17/18) (members only) WCIRB Calls for 4.5% Cut in Advisory Pure Premium Rates Effective 1/1/19. On Aug. 8 the WCIRB approved a recommendation calling for an avg 4.5% reduction in WC advisory pure premium rates for new and renewal WC policies effective 1/1/19. This was the 8th consecutive rate cut WCIRB has recommended. If approved, it would result in a cumulative 40% reduction in the advisory rate since 2015. Executive Briefing (8/17/18) (members only) Save the Date For CWCI’s 55th Annual Mtg. CWCI’s 2019 annual meeting will be held Thurs., March 28 at the Oakland City Center Marriott, 1001 Broadway. A block of rooms has been reserved at the Marriott. Executive Briefing (8/17/18) (members only) Minutes from the Legal Committee Meeting. The meeting was held August 6 by webinar. The agenda included an updates on CWCI amicus activity (King; Black; Lindh; Pike; Austin; Fitzpatrick); Mr. Allweiss’ report on the Cal Chamber’s potential amicus activity in Allen v. Antelope Valley; a legislative review of several 2019 WC bills that were still alive (breast cancer ratings; revisions to DIR’s RTW Fund; coverage for off-duty police officers for specified out-of-state police activities; medical cannabis; insurance payment intercepts for back child support; a workers’ comp debit card pilot program for indemnity payments; and apportionment. The meeting also included a review of recent appointments (WCAB commissioners; a new WCJ in Sacramento, the acting secretary of the WCAB, and the Pharmacy Therapeutics Commitee; and an update on the litigation environment. Meeting Minutes (8/06/18) (members only) CWCI Quarterly Summaries 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. Quarterly Summaries Q2/18 (07/02/18) (members only) |