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Trends in the Utilization and Reimbursement of Professional Medical Services in California Workers Compensation, 2013-2018

CWCI's analysis of changes in the volume and reimbursement of California workers comp professional medical services from 2013-2018, which includes the 4-year transition to the RBRVS fee schedule that began in 2014. The study reviews data from nearly 36 million medical services rendered to injured workers during that period to measure shifts in the mix of services and payments across and within 9 major services categories, and discusses the underlying changes to the fee schedule that affected those moves.

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The Impact of Declining Opioid Use on Lost-Time Claim Development and Outcomes in California WC

A 30-page CWCI Report to the Industry details CWCI research that quantifies the declining prevalence of opioids in workers comp lost-time claims, the impact on average benefit payments and average days away from work, and in light of the opioid trends, estimates projected costs for 2010-2017 claims at 10 years of development.

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Post-Reform Medical Service Approval Rates in California WC

A new CWCI study on California workers comp medical care approval rates shows 94% of all treatment services performed or requested for injured workers in the first 10 months of 2018 were either approved or approved with modifications, though outcomes varied by type of service.

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California Workers' Compensation Inpatient Hospitalization Trends, 2010-2018

CWCI's updated look at changes in the volume of inpatient hospitalizations in WC, Medicare, Medi-Cal and private plans from 2010-2018. The study shows the most common WC inpatient diagnosis-related group codes (MS-DRGs) and the top 5 Major Diagnostic Categories (MDCs); and provides detailed data on other workers compensation inpatient trends, including changes in the volume of implant-eligible spinal surgeries and a listing of the top 10 hospitals based on injured workers as a percent of their total inpatient discharges. CWCI members and subscribers can log in to view the summary Bulletin under the Communications tab, and the full report under the Research tab. Institute members can also log in to access the updated version of the Inpatient Hospital interactive tool from the Research section. CWCI members and subscribers who log in may read the full report, others may purchase a copy from the Store.

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IMR Decisions: January 2014 Through December 2018

Independent Medical Review Volume and Outcomes Through Q4 2018. Click below for the Research Update report. Summarized results are included in the news release in the Newsroom, and CWCI members and subscribers may log in to access the summary Bulletin.

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Calif WC Pharmaceutical Utilization and Reimbursement: Emerging Outcomes Under the Formulary

A CWCI Spotlight Report examines the impact that the Medical Treatment Utilization Schedule has had on the types of medications dispensed to injured workers and recent shifts in the total drug spend.

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California Workers' Compensation Prescription Drug Utilization & Payment Distributions, 2009-2018: Part 1

CWCI's analysis of changes in the types of prescription drugs used in California workers' compensation over the past decade. The report looks at the breakdown of prescriptions and payments by therapeutic drug group by service year, as well as the generic utilization rates for the different drug groups and how the average amounts paid for drugs within each group changed over the 10-year study period.

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IMR Decisions, January 2014 Through June 2018

Independent Medical Review Volume and Outcomes Through Q2 2018. For further details see the news release in the Newsroom and CWCI members and subscribers may log in to view a summary Bulletin and the Research Update report.

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An Examination of Polypharmacy Claims

A study that uses 2016 - 2017 California workers' compensation prescription data to determine the prevalence of polypharmacy in the system and to identify the types of drugs used in polypharmacy prescribing.

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Initial UR & IMR Rx Drug Outcomes Under the Formulary

Using data from 141,643 pharmaceutical requests and UR decisions from the first five months of 2017 and 2018, and 58,604 IMR decisions from the first four months of those same two years, CWCI takes a preliminary look at changes in pharmaceutical UR and IMR outcomes in the first few months after Californias WC Formulary took effect.

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California Workers' Compensation Inpatient Hospitalization Trends

CWCI research measures and compares changes in the volume of inpatient hospitalizations in WC, Medicare, Medi-Cal and private plans from 2008-2016, notes the most common WC inpatient diagnosis-related group codes (MS-DRGs) and the top 5 Major Diagnostic Categories (MDCs); and provides detailed data on other workers compensation inpatient trends, including average length of stay and changes in the volume of implant-eligible spinal surgeries.

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CWCI Prescription Drug Interactive Tool

An online application that CWCI members can use to examine and compare industrywide prescription drug data derived from 12.5 million prescriptions dispensed to injured workers between January 2007 and June 2017.

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Independent Medical Review Decisions, January 2014 Through December 2017

Recent data on the IMR process for resolving workers comp medical disputes. measuring changes in IMR volume in 2017, and comparing IMR outcomes based on a review of 648,450 IMR decision letters issued from 2014 through 2017.

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California Workers' Compensation Prescription Drug Distributions & Opioid Trends

A CWCI Research Update report shows changes in California workers' comp prescription drug and payment distributions by therapeutic drug group and provides detailed information on the latest opioid trends.

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Revisiting 24-Hour Health Care Coverage and Its Integration With the California Workers' Comp System

A CWCI white paper that examines the issues, opportunities, and unresolved problems surrounding the integration of California workers' comp into a 24-hour system.

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Changes in the QME Population and Medical-Legal Trends in California Workers' Compensation

This study tracks changes in the composition of the Qualified Medical Evaluator (QME) population in California workers' compensation in terms of medical specialty representation and geographic availability, comparing data on medical providers certified as QMEs in 2012 and in 2017. The study also uses 2007 - June 2017 claims data to examine changes in the level of services rendered by evaluators, the mix of services, average payments for all medical-legal services and for specific levels of service, and the proportion of evaluations performed by AMEs vs. QMEs.

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Opioids in Workers' Compensation Medicare Set-Asides

CWCIs analysis of the prevalence and cost of prescription drugs within approved Workers' Compensation Medicare Set-Aside Arrangements.

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IRIS Regional Scorecard Interactive Tool

An interactive application based on updated IRIS data on claims from the last decade (AY 2007 through 2016) so that users can compare results from each region to statewide results on key metrics, compare results between different regions, and identify regional and statewide trends that have developed.

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CWCI Claims Monitoring Interactive Tool

CWCI members can now access a new interactive application that shows average paid indemnity and medical losses on claims from AY 2005 through the end of AY 2016 at nine levels of development (with payments valued through December 2016). The online tool gives Institute members 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.

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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.

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