Research

Physician-dispensed prescription drugs comprise a significant portion of all pharmaceutical prescriptions dispensed in California's workers' compensation system. Because of limits on the reach of statute and regulations adopted under Senate Bill (SB) 228, physician-dispensed pharmaceuticals are also much more expensive than the same drugs dispensed through a pharmacy. This report, prepared for the Commission for Health and Safety for Workers' Compensation, documents the extra costs placed on the workers' compensation system by physician-dispensed drugs. The report also reviews research on both the positive and negative impacts of physician dispensing.

This study considers the association between two managed care reforms -the adoption of the 1993 Medical Legal Fee Schedule and the 2004 Utilization Review Schedule – and changes in access to workers' compensation medical services. Using a sample of more than 900,000 claims from injured workers treated between 1993 and 2005 — before and after implementation of the medical reforms — the study measures the workers' proximity to a choice of three active providers who saw injured workers in each corresponding calendar year. The findings show that implementation of managed care controls was not associated with a material change in access to a choice of medical providers.

This study estimated the impact on California workers compensation medical payments in 2005 had the Official Medical Fee Schedule reimbursements for evaluation andmanagement (E&M) office visits been set at 2006 Medicare rates.

The goal of this study was to measure the associations between the California workers' compensation medical care reforms implemented in 2004 – most notably, mandatory utilization review, the ACOEM guidelines, and the 24-visit caps on physical therapy and chiropractic care – and changes in the amount of treatment provided to injured workers, and the associated medical reimbursements.

The enclosed Score Card is the first in the ICIS injury series and provides detailed data and graphics on California work injury claims involving medical back problems without spinal cord involvement. Based on CWCI Industry Claims Information System (ICIS) data, these are the most commonly diagnosed work injuries in California, and though treatment plans for these injuries rely heavily on physical medicine and less invasive types of care, a high proportion of these claims result in lost time and litigation, as well as above average costs.

These worksheets provide detailed supplemental exhibits and analysis to the injury scorecard associated with medical back problems without spinal cord involvement.