Research

Initial data on AY 2014 lost-time claims indicate that average medical payments at 3 and 6 months post injury declined following implementation of SB 863, though the 12- and 24-month data on claims from prior years still show average losses trending up, led by ongoing increases in payments for prescription drugs and DME.

The average amount paid for all California WC physician reports fell 37% from $26.13 in the 1st quarter of 2013 to $16.53 in the 1st quarter of 2014 as the state began to transition to the new RBRVS Fee Schedule, but that decline was due to changes in the underlying E&M services in the schedule and not a decrease in the fee schedule amounts assigned to report codes.

A review of DWCs 2009-2013 UR audit results show claims administrators had an average performance rating of more than 97% over the 5-year period.

A CWCI analysis of 2014 IMR decisions suggests that the medical dispute resolution process mandated by SB 863 is working to assure that treatment provided to California injured workers meet evidence-based medicine standards and is providing a needed check against unnecessary and potentially harmful tests, surgeries, drugs and procedures.

An analysis of 2015 independent medical review (IMR) decisions from the first quarter of 2015 shows no significant decline in IMR volume in the first three months of this year, even though the independent medical reviewers continue to concur with the utilization review (UR) physicians denial or modification of treatment in about 90 percent of the cases.

A new analysis examines the history, form and function of the ICD-10 classification system for healthcare delivery, which takes effect October 1 for all health care systems in the U.S. – including California workers' comp.