Research

A Research Update report that continues CWCIs series of studies examining inpatient utilization trends using data compiled by the California Department of Health Care Access and Information. The analysis compares the volume and types of inpatient hospitalizations covered by workers compensation to those covered by Medicare, Medi-Cal, and private coverage.

In both 2021 and 2022, California legislators have debated proposals that would shorten the compensability determination timeline for California workers compensation claims. This CWCI Impact Analysis report helps bring the debate into focus by providing background information on the compensability determination process for litigated and non-litigated claims, reviewing existing statutory and regulatory timeframes for various steps within the process, and using data from nearly 460,000 non-COVID-19 claims and more than 17,000 COVID-19 claims to evaluate the need for and the potential impact of the proposals, including the unintended consequences.

CWCI research takes an in-depth look at the impact of the Med-Legal Fee Schedules revised reimbursement rules and fees by comparing various utilization and payment metrics from before and after the schedule took effect on April 1, 2021. Read the full report.

CWCI’s latest update on Independent Medical Review, derived from IMR decision letters from 2015 through 2021, measures changes in IMR volume, shifts in the mix of services reviewed; changes in IMR response times; regional variations; and IMR uphold rates by medical service category. The study also looks at the distribution of prescription drug IMRs and uphold rates by drug category; the proportion of IMRs involving medical service request modifications among six treatment categories; and the concentration of IMR activity among high-volume physicians named in IMR letters.

CWCI takes a detailed look at issues surrounding injured worker access to medical treatment in California workers compensation. The study measures the average and median days to initial treatment for various services and injured workers proximity to care, and notes provider perspectives, gleaned from individual interviews, on the administrative burdens associated with rendering care in the workers’ compensation system.

A CWCI Research Update report uses OSPHD data to track changes in the volume and types of inpatient hospitalizations in California workers compensation from 2010 through 2020 and compare workers compensation inpatient hospitalization trends to those in Medicare, Medi-Cal and private coverage. While updating the long-term inpatient hospitalization trends, the report also provides a focused look at the changes in inpatient hospitalizations between 2019 and 2020, highlighting the impact of COVID-19 on California workers compensation inpatient care, identifying changes in the types of conditions treated and the services delivered to injured workers during the first year of the pandemic.