Research

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.

COVID-19 Death Claims: a new CWCI report takes an in-depth look at the trends and characteristics associated with 1,032 California workers compensation death claims from the first 18 months of the pandemic. The report tracks changes in the number of COVID and non-COVID death claims from January 2020 through June 2021 as well as changes in the percentage of all death claims ascribed to COVID during that 18-month span, and compares the distributions of COVID death claims vs. all COVID claims, and non-COVID death claims based on the workers age and gender, as well as by region and industry.

A CWCI report examines SB 335, a bill that would cut the amount of time claims administrators have to investigate job injury claims and increase employers liability for medical benefits during the investigation period by 70%.

A CWCI analysis of a 2021 legislative proposal (AB 1465) intended to increase injured workers access to medical care by requiring the state to create a medical provider network (CAMPN) as an alternative to private networks that render 90 percent of California workers' compensation treatment. The report provides background information on the use of medical networks in California workers' compensation, reviews how the proposed statewide network would be structured, and evaluates the potential for improving injured worker access to care. The analysis includes data on time to initial treatment and injured worker proximity to treating providers for current MPN and non-MPN claims, shows the percentage of injured workers treated within and outside MPNs who meet the states access to care standards, notes the average distances these workers must travel to receive primary care and surgery services, with results broken out for urban, suburban and rural residents, and estimates the cost of building and maintaining the CAMPN.