Research

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.

The number of IMR determination letters in California workers' comp fell 11.3% in 2019, led by a sharp decline in prescription drug disputes, with initial data from 2020 showing the decline is continuing.

A CWCI Research Update report finds that the steep drop in inpatient hospitalizations involving California injured workers over the past decade was largely due to the ongoing decline in spinal fusions and a more recent decline in lower extremity joint surgeries. The study reviews OSHPD discharge data on 35.9 million inpatient hospital stays from 2010 through 2019 paid by workers' compensation, Medicare, Medi-Cal and private insurance to identify workers' comp inpatient trends and compare the volume and types of inpatient hospitalizations covered by workers comp to those covered by the three other systems. CWCI members and subscribers can log in to view a summary Bulletin under the Communications tab, and the full report under the Research tab. CWCI members can also log in to the Research section to access the updated version of the Inpatient Hospital interactive data tool.

Institute research tracks changes in California workers' compensation treatment patterns, including utilization and payment trends for different categories of medical services, following the implementation of major legislative and regulatory reforms enacted over the past two decades. The study has been released as a Research Note which includes background on the reforms, plus exhibits and analyses for the various service categories. A news release is in the Newsroom, and members and subscribers can log in to view a summary Bulletin as well as the full report.

A CWCI Research Update Report provides new data on prescription drug utilization and reimbursement trends, based on 5.85 million prescriptions dispensed to California injured workers from 2011 through June 2020. The report looks at changes in the distribution of prescriptions and payments by therapeutic drug group; details opioid utilization trends for AY 2007 -2018 claims at 24 months post injury using four different metrics; and measures pre- and post-formulary shifts in the mix of prescription drugs and payments among the formularys drug categories.

A CWCI Research Update report documents the sharp decline in IMR volume in 2019 and 2020, fueled by the reduction in prescription drug IMRs and the economic slowdown brought on by the COVID-19 pandemic in 2020. The report also looks at the distribution of IMRs and IMR outcomes by medical service category, regional distributions, IMR response times, and examines the distribution of pharmaceutical IMRs among therapeutic drug groups.