CWCI Updates Interactive Applications

CWCI has posted updates to our Claims Monitoring, Medical Services, Regional Scorecard, and Prescription Drug interactive applications, which now feature IRIS data on California workers’ comp claims valued as of June 30, 2022, and our Inpatient Hospitalization app with data on 2012 through 2021 discharges.  All 5 apps are available exclusively to CWCI members who log on to our website (www.cwci.org) with their username and password.  Once logged in, users can access the apps from the drop-down menu under the Research tab on our home page.  The applications offer detailed data that can be used to examine and compare industry data on key metrics as noted below. 

The Claims Monitoring App allows users to examine industrywide trends for average paid indemnity, average paid medical, and combined medical and indemnity payments for claims from AY 2009 through March of AY 2022 at development periods from 3 to 72 months for all claims or just indemnity claims.  The tool can be used to calculate the percent changes in average payments for each metric across accident years; obtain data for a region or an industry; and view regional differences displayed on heat maps.  Paid medical loss data can be broken out to show average payments for Treatment, Pharmacy, Medical Case Management, Med-Legal expense, and other medical payments.  Some examples of the latest findings: 

• Excluding COVID claims, average paid medical per indemnity claim at 12 months rose steadily from $7,852 in AY 2015 to $8,880 in AY 2020 (+13.1%), but declined in the second year of the pandemic, falling 3.6% to $8,564 in AY 2021.
• Including COVID cases in the mix of AY 2020 and AY 2021 claims had a negligible effect on first-year paid medical losses, increasing the overall average medical payment per indemnity claim at 12 months by $76 (0.9%) to $8,956 in AY 2020 and by $24 (0.3%) to $8,588 in AY 2021.
• Excluding COVID claims, average indemnity payments per indemnity claim at 12 months followed a similar pattern, climbing from $7,429 in AY 2014 to $9,608 in AY 2020 (+29.3%), then edging down 0.7% to $9,536 in AY 2021.
• Including COVID cases in the mix of AY 2020 and AY 2021 claims only reduced the overall average indemnity payment per indemnity claim at 12 months by $48 (-0.5%) to $9,560 in AY 2020 and by $40  (-0.4%) to $9,496 in AY 2021. 

The Medical Services App contains detailed medical service data for claims starting treatment from 2012 through June 2022 that allows users to monitor utilization and payment trends for different categories of treatment services at different levels of development and across key claim characteristics.  Examples of findings from the latest update: 

• The average number of E&M and Physical Medicine visits per indemnity claim within the 1st year of treatment remains below 2012 levels (when SB 863 was enacted) but with the adoption of the RBRVS fee schedule and other reforms, the average paid per indemnity claim for 1st-year E&M visits has increased from $1,108 in 2012 to $1,435 in 2020 (+29.5%) and the average paid for 1st-year Physical Medicine has grown from $1,276 to $1,802 (+41.2%). 
• The Bay Area had the highest proportion of indemnity claims with mental health services within 12 months of injury (6.6% in 2020) twice the proportion noted for Los Angeles County, while San Diego had the lowest proportion of indemnity claims with mental health services at 12 months: 8%.  Total payments per claim for 1st-year mental health services on indemnity claims in 2020 were highest in the Bay Area ($1,563), followed by Inland Empire/Orange ($1,440), Los Angeles ($1,404) and San Diego ($1,392).    

The Regional Scorecard App updates CWCI’s Regional Scorecard series with new data on AY 2008-June 2022 claims valued through June 2022.  Users can view regional and statewide data on 19 key metrics, compare results from 7 regions, and identify regional and statewide trends that have developed.  The app includes data on average medical, indemnity and other payments (including breakdowns showing average paid TD and PD, allocated loss adjustment expense, and data on demographics, claim status, and claim volume.  Users may also drill down to view results by injury year and industry.  Examples of updated data from the Regional Scorecard: 

• Statewide, total payments per claim for all AY 2021 claims, including M-O claims, averaged $7,601, but the amounts ranged from $6,547 in the Central Valley to $9,164 in the No. Counties/Sierras, which had a high percentage of TD claims (31.2% of all No. County/Sierra claims from AY 2021 had TD, ranking just below the Bay Area where 32.2% of all claims had TD.)  Statewide, 28.0% of all AY 2021 claims had TD.
• In the first 2 years of the pandemic (AY 2020 and 2021), claim payments for open and closed indemnity claims statewide averaged $26,535 but were above that average in the No. Counties/Sierras ($29,218), the Bay Area ($28,222), L.A. County ($27,678), and the Inland Empire/Orange County ($26,883).
• For the 5-year period ending in December 2020, 53% of indemnity claims statewide involved an attorney. Attorney involvement was highest in L.A. County (64.0%) and the Inland Empire/Orange Co, (58.8%), but more than half of all indemnity claims in San Diego (50.9%) and the Central Coast (50.5%) also had attorney involvement during this 5-year span.  The attorney involvement rate was lowest in the No. Counties/Sierras (39.8%) and the Bay Area (42.8%). 

The Prescription Drug App can help identify trends and compare industrywide data on prescriptions dispensed between January 2010 and June 2022.  Claim level data allows users to examine prescription drug utilization by accident year at 6 levels of development, and service-level data allows users to look at prescription drugs dispensed during the 12-1/2 years ending in June 2022.  Dashboards allow users to build custom views of statewide or regional pharmaceutical data for all claims or indemnity claims, and global selection settings and drop down menus allow them to see results at different levels of development; for open and/or closed claims; for drug groups; for generic and/or brand drugs; by opioid drug name; by industry; and for specific accident years or service years.  As users choose from a menu of specific metrics, the tables and charts automatically display the results, with regional data provided in color-coded heat maps.  Examples of recent findings: 

• Opioid utilization continues to decline. The percentage of all claims in which opioids were dispensed in the first year fell from an all-time high of 24.6% in AY 2013 to just 3.2% in AY 2021.  
• Rankings of the top 7 drug categories were unchanged between 2021 and the first half of 2022 except for dermatologicals which surpassed opioids to become the 3^rd most common drug group. NSAIDs accounted for 33.9% of all workers’ comp prescriptions, followed by anticonvulsants (10.0%), dermatologicals (9.8%) opioids (9.2%) antidepressants (8.4%), musculoskeletal drugs (5.9%) and ulcer drugs (5.2%).
• Lidocaine, with an average payment of $185, accounted for the largest share of the dermatological drug spend (24.5%) in the first half of 2022, followed by Diclofenac Sodium, which had an average payment of $57 and accounted for 21.6% of the total prescription dollars paid.

Inpatient Hospitalization App:  This application offers detailed data on utilization trends, costs, and characteristics of California workers’ comp Inpatient Hospitalization claims, including comparative data on back surgery rates, average lengths of stay, and hospital charges for spinal fusions paid under Medicare, Medi-Cal and private coverage, regional variations, and hospital-specific data for 2012-2021 spinal fusion discharges.  Recent findings include:

• The total number of workers’ comp inpatient stays fell 5.7% in 2021, but the number of workers’ comp spinal surgery inpatient stays, which declined from 2012 through 2020, increased 4.3% in 2021.
• Injured workers’ average length of stay for an inpatient hospitalization increased from 5.4 days in 2020 to 5.6 days in 2021. The average length of stay ranged from 1.9 days in Sutter County to 13.67 days in San Benito County.  In Los Angeles County it was 5.54 days, but in Santa Clara County it was 8.12 days.
• Statewide, average workers’ comp inpatient charges increased 7.5% to $172,568 in 2021 but varied by county, ranging from $10,258 in Modoc (which only had one inpatient stay) to $321,810 in Santa Clara.

How to Access the Apps:  Log on to www.cwci.org with your user name and password (if you don’t have an account, select “Your Account” at the top of the home page, click “Add Me as a Member User” from the pull-down menu, complete the form, then use that info to log in).  Once you are logged on, use the drop-down menu under the Research tab and click Interactive Research Tools, then click the app you want to open.