CWCI Documents Recent California Workers’ Comp Professional Medical Service Treatment Patterns

A new study finds treatment patterns for California workers’ comp professional medical services have stabilized in recent years, with only minor changes in the utilization rates and volume of services rendered to injured workers within the first two years for indemnity claims with 2014 through 2019 initial treatment dates, and within the first six months for indemnity claims with 2018 through 2021 initial treatment dates.

The study uses data from CWCI’s Industry Research Information System (IRIS) database to analyze professional medical services from non-COVID indemnity claims to determine the percent of claims that involved a major surgery within two years of the initial treatment date. The authors then calculated the percent of claims with and without major surgery from each of the initial treatment years that utilized Evaluation and Management (E&M); Physical Medicine; Advanced Imaging; Mental Health; and Injection services. Among the key findings:

• Since 2014, the percentage of indemnity claims involving a major surgery in the first 2 years has declined 1 percentage point per year, falling from 28% of the 2014 claims to 23% of the 2019 claims.
• Across the 6-year span of the study, surgical claims averaged about 7 to 9 more E&M visits in the first 2 years than claims without major surgery.
• The share of claims that had Physical Medicine services in the first 24 months showed little change, even after the pandemic was declared. Claims with major surgery have consistently averaged about 26 Physical Medicine visits in the first 2 years, more than twice the average for claims without major surgery.
• Use of Advanced Imaging in the initial 24 months was also fairly stable across the 6 initial treatment years, ranging from 40 to 42% of the claims without major surgery and from 61 to 64% of the surgical claims.
• Only 5 to 6% of the claims without major surgery and 6 to 7% of the surgical claims received Mental Health services in the first 24 months of treatment, with almost no change in the prevalence of these services among claims in which initial treatment was rendered in 2018 and 2019.
• Though the percentage of claims with Mental Health services showed little change after the pandemic was declared, the average number of Mental Health visits within 24 months increased in the 2 most recent years.
• About half of all claims with surgery had Injections compared to 17 to 18% of claims without major surgery.
• The 6-month data on claims with 2018 to 2021 initial service dates showed pandemic-related disruptions to medical service delivery had little impact on the prevalence or volume of early treatment provided.

The full study provides a detailed look at California workers’ compensation professional medical service utilization trends for initial treatment years 2014 through 2021, including graphics and additional analyses. CWCI has published the study in a Research Update Report, “Patterns in the Provision of Professional Medical Services in California Workers’ Compensation” which is available in the Research section at www.cwci.org.

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