Indemnity claims receiving treatment, number of visits, and the
average payments per claim are all down following the changes made
by the workers' comp reforms to overall utilization, according to
research by the California Workers' Compensation Institute. This
includes fee schedule changes and treatment guidelines. CWCI did
its study based on 303,000 open and closed indemnity claims for
injuries between January 2001 and December 2004 across seven
medical service categories.
The biggest decrease was in chiropractic manipulation where the
percentage of indemnity claims receiving medical treatment was 21.4
percent in 2003 dropping down to 13.9 percent in 2004. Physical
therapy declined from 67.4 percent in 2003 to 61.0 percent in 2004.
Both chiropractic and physical therapy treatments were capped by
the 2003 reforms. The Medicine section and Injections categories
were also down, albeit slightly.
But some treatments showed increases as well. Radiology
increased from 30.2 percent in 2003 to 37.7 percent in 2004.
Evaluation and Management (office visits) increased slightly as did
the Surgery category.
Overall, visits declined across all seven categories at nine
months post injury. Chiropractic manipulation and Physical Therapy
showed the largest decreases between 2003 and 2004. Chiropractic
averaged 32.6 visits in 2003 and averaged 17.4 visits in 2004. The
other five categories also showed decreases although they were
smaller. Radiology averaged 4.6 visits in 2003 dropping to 4.3
visits in 2004.
The average total cost per claim for six of the seven medical
categories was also down. In 2003 the cost of chiropractic
manipulation per claim was $1,488. In 2004 it was $748. Only
surgery went up from $3,447 in 2003 to $4,086 in 2004. Earlier CWCI
research indicates that the surgical trend is toward more expensive
procedures.
These early returns offer a positive outlook on the workers'
comp reforms and their impact on the California worker's comp
market. But CWCI cautions the industry that this research only
reflects medical care rendered during the first nine months
following the date of injury. Workers' comp medical costs typically
develop over years and court challenges and legislative rollbacks
to the reforms could impact future savings.
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