Workers’ Compensation ResearchTN. VA. FL. MD. MA. MI. SC. OK. GA. CA. NC. TX. PA. NY. LA % Of...

Workers’ Compensation Research

▪ Independent, not-for-profit research organization ▪ Founded in Cambridge MA in 1983 ▪ Diverse membership support ▪ Studies are peer-reviewed ▪ Resource for public officials & stakeholders ▪ Content-rich website: www.wcrinet.org ▪ Over 500 WC studies published

About WCRI

2 © Copyright 2015 WCRI. All Rights Reserved.

▪ Mission “Be a catalyst for improving WC systems by providing the public with high-quality, credible information on important public policy issues.”

▪ Studies focus on benefit delivery system ▪ Does not make recommendations nor take positions

on issues

WCRI Approach


▪ How states compare ▪ Income benefit payments

▪ Worker outcomes

▪ Medical costs and care delivered

▪ Long-term opioid use

▪ Physician dispensing of Rx ▪ Trust in the workplace and worker outcomes ▪ Provider responses to medical price regulation

Outline: Illustrations Of Available Information


Wisconsin Indemnity Payments/Claim 39% Lower Than The Median State

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

IN TX WI NJ FL AR MI MN VA MA CA IL IA PA LA GA NC

Aver

age

Inde

mni

ty P

aym

ent/

Clai

m

$10,847

Median State: $17,670


2011/14 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix And Wages; Source: CompScope™ Benchmarks For Wisconsin, 15th Edition (2015).

WI Workers Achieve Better Outcomes

Outcome Wisconsin Median State

RTW: Not Working At Interview (%) 12% 13%

Median Duration Of Disability (Weeks) 9 weeks 10 weeks

Access: % Reported “Big Problems” Getting Desired Care 10% 16%

Satisfaction: % Reported “Very Dissatisfied” With Care 9% 13%

Earning A Lot Less At Interview (%) 6% 8%

6

* Statistically Significant

© Copyright 2015 WCRI. All Rights Reserved.

Wisconsin Medical Payments Per Claim 40% Higher Than Typical

$0

$5,000

$10,000

$15,000

$20,000

MA CA MI TX MN AR FL NC PA LA IL IA NJ VA WI IN

Aver

age

Med

ical

Pay

men

t/Cl

aim

$16,980 Median: $12,167


2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScope™ Medical Benchmarks For Wisconsin, 15th Edition (2014).

WI Medical Payments Higher And Have Grown Rapidly


Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix And Wages; Source: CompScope™ Medical Benchmarks For Wisconsin, 15th Edition (2014).

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Aver

age

Med

ical

Pay

men

t/Cl

aim

Wisconsin

Other Study States

AAPC 2007/08 To 2012/13 WI: 6.5% Median Study State: 4.5%

0

50

100

150

200

250

FL CA SC NC NY OK MI MD PA MA AR TN LA AZ TX MN GA CT VA IA IL MO NJ IN WI

25-S

tate

Med

ian

= 10

0 Nonhospital Prices Paid In Wisconsin Were The Highest Of 25 States

9

Prices Paid For Nonhospital Services Rendered In 2013 (January Through June) Source: WCRI Medical Price Index For Workers’ Compensation, Sixth Edition (2014)

States With Fee Schedule No Fee Schedule


Payments Per Claim In WI For Key Nonhospital Services 26%–265% Higher

Payments/Claim For Nonhospital Services Wisconsin 16-State

Median %

Difference Pain Mgmt. Injections $1,853 $508 265% Major Surgery $7,692 $2,595 196% Minor Radiology $421 $171 147% Major Radiology $1,649 $832 98% Evaluation And Mgmt. $1,071 $751 43% Physical Medicine $3,814 $3,029 26%

10

2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScope™ Medical Benchmarks For Wisconsin, 15th Edition (2014).


Wisconsin WC Paid Much Higher Prices Than Group Health For Knee Arthroscopy

11

Group Health Data Include Copays And Deductibles. Source: A New Benchmark For Workers’ Compensation Fee Schedules: Prices Paid By Commercial Insurers? (2013)

$3,728

$1,573

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500

MI* AR FL TX MD NC LA

TN* GA PA CA

OK* VA IA NY

MA AZ CT* WI

IN IL* NJ

Median WC Price Paid Median GH Price Paid

WC

And

GH

Med

ian

Pric

es P

aid,

20

09 (C

PT 2

9881

)

* MI, OK, TN, CT, and IL implemented a double-digit fee schedule decrease for a common knee arthroscopy (CPT 29881) from 2009 to 2012.


Wisconsin Average Morphine Equivalent Amount Per Claim Lower Than Typical

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

MO IA WI NJ IN MN AR CT FL IL KS TN VA MI GA TX CA SC MD NC MA OK PA NY LA

Avg.

MEA

/Cla

im W

ith N

arco

tics

(mill

igra

ms)

Median: 1,861 mg

12

Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2009 To September 2010, Prescriptions Filled Through March 2012 Source: Interstate Variations In Use Of Narcotics, 2nd Edition (2014)


WI % Workers Who Were Longer-Term Users Of Opioids Lowest Of Study States

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

WI IN NJ MO IA AR KS MN CT IL TN VA FL MD MA MI SC OK GA CA NC TX PA NY LA

% O

f Cla

ims

With

Opi

oids

Iden

tifie

d

As L

onge

r-Ter

m U

sers

Of O

pioi

ds Median: 7%

4%

13

Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2009 To September 2010, Prescriptions Filled Through March 2012 Source: Longer-Term Use Of Opioids, 2nd Edition (2014)


▪ Income benefits ▪ Worker outcomes ▪ Medical costs ▪ Medical price indices ▪ Nature of care (e.g., surgery rates, opioid use) ▪ Litigiousness and litigation costs ▪ Medical cost containment expenses ▪ Timely payment to worker

Benchmark Metrics


▪ Impact of state reforms ▪ Physician dispensing ▪ Medical treatment guidelines/utilization review ▪ Effect of ACA on WC systems ▪ Medical price regulation ▪ Compounding of Rx medications ▪ Impact of provider choice laws

Topical Studies—Examples



▪ Worker outcomes



Physician dispensing of Rx Trust in the workplace and worker outcomes ▪ Provider responses to medical price regulation

Outline: Illustrations Of Available Information


18 States Changed Rules Governing Reimbursement For Physician-Dispensed Drugs


States Where Physician Dispensing Not Allowed In General Or Infrequent

CA

FL

SC

NC

IL

OK

MI

AZ TN

IN

GA MS

CT DE

HI

AL

PA

ID

Reform States Focusing On Price Reduction Only

Reform States Further Limiting Physician Dispensing To Short Timeframe Or Certain Drugs

The Same Drugs, When Physician-Dispensed, Are Much Higher Priced

18

Common WC Drugs Prescribed By Physicians

Price Per Pill %

Difference Physician Rx

Pharmacy Rx

Hydrocodone-acetaminophen (Vicodin®) $1.41 $0.52 172%

Ibuprofen (Motrin®) $0.49 $0.27 81% Tramadol HCL (Ultram®) $1.55 $0.73 114% Cyclobenzaprine HCL (Flexeril®) $1.85 $0.99 88% Meloxicam (Mobic®) $5.86 $3.19 84%

Illinois 2011/12 Claims With > 7 Days Of Lost Time With Prescriptions Source: The Prevalence And Costs Of Physician-Dispensed Drugs (2013)


Does Physician Dispensing Increase Opioid Use?

19

Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014) © Copyright 2015 WCRI. All Rights Reserved.

3.9%

0.5%

12.2% 14.2%

12.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Pre-Reform Post-Reform

% O

f Wor

kers

With

Stro

ng O

pioi

ds

Physician Dispensed

Pharmacy Dispensed

*

* Statistically Significant at the 0.01 level

Does Physician Dispensing Increase Opioid Use? Likely

20

3.9%

0.5%

12.2% 14.2%

12.2% 12.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%


% O

f Wor

kers

With

Stro

ng O

pioi

ds

Physician Dispensed

Pharmacy Dispensed

Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014) © Copyright 2015 WCRI. All Rights Reserved.


*

Most Received Physician-Dispensed NSAIDs And Weaker Opioids

9.1% 10.1%

24.1% 25.8%

3.9%

0.5% 0%

5%

10%

15%

20%

25%

30%


% O

f Wor

kers

With

Phy

sici

an-

Dis

pens

ed R

x


Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014)

NSAIDs

Weaker Opioids

Strong Opioids

*

*

*



Cyclobenzaprine New Strength In California: Rapid Increase, Much Higher Prices

0%

10%

20%

30%

40%

50%

60%

70%

80%7.5 Milligrams Price Per Pill Paid: $2.90–$3.45

5 Milligrams Price Per Pill Paid: $0.35–$0.59

10 Milligrams Price Per Pill Paid: $0.49–$0.70


Included Are Prescriptions (Rx) Dispensed By Physicians In California From First Quarter Of 2011 (2011Q1) To First Quarter Of 2013 (2013Q1)

Calendar Quarters

% O

f Pre

scrip

tions

For

Cyc

lobe

nzap

rine

HCL

By

Stre

ngth

Frequent Dispensing Of 7.5-Milligram Product At Much Higher Price Drove Up Physician Price

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

2010Q1

2010Q2

2010Q3

2010Q4

2011Q1

2011Q2

2011Q3

2011Q4

2012Q1

2012Q2

2012Q3

2012Q4

2013Q1

Physician-Dispensed Rx Pharmacy-Dispensed Rx


Calendar Quarters

Aver

age

Pric

e Pe

r Pill

Pai

d Fo

r Cy

clob

enza

prin

e H

CL B

y D

ispe

nsin

g Po

int

Included Are Prescriptions (Rx) Dispensed By Physicians In California From First Quarter Of 2010 (2010Q1) To First Quarter Of 2013 (2013Q1)

About The “Fear Of Firing” Predictor

Responses % Of Workers In Survey – WI Strongly Disagree 51% Somewhat Disagree 12% Somewhat Agree 13% Strongly Agree 24%

25

Survey question: When injured, I was afraid of being fired or laid off?


Those Who Strongly Agreed Were Most Likely To Have Worse Outcomes

Outcome Strongly Or Somewhat Disagreed

Strongly Agreed (Fearful)

RTW: Not Working At Interview (%) 10% 21%* Median Duration Of Disability (Weeks) 9 13* Access: % Reported “Big Problems” Getting Desired Care 9% 20%*

Satisfaction: % Reported “Very Dissatisfied” With Care 8% 18%*

Earning A Lot Less At Interview (%) 3% 16%*

26

* Statistically Significant



▪ Worker outcomes



▪ Physician dispensing of Rx ▪ Trust in the workplace and worker outcomes Provider responses to medical price regulation

Outline: Illustrations of Available Information


-10

10

30

50

70

90

110

130

150

170

190

CA MA FL NC NY HI PA OK UT MD SD MI

KY WV

CO WY

OH SC KS LA ME VT N

M AR MN AZ MS NE

WA AL TX CT GA TN ND NV

MT

OR DE ID IL AK

WC

Fee

Sche

dule

% A

bove

/Bel

ow

Stat

e M

edic

are

Rate

s, 2

011

In Most States, WC Physician Fee Schedule Above Medicare Rates By 30% Or More

28

Source: Designing Workers’ Compensation Medical Fee Schedules (2012)


Lower Prices Associated With More Frequent Billing Of Complex Office Visits


Common Office Visits In Calendar Year 2012 Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)

$0$20$40$60$80$100$120$140$160$180$200

0%10%20%30%40%50%60%70%80%90%

100%

IA WI AR TX MI IN MN PA MA VA LA NC IL NJ FL CA

% Of Office Visits Billed As More Complex Average Price—Common Office Visit

% O

f Est

ablis

hed

Patie

nt O

ffice

Vi

sits

Bill

ed A

s M

ore

Com

plex

Average Price Paid For Comm

on Office Visits

Correlation Coefficient: -0.6

CA: Most Office Visits Were “Intermediate” (CPT 99213)

0%

20%

40%

60%

80%

100%

2004

% O

f E&

M S

ervi

ces

For

Est

ablis

hed

Patie

nts

Level 1 Level 2 Level 3 Level 4 Level 5


E&M: Evaluation & Management Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)

$46

$69

$104

Prices Paid

CA Prices Frozen For 3 Years—More Office Visits Coded As More Expensive

0%

20%

40%

60%

80%

100%

2004 2005 2006

% O

f E&

M S

ervi

ces

For

Est

ablis

hed

Patie

nts



$45

$69

$101

$46

$69

$103

$46

$69

$104

Prices Paid

Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)

After CA Raised The Fee Schedule, Upcoding Stopped

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007

% O

f E&

M S

ervi

ces

For

Est

ablis

hed

Patie

nts



$46

$69

$103

$46

$69

$104

Prices Paid

$52

$81

$107

$45

$69

$101


FS Increase

When The Fee Schedule Was Re-Frozen, Upcoding Resumed

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007 2008 2009 2010 2011 2012

99211 99212 99213 99214 99215


$104 $103 $107 $113 $101 $116 $116

$69 $69 $81 $84

$69 $84

$83

$46 $46 $52 $54

$45 $54 $54

Prices Paid

$113

$84

$54


FS Increase

$83

$54

$112

% O

f Offi

ce V

isits

For

Es

tabl

ishe

d Pa

tient

s

2003 FL Reforms Reduced Fee Schedule Rates For Many Hospital Outpatient Services

Hospital Outpatient Pre-Reform Post-Reform

Scheduled Radiology 75% of charges 110% Medicare

Unscheduled Radiology 75% of charges 75% of charges


Source: CompScope™ Medical Benchmarks For Florida, 15th Edition (2014)

Lumbar MRIs Were Paid More Often As Unscheduled With Higher Rates After 2005

38% 34% 53%

68% 63% 82% 86%

71% 71%

62% 66% 47%

32% 37% 18% 14%

29% 29%

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007 2008 2009 2010 2011 2012

% O

f Lum

bar M

RIs

Don

e In

H

ospi

tal O

utpa

tient

Set

tings

Paid > Nonhospital FS Paid <= Nonhospital FS


Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix Source: CompScope™ Medical Benchmarks For Florida, 15th Edition (2014)

WCRI Is A Resource For You

For further information: website www.wcrinet.org Richard Victor 617.661.9274


Date post:	24-May-2020
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

Workers’ Compensation ResearchTN. VA. FL. MD. MA. MI. SC. OK. GA. CA. NC. TX. PA. NY. LA % Of...

Documents