兰德-Access-to-Medical-Treatment-for-Injured-Workers-in-California_-Year-3-Annual-Report_39页_1mb

Summary of "Access to Medical Treatment for Injured Workers in California" (Year 3 Annual Report)

Core Content

This report is part of a three-year study commissioned by the California Department of Industrial Relations to assess the access to medical care for injured workers in California. The study is mandated by Section 5307.2 of the California Labor Code, which requires the California Division of Workers' Compensation (DWC) to evaluate annually whether injured workers have adequate access to quality care. The report uses Version 2.0 of the Workers' Compensation Information System (WCIS), which was implemented in April 2016 and introduced significant changes in data collection and reporting.

The main focus of this Year 3 report is to describe access to medical care among injured workers, based on data from 2016. Due to changes in the data infrastructure, the sample is not directly comparable to previous years, and the report emphasizes descriptive analysis rather than trend analysis.

Key Objectives

• To evaluate the availability and utilization of medical services for injured workers in California.
• To identify variations in access by provider specialty, geography, and type of service.
• To examine wait times and provider churn as indicators of access.

Main Findings

Number of Providers

• In 2016, there were 76,950 unique providers in the WCIS data, representing approximately 16.5 million medical services.
• Nearly 15,000 providers were entities or organizations (e.g., hospitals, pharmacies).
• 62,216 physicians and nonphysician providers were identified as serving injured workers.
• The most common specialties included:
  • Internal medicine (8,206)
  • Physical therapist (6,567)
  • Physician assistant/nurse practitioner (5,428)
  • Emergency medicine (5,361)
  • Family medicine/general practice (4,879)

Medical Claims per Provider

• On average, 29.4 claims per provider were recorded in 2016.
• Occupational medicine physicians had the highest number of claims per provider, at 316.
• Dental providers had the lowest, at 2.4.

Medical Services per Provider

• The average number of medical services per claim was 208.1.
• Occupational medicine physicians delivered the highest number of services per claim, at 1,895.
• Ophthalmologists delivered the lowest, at 14.3.

Total Payments and Mean Payments per Claim

• The average total annual payment per provider was $24,440.
• The average payment per claim was $1,306.
• Occupational medicine physicians and orthopaedic surgeons had the highest total payments, at $131,166 and $118,975, respectively.
• Other surgery and dental providers had the highest average payments per claim, at $3,830 and $3,017, respectively.
• Pathology had the lowest total annual payment per provider and lowest average payment per claim, at $1,074 and $123, respectively.

Access by Geography

• Significant variation in access was observed across regions and counties.
• 94% of claims included some type of evaluation and management (E&M) service.
• Radiology and medicine were the second most common service types, appearing in 56% and 55% of claims, respectively.
• The median time to first E&M visit was 2 days.
• The median time to first E&M visit with a primary care provider (PCP) in a non-emergency department setting was 6 days.
• Only 13% of injured workers saw more than one PCP in the year following their injuries.

Other Access Measures

• Provider churn was measured as the percentage of injured workers who saw more than one PCP in the first year.
• Proxy measures such as physician supply, geographic proximity, and timeliness of care were used to assess resource availability and access.

Limitations and Considerations

• The sample size and data structure differ from previous years due to the new WCIS Version 2.0.
• The NPI (National Provider Identifier) replaced the TIN (Taxpayer Identification Number) as the unique provider identifier, leading to more accurate and detailed provider counts.
• Out-of-state services were excluded from the analysis.
• Statistical comparisons between years were not conducted due to sample differences.

Conclusion

The findings suggest stability or slight improvements in most access measures when compared to the Year 2 report. The new data structure provides a more accurate picture of the state of access in California's workers' compensation system, though the focus remains on descriptive analysis rather than causal inference. The report highlights the importance of provider availability, timeliness of care, and service utilization in assessing access to medical treatment for injured workers.

Key Information

• Data Source: Workers' Compensation Information System (WCIS), Version 2.0.
• Time Frame: 2016.
• Scope: Analysis of medical billing data for injured workers.
• Key Metrics:
  • Number of providers
  • Number of medical claims per provider
  • Number of medical services per provider
  • Total payments and mean payments per claim
  • Time to first E&M visit
  • Provider churn (multiple PCP visits)
• Comparisons: The study compares data with previous years, but due to changes in data infrastructure, direct trend analysis is not feasible.
• Proxy Measures: Used to assess access, including provider supply, geographic proximity, and timeliness of care.

Structure

• Chapter 1: Background and key objectives.
• Chapter 2: Analytic approach, including data and sample selection.
• Chapter 3: Results, including data by specialty, geography, and service type.
• Chapter 4: Discussion and summary of findings.

Appendices and References

• Appendix: SAS code for type of service.
• References: Cited sources include the RAND Corporation, California Department of Industrial Relations, Texas Department of Insurance, and Institute of Medicine.