Time From Injury to Treatment in Workers Compensation Preliminary Results

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Jeffery Black
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1 2015 Annual Issues Symposium Time From Injury to Treatment in Workers Compensation Preliminary Results Barry Lipton, FCAS, MAAA Practice Leader and Senior Actuary, NCCI May 14, 2015

2 Overview Background Illustrative findings Time from injury to first encounter with a medical professional Specific examples Time to first office visit Time to see an orthopedist Summary Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 2

examples Time to first office visit Time to see an

3 Background This is the first phase of a long-term study on the impact of the Affordable Care Act (ACA) on time from injury to treatment ACA s impact on Workers Compensation (WC) cases is uncertain Increasing the insured population may drive up demand without a corresponding increase in the supply of doctors and other professionals Resources may be governed by the needs of Medicaid, Medicare, and Group Health; each has different priorities than WC Will this affect injured worker access to medical care? Phase one establishes pre-aca benchmarks on the time from injury to treatment Findings here are based on Medical Data Call (MDC) treatments for injuries occurring between 7/1/2010 and 12/31/2012 Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 3

Medicaid, Medicare, and Group Health; each has different priorities than WC Will this affect injured worker access to medical care?

4 Measuring Access to Care One measure of access is the days from injury to initial medical encounter we call that measure the time to treatment Encounters are classified by provider and service type Time to first office visit measures a different type of access than time to see an orthopedist Not all patients seek medical care right away We have no measure for when care was initially sought Claimants vary in how soon they seek care Here we exclude disease cases and look only at trauma cases Disease cases include degenerative disk and other musculoskeletal conditions, as well as occupational diseases (e.g., silicosis) Assigning a date of injury for some disease cases can be problematic Occupational diseases (e.g., silicosis) can take many years to emerge Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 4

Claimants vary in how soon they seek care Here we exclude disease cases and look only at trauma cases Disease cases include degenerative disk and other musculoskeletal conditions, as well as

5 Percent of Trauma Cases 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 85% of Trauma Cases Are Treated Within Three Days From the Date of Injury Time to First Treatment of Any Kind Days From Injury 63% of trauma cases are treated on the date of injury Source: NCCI Medical Data Call Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 5

Kind 0 5 10 15 20 25 30 Days From Injury 63% of trauma cases are treated on the date of

6 Percent of Trauma Cases 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Professional Providers Have Distinct Treatment Patterns Time to First Treatment by Given Type of Provider Physician NOC Physician Assistant Surgeon NOC Chiropractor Orthopedist Therapist Days From Injury Physician NOC Physician Assistant Surgeon NOC Chiropractor Orthopedist Therapist Source: NCCI Medical Data Call Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 6

Orthopedist Therapist 0 20 40 60 80 100 120 140 160 180 Days From Injury Physician NOC Physician Assistant Surgeon NOC

7 Days From Injury Professional Providers Have Distinct Treatment Patterns Median Median and 85th Percentile of Time to Treatment by Given Type of Provider for Trauma Cases 85th Percentile Surgeon NOC Physician NOC Physician Assistant Chiropractor Orthopedist Therapist Because such a high proportion of trauma-case patients are seen by a doctor or physician assistant soon after the injury, differences in time to treatment patterns become clear only at higher percentiles Source: NCCI Medical Data Call Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 7

Orthopedist Therapist Because such a high proportion of trauma-case patients are seen by a doctor or physician assistant soon after the injury,

8 Some Specific Examples We look at the office visit service category as an example of access to primary care We look at the orthopedist provider category as an example of access to specialty care We look at three states Alabama, Louisiana, and Oklahoma to illustrate how states can differ in their timing for primary and specialty care We look at two cities Birmingham, Alabama, and Chicago, Illinois and ask whether there is a difference between urban and rural in timing for primary care Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 8

states can differ in their timing for primary and specialty care We look at two cities Birmingham, Alabama, and Chicago, Illinois and

9 Percent of Trauma Cases 100% Time to First Office Visit Can Vary by State 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Time to First Office Visit Days From Injury Some claimants wait longer to see a doctor in Louisiana or Oklahoma than in Alabama We cannot assess whether longer waiting times are due to claimants waiting longer to seek a doctor s appointment, the time it takes for them to be seen, or both AL LA OK Source: NCCI Medical Data Call Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 9

Alabama We cannot assess whether longer waiting times are due to claimants waiting longer to seek a doctor s appointment, the

10 Time to See an Orthopedist Can Vary by State Percent of Trauma Cases 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Time to First Treatment by an Orthopedist Days From Injury Patients wait longer to see an orthopedist in Oklahoma than in Alabama or Louisiana For example, half of the patients seen by an orthopedist within a year of the injury are actually seen within nine days in both Alabama and Louisiana, while that proportion drops to one-third in Oklahoma AL LA OK Source: NCCI Medical Data Call Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 10

For example, half of the patients seen by an orthopedist within a year of the injury are actually seen within nine days in both Alabama and

11 Time to First Office Visit: Urban Versus Rural Percent of Trauma Cases 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Time to First Office Visit Birmingham, AL Other AL Chicago, IL Other IL Days From Injury Claimants take the same amount of time to see a doctor in Birmingham, Alabama, as in the rest of Alabama Similarly for Illinois, there is no difference in the time it takes for claimants to see a doctor in Chicago than elsewhere in the state Source: NCCI Medical Data Call Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 11

doctor in Birmingham, Alabama, as in the rest of Alabama Similarly for Illinois, there is no difference in the time it takes for claimants

12 Summary Significant differences by state This complicates the isolation of the impact of the ACA Areas of research to understand the baseline: Treatment guidelines Providers per capita Population density Claimant attorney involvement WC fee schedules versus Medicare/Medicaid Copyright 2015 NCCI Holdings, Inc. All Rights Reserved. 12

guidelines Providers per capita Population density Claimant attorney involvement WC

Time to First Medical Treatment Under the ACAP

Time to First Medical Treatment Under the ACAP January 2016 By Barry Lipton, Dan Corro, and John Robertson Time From Injury to Treatment in Workers Compensation: Setting a Baseline to Monitor the Affordable Care Act There continues to be uncertainty