Workers Compensation Research

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1 Workers Compensation Research

2 About WCRI 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: Over 500 WC studies published 2

3 WCRI Approach 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 3

4 Outline: Illustrations Of Available Information 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 4

5 Wisconsin Indemnity Payments/Claim 39% Lower Than The Median State Average Indemnity Payment/Claim $35,000 Median State: $17,670 $30,000 $25,000 $20,000 $15,000 $10,847 $10,000 $5,000 $0 IN TX WI NJ FL AR MI MN VA MA CA IL IA PA LA GA NC 2011/14 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix And Wages; Source: CompScope Benchmarks For Wisconsin, 15 th Edition (2015). 5

6 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 Satisfaction: % Reported Very Dissatisfied With Care 10% 16% 9% 13% Earning A Lot Less At Interview (%) 6% 8% * Statistically Significant 6

7 Wisconsin Medical Payments Per Claim 40% Higher Than Typical Average Medical Payment/Claim $20,000 Median: $12,167 $16,980 $15,000 $10,000 $5,000 $0 MA CA MI TX MN AR FL NC PA LA IL IA NJ VA WI IN 2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScope Medical Benchmarks For Wisconsin, 15 th Edition (2014). 7

8 WI Medical Payments Higher And Have Grown Rapidly Average Medical Payment/Claim $20,000 $18,000 $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 AAPC 2007/08 To 2012/13 WI: 6.5% Median Study State: 4.5% Wisconsin Other Study States 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, 15 th Edition (2014). 8

9 Nonhospital Prices Paid In Wisconsin Were The Highest Of 25 States State Median = 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 States With Fee Schedule No Fee Schedule Prices Paid For Nonhospital Services Rendered In 2013 (January Through June) Source: WCRI Medical Price Index For Workers Compensation, Sixth Edition (2014) 9

10 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 $ % Major Surgery $7,692 $2, % Minor Radiology $421 $ % Major Radiology $1,649 $832 98% Evaluation And Mgmt. $1,071 $751 43% Physical Medicine $3,814 $3,029 26% 2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScope Medical Benchmarks For Wisconsin, 15 th Edition (2014). 10

11 Wisconsin WC Paid Much Higher Prices Than Group Health For Knee Arthroscopy WC And GH Median Prices Paid, 2009 (CPT 29881) $4,500 $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 $3,728 $1,573 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 * MI, OK, TN, CT, and IL implemented a double-digit fee schedule decrease for a common knee arthroscopy (CPT 29881) from 2009 to Group Health Data Include Copays And Deductibles. Source: A New Benchmark For Workers Compensation Fee Schedules: Prices Paid By Commercial Insurers? (2013) 11

12 Wisconsin Average Morphine Equivalent Amount Per Claim Lower Than Typical Avg. MEA/Claim With Narcotics (milligrams) 4,000 3,500 3,000 2,500 2,000 1,500 1, Median: 1,861 mg 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 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) 12

13 WI % Workers Who Were Longer-Term Users Of Opioids Lowest Of Study States % Of Claims With Opioids Identified As Longer-Term Users Of Opioids 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Median: 7% 4% 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 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) 13

14 Benchmark Metrics 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 14

15 Topical Studies Examples 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 15

16 Outline: Illustrations Of Available Information 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 16

17 18 States Changed Rules Governing Reimbursement For Physician-Dispensed Drugs Reform States Focusing On Price Reduction Only CA Reform States Further Limiting Physician Dispensing To Short Timeframe Or Certain Drugs States Where Physician Dispensing Not Allowed In General Or Infrequent ID AZ HI OK IL MS MI IN TN AL GA SC FL PA NC DE CT 17

18 The Same Drugs, When Physician-Dispensed, Are Much Higher Priced Common WC Drugs Prescribed By Physicians Hydrocodone-acetaminophen (Vicodin ) Price Per Pill Physician Rx Pharmacy Rx % Difference $1.41 $ % Ibuprofen (Motrin ) $0.49 $ % Tramadol HCL (Ultram ) $1.55 $ % Cyclobenzaprine HCL (Flexeril ) $1.85 $ % Meloxicam (Mobic ) $5.86 $ % Illinois 2011/12 Claims With > 7 Days Of Lost Time With Prescriptions Source: The Prevalence And Costs Of Physician-Dispensed Drugs (2013) 18

19 Does Physician Dispensing Increase Opioid Use? % Of Workers With Strong Opioids 16% 14% 12% 10% 8% 6% 4% 2% 0% * Statistically Significant at the 0.01 level Underlying data include six months of Rx utilization for FL injuries between Jan. Jun (pre-reform) and Jul. Dec (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014) % 3.9% Pre-Reform 14.2% 12.2% 0.5% Post-Reform * Pharmacy Dispensed Physician Dispensed

20 Does Physician Dispensing Increase Opioid Use? Likely % Of Workers With Strong Opioids 16% 14% 12% 10% 8% 6% 4% 2% 0% 12.2% 3.9% Pre-Reform 14.2% 12.5% 12.2% 0.5% Post-Reform Pharmacy Dispensed Physician Dispensed * Statistically Significant at the 0.01 level Underlying data include six months of Rx utilization for FL injuries between Jan. Jun (pre-reform) and Jul. Dec (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014) 20 *

21 Most Received Physician-Dispensed NSAIDs And Weaker Opioids % Of Workers With Physician- Dispensed Rx 30% 25% 20% 15% 10% 5% 0% * Statistically Significant at the 0.01 level 24.1% 9.1% 3.9% Pre-Reform 25.8% 10.1% 0.5% Post-Reform Underlying data include six months of Rx utilization for FL injuries between Jan. Jun (pre-reform) and Jul. Dec (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014) 21 * * * NSAIDs Weaker Opioids Strong Opioids

22 22

23 Cyclobenzaprine New Strength In California: Rapid Increase, Much Higher Prices % Of Prescriptions For Cyclobenzaprine HCL By Strength 80% 70% 60% 50% 40% 30% 20% 10% 0% 7.5 Milligrams Price Per Pill Paid: $2.90 $ Milligrams Price Per Pill Paid: $0.35 $ 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) 23 Calendar Quarters

24 Frequent Dispensing Of 7.5-Milligram Product At Much Higher Price Drove Up Physician Price Average Price Per Pill Paid For Cyclobenzaprine HCL By Dispensing Point $2.50 $2.00 $1.50 $1.00 $0.50 $ Q Q Q Q Q Q2 Physician-Dispensed Rx 2011 Q Q4 Calendar Quarters 2012 Q Q Q3 Pharmacy-Dispensed Rx 2012 Q4 Included Are Prescriptions (Rx) Dispensed By Physicians In California From First Quarter Of 2010 (2010Q1) To First Quarter Of 2013 (2013Q1) Q1

25 About The Fear Of Firing Predictor Survey question: When injured, I was afraid of being fired or laid off? Responses % Of Workers In Survey WI Strongly Disagree 51% Somewhat Disagree 12% Somewhat Agree 13% Strongly Agree 24% 25

26 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 Satisfaction: % Reported Very Dissatisfied With Care 9% 20%* 8% 18%* Earning A Lot Less At Interview (%) 3% 16%* * Statistically Significant 26

27 Outline: Illustrations of Available Information 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 27

28 In Most States, WC Physician Fee Schedule Above Medicare Rates By 30% Or More 190 WC Fee Schedule % Above/Below State Medicare Rates, CA MA FL NC NY HI PA OK UT MD SD MI KY WV CO WY OH SC KS LA ME VT NM AR MN AZ MS NE WA AL TX CT GA TN ND NV MT OR DE ID IL AK Source: Designing Workers Compensation Medical Fee Schedules (2012) 28

29 Lower Prices Associated With More Frequent Billing Of Complex Office Visits % Of Established Patient Office Visits Billed As More Complex 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Common Office Visits In Calendar Year 2012 Source: Estimating The Effect Of California s Fee Schedule Changes: Lessons From WCRI Studies (2014) 29 Correlation Coefficient: -0.6 IA WI AR TX MI IN MN PA MA VA LA NC IL NJ FL CA $200 $180 $160 $140 $120 $100 $80 $60 $40 $20 $0 % Of Office Visits Billed As More Complex Average Price Common Office Visit Average Price Paid For Common Office Visits

30 CA: Most Office Visits Were Intermediate (CPT 99213) 100% $104 % Of E&M Services For Established Patients 80% 60% 40% 20% $69 $46 Prices Paid 0% 2004 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) 30

31 CA Prices Frozen For 3 Years More Office Visits Coded As More Expensive 100% $104 $103 $101 % Of E&M Services For Established Patients 80% 60% 40% 20% $69 $46 $69 $46 $69 $45 Prices Paid 0% Level 1 Level 2 Level 3 Level 4 Level 5 Source: Estimating The Effect Of California s Fee Schedule Changes: Lessons From WCRI Studies (2014) 31

32 After CA Raised The Fee Schedule, Upcoding Stopped FS Increase 100% $104 $103 $101 $107 % Of E&M Services For Established Patients 80% 60% 40% 20% $69 $46 $69 $46 $69 $45 $81 $52 Prices Paid 0% Level 1 Level 2 Level 3 Level 4 Level 5 Source: Estimating The Effect Of California s Fee Schedule Changes: Lessons From WCRI Studies (2014) 32

33 When The Fee Schedule Was Re-Frozen, Upcoding Resumed 100% $104 $103 FS Increase $101 $107 $113 $116 $116 $113 $112 % Of Office Visits For Established Patients 80% 60% 40% 20% $69 $69 $46 $46 $69 $45 $81 $84 $52 $54 $84 $84 $83 $54 $54 $54 $83 $54 Prices Paid 0% Source: Estimating The Effect Of California s Fee Schedule Changes: Lessons From WCRI Studies (2014) 33

34 2003 FL Reforms Reduced Fee Schedule Rates For Many Hospital Outpatient Services Hospital Outpatient Pre-Reform Post-Reform Scheduled Radiology Unscheduled Radiology 75% of charges 110% Medicare 75% of charges 75% of charges Source: CompScope Medical Benchmarks For Florida, 15th Edition (2014) 34

35 Lumbar MRIs Were Paid More Often As Unscheduled With Higher Rates After 2005 % Of Lumbar MRIs Done In Hospital Outpatient Settings 100% 80% 60% 40% 20% 62% 66% 38% 34% 47% 53% 32% 68% 37% 63% 18% 14% 82% 86% 29% 29% 71% 71% 0% 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) 35

36 WCRI Is A Resource For You For further information: website Richard Victor

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